18F-NaF PET-MRI for detection of Carotid Atheroma in acute neurovascular syndrome

Jakub Kaczynski; Stephanie  Sellers; Michael A.  Seidman; Maaz Syed; Martin Dennis; Gillian Macnaught; Maurits Jansen; Scott I  Semple; Carlos  Alcaide-Corral; Adriana A S Tavares; Tom MacGillivray; Samuel Debono; Rachael Forsythe; Andrew Tambyraja; Piotr J Slomka; Jonathon Leipsic; Marc R Dweck; William  Whiteley; Joanna  Wardlaw; Edwin J R  van Beek; David E Newby; Michelle C Williams

doi:10.1148/radiol.212283

18F-NaF PET-MRI for detection of Carotid Atheroma in acute neurovascular syndrome

Jakub Kaczynski^*, Stephanie Sellers , Michael A. Seidman, Maaz Syed, Martin Dennis, Gillian Macnaught, Maurits Jansen, Scott I Semple, Carlos Alcaide-Corral, Adriana A S Tavares, Tom MacGillivray, Samuel Debono, Rachael Forsythe, Andrew Tambyraja, Piotr J Slomka, Jonathon Leipsic, Marc R Dweck, William Whiteley, Joanna Wardlaw, Edwin J R van BeekDavid E Newby, Michelle C Williams

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Fluorine 18–labeled sodium fluoride PET/MRI characteristics were associated with the culprit atherosclerotic plaques in the carotid circulation of study participants with acute neurovascular syndrome; PET/MRI was also usable in the assessment of carotid stenosis, high-risk plaque features, and plaque biologic activity.

Background

MRI and fluorine 18–labeled sodium fluoride (18F-NaF) PET can be used to identify features of plaque instability, rupture, and disease activity, but large studies have not been performed.

Purpose

To evaluate the association between 18F-NaF activity and culprit carotid plaque in acute neurovascular syndrome.

Materials and Methods

In this prospective observational cohort study (October 2017 to January 2020), participants underwent 18F-NaF PET/MRI. An experienced clinician determined the culprit carotid artery based on symptoms and record review. 18F-NaF uptake was quantified using standardized uptake values and tissue-to-background ratios. Statistical significance was assessed with the Welch, χ2, Wilcoxon, or Fisher test. Multivariable models were used to evaluate the relationship between the imaging markers and the culprit versus nonculprit vessel.

Results

A total of 110 participants were evaluated (mean age, 68 years ± 10 [SD]; 70 men and 40 women). Of the 110, 34 (32%) had prior cerebrovascular disease, and 26 (24%) presented with amaurosis fugax, 54 (49%) with transient ischemic attack, and 30 (27%) with stroke. Compared with nonculprit carotids, culprit carotids had greater stenoses (≥50% stenosis: 30% vs 15% [P = .02]; ≥70% stenosis: 25% vs 4.5% [P < .001]) and had increased prevalence of MRI-derived adverse plaque features, including intraplaque hemorrhage (42% vs 23%; P = .004), necrotic core (36% vs 18%; P = .004), thrombus (7.3% vs 0%; P = .01), ulceration (18% vs 3.6%; P = .001), and higher 18F-NaF uptake (maximum tissue-to-background ratio, 1.38 [IQR, 1.12–1.82] vs 1.26 [IQR, 0.99–1.66], respectively; P = .04). Higher 18F-NaF uptake was positively associated with necrosis, intraplaque hemorrhage, ulceration, and calcification and inversely associated with fibrosis (P = .04 to P < .001). In multivariable analysis, carotid stenosis at or over 70% (odds ratio, 5.72 [95% CI: 2.2, 18]) and MRI-derived adverse plaque characteristics (odds ratio, 2.16 [95% CI: 1.2, 3.9]) were both associated with the culprit versus nonculprit carotid vessel.

Conclusion

Fluorine 18–labeled sodium fluoride PET/MRI characteristics were associated with the culprit carotid vessel in study participants with acute neurovascular syndrome.

