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18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial

The use of non-invasive imaging to identify ruptured or high-risk coronary atherosclerotic plaques would represent a major clinical advance for prevention and treatment of coronary artery disease. We used combined PET and CT to identify ruptured and high-risk atherosclerotic plaques using the radioa... Full description

Journal Title: The Lancet 2014, Vol.383 (9918), p.705-713
Main Author: Joshi, Nikhil V
Other Authors: Vesey, Alex T , Williams, Michelle C , Shah, Anoop S V , Calvert, Patrick A , Craighead, Felicity H M , Yeoh, Su Ern , Wallace, William , Salter, Donald , Fletcher, Alison M , van Beek, Edwin J R , Flapan, Andrew D , Uren, Neal G , Behan, Miles W H , Cruden, Nicholas L M , Mills, Nicholas L , Fox, Keith A A , Rudd, James H F , Dweck, Marc R , Newby, David E
Format: Electronic Article Electronic Article
Language: English
Subjects:
Aged
Angina pectoris
Angina Pectoris - metabolism
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Blood and lymphatic vessels
Cardiology
Cardiology. Vascular system
Carotid Stenosis - diagnosis
Carotid Stenosis - metabolism
computed tomography
Confounding Factors, Epidemiologic
Coronary Angiography
coronary artery disease
Coronary Artery Disease - diagnosis
Coronary Artery Disease - metabolism
Coronary vessels
Female
Fluorodeoxyglucose F18 - metabolism
General aspects
Heart attacks
Humans
Male
Medical imaging
Medical sciences
Medicine(all)
Middle Aged
Myocardial Infarction - metabolism
myocardial perfusion
Plaque, Atherosclerotic - diagnosis
Plaque, Atherosclerotic - metabolism
positron emission tomography
Positron-Emission Tomography - methods
Prospective Studies
radiation dose
Radiopharmaceuticals - metabolism
Risk Factors
Rupture, Spontaneous
Scotland
Sodium Fluoride - metabolism
Tomography, X-Ray Computed
Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: 18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial
format: Article
creator:
  • Joshi, Nikhil V
  • Vesey, Alex T
  • Williams, Michelle C
  • Shah, Anoop S V
  • Calvert, Patrick A
  • Craighead, Felicity H M
  • Yeoh, Su Ern
  • Wallace, William
  • Salter, Donald
  • Fletcher, Alison M
  • van Beek, Edwin J R
  • Flapan, Andrew D
  • Uren, Neal G
  • Behan, Miles W H
  • Cruden, Nicholas L M
  • Mills, Nicholas L
  • Fox, Keith A A
  • Rudd, James H F
  • Dweck, Marc R
  • Newby, David E
subjects:
  • Aged
  • Angina pectoris
  • Angina Pectoris - metabolism
  • Atherosclerosis (general aspects, experimental research)
  • Biological and medical sciences
  • Blood and lymphatic vessels
  • Cardiology
  • Cardiology. Vascular system
  • Carotid Stenosis - diagnosis
  • Carotid Stenosis - metabolism
  • computed tomography
  • Confounding Factors, Epidemiologic
  • Coronary Angiography
  • coronary artery disease
  • Coronary Artery Disease - diagnosis
  • Coronary Artery Disease - metabolism
  • Coronary vessels
  • Female
  • Fluorodeoxyglucose F18 - metabolism
  • General aspects
  • Heart attacks
  • Humans
  • Male
  • Medical imaging
  • Medical sciences
  • Medicine(all)
  • Middle Aged
  • Myocardial Infarction - metabolism
  • myocardial perfusion
  • Plaque, Atherosclerotic - diagnosis
  • Plaque, Atherosclerotic - metabolism
  • positron emission tomography
  • Positron-Emission Tomography - methods
  • Prospective Studies
  • radiation dose
  • Radiopharmaceuticals - metabolism
  • Risk Factors
  • Rupture, Spontaneous
  • Scotland
  • Sodium Fluoride - metabolism
  • Tomography, X-Ray Computed
ispartof: The Lancet, 2014, Vol.383 (9918), p.705-713
