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Feasibility of Coronary 18F-Sodium Fluoride Positron-Emission Tomography Assessment With the Utilization of Previously Acquired Computed Tomography Angiography

 Jacek Kwiecinski  ;  Philip D Adamson  ;  Martin L Lassen  ;  Mhairi K Doris  ;  Alastair J Moss  ;  Sebastian Cadet  ;  Maurits A Jansen  ;  Damini Dey  ;  Sang-Eun Lee  ;  Mijin Yun  ;  Hyuk-Jae Chang  ;  Marc R Dweck  ;  David E Newby  ;  Daniel S Berman  ;  Piotr J Slomka 
 Circulation. Cardiovascular Imaging, Vol.11(12) : e008325, 2018 
Journal Title
 Circulation. Cardiovascular Imaging 
Issue Date
Aged ; Biological Transport ; Computed Tomography Angiography/methods* ; Coronary Artery Disease/diagnosis* ; Coronary Artery Disease/metabolism ; Coronary Vessels/diagnostic imaging* ; Coronary Vessels/metabolism ; Feasibility Studies ; Female ; Fluorine Radioisotopes/pharmacokinetics* ; Follow-Up Studies ; Humans ; Male ; Plaque, Atherosclerotic/diagnosis* ; Plaque, Atherosclerotic/metabolism ; Positron-Emission Tomography/methods* ; Sodium Fluoride/pharmacokinetics*
computed tomography angiography ; coronary artery disease ; fluoride ; patients ; positron-emission tomography
BACKGROUND: We assessed the feasibility of utilizing previously acquired computed tomography angiography (CTA) with subsequent positron-emission tomography (PET)-only scan for the quantitative evaluation of 18F-NaF PET coronary uptake. METHODS AND RESULTS: Forty-five patients (age 67.1±6.9 years; 76% males) underwent CTA (CTA1) and combined 18F-NaF PET/CTA (CTA2) imaging within 14 [10, 21] days. We fused CTA1 from visit 1 with 18F-NaF PET (PET) from visit 2 and compared visual pattern of activity, maximal standard uptake (SUVmax) values, and target to background ratio (TBR) measurements on (PET/CTA1) fused versus hybrid (PET/CTA2). On PET/CTA2, 226 coronary plaques were identified. Fifty-eight coronary segments from 28 (62%) patients had high 18F-NaF uptake (TBR >1.25), whereas 168 segments had lesions with 18F-NaF TBR ≤1.25. Uptake in all lesions was categorized identically on coregistered PET/CTA1. There was no significant difference in 18F-NaF uptake values between PET/CTA1 and PET/CTA2 (SUVmax, 1.16±0.40 versus 1.15±0.39; P=0.53; TBR, 1.10±0.45 versus 1.09±0.46; P=0.55). The intraclass correlation coefficient for SUVmax and TBR was 0.987 (95% CI, 0.983-0.991) and 0.986 (95% CI, 0.981-0.992). There was no fixed or proportional bias between PET/CTA1 and PET/CTA2 for SUVmax and TBR. Cardiac motion correction of PET scans improved reproducibility with tighter 95% limits of agreement (±0.14 for SUVmax and ±0.15 for TBR versus ±0.20 and ±0.20 on diastolic imaging; P<0.001). CONCLUSIONS: Coronary CTA/PET protocol with CTA first followed by PET-only allows for reliable and reproducible quantification of 18F-NaF coronary uptake. This approach may facilitate selection of high-risk patients for PET-only imaging based on results from prior CTA, providing a practical workflow for clinical application.
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1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Yun, Mi Jin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
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