Abstract 3017: Fluorine-18 Sodium Fluoride Positron Emission Tomography/ Computed Tomography Imaging Of Calcium Progression In Patients With Peripheral Artery Disease

• DOI: 10.1161/atvb.44.suppl_1.3017
• Publication Date: 2024-07-24T13:03:55Z
• Authors: Eleanor T Rimmerman; Ting-Heng Chou; Kumudha N Musini; Surina Patel; Molly Wynveen; Jenna Trainer; Katy Mevis; Said Atway; Michael Go; Mitchel R Stacy
• Keywords: 03 medical and health sciences; 0302 clinical medicine

Introduction: Peripheral artery disease (PAD) is an atherosclerotic disease that promotes lower extremity ischemia and is associated with necrosis, limb loss, and premature death. Fluorine-18 sodium fluoride ( 18 F-NaF) PET/CT imaging has been utilized for early detection of calcific disease progression in the coronary arteries; however, this technique has not been assessed in PAD to predict developing arterial calcification.

Hypothesis: We hypothesized that 18 F-NaF PET/CT imaging could identify sites undergoing active microcalcification and predict the formation or expansion of vascular calcium.

Methods: Patients with PAD (n=26) underwent 18 F-NaF PET/CT imaging at baseline and CT imaging 18 months later. Regions of interest were manually drawn on axial PET and CT images for the arteries of the symptomatic limb (totaling 8,001 arterial segments). Arterial uptake of 18 F-NaF was quantified and reported on a segment-by-segment basis as maximum standard uptake values (SUV max ). Baseline and 18-month CT images were co-registered to quantify serial changes in calcium density for each arterial segment using CT image cutoffs for calcium (≥130 Hounsfield Units). Differences in arterial uptake of 18 F-NaF were compared across 3 categories of segments: 1) no calcium at baseline or 18 months, 2) newly formed calcium and 3) existing calcified lesions with expansion of calcium.

Results: Arterial segments containing newly formed calcium had significantly higher baseline uptake of 18 F-NaF than segments without calcium progression. Existing calcified arterial lesions with progression showed significantly higher 18 F-NaF uptake compared to segments with newly formed calcium and segments without calcium progression ( Figure 1 ).

Conclusions: In conclusion, calcium progression can be detected and potentially predicted using 18 F-NaF PET/CT imaging, thereby providing a molecular imaging tool for monitoring PAD pathophysiology and responses to medical therapy.