Clinical trial registration no. NCT03215550 and NCT03215563

Original language	English
Journal	Radiology
Early online date	7 Jun 2022
DOIs	https://doi.org/10.1148/radiol.212283
Publication status	E-pub ahead of print - 7 Jun 2022

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R3_anvs_clean_copyAccepted author manuscript, 296 KBLicence: Creative Commons: Attribution (CC-BY)

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Predicting Endoleaks Following Endovascular Aortic Aneurysm Repair
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Williams, M., Mills, N. & Newby, D.
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Kaczynski, J., Sellers , S., Seidman, M. A., Syed, M., Dennis, M., Macnaught, G., Jansen, M., Semple, S. I., Alcaide-Corral, C., Tavares, A. A. S., MacGillivray, T., Debono, S., Forsythe, R., Tambyraja, A., Slomka, P. J., Leipsic, J., Dweck, M. R., Whiteley, W., Wardlaw, J., ... Williams, M. C. (2022). 18F-NaF PET-MRI for detection of Carotid Atheroma in acute neurovascular syndrome. Radiology. https://doi.org/10.1148/radiol.212283

Kaczynski, Jakub ; Sellers , Stephanie ; Seidman, Michael A. ; Syed, Maaz ; Dennis, Martin ; Macnaught, Gillian ; Jansen, Maurits ; Semple, Scott I ; Alcaide-Corral, Carlos ; Tavares, Adriana A S ; MacGillivray, Tom ; Debono, Samuel ; Forsythe, Rachael ; Tambyraja, Andrew ; Slomka, Piotr J ; Leipsic, Jonathon ; Dweck, Marc R ; Whiteley, William ; Wardlaw, Joanna ; van Beek, Edwin J R ; Newby, David E ; Williams, Michelle C. / 18F-NaF PET-MRI for detection of Carotid Atheroma in acute neurovascular syndrome. In: Radiology. 2022.

@article{367fac63496d492b8839819442e328ee,

title = "18F-NaF PET-MRI for detection of Carotid Atheroma in acute neurovascular syndrome",

abstract = "Fluorine 18–labeled sodium fluoride PET/MRI characteristics were associated with the culprit atherosclerotic plaques in the carotid circulation of study participants with acute neurovascular syndrome; PET/MRI was also usable in the assessment of carotid stenosis, high-risk plaque features, and plaque biologic activity.BackgroundMRI and fluorine 18–labeled sodium fluoride (18F-NaF) PET can be used to identify features of plaque instability, rupture, and disease activity, but large studies have not been performed.PurposeTo evaluate the association between 18F-NaF activity and culprit carotid plaque in acute neurovascular syndrome.Materials and MethodsIn this prospective observational cohort study (October 2017 to January 2020), participants underwent 18F-NaF PET/MRI. An experienced clinician determined the culprit carotid artery based on symptoms and record review. 18F-NaF uptake was quantified using standardized uptake values and tissue-to-background ratios. Statistical significance was assessed with the Welch, χ2, Wilcoxon, or Fisher test. Multivariable models were used to evaluate the relationship between the imaging markers and the culprit versus nonculprit vessel.ResultsA total of 110 participants were evaluated (mean age, 68 years ± 10 [SD]; 70 men and 40 women). Of the 110, 34 (32%) had prior cerebrovascular disease, and 26 (24%) presented with amaurosis fugax, 54 (49%) with transient ischemic attack, and 30 (27%) with stroke. Compared with nonculprit carotids, culprit carotids had greater stenoses (≥50% stenosis: 30% vs 15% [P = .02]; ≥70% stenosis: 25% vs 4.5% [P < .001]) and had increased prevalence of MRI-derived adverse plaque features, including intraplaque hemorrhage (42% vs 23%; P = .004), necrotic core (36% vs 18%; P = .004), thrombus (7.3% vs 0%; P = .01), ulceration (18% vs 3.6%; P = .001), and higher 18F-NaF uptake (maximum tissue-to-background ratio, 1.38 [IQR, 1.12–1.82] vs 1.26 [IQR, 0.99–1.66], respectively; P = .04). Higher 18F-NaF uptake was positively associated with necrosis, intraplaque hemorrhage, ulceration, and calcification and inversely associated with fibrosis (P = .04 to P < .001). In multivariable analysis, carotid stenosis at or over 70% (odds ratio, 5.72 [95% CI: 2.2, 18]) and MRI-derived adverse plaque characteristics (odds ratio, 2.16 [95% CI: 1.2, 3.9]) were both associated with the culprit versus nonculprit carotid vessel.ConclusionFluorine 18–labeled sodium fluoride PET/MRI characteristics were associated with the culprit carotid vessel in study participants with acute neurovascular syndrome.Clinical trial registration no. NCT03215550 and NCT03215563",