description: The use of non-invasive imaging to identify ruptured or high-risk coronary atherosclerotic plaques would represent a major clinical advance for prevention and treatment of coronary artery disease. We used combined PET and CT to identify ruptured and high-risk atherosclerotic plaques using the radioactive tracers 18F-sodium fluoride (18F-NaF) and 18F-fluorodeoxyglucose (18F-FDG). In this prospective clinical trial, patients with myocardial infarction (n=40) and stable angina (n=40) underwent 18F-NaF and 18F-FDG PET-CT, and invasive coronary angiography. 18F-NaF uptake was compared with histology in carotid endarterectomy specimens from patients with symptomatic carotid disease, and with intravascular ultrasound in patients with stable angina. The primary endpoint was the comparison of 18F-fluoride tissue-to-background ratios of culprit and non-culprit coronary plaques of patients with acute myocardial infarction. In 37 (93%) patients with myocardial infarction, the highest coronary 18F-NaF uptake was seen in the culprit plaque (median maximum tissue-to-background ratio: culprit 1·66 [IQR 1·40–2·25] vs highest non-culprit 1·24 [1·06–1·38], p
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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title18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial
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creatorJoshi, Nikhil V ; Vesey, Alex T ; Williams, Michelle C ; Shah, Anoop S V ; Calvert, Patrick A ; Craighead, Felicity H M ; Yeoh, Su Ern ; Wallace, William ; Salter, Donald ; Fletcher, Alison M ; van Beek, Edwin J R ; Flapan, Andrew D ; Uren, Neal G ; Behan, Miles W H ; Cruden, Nicholas L M ; Mills, Nicholas L ; Fox, Keith A A ; Rudd, James H F ; Dweck, Marc R ; Newby, David E
creatorcontribJoshi, Nikhil V ; Vesey, Alex T ; Williams, Michelle C ; Shah, Anoop S V ; Calvert, Patrick A ; Craighead, Felicity H M ; Yeoh, Su Ern ; Wallace, William ; Salter, Donald ; Fletcher, Alison M ; van Beek, Edwin J R ; Flapan, Andrew D ; Uren, Neal G ; Behan, Miles W H ; Cruden, Nicholas L M ; Mills, Nicholas L ; Fox, Keith A A ; Rudd, James H F ; Dweck, Marc R ; Newby, David E
descriptionThe use of non-invasive imaging to identify ruptured or high-risk coronary atherosclerotic plaques would represent a major clinical advance for prevention and treatment of coronary artery disease. We used combined PET and CT to identify ruptured and high-risk atherosclerotic plaques using the radioactive tracers 18F-sodium fluoride (18F-NaF) and 18F-fluorodeoxyglucose (18F-FDG). In this prospective clinical trial, patients with myocardial infarction (n=40) and stable angina (n=40) underwent 18F-NaF and 18F-FDG PET-CT, and invasive coronary angiography. 18F-NaF uptake was compared with histology in carotid endarterectomy specimens from patients with symptomatic carotid disease, and with intravascular ultrasound in patients with stable angina. The primary endpoint was the comparison of 18F-fluoride tissue-to-background ratios of culprit and non-culprit coronary plaques of patients with acute myocardial infarction. In 37 (93%) patients with myocardial infarction, the highest coronary 18F-NaF uptake was seen in the culprit plaque (median maximum tissue-to-background ratio: culprit 1·66 [IQR 1·40–2·25] vs highest non-culprit 1·24 [1·06–1·38], p<0·0001). By contrast, coronary 18F-FDG uptake was commonly obscured by myocardial uptake and where discernible, there were no differences between culprit and non-culprit plaques (1·71 [1·40–2·13] vs 1·58 [1·28–2·01], p=0·34). Marked 18F-NaF uptake occurred at the site of all carotid plaque ruptures and was associated with histological evidence of active calcification, macrophage infiltration, apoptosis, and necrosis. 18 (45%) patients with stable angina had plaques with focal 18F-NaF uptake (maximum tissue-to-background ratio 1·90 [IQR 1·61–2·17]) that were associated with more high-risk features on intravascular ultrasound than those without uptake: positive remodelling (remodelling index 1·12 [1·09–1·19] vs 1·01 [0·94–1·06]; p=0·0004), microcalcification (73% vs 21%, p=0·002), and necrotic core (25% [21–29] vs 18% [14–22], p=0·001). 18F-NaF PET-CT is the first non-invasive imaging method to identify and localise ruptured and high-risk coronary plaque. Future studies are needed to establish whether this method can improve the management and treatment of patients with coronary artery disease. Chief Scientist Office Scotland and British Heart Foundation.
