Predictive Value of 18F-Sodium Fluoride Positron Emission Tomography in Detecting High-Risk Coronary Artery Disease in Combination With Computed Tomography.

Abstract

BackgroundApplication of 18F‐sodium fluoride (18F‐NaF) positron emission tomography (PET) to coronary artery disease has attracted interest. We investigated the utility of 18F‐NaF uptake for predicting coronary events and evaluated the combined use of coronary computed tomography (CT) angiography (CCTA) and 18F‐NaF PET/CT in coronary artery disease risk assessment.Methods and ResultsThis study included patients with ≥1 coronary atherosclerotic lesion detected on CCTA who underwent 18F‐NaF PET/CT. High‐risk plaque on CCTA was defined as plaque with low density (<30 Hounsfield units) and high remodeling index (>1.1). Focal 18F‐NaF uptake in each lesion was quantified using the maximum tissue:background ratio (TBR max), and maximum TBR max per patient (M‐TBR max) was determined. Thirty‐two patients having a total of 112 analyzed lesions were followed for 2 years after 18F‐NaF PET/CT scan, and 11 experienced coronary events (acute coronary syndrome and/or late coronary revascularization [after 3 months]). Patients with coronary events had higher M‐TBR max than those without (1.39±0.18 versus 1.19±0.17, respectively; P=0.0034). The optimal M‐TBR max cutoff to predict coronary events was 1.28 (area under curve: 0.79). Patients with M‐TBR max ≥1.28 had a higher risk of earlier coronary events than those with lower M‐TBR max (P=0.0062 by log‐rank test). In patient‐based (n=41) and lesion‐based (n=143) analyses of CCTA findings that predicted higher coronary 18F‐NaF uptake, the presence of high‐risk plaque was a significant predictor of both M‐TBR max ≥1.28 and TBR max ≥1.28.Conclusions 18F‐NaF PET/CT has the potential to detect high‐risk coronary artery disease and individual coronary lesions and to predict future coronary events when combined with CCTA.Clinical Trial Registration URL: http://www.umin.ac.jp. Unique identifier: UMIN000013735.