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Park PSU, Werner TJ, Høilund-Carlsen PF, Alavi A. Imaging of Rotator Cuff Calcific Tendinopathy Using 18 F-NaF and 18 F-FDG PET/CT. Clin Nucl Med 2024; 49:270-271. [PMID: 38048402 DOI: 10.1097/rlu.0000000000004975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
ABSTRACT Calcific tendinopathy is a common condition of the shoulder caused by the inflammation and deposition of hydroxyapatite crystals in the rotator cuff tendons. PET tracers capturing the molecular changes associated with the crystal deposition of calcific tendinopathy remain underinvestigated. In this report, we present calcified tendinopathy of the infraspinatus tendon demonstrating both 18 F-NaF and 18 F-FDG focal uptake in a 61-year-old woman.
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Affiliation(s)
| | - Thomas J Werner
- From the Department of Radiology, Hospital of the University of Pennsylvania
| | | | - Abass Alavi
- From the Department of Radiology, Hospital of the University of Pennsylvania
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2
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Park MM, Park PSU, Werner TJ, Høilund-Carlsen PF, Alavi A. Simultaneous Uptake of 18 F-NaF and 18 F-FDG by Bladder and Prostate Calculi. Clin Nucl Med 2023; 48:1105-1106. [PMID: 37883212 DOI: 10.1097/rlu.0000000000004917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
ABSTRACT Calcification and formation of calculi in the genitourinary system such as the bladder, kidney, and prostate are common processes of aging. Despite being in different parts of the body, these calculi can share risk factors; for instance, bladder and prostate calculi are seen in older men with benign prostatic hyperplasia. There have been increasing reports of detection of calculi using PET tracers such as 18 F-NaF and 18 F-FDG, suggesting their role for detection of extraosseous calcification. In this report, we present simultaneous detection of bladder and prostate calculi with both 18 F-NaF and 18 F-FDG avidity in a 74-year-old man with multiple myeloma.
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Affiliation(s)
- Mia Mijung Park
- From the Department of Radiology, Hospital of the University of Pennsylvania
| | - Peter Sang Uk Park
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Thomas J Werner
- From the Department of Radiology, Hospital of the University of Pennsylvania
| | | | - Abass Alavi
- From the Department of Radiology, Hospital of the University of Pennsylvania
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3
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Blanchard I, Vootukuru N, Bhattaru A, Patil S, Rojulpote C. PET Radiotracers in Atherosclerosis: A Review. Curr Probl Cardiol 2023; 48:101925. [PMID: 37392979 DOI: 10.1016/j.cpcardiol.2023.101925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
Traditional atherosclerosis imaging modalities are limited to late stages of disease, prior to which patients are frequently asymptomatic. Positron emission tomography (PET) imaging allows for the visualization of metabolic processes underscoring disease progression via radioactive tracer, allowing earlier-stage disease to be identified. 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG) uptake largely reflects the metabolic activity of macrophages, but is unspecific and limited in its utility. By detecting areas of microcalcification, 18F-Sodium Fluoride (18F-NaF) uptake also provides insight into atherosclerosis pathogenesis. Gallium-68 DOTA-0-Tyr3-Octreotate (68Ga-DOTATATE) PET has also shown potential in identifying vulnerable atherosclerotic plaques with high somatostatin receptor expression. Finally, 11-carbon (11C)-choline and 18F-fluoromethylcholine (FMCH) tracers may identify high-risk atherosclerotic plaques by detecting increased choline metabolism. Together, these radiotracers quantify disease burden, assess treatment efficacy, and stratify risk for adverse cardiac events.
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Affiliation(s)
| | - Nishita Vootukuru
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Abhijit Bhattaru
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ; Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | - Chaitanya Rojulpote
- Department of Radiology, University of Pennsylvania, Philadelphia, PA; Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA.
