Carotid artery molecular calcification assessed by [18F]fluoride PET/CT: correlation with cardiovascular and thromboembolic risk factors

Simon A. Castro, Daniele Muser, Hwan Lee, Emily C. Hancin, Austin J. Borja, Oswaldo Acosta, Thomas J. Werner, Anders Thomassen, Caius Constantinescu, Poul Flemming Høilund-Carlsen, Abass Alavi*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Objectives: There is growing evidence that sodium fluoride ([18F]fluoride) PET/CT can detect active arterial calcifications at the molecular stage. We investigated the relationship between arterial mineralization in the left common carotid artery (LCC) assessed by [18F]fluoride PET/CT and cardiovascular/thromboembolic risk. Methods: In total, 128 subjects (mean age 48 ± 14 years, 51% males) were included. [18F]fluoride uptake in the LCC was quantitatively assessed by measuring the blood-pool-corrected maximum standardized uptake value (SUVmax) on each axial slice. Average SUVmax (aSUVmax) was calculated over all slices and correlated with 10-year risk of cardiovascular events estimated by the Framingham model, CHA2DS2-VASc score, and level of physical activity (LPA). Results: The aSUVmax was significantly higher in patients with increased risk of cardiovascular (one-way ANOVA, p < 0.01) and thromboembolic (one-way ANOVA, p < 0.01) events, and it was significantly lower in patients with greater LPA (one-way ANOVA, p = 0.02). On multivariable linear regression analysis, age (= 0.07, 95% CI 0.05 – 0.10, p < 0.01), body mass index (= 0.02, 95% CI 0.01 – 0.03, p < 0.01), arterial hypertension (= 0.15, 95% CI 0.08 – 0.23, p < 0.01), and LPA (= −0.10, 95% CI −0.19 to −0.02, p=0.02) were independent associations of aSUVmax. Conclusions: Carotid [18F]fluoride uptake is significantly increased in patients with unfavorable cardiovascular and thromboembolic risk profiles. [18F]fluoride PET/CT could become a valuable tool to estimate subjects’ risk of future cardiovascular events although still major trials are needed to further evaluate the associations found in this study and their potential clinical usefulness. Key Points: • Sodium fluoride ([18F]fluoride) PET/CT imaging identifies patients with early-stage atherosclerosis. • Carotid [18F]fluoride uptake is significantly higher in patients with increased risk of cardiovascular and thromboembolic events and inversely correlated with the level of physical activity. • Early detection of arterial mineralization at a molecular level could help guide clinical decisions in the context of cardiovascular risk assessment.

Original languageEnglish
JournalEuropean Radiology
Volume31
Issue number10
Pages (from-to)8050-8059
ISSN0938-7994
DOIs
Publication statusPublished - Oct 2021

Keywords

  • Atherosclerosis
  • Cardiovascular diseases
  • Common carotid artery
  • Positron emission tomography
  • Sodium fluoride
  • Humans
  • Middle Aged
  • Risk Factors
  • Male
  • Positron-Emission Tomography
  • Fluorides
  • Carotid Arteries/diagnostic imaging
  • Positron Emission Tomography Computed Tomography
  • Adult
  • Female
  • Fluorine Radioisotopes
  • Radiopharmaceuticals

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