Respiration-averaged CT versus standard CT attenuation map for correction of 18F-sodium fluoride uptake in coronary atherosclerotic lesions on hybrid PET/CT

Abstract Background Acute aortic syndrome is characterised by diseases that disrupt the intima and weaken the aorta. This damaged aorta is prone to aneurysmal dilation and ultimately rupture – a catastrophic event. 18F-sodium fluoride positron emission tomography and computed tomography (PET-CT) is a promising multimodality imaging technique that informs on the pathological state of the aorta. In abdominal aortic aneurysms (a chronic aortic disease), 18F-sodium fluoride PET uptake is associated with aortic expansion and requirement for aortic repair. Purpose The aim of this study was to describe aortic 18F-sodium fluoride uptake in patients with acute aortic syndrome for the first time. Methods Patients with intramural haematomas, aortic dissections or penetrating aortic ulcers, along with healthy control subjects, underwent contrast-enhanced 18F-sodium fluoride PET-CT. 18F-Sodium fluoride uptake was assessed using standardised uptake values and corrected for background blood pool activity to obtain tissue-to-background ratios (TBR). Results Forty-six patients and twenty healthy control subjects were matched for age, gender, body mass index, ischaemic heart disease and diabetes mellitus. Participants with acute aortic syndrome had widespread aortic 18F-sodium fluoride uptake. Radiotracer binding in patients with acute aortic syndrome was substantially greater than healthy subjects (TBR 2.00±0.45 vs 1.36±0.39, p<0.001). Subgroup analysis in patients with untreated type B acute aortic dissection revealed peak radiotracer binding at the site of intimal disruption compared to the proximal reference aorta (TBR [inter-quartile range] 1.61 [1.38–1.88] vs 1.18 [1.08–1.39] respectively; p<0.001). Radiotracer uptake was highest in patients with penetrating aortic ulcers, followed by aortic dissection and intramural haematomas (TBR (±SD) 2.19±0.55 vs 1.99±0.43 vs 1.71±0.27 respectively; p=0.046). No difference in radiotracer uptake was observed between patients with sub-acute and chronic disease (TBR (±SD) 1.94±0.37 vs 2.04±0.51, p=0.497). 18F-sodium fluoride uptake was similar between Stanford Type A and Type B dissections (TBR (±SD) 1.98±0.49, 2.00±0.44, p=0.851). 18F-Sodium fluoride binding was independent of maximum aortic diameter (R2 = 0.036, p=0.21). Conclusion Our preliminary findings suggest that aortic 18F-sodium fluoride uptake is increased in patients with acute aortic syndrome, especially around the site of intimal disruption or penetrating aortic ulcers. This technique appears to identify disease activity that may have clinical applications for assessing prognosis and guiding therapeutic interventions. 18F-NaF PET/CT in Acute Aortic Syndrome Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

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Cardiovascular 18F-fluoride positron emission tomography-magnetic resonance imaging: A comparison study

Journal of Nuclear Cardiology ◽

10.1007/s12350-019-01962-y ◽

2019 ◽

Cited By ~ 2

Author(s):

Jack P. M. Andrews ◽

Gillian MacNaught ◽

Alastair J. Moss ◽

Mhairi K. Doris ◽

Tania Pawade ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Attenuation Correction ◽