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4
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Høilund-Carlsen PF, Revheim ME, Costa T, Kepp KP, Castellani RJ, Perry G, Alavi A, Barrio JR. FDG-PET versus Amyloid-PET Imaging for Diagnosis and Response Evaluation in Alzheimer's Disease: Benefits and Pitfalls. Diagnostics (Basel) 2023; 13:2254. [PMID: 37443645 DOI: 10.3390/diagnostics13132254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
In June 2021, the US Federal Drug and Food Administration (FDA) granted accelerated approval for the antibody aducanumab and, in January 2023, also for the antibody lecanemab, based on a perceived drug-induced removal of cerebral amyloid-beta as assessed by amyloid-PET and, in the case of lecanemab, also a presumption of limited clinical efficacy. Approval of the antibody donanemab is awaiting further data. However, published trial data indicate few, small and uncertain clinical benefits, below what is considered "clinically meaningful" and similar to the effect of conventional medication. Furthermore, a therapy-related decrease in the amyloid-PET signal may also reflect increased cell damage rather than simply "amyloid removal". This interpretation is more consistent with increased rates of amyloid-related imaging abnormalities and brain volume loss in treated patients, relative to placebo. We also challenge the current diagnostic criteria for AD based on amyloid-PET imaging biomarkers and recommend that future anti-AD therapy trials apply: (1) diagnosis of AD based on the co-occurrence of cognitive decline and decreased cerebral metabolism assessed by FDA-approved FDG-PET, (2) therapy efficacy determined by favorable effect on cognitive ability, cerebral metabolism by FDG-PET, and brain volumes by MRI, and (3) neuropathologic examination of all deaths occurring in these trials.
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Affiliation(s)
- Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense C, Denmark
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, 5230 Odense M, Denmark
| | - Mona-Elisabeth Revheim
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, 0372 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
| | - Tommaso Costa
- GDS, Department of Psychology, Koelliker Hospital, University of Turin, 10124 Turin, Italy
- FOCUS Lab, Department of Psychology, University of Turin, 10124 Turin, Italy
| | - Kasper P Kepp
- Section of Biophysical and Biomedicinal Chemistry, DTU Chemistry, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Rudolph J Castellani
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - George Perry
- Department of Neuroscience, Developmental and Regenerative Biology and Genetics of Neurodegeneration, Departments of Psychiatry and Neuroscience, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Abass Alavi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jorge R Barrio
- Department of Molecular and Medical Pharmacology, David Geffen UCLA School of Medicine, Los Angeles, CA 90095, USA
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Amini A, Jafari E, Pourbehi MR, Iranpour D, Nemati R, Ahmadzadehfar H, Assadi M. Potential Role of Somatostatin Receptor Scintigraphy for In Vivo Imaging of Vulnerable Atherosclerotic Plaques and Its Association with Myocardial Perfusion Imaging Finding: A Preliminary Study. Mol Imaging Radionucl Ther 2023; 32:123-130. [PMID: 37337773 PMCID: PMC10284178 DOI: 10.4274/mirt.galenos.2022.08860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/15/2022] [Indexed: 06/21/2023] Open
Abstract
Objectives This study was conducted to detect atherosclerotic plaques with somatostatin receptor scintigraphy (SRS) using Tc-99m-octreotide that binds to somatostatin receptor-2. Methods Of the 783 patients referred for myocardial perfusion imaging (MPI), 52 underwent additional chest single-photon emission computed tomography (SPECT) with Tc-99m-octreotide and participated in this study. In addition, 43 patients who underwent Tc-99m-octreotide scan for neuroendocrine tumor (NET) also received cardiac SPECT. Angiography was performed within 1 month after SRS for 19 patients who showed intensive uptake in SRS and had cardiac risk factors. Results Of 52 patients who underwent MPI and SRS, 15 showed intensive cardiac uptake in SRS. Moreover, of 43 patients who were referred for NET, 4 patients had marked cardiac uptake in SRS in the heart. Nineteen patients including 12 women and 7 men aged 28 to 84 (58±8.04) years underwent coronary angiography. SRS and angiography in the left anterior descending territory were concordant in 15/19 (79%) patients, whereas only 7/15 (46%) cases had concordant MPI and angiography results. In the right coronary artery territory, SRS and angiography were concordant in 16/19 (84%) cases, while MPI and angiography were concordant in 11/15 (73%) cases. In the left circumflex artery territory, SRS and angiography were concordant in 15/19 (79%) cases, whereas MPI and angiography were concordant in 6/15 (40%) cases. In the remaining 76 patients who did not undergo coronary angiography based on cardiovascular profile and SRS, no cardiac events occurred in a follow-up of 2-11 months (7.52±2.71). Conclusion Tc-99m-octreotide uptake was more concordant with coronary plaques relative to MPI findings, suggesting a potential role for Tc-99m-octreotide in the evaluation of atherosclerosis.
