Atherosclerosis Imaging with ¹⁸F-Sodium Fluoride PET

Area of Science:

• Cardiovascular Imaging
• Nuclear Medicine
• Atherosclerosis Research

Background:

• Evidence on 18F-sodium-fluoride (NaF) positron emission tomography (PET) for atherosclerosis imaging is debated due to study variations.
• A previous review (2010-2018) identified open questions regarding NaF PET in atherosclerosis.

Purpose of the Study:

• To evaluate recent literature (post-2018) to address unresolved questions from a prior review on NaF PET imaging in atherosclerosis.
• To synthesize current knowledge on NaF uptake as a marker for active arterial calcification and its association with cardiovascular risk.

Main Methods:

• Systematic review methodology applied to analyze 25 recent articles.
• Studies encompassed various vascular beds including carotid, coronary, aorta, femoral, intracranial, renal, and penile arteries.

Main Results:

• NaF uptake targets active arterial microcalcification, signifying early-stage atherosclerosis, age-dependency, and consistent association with cardiovascular risk.
• Longitudinal studies in the abdominal aorta show stable NaF uptake in postmenopausal women and variable uptake in prostate cancer patients, despite stable/increasing CT-detected calcification.
• Uncertainty persists regarding the transition from active calcification (NaF uptake) to consolidated calcification (CT-detected).

Conclusions:

• NaF PET is a marker for active, early-stage atherosclerosis and associated cardiovascular risk.
• The relationship between NaF uptake and CT-detected calcification, and the modification of early atherosclerosis, require further investigation.
• Lack of intervention studies prevents conclusions on modifying early-phase atherosclerosis and calcification.