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Simultaneous assessment of microcalcifications and morphological criteria of vulnerability in carotid artery plaque using hybrid 18F-NaF PET/MRI

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Previous studies have suggested the role of microcalcifications in plaque vulnerability. This exploratory study sought to assess the potential of hybrid positron-emission tomography (PET)/magnetic resonance imaging (MRI) using 18F-sodium fluoride (18F-NaF) to check simultaneously 18F-NaF uptake, a marker of microcalcifications, and morphological criteria of vulnerability.

Methods and results

We included 12 patients with either recently symptomatic or asymptomatic carotid stenosis. All patients underwent 18F-NaF PET/MRI. 18F-NaF target-to-background ratio (TBR) was measured in culprit and nonculprit (including contralateral plaques of symptomatic patients) plaques as well as in other arterial walls. Morphological criteria of vulnerability were assessed on MRI. Mineral metabolism markers were also collected. 18F-NaF uptake was higher in culprit compared to nonculprit plaques (median TBR 2.6 [2.2-2.8] vs 1.7 [1.3-2.2]; P = 0.03) but was not associated with morphological criteria of vulnerability on MRI. We found a positive correlation between 18F-NaF uptake and calcium plaque volume and ratio but not with circulating tissue-nonspecific alkaline phosphatase (TNAP) activity and inorganic pyrophosphate (PPi) levels. 18F-NaF uptake in the other arterial walls did not differ between symptomatic and asymptomatic patients.

Conclusions

18F-NaF PET/MRI may be a promising tool for providing additional insights into the plaque vulnerability.

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Abbreviations

18F-NaF:

18F-sodium fluoride

AP:

Alkaline phosphatase

BMI:

Body mass index

BW:

Bandwidth

CE-MRA:

Contrast-enhanced

CRP:

C-reactive protein

CT:

Computed tomography

DUS:

Doppler ultrasound

FC:

Fibrous cap

FLASH:

Fast-low angle shot

FOV:

Field of view

IPH:

Intraplaque hemorrhage

IQR:

Interquartile range

LDL:

Low-density lipoprotein

LRNC:

Lipid-rich necrotic core

MR:

Angiography

MRI:

Magnetic resonance imaging

NA:

Number of averages

NASCET:

North American Symptomatic Carotid Endarterectomy Trial

NIHSS:

National institutes of health stroke scale

PET:

Positron-emission tomography

PPi:

Inorganic pyrophosphate

ROI:

Region of interest

SD:

Standard Deviation

SPAIR:

Spectral attenuated inversion recovery

SUVmax:

Maximum standard uptake value

TE:

Echo time

TBR:

Target-to-background ratio

TIA:

Transient ischemic attack

TNAP:

Tissue-nonspecific alkaline phosphatase

TOF:

Time-of-flight angiography

TR:

Repetition time

VSMC:

Vascular smooth muscle cell

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Acknowledgements

We thank Thomas Troalen, application engineer Siemens Healthcare France, for his assistance in the development of the sequences used in this study, Curium for providing 18F-NaF (CISNAF 100 MBq/mL solution for injection, Cis bio international), Karen Reilly for proofreading the English, Morgane Bouin (Cellule Recherche Imagerie) for data collection and the French National ‘invest for the future’ programs: LILI – Lyon Integrated Life Imaging: hybrid MR-PET ANR-11-EQPX-0026 and CESAME - Brain and Mental Health ANR-10-IBHU-0003. Human biological samples and associated data were obtained from NeuroBioTec (CRB-HCL, Lyon France, Biobank BB-0033-00046).

Disclosure

The authors declare that they have no conflict of interest.

Funding

CREATIS CNRS Lab grant.

Author information

Authors and Affiliations

  1. Stroke Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France

    Laura Mechtouff & Norbert Nighoghossian

  2. INSERM U1060, CarMeN Laboratory, University Lyon 1, Lyon, France

    Laura Mechtouff, Emmanuelle Canet-Soulas, Thomas Bochaton, Claire Crola Da Silva, Alexandre Paccalet & Norbert Nighoghossian

  3. CNRS, UMR 5220, CREATIS, University of Lyon, Lyon, France

    Monica Sigovan, Philippe Douek & Yves Berthezene

  4. INSA‐Lyon UCBL, Inserm U1206, UJM-Saint Etienne, Lyon, France

    Monica Sigovan & Philippe Douek

  5. Department of Radiology, Louis Pradel University Hospital, Bron, France

    Philippe Douek, Stéphane Luong & Salim Si-Mohamed

  6. CERMEP - Imagerie du vivant, Lyon, France

    Nicolas Costes & Didier Le Bars

  7. ICBMS, University C. Bernard Lyon 1 & Hospices Civils de Lyon, Lyon, France

    Didier Le Bars

  8. Cellule Recherche Imagerie, Louis Pradel University Hospital, Bron, France

    Adeline Mansuy

  9. Clinical Research and Epidemiology Unit, Public Health Department Hospices Civils de Lyon & Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, 42023, Saint-Etienne, France

    Julie Haesebaert

  10. Department of Nuclear Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France

    Alexandre Bani-Sadr & Jérémie Tordo

  11. Vascular Surgery Department, Edouard Herriot University Hospital & Claude Bernard Lyon 1 University, Lyon, France

    Patrick Feugier & Antoine Millon

  12. Laboratoire d’Anatomie et de Cytologie pathologiques Technipath, Limonest, France

    Diane Collet-Benzaquen

  13. ICBMS, CNRS, UMR 5246, University Lyon 1, Lyon, France

    David Magne

  14. Neuroradiology Department, Pierre Wertheimer Hospital, Bron, France

    Yves Berthezene

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  1. Laura Mechtouff
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Correspondence to Laura Mechtouff.

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Mechtouff, L., Sigovan, M., Douek, P. et al. Simultaneous assessment of microcalcifications and morphological criteria of vulnerability in carotid artery plaque using hybrid 18F-NaF PET/MRI. J. Nucl. Cardiol. 29, 1064–1074 (2022). https://doi.org/10.1007/s12350-020-02400-0

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