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Affiliation(s)
- Abdullatif Amini
- Bushehr University of Medical Sciences Faculty of Medicine, Bushehr Medical Heart Center, Bushehr, Iran
| | - Esmail Jafari
- The Persian Gulf Nuclear Medicine Research Center, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Department of Molecular Imaging and Theranostics, Bushehr, Iran
| | - Mohammad Reza Pourbehi
- Bushehr University of Medical Sciences Faculty of Medicine, Bushehr Medical Heart Center, Bushehr, Iran
| | - Dariush Iranpour
- Bushehr University of Medical Sciences Faculty of Medicine, Bushehr Medical Heart Center, Bushehr, Iran
| | - Reza Nemati
- Bushehr University of Medical Sciences, Bushehr Medical University Hospital, Department of Neurology, Bushehr, Iran
| | | | - Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Department of Molecular Imaging and Theranostics, Bushehr, Iran
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Singh SB, Ng SJ, Lau HC, Khanal K, Bhattarai S, Paudyal P, Shrestha BB, Naseer R, Sandhu S, Gokhale S, Raynor WY. Emerging PET Tracers in Cardiac Molecular Imaging. Cardiol Ther 2023; 12:85-99. [PMID: 36593382 PMCID: PMC9986170 DOI: 10.1007/s40119-022-00295-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/26/2022] [Indexed: 01/04/2023] Open
Abstract
18F-fluorodeoxyglucose (FDG) and 18F-sodium fluoride (NaF) represent emerging PET tracers used to assess atherosclerosis-related inflammation and molecular calcification, respectively. By localizing to sites with high glucose utilization, FDG has been used to assess myocardial viability for decades, and its role in evaluating cardiac sarcoidosis has come to represent a major application. In addition to determining late-stage changes such as loss of perfusion or viability, by targeting mechanisms present in atherosclerosis, PET-based techniques have the ability to characterize atherogenesis in the early stages to guide intervention. Although it was once thought that FDG would be a reliable indicator of ongoing plaque formation, micro-calcification as portrayed by NaF-PET/CT appears to be a superior method of monitoring disease progression. PET imaging with NaF has the additional advantage of being able to determine abnormal uptake due to coronary artery disease, which is obscured by physiologic myocardial activity on FDG-PET/CT. In this review, we discuss the evolving roles of FDG, NaF, and other PET tracers in cardiac molecular imaging.
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Affiliation(s)
- Shashi Bhushan Singh
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sze Jia Ng
- Department of Medicine, Crozer-Chester Medical Center, 1 Medical Center Boulevard, Upland, PA, 19013, USA
| | - Hui Chong Lau
- Department of Medicine, Crozer-Chester Medical Center, 1 Medical Center Boulevard, Upland, PA, 19013, USA
| | - Kishor Khanal
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Division of Cardiology, Memorial Healthcare System, 3501 Johnson Street, Hollywood, FL, 33021, USA
| | - Sanket Bhattarai
- Department of Medicine, KIST Medical College, Mahalaxmi 01, Lalitpur, Bagmati, Nepal
| | - Pranita Paudyal
- West China Hospital, Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Bimash Babu Shrestha
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Rizwan Naseer
- Department of Medicine, Crozer-Chester Medical Center, 1 Medical Center Boulevard, Upland, PA, 19013, USA
| | - Simran Sandhu
- College of Health and Human Development, Pennsylvania State University, 10 East College Avenue, University Park, PA, 16802, USA
| | - Saket Gokhale
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB #404, New Brunswick, NJ, 08901, USA.