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0ISSN: 0140-6736
1EISSN: 1474-547X
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3PMID: 24224999
4CODEN: LANCAO
languageeng
publisherKidlington: Elsevier Ltd
subjectAged ; Angina pectoris ; Angina Pectoris - metabolism ; Atherosclerosis (general aspects, experimental research) ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology ; Cardiology. Vascular system ; Carotid Stenosis - diagnosis ; Carotid Stenosis - metabolism ; computed tomography ; Confounding Factors, Epidemiologic ; Coronary Angiography ; coronary artery disease ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - metabolism ; Coronary vessels ; Female ; Fluorodeoxyglucose F18 - metabolism ; General aspects ; Heart attacks ; Humans ; Male ; Medical imaging ; Medical sciences ; Medicine(all) ; Middle Aged ; Myocardial Infarction - metabolism ; myocardial perfusion ; Plaque, Atherosclerotic - diagnosis ; Plaque, Atherosclerotic - metabolism ; positron emission tomography ; Positron-Emission Tomography - methods ; Prospective Studies ; radiation dose ; Radiopharmaceuticals - metabolism ; Risk Factors ; Rupture, Spontaneous ; Scotland ; Sodium Fluoride - metabolism ; Tomography, X-Ray Computed
ispartofThe Lancet, 2014, Vol.383 (9918), p.705-713
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0Joshi, Nikhil V
1Vesey, Alex T
2Williams, Michelle C
3Shah, Anoop S V
4Calvert, Patrick A
5Craighead, Felicity H M
6Yeoh, Su Ern
7Wallace, William
8Salter, Donald
9Fletcher, Alison M
10van Beek, Edwin J R
11Flapan, Andrew D
12Uren, Neal G
13Behan, Miles W H
14Cruden, Nicholas L M
15Mills, Nicholas L
16Fox, Keith A A
17Rudd, James H F
18Dweck, Marc R
19Newby, David E
title
018F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial
1The Lancet
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descriptionThe use of non-invasive imaging to identify ruptured or high-risk coronary atherosclerotic plaques would represent a major clinical advance for prevention and treatment of coronary artery disease. We used combined PET and CT to identify ruptured and high-risk atherosclerotic plaques using the radioactive tracers 18F-sodium fluoride (18F-NaF) and 18F-fluorodeoxyglucose (18F-FDG). In this prospective clinical trial, patients with myocardial infarction (n=40) and stable angina (n=40) underwent 18F-NaF and 18F-FDG PET-CT, and invasive coronary angiography. 18F-NaF uptake was compared with histology in carotid endarterectomy specimens from patients with symptomatic carotid disease, and with intravascular ultrasound in patients with stable angina. The primary endpoint was the comparison of 18F-fluoride tissue-to-background ratios of culprit and non-culprit coronary plaques of patients with acute myocardial infarction. In 37 (93%) patients with myocardial infarction, the highest coronary 18F-NaF uptake was seen in the culprit plaque (median maximum tissue-to-background ratio: culprit 1·66 [IQR 1·40–2·25] vs highest non-culprit 1·24 [1·06–1·38], p<0·0001). By contrast, coronary 18F-FDG uptake was commonly obscured by myocardial uptake and where discernible, there were no differences between culprit and non-culprit plaques (1·71 [1·40–2·13] vs 1·58 [1·28–2·01], p=0·34). Marked 18F-NaF uptake occurred at the site of all carotid plaque ruptures and was associated with histological evidence of active calcification, macrophage infiltration, apoptosis, and necrosis. 18 (45%) patients with stable angina had plaques with focal 18F-NaF uptake (maximum tissue-to-background ratio 1·90 [IQR 1·61–2·17]) that were associated with more high-risk features on intravascular ultrasound than those without uptake: positive remodelling (remodelling index 1·12 [1·09–1·19] vs 1·01 [0·94–1·06]; p=0·0004), microcalcification (73% vs 21%, p=0·002), and necrotic core (25% [21–29] vs 18% [14–22], p=0·001). 18F-NaF PET-CT is the first non-invasive imaging method to identify and localise ruptured and high-risk coronary plaque. Future studies are needed to establish whether this method can improve the management and treatment of patients with coronary artery disease. Chief Scientist Office Scotland and British Heart Foundation.
