In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

This content is currently on FREE ACCESS, enjoy another 27 days of free consultation


Whole-vessel coronary 18F-sodium fluoride coronary microcalfication activity is associated with Low density plaque.

Session Advanced PET & CT techniques for clinical practice

Speaker Jacek Kwiecinski

Congress : ESC Congress 2019

  • Topic : imaging
  • Sub-topic : Positron Emission Tomography (PET)
  • Session type : Abstract Session
  • FP Number : 5966

Authors : J Kwiecinski (Los Angeles,US), S Cadet (Los Angeles,US), D Dey (Los Angeles,US), M Daghem (Edinburgh,GB), ML Lassen (Los Angeles,US), G Germano (Los Angeles,US), MR Dweck (Edinburgh,GB), DE Newby (Edinburgh,GB), DS Berman (Los Angeles,US), PJ Slomka (Los Angeles,US)

J Kwiecinski1 , S Cadet1 , D Dey1 , M Daghem2 , ML Lassen1 , G Germano1 , MR Dweck2 , DE Newby2 , DS Berman1 , PJ Slomka1 , 1Cedars-Sinai Medical Center - Los Angeles - United States of America , 2University of Edinburgh, Centre for Cardiovascular Sciences - Edinburgh - United Kingdom of Great Britain & Northern Ireland ,


18F-sodium fluoride (18F-NaF) showed promise in imaging vulnerable coronary plaques. To date reporting of the highest per patient target to background ratio (TBR), total number of lesions with visual uptake and whole-heart tracer activity have been proposed. Unfortunately, each of these approaches has limitations which become especially prominent in patients with multiple foci of uptake, where reproducible global per-vessel measures are required. In oncology, the total metabolic active tumor volume has been found to be a significant prognostic factor for disease progression, recurrence and death. We evaluated if such methodology could be applied to coronary PET imaging. 
To quantify whole-vessel coronary 18F-NaF PET activity by utilizing automatically derived coronary vessel regions of interest (ROI) from CT angiography and assess the relationship between coronary microcalcification activity (CMA) and per vessel quantitative plaque characteristics on coronary CT angiography (CTA). 
Twenty patients (68±6 years old, 70% males) with multivessel coronary artery disease underwent a 30 min single bed position PET 1h after a 250mB injection of 18F-NaF and CTA on a hybrid PET/CT scanner. We assessed coronary 18F-NaF uptake using novel whole-vessel tubular and tortuous 3D ROIs which were automatically extracted from CTA datasets. Within such ROIs we measured mean standard uptake value (SUV), maximum TBR (TBRmax) and the activity of voxels (CMA) above 1.25 the background SUV (left atrium activity). We used a previously established 1.25 TBRmax threshold to distinguish vessels positive and negative for 18F-NaF uptake. Coronary CTA datasets were analyzed by semi-automated software to quantify volumes and percentage lesion content of non-calcified plaque (NCP), low-density non-calcified plaque (LD-NCP, attenuation <30 Hounsfield units) and calcified plaque (CP). 
13 (65%) patients and 24 (40%) out of 60 main epicardial vessels presented with 18F-NaF uptake exceeding the 1.25 TBRmax threshold. While coronaries positive for uptake had higher CMA 0.92 [0.17, 2.03] vs 0.0, p<0.001 and TBRmax 1.42 [1.35, 1.74] vs 1.09 [1.0, 1.19], there was no difference in whole-vessel SUVmean 0.90 [0.77, 1.17] vs 0.87 [0.78, 0.96], p=0.33 compared to 18F-NaF negative arteries. Of the quantitative plaque characteristics vessels positive for uptake had higher NCP 278.4 [145.6, 576.9] vs 184.6 [63.8, 367.0]mm3, p=0.030; and LD-NCP 8.4 [0.3, 11.0] vs 2.7 [12.1, 43.5]mm3, p=0.01. CMA showed a stronger correlation with LD-NCP (r=0.70, p<0.001) than TBRmax (r=0.52, p<0.001). On regression analysis LD-NCP acted as an independent predictor of CMA after adjustments for CP and vessel SUVmean (p<0.001). 
Whole-vessel 18F-NaF coronary microcalcification activity assessment with CT angiography automatically derived 3-dimensional ROIs is feasible and the measured coronary microcalcification burden correlates well with low density plaque.

This content is currently on FREE ACCESS, enjoy another 27 days of free consultation


Based on your interests

Members get more

Join now
  • 1ESC Professional Members – access all resources from ESC Congress and ESC Asia with APSC & AFC
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s congress resources
  • 3Under 40 or in training - with a Combined Membership, access resources from all congresses
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are