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Piri R, Hamakan Y, Vang A, Edenbrandt L, Larsson M, Enqvist O, Gerke O, Høilund-Carlsen PF. Common carotid segmentation in 18 F-sodium fluoride PET/CT scans: Head-to-head comparison of artificial intelligence-based and manual method. Clin Physiol Funct Imaging 2023; 43:71-77. [PMID: 36331059 PMCID: PMC10100011 DOI: 10.1111/cpf.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Carotid atherosclerosis is a major cause of stroke, traditionally diagnosed late. Positron emission tomography/computed tomography (PET/CT) with 18 F-sodium fluoride (NaF) detects arterial wall micro-calcification long before macro-calcification becomes detectable by ultrasound, CT or magnetic resonance imaging. However, manual PET/CT processing is time-consuming and requires experience. We compared a convolutional neural network (CNN) approach with manual segmentation of the common carotids. METHODS Segmentation in NaF-PET/CT scans of 29 healthy volunteers and 20 angina pectoris patients were compared for segmented volume (Vol) and mean, maximal, and total standardized uptake values (SUVmean, SUVmax, and SUVtotal). SUVmean was the average of SUVmeans within the VOI, SUVmax the highest SUV in all voxels in the VOI, and SUVtotal the SUVmean multiplied by the Vol of the VOI. Intra and Interobserver variability with manual segmentation was examined in 25 randomly selected scans. RESULTS Bias for Vol, SUVmean, SUVmax, and SUVtotal were 1.33 ± 2.06, -0.01 ± 0.05, 0.09 ± 0.48, and 1.18 ± 1.99 in the left and 1.89 ± 1.5, -0.07 ± 0.12, 0.05 ± 0.47, and 1.61 ± 1.47, respectively, in the right common carotid artery. Manual segmentation lasted typically 20 min versus 1 min with the CNN-based approach. Mean Vol deviation at repeat manual segmentation was 14% and 27% in left and right common carotids. CONCLUSIONS CNN-based segmentation was much faster and provided SUVmean values virtually identical to manually obtained ones, suggesting CNN-based analysis as a promising substitute of slow and cumbersome manual processing.
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Affiliation(s)
- Reza Piri
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Yaran Hamakan
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Ask Vang
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Lars Edenbrandt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Olof Enqvist
- Eigenvision AB, Malmö, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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NaF-PET Imaging of Atherosclerosis Burden. J Imaging 2023; 9:jimaging9020031. [PMID: 36826950 PMCID: PMC9966512 DOI: 10.3390/jimaging9020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The method of 18F-sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) of atherosclerosis was introduced 12 years ago. This approach is particularly interesting because it demonstrates microcalcification as an incipient sign of atherosclerosis before the development of arterial wall macrocalcification detectable by CT. However, this method has not yet found its place in the clinical routine. The more exact association between NaF uptake and future arterial calcification is not fully understood, and it remains unclear to what extent NaF-PET may replace or significantly improve clinical cardiovascular risk scoring. The first 10 years of publications in the field were characterized by heterogeneity at multiple levels, and it is not clear how the method may contribute to triage and management of patients with atherosclerosis, including monitoring effects of anti-atherosclerosis intervention. The present review summarizes findings from the recent 2¾ years including the ability of NaF-PET imaging to assess disease progress and evaluate response to treatment. Despite valuable new information, pertinent questions remain unanswered, not least due to a pronounced lack of standardization within the field and of well-designed long-term studies illuminating the natural history of atherosclerosis and effects of intervention.
