Clinical Relevance of 18 F-Sodium Fluoride Positron-Emission Tomography in Noninvasive Identification of High-Risk Plaque in Patients With Coronary Artery Disease

• DOI: 10.1161/circimaging.117.006704
• Publication Date: 2017-11-14T01:10:29Z
• Authors: Joo Myung Lee; Ji-In Bang; Bon-Kwon Koo; Doyeon Hwang; Jonghanne Park; Jinlong Zhang; Tong Yaliang; Minseok Suh; Jin Chul Paeng; Yasutsugu Shiono; Takashi Kubo; Takashi Akasaka
• Keywords: Male; Fluorine Radioisotopes; Rupture, Spontaneous; Computed Tomography Angiography; Coronary Stenosis; Coronary Artery Disease; Middle Aged; Coronary Angiography; Prognosis; Coronary Vessels; Plaque, Atherosclerotic; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Risk Factors; Positron-Emission Tomography; Multidetector Computed Tomography; Humans; Female; Prospective Studies; Radiopharmaceuticals; Aged

Background—

18 F-sodium fluoride ( 18 F-NaF) positron-emission tomography has been introduced as a potential noninvasive imaging tool to identify plaques with high-risk characteristics in patients with coronary artery disease. We sought to evaluate the clinical relevance of 18 F-NaF uptake using optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography angiography in patients with coronary artery disease.

Methods and Results—

The target population consisted of 51 prospectively enrolled patients (93 stenoses) who underwent 18 F-NaF positron-emission tomography before invasive coronary angiography. 18 F-NaF uptake was compared with IVUS- and OCT-derived plaque characteristics. In the coronary computed tomography angiography subgroup (46 lesions), qualitative lesion characteristics were compared between 18 F-NaF–positive and 18 F-NaF–negative plaques using adverse plaque characteristics. The plaques with 18 F-NaF uptake showed significantly higher plaque burden, more frequent posterior attenuation and positive remodeling in IVUS, and significantly higher maximum lipid arc and more frequent microvessels in OCT (all P <0.05). There were no differences in minimum lumen area and area of calcium between 18 F-NaF–positive and 18 F-NaF–negative lesions. Among 51 lesions with 18 F-NaF–positive uptake, 48 lesions (94.1%) had at least one of high-risk characteristics. The 18 F-NaF tissue-to-background ratio in plaques with high-risk characteristics was significantly higher than in those without (1.09 [95% confidence interval, 0.85–1.34] versus 0.62 [95% confidence interval, 0.42–0.82], P <0.001 for IVUS definition; 0.76 [95% confidence interval, 0.54–0.98] versus 0.42 [95% confidence interval, 0.21–0.62], P =0.014 for OCT definition). Among the 15 lesions that met both IVUS- and OCT-defined criteria for high-risk plaque, 14 (93.3%) showed 18 F-NaF–positive uptake. There was no difference in the prevalence of plaques with any adverse plaque characteristics between 18 F-NaF–positive and 18 F-NaF–negative plaques in the coronary computed tomography angiography subgroup (85.2% versus 78.9%; P =0.583).

Conclusions—

This study’s results suggest that 18 F-NaF positron-emission tomography can be a useful noninvasive diagnostic tool to identify and localize plaque with high-risk characteristics.

Clinical Trial Registration—

URL: http://www.clinicaltrials.gov . Unique identifier: NCT02388412.