Quantitative Agreement ◽

Comparison Study ◽

Limits Of Agreement ◽

Fluoride Uptake ◽

Positron Emission ◽

Pet Ct ◽

Ct Attenuation

Abstract Background 18F-Fluoride uptake denotes calcification activity in aortic stenosis and atherosclerosis. While PET/MR has several advantages over PET/CT, attenuation correction of PET/MR data is challenging, limiting cardiovascular application. We compared PET/MR and PET/CT assessments of 18F-fluoride uptake in the aortic valve and coronary arteries. Methods and results 18 patients with aortic stenosis or recent myocardial infarction underwent 18F-fluoride PET/CT followed immediately by PET/MR. Valve and coronary 18F-fluoride uptake were evaluated independently. Both standard (Dixon) and novel radial GRE) MR attenuation correction (AC) maps were validated against PET/CT with results expressed as tissue-to-background ratios (TBRs). Visually, aortic valve 18F-fluoride uptake was similar on PET/CT and PET/MR. TBRMAX values were comparable with radial GRE AC (PET/CT 1.55±0.33 vs. PET/MR 1.58 ± 0.34, P = 0.66; 95% limits of agreement − 27% to + 25%) but performed less well with Dixon AC (1.38 ± 0.44, P = 0.06; bias (−)14%; 95% limits of agreement − 25% to + 53%). In native coronaries, 18F-fluoride uptake was similar on PET/MR to PET/CT regardless of AC approach. PET/MR identified 28/29 plaques identified on PET/CT; however, stents caused artifact on PET/MR making assessment of 18F-fluoride uptake challenging. Conclusion Cardiovascular PET/MR demonstrates good visual and quantitative agreement with PET/CT. However, PET/MR is hampered by stent-related artifacts currently limiting clinical application.

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Contribution of 18F-sodium fluoride PET/CT to the study of the carotid atheroma calcification

Revista Española de Medicina Nuclear e Imagen Molecular ◽

10.1016/j.remn.2012.08.003 ◽

2013 ◽

Vol 32 (1) ◽

pp. 22-25 ◽

Cited By ~ 1

Author(s):

R. Quirce ◽

I. Martínez-Rodríguez ◽

M. De Arcocha Torres ◽

J.F. Jiménez-Bonilla ◽

I. Banzo ◽

...

Keyword(s):

Sodium Fluoride ◽

Pet Ct

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A Retrospective Comparative Study of Sodium Fluoride (NaF-18)-PET/CT and Fluorocholine (F-18-CH) PET/CT in the Evaluation of Skeletal Metastases in Metastatic Prostate Cancer Using a Volumetric 3-D Radiomics Analysis

Diagnostics ◽

10.3390/diagnostics11010017 ◽

2020 ◽

Vol 11 (1) ◽

pp. 17

Author(s):

Kalevi Kairemo ◽

S. Cheenu Kappadath ◽

Timo Joensuu ◽

Homer A. Macapinlac

Keyword(s):

Prostate Cancer ◽

Cell Membrane ◽

Sodium Fluoride ◽

Bone Mineralization ◽

Membrane Lipid ◽

Skeletal Metastases ◽

Study Cohort ◽

Skeletal Disease ◽

Sclerotic Bone ◽

Pet Ct

Bone metastases are common in prostate cancer (PCa). Fluorocholine-18 (FCH) and sodium fluoride-18 (NaF) have been used to assess PCa associated skeletal disease in thousands of patients by demonstrating different mechanism of uptake-cell membrane (lipid) synthesis and bone mineralization. Here, this difference is characterized quantitatively in detail. Our study cohort consisted of 12 patients with advanced disease (> 5 lesions) (M) and of five PCa patients with no skeletal disease (N). They had routine PET/CT with FCH and NaF on consecutive days. Skeletal regions in CT were used to co-register the two PET/CT scans. Bone 3-D volume of interest (VOI) was defined on the CT of PET with a threshold of HU > 150, and sclerotic/dense bone as HU > 600, respectively. Additional VOIs were defined on PET uptake with the threshold values on both FCH (SUV > 3.5) and NaF (SUV > 10). The pathologic skeletal volumes for each technique (CT, HU > 600), NaF (SUV > 10) and FCH (SUV > 3.5) were developed and analyzed. The skeletal VOIs varied from 5.03 L to 7.31 L, whereas sclerotic bone VOIs were from 0.88 L to 2.99 L. Total choline kinase (cell membrane synthesis) activity for FCH (TCA) varied from 0.008 to 4.85 [kg] in M group and from 0.0006 to 0.085 [kg] in N group. Total accelerated osteoblastic (bone demineralization) activity for NaF (TBA varied from 0.25 to 13.6 [kg] in M group and varied from 0.000 to 1.09 [kg] in N group. The sclerotic bone volume represented only 1.86 ± 1.71% of the pathologic FCH volume and 4.07 ± 3.21% of the pathologic NaF volume in M group, and only 0.08 ± 0.09% and 0.18 ± 0.19% in N group, respectively. Our results suggest that CT alone cannot be used for the assessment of the extent of active metastatic skeletal disease in PCa. NaF and FCH give complementary information about the activity of the skeletal disease, improving diagnosis and disease staging.

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