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Recent Advances in Cardiovascular Diseases Research Using Animal Models and PET Radioisotope Tracers. Int J Mol Sci 2022; 24:ijms24010353. [PMID: 36613797 PMCID: PMC9820417 DOI: 10.3390/ijms24010353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Cardiovascular diseases (CVD) is a collective term describing a range of conditions that affect the heart and blood vessels. Due to the varied nature of the disorders, distinguishing between their causes and monitoring their progress is crucial for finding an effective treatment. Molecular imaging enables non-invasive visualisation and quantification of biological pathways, even at the molecular and subcellular levels, what is essential for understanding the causes and development of CVD. Positron emission tomography imaging is so far recognized as the best method for in vivo studies of the CVD related phenomena. The imaging is based on the use of radioisotope-labelled markers, which have been successfully used in both pre-clinical research and clinical studies. Current research on CVD with the use of such radioconjugates constantly increases our knowledge and understanding of the causes, and brings us closer to effective monitoring and treatment. This review outlines recent advances in the use of the so-far available radioisotope markers in the research on cardiovascular diseases in rodent models, points out the problems and provides a perspective for future applications of PET imaging in CVD studies.
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10
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Atherosclerosis Burdens in Diabetes Mellitus: Assessment by PET Imaging. Int J Mol Sci 2022; 23:ijms231810268. [PMID: 36142181 PMCID: PMC9499611 DOI: 10.3390/ijms231810268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 01/14/2023] Open
Abstract
Arteriosclerosis and its sequelae are the most common cause of death in diabetic patients and one of the reasons why diabetes has entered the top 10 causes of death worldwide, fatalities having doubled since 2000. The literature in the field claims almost unanimously that arteriosclerosis is more frequent or develops more rapidly in diabetic than non-diabetic subjects, and that the disease is caused by arterial inflammation, the control of which should therefore be the goal of therapeutic efforts. These views are mostly based on indirect methodologies, including studies of artery wall thickness or stiffness, or on conventional CT-based imaging used to demonstrate tissue changes occurring late in the disease process. In contrast, imaging with positron emission tomography and computed tomography (PET/CT) applying the tracers 18F-fluorodeoxyglucose (FDG) or 18F-sodium fluoride (NaF) mirrors arterial wall inflammation and microcalcification, respectively, early in the course of the disease, potentially enabling in vivo insight into molecular processes. The present review provides an overview of the literature from the more than 20 and 10 years, respectively, that these two tracers have been used for the study of atherosclerosis, with emphasis on what new information they have provided in relation to diabetes and which questions remain insufficiently elucidated.
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Yang W, Zhong Z, Feng G, Wang Z. Advances in positron emission tomography tracers related to vascular calcification. Ann Nucl Med 2022; 36:787-797. [PMID: 35834116 DOI: 10.1007/s12149-022-01771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022]
Abstract
Microcalcification, a type of vascular calcification, increases the instability of plaque and easily leads to acute clinical events. Positron emission tomography (PET) is a new examination technology with significant advantages in identifying vascular calcification, especially microcalcification. The use of the 18F-NaF is undoubtedly the benchmark, and other PET tracers related to vascular calcification are also currently in development. Despite all this, a large number of studies are still needed to further clarify the specific mechanisms and characteristics. This review aimed at providing a summary of the application and progress of different PET tracers and also the future development direction.
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Affiliation(s)
- Wenjun Yang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Zhiqi Zhong
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Guoquan Feng
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China.
