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Journal of Nuclear Cardiology

, Volume 25, Issue 5, pp 1774–1783 | Cite as

In search of the vulnerable patient or the vulnerable plaque: 18F-sodium fluoride positron emission tomography for cardiovascular risk stratification

  • Jamie W. Bellinge
  • Roslyn J. Francis
  • Kamran Majeed
  • Gerald F. Watts
  • Carl J. Schultz
Review Article

Abstract

Cardiovascular disease (CVD) remains a leading cause of death. Preventative therapies that reduce CVD are most effective when targeted to individuals at high risk. Current risk stratification tools have only modest prognostic capabilities, resulting in over-treatment of low-risk individuals and under-treatment of high-risk individuals. Improved methods of CVD risk stratification are required. Molecular imaging offers a novel approach to CVD risk stratification. In particular, 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) has shown promise in the detection of both high-risk atherosclerotic plaque features and vascular calcification activity, which predicts future development of new vascular calcium deposits. The rate of change of coronary calcium scores, measured by serial computed tomography scans over a 2-year period, is a strong predictor of CVD risk. Vascular calcification activity, as measured with 18F-NaF PET, has the potential to provide prognostic information similar to consecutive coronary calcium scoring, with a single-time-point convenience. However, owing to the rapid motion and small size of the coronary arteries, new solutions are required to address the traditional limitations of PET imaging. Two different methods of coronary PET analysis have been independently proposed and here we compare their respective strengths, weaknesses, and the potential for clinical translation.

Keywords

CAD PET image analysis molecular imaging agents diagnostic and prognostic application atherosclerosis 

Abbreviations

18F-NaF

18F-sodium fluoride

18F-FDG

18F-fluorodeoxyglucose

PET

Positron emission tomography

CVD

Cardiovascular disease

CT

Computed tomography

OCT

Optical coherence tomography

IVUS

Intravascular ultrasound

CCS

Coronary artery calcium score

Notes

Acknowledgements

The authors wish to acknowledge James Goodchild from Royal Perth Hospital Medical Illustrations for his artistic contribution to the manuscript.

Disclosure

Dr. Bellinge, Prof. Watts, A/Prof. Francis and Dr. Majeed have no disclosures. Prof. Schultz reports a research grant from Abbot Vascular outside the submitted work.

Supplementary material

12350_2018_1360_MOESM1_ESM.pptx (21.5 mb)
Supplementary material 1 (PPTX 22021 kb)

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Copyright information

© American Society of Nuclear Cardiology 2018

Authors and Affiliations

  • Jamie W. Bellinge
    • 1
    • 2
  • Roslyn J. Francis
    • 2
    • 3
  • Kamran Majeed
    • 1
    • 2
  • Gerald F. Watts
    • 1
    • 2
  • Carl J. Schultz
    • 1
    • 2
  1. 1.Department of CardiologyRoyal Perth HospitalPerthAustralia
  2. 2.School of MedicineUniversity of Western AustraliaPerthAustralia
  3. 3.Department of Nuclear MedicineSir Charles Gairdner HospitalPerthAustralia

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