A longitudinal pilot study to assess temporal changes in coronary arterial ¹⁸F-sodium fluoride uptake

How coronary arterial ¹⁸F-sodium fluoride (¹⁸F-NaF) uptake on positron emission tomography changes over the long term and what clinical factors impact the changes remain unclear. We sought to investigate the topics in this study.

We retrospectively studied 15 patients with ≥1 coronary atherosclerotic lesion/s detected on cardiac computed tomography who underwent baseline and follow-up (interval of >3 years) ¹⁸F-NaF positron emission tomography/computed tomography scans. Focal ¹⁸F-NaF uptake in each lesion was quantified using maximum tissue-to-background ratio (TBR_max). The temporal change in TBR_max was assessed using a ratio of follow-up to baseline TBR_max (R-TBR_max).

A total of 51 lesions were analyzed. Mean R-TBR_max was 0.96 ± 0.21. CT-based lesion features (location, obstructive stenosis, plaque types, features of high-risk plaque) did not correlate with an increase in R-TBR_max. In multivariate analysis, baseline TBR_max significantly correlated with higher follow-up TBR_max (β = 0.57, P < 0.0001), and the presence of diabetes mellitus significantly correlated with both higher follow-up TBR_max (β = 0.34, P = 0.001) and elevated R-TBR_max (β = 0.40, P = 0.003).

Higher coronary arterial ¹⁸F-NaF uptake is likely to remain continuously high. Diabetes mellitus affects the long-term increase in coronary arterial ¹⁸F-NaF uptake.