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12
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Alavi A, Werner TJ, Raynor W, Høilund-Carlsen PF, Revheim ME. Critical review of PET imaging for detection and characterization of the atherosclerotic plaques with emphasis on limitations of FDG-PET compared to NaF-PET in this setting. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2021; 11:337-351. [PMID: 34754605 PMCID: PMC8569336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
Applications of various positron emission tomography (PET) tracers for assessing atherosclerosis have been evolving over the years. 18F-fluorodeoxyglucose (FDG)-PET was introduced in 2001 as a probe for this purpose. During the past decade, numerous papers have described a major role for sodium 18F-fluoride (NaF) as another tracer for assessing this vascular disease. We have reviewed the existing data about the merits of both techniques for assessing atherosclerosis. We have to emphasize that our team has been actively involved in conducting research with both tracers over many years. In this review, we have relied upon the data from the CAMONA study which has become a gold standard for defining the role of PET imaging in atherosclerosis. This study was one of the largest of any in recent years and has allowed comprehensive comparison between these two tracers in detecting and quantifying atherosclerosis. Based on what we have learned from this major undertaking, we believe the role of FDG-PET will be limited in assessing atherosclerosis in clinical work-up. This is relevant to both major and coronary arteries. In contrast to NaF-PET, the role of FDG-PET in assessing coronary artery atherosclerosis is almost non-existent. Based on the existing data in this domain, NaF-PET is an ideal imaging modality for both research and clinical assessment of atherosclerosis. The aim of this review is to describe the pros and cons of both approaches based on the existing data in the literature.
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Affiliation(s)
- Abass Alavi
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - William Raynor
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University HospitalOdense 5000, Denmark
- Department of Clinical Research, University of Southern DenmarkOdense, Denmark
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University HospitalOslo 0424, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of OsloOslo 0424, Norway
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Kondakov A, Lelyuk V. Clinical Molecular Imaging for Atherosclerotic Plaque. J Imaging 2021; 7:jimaging7100211. [PMID: 34677297 PMCID: PMC8538040 DOI: 10.3390/jimaging7100211] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Atherosclerosis is a well-known disease leading to cardiovascular events, including myocardial infarction and ischemic stroke. These conditions lead to a high mortality rate, which explains the interest in their prevention, early detection, and treatment. Molecular imaging is able to shed light on the basic pathophysiological processes, such as inflammation, that cause the progression and instability of plaque. The most common radiotracers used in clinical practice can detect increased energy metabolism (FDG), macrophage number (somatostatin receptor imaging), the intensity of cell proliferation in the area (labeled choline), and microcalcifications (fluoride imaging). These radiopharmaceuticals, especially FDG and labeled sodium fluoride, can predict cardiovascular events. The limitations of molecular imaging in atherosclerosis include low uptake of highly specific tracers, possible overlap with other diseases of the vessel wall, and specific features of certain tracers’ physiological distribution. A common protocol for patient preparation, data acquisition, and quantification is needed in the area of atherosclerosis imaging research.
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14
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Saboury B, Edenbrandt L, Piri R, Gerke O, Werner T, Arbab-Zadeh A, Alavi A, Høilund-Carlsen PF. Alavi-Carlsen Calcification Score (ACCS): A Simple Measure of Global Cardiac Atherosclerosis Burden. Diagnostics (Basel) 2021; 11:1421. [PMID: 34441355 PMCID: PMC8391812 DOI: 10.3390/diagnostics11081421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
Multislice cardiac CT characterizes late stage macrocalcification in epicardial arteries as opposed to PET/CT, which mirrors early phase arterial wall changes in epicardial and transmural coronary arteries. With regard to tracer, there has been a shift from using mainly 18F-fluorodeoxyglucose (FDG), indicating inflammation, to applying predominantly 18F-sodium fluoride (NaF) due to its high affinity for arterial wall microcalcification and more consistent association with cardiovascular risk factors. To make NaF-PET/CT an indispensable adjunct to clinical assessment of cardiac atherosclerosis, the Alavi-Carlsen Calcification Score (ACCS) has been proposed. It constitutes a global assessment of cardiac atherosclerosis burden in the individual patient, supported by an artificial intelligence (AI)-based approach for fast observer-independent segmentation. Common measures for characterizing epicardial coronary atherosclerosis by NaF-PET/CT as the maximum standardized uptake value (SUV) or target-to-background ratio are more versatile, error prone, and less reproducible than the ACCS, which equals the average cardiac SUV. The AI-based approach ensures a quick and easy delineation of the entire heart in 3D to obtain the ACCS expressing ongoing global cardiac atherosclerosis, even before it gives rise to CT-detectable coronary calcification. The quantification of global cardiac atherosclerotic burden by the ACCS is suited for management triage and monitoring of disease progression with and without intervention.