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1Angina pectoris
2Angina Pectoris - metabolism
3Atherosclerosis (general aspects, experimental research)
4Biological and medical sciences
5Blood and lymphatic vessels
6Cardiology
7Cardiology. Vascular system
8Carotid Stenosis - diagnosis
9Carotid Stenosis - metabolism
10computed tomography
11Confounding Factors, Epidemiologic
12Coronary Angiography
13coronary artery disease
14Coronary Artery Disease - diagnosis
15Coronary Artery Disease - metabolism
16Coronary vessels
17Female
18Fluorodeoxyglucose F18 - metabolism
19General aspects
20Heart attacks
21Humans
22Male
23Medical imaging
24Medical sciences
25Medicine(all)
26Middle Aged
27Myocardial Infarction - metabolism
28myocardial perfusion
29Plaque, Atherosclerotic - diagnosis
30Plaque, Atherosclerotic - metabolism
31positron emission tomography
32Positron-Emission Tomography - methods
33Prospective Studies
34radiation dose
35Radiopharmaceuticals - metabolism
36Risk Factors
37Rupture, Spontaneous
38Scotland
39Sodium Fluoride - metabolism
40Tomography, X-Ray Computed
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3Shah, Anoop S V
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6Yeoh, Su Ern
7Wallace, William
8Salter, Donald
9Fletcher, Alison M
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11Flapan, Andrew D
12Uren, Neal G
13Behan, Miles W H
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title18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial
authorJoshi, Nikhil V ; Vesey, Alex T ; Williams, Michelle C ; Shah, Anoop S V ; Calvert, Patrick A ; Craighead, Felicity H M ; Yeoh, Su Ern ; Wallace, William ; Salter, Donald ; Fletcher, Alison M ; van Beek, Edwin J R ; Flapan, Andrew D ; Uren, Neal G ; Behan, Miles W H ; Cruden, Nicholas L M ; Mills, Nicholas L ; Fox, Keith A A ; Rudd, James H F ; Dweck, Marc R ; Newby, David E
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1Angina pectoris
2Angina Pectoris - metabolism
3Atherosclerosis (general aspects, experimental research)
4Biological and medical sciences
5Blood and lymphatic vessels
6Cardiology
7Cardiology. Vascular system
8Carotid Stenosis - diagnosis
9Carotid Stenosis - metabolism
10computed tomography
11Confounding Factors, Epidemiologic
12Coronary Angiography
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18Fluorodeoxyglucose F18 - metabolism
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27Myocardial Infarction - metabolism
28myocardial perfusion
29Plaque, Atherosclerotic - diagnosis
30Plaque, Atherosclerotic - metabolism
31positron emission tomography
32Positron-Emission Tomography - methods
33Prospective Studies
34radiation dose
35Radiopharmaceuticals - metabolism
36Risk Factors
37Rupture, Spontaneous
38Scotland
39Sodium Fluoride - metabolism
40Tomography, X-Ray Computed
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7Wallace, William
8Salter, Donald
9Fletcher, Alison M
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eissn1474-547X
codenLANCAO
abstractThe use of non-invasive imaging to identify ruptured or high-risk coronary atherosclerotic plaques would represent a major clinical advance for prevention and treatment of coronary artery disease. We used combined PET and CT to identify ruptured and high-risk atherosclerotic plaques using the radioactive tracers 18F-sodium fluoride (18F-NaF) and 18F-fluorodeoxyglucose (18F-FDG). In this prospective clinical trial, patients with myocardial infarction (n=40) and stable angina (n=40) underwent 18F-NaF and 18F-FDG PET-CT, and invasive coronary angiography. 18F-NaF uptake was compared with histology in carotid endarterectomy specimens from patients with symptomatic carotid disease, and with intravascular ultrasound in patients with stable angina. The primary endpoint was the comparison of 18F-fluoride tissue-to-background ratios of culprit and non-culprit coronary plaques of patients with acute myocardial infarction. In 37 (93%) patients with myocardial infarction, the highest coronary 18F-NaF uptake was seen in the culprit plaque (median maximum tissue-to-background ratio: culprit 1·66 [IQR 1·40–2·25] vs highest non-culprit 1·24 [1·06–1·38], p<0·0001). By contrast, coronary 18F-FDG uptake was commonly obscured by myocardial uptake and where discernible, there were no differences between culprit and non-culprit plaques (1·71 [1·40–2·13] vs 1·58 [1·28–2·01], p=0·34). Marked 18F-NaF uptake occurred at the site of all carotid plaque ruptures and was associated with histological evidence of active calcification, macrophage infiltration, apoptosis, and necrosis. 18 (45%) patients with stable angina had plaques with focal 18F-NaF uptake (maximum tissue-to-background ratio 1·90 [IQR 1·61–2·17]) that were associated with more high-risk features on intravascular ultrasound than those without uptake: positive remodelling (remodelling index 1·12 [1·09–1·19] vs 1·01 [0·94–1·06]; p=0·0004), microcalcification (73% vs 21%, p=0·002), and necrotic core (25% [21–29] vs 18% [14–22], p=0·001). 18F-NaF PET-CT is the first non-invasive imaging method to identify and localise ruptured and high-risk coronary plaque. Future studies are needed to establish whether this method can improve the management and treatment of patients with coronary artery disease. Chief Scientist Office Scotland and British Heart Foundation.
copKidlington
pubElsevier Ltd
pmid24224999
doi10.1016/S0140-6736(13)61754-7
oafree_for_read