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Affiliation(s)
- Babak Saboury
- Clinical Center, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD 20892, USA;
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250, USA
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Lars Edenbrandt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden;
- Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, 41345 Gothenburg, Sweden
| | - Reza Piri
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense C, Denmark; (R.P.); (O.G.)
- Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense C, Denmark; (R.P.); (O.G.)
- Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
| | - Tom Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Armin Arbab-Zadeh
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense C, Denmark; (R.P.); (O.G.)
- Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
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15
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Piri R, Lici G, Riyahimanesh P, Gerke O, Alavi A, Høilund-Carlsen PF. Two-year change in 18F-sodium fluoride uptake in major arteries of healthy subjects and angina pectoris patients. Int J Cardiovasc Imaging 2021; 37:3115-3126. [PMID: 33950330 DOI: 10.1007/s10554-021-02263-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Abstract
To examine 2-year changes in carotid and aortic 18F-sodium fluoride (NaF) uptake in both healthy controls and angina pectoris patients. Twenty-nine healthy subjects and 20 angina pectoris patients underwent 90-min NaF-PET/CT twice 2 years apart. The carotids and three sections of the aorta (arch, thoracic, abdominal) were manually segmented. NaF uptake was expressed as the mean and total standardized uptake values without and with partial volume correction (SUVmean, SUVtotal and pvcSUVmean, pvcSUVtotal). Insignificant tendencies were higher NaF uptake in angina patients at both time points with less uptake in healthy subjects and higher uptake in angina patients after 2 years. Thus, aortic pvcSUVmean of angina patients was 1.14 ± 0.35 and 1.29 ± 0.71 at baseline and after 2 years vs. 0.99 ± 0.31 and 0.95 ± 0.28 in healthy subjects. A similar pattern was observed for the carotid pvcSUVmean. NaF uptake at baseline could not predict a change in CT-calcification after 2 years. NaF uptake in all parts of the aorta correlated positively with age. There was an insignificant, but consistent, tendency for slightly higher arterial NaF uptake in the angina group indicating more ongoing microcalcification at both time points in patients than healthy subjects. The 2-year changes were in both groups very small suggesting that the atherosclerotic process is slow, albeit with a tendency of slight decreases among healthy controls and slight increases in angina patients despite statin therapy in half of these.
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Affiliation(s)
- Reza Piri
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Gauher Lici
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pooriya Riyahimanesh
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Høilund-Carlsen PF, Piri R, Gerke O, Edenbrandt L, Alavi A. Assessment of Total-Body Atherosclerosis by PET/Computed Tomography. PET Clin 2020; 16:119-128. [PMID: 33160930 DOI: 10.1016/j.cpet.2020.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Atherosclerotic burden has become the focus of cardiovascular risk assessment. PET/computed tomography (CT) imaging with the tracers 18F-fluorodeoxyglucose and 18F-sodium fluoride shows arterial wall inflammation and microcalcification, respectively. Arterial uptake of both tracers is modestly age dependent. 18F-sodium fluoride uptake is consistently associated with risk factors and more easily measured in the heart. Because of extremely high sensitivity, ultrashort acquisition, and minimal radiation to the patient, total-body PET/CT provides unique opportunities for atherosclerosis imaging: disease screening and delayed and repeat imaging with global disease scoring and parametric imaging to better characterize the atherosclerosis of individual patients.
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Affiliation(s)
- Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Kløvervænget 47, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark.
| | - Reza Piri
- Department of Nuclear Medicine, Odense University Hospital, Kløvervænget 47, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Kløvervænget 47, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
| | - Lars Edenbrandt
- Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, SU Sahlgrenska, 41345 Göteborg, Sweden
| | - Abass Alavi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, PA 19104, USA
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