author = "Jakub Kaczynski and Stephanie Sellers and Seidman, {Michael A.} and Maaz Syed and Martin Dennis and Gillian Macnaught and Maurits Jansen and Semple, {Scott I} and Carlos Alcaide-Corral and Tavares, {Adriana A S} and Tom MacGillivray and Samuel Debono and Rachael Forsythe and Andrew Tambyraja and Slomka, {Piotr J} and Jonathon Leipsic and Dweck, {Marc R} and William Whiteley and Joanna Wardlaw and {van Beek}, {Edwin J R} and Newby, {David E} and Williams, {Michelle C}",

year = "2022",

month = jun,

day = "7",

doi = "10.1148/radiol.212283",

language = "English",

journal = "Radiology",

issn = "0033-8419",

publisher = "Radiological Society of North America Inc.",

}

Kaczynski, J, Sellers , S, Seidman, MA, Syed, M, Dennis, M, Macnaught, G, Jansen, M , Semple, SI, Alcaide-Corral, C, Tavares, AAS , MacGillivray, T, Debono, S, Forsythe, R, Tambyraja, A, Slomka, PJ, Leipsic, J, Dweck, MR , Whiteley, W , Wardlaw, J , van Beek, EJR , Newby, DE & Williams, MC 2022, '18F-NaF PET-MRI for detection of Carotid Atheroma in acute neurovascular syndrome', Radiology. https://doi.org/10.1148/radiol.212283

18F-NaF PET-MRI for detection of Carotid Atheroma in acute neurovascular syndrome. / Kaczynski, Jakub; Sellers , Stephanie ; Seidman, Michael A. ; Syed, Maaz; Dennis, Martin; Macnaught, Gillian; Jansen, Maurits ; Semple, Scott I ; Alcaide-Corral, Carlos ; Tavares, Adriana A S ; MacGillivray, Tom; Debono, Samuel; Forsythe, Rachael; Tambyraja, Andrew; Slomka, Piotr J; Leipsic, Jonathon; Dweck, Marc R ; Whiteley, William ; Wardlaw, Joanna ; van Beek, Edwin J R ; Newby, David E ; Williams, Michelle C.

In: Radiology, 07.06.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - 18F-NaF PET-MRI for detection of Carotid Atheroma in acute neurovascular syndrome

AU - Kaczynski, Jakub

AU - Sellers , Stephanie

AU - Seidman, Michael A.

AU - Syed, Maaz

AU - Dennis, Martin

AU - Macnaught, Gillian

AU - Jansen, Maurits

AU - Semple, Scott I

AU - Alcaide-Corral, Carlos

AU - Tavares, Adriana A S

AU - MacGillivray, Tom

AU - Debono, Samuel

AU - Forsythe, Rachael

AU - Tambyraja, Andrew

AU - Slomka, Piotr J

AU - Leipsic, Jonathon

AU - Dweck, Marc R

AU - Whiteley, William

AU - Wardlaw, Joanna

AU - van Beek, Edwin J R

AU - Newby, David E

AU - Williams, Michelle C

PY - 2022/6/7

Y1 - 2022/6/7

N2 - Fluorine 18–labeled sodium fluoride PET/MRI characteristics were associated with the culprit atherosclerotic plaques in the carotid circulation of study participants with acute neurovascular syndrome; PET/MRI was also usable in the assessment of carotid stenosis, high-risk plaque features, and plaque biologic activity.BackgroundMRI and fluorine 18–labeled sodium fluoride (18F-NaF) PET can be used to identify features of plaque instability, rupture, and disease activity, but large studies have not been performed.PurposeTo evaluate the association between 18F-NaF activity and culprit carotid plaque in acute neurovascular syndrome.Materials and MethodsIn this prospective observational cohort study (October 2017 to January 2020), participants underwent 18F-NaF PET/MRI. An experienced clinician determined the culprit carotid artery based on symptoms and record review. 18F-NaF uptake was quantified using standardized uptake values and tissue-to-background ratios. Statistical significance was assessed with the Welch, χ2, Wilcoxon, or Fisher test. Multivariable models were used to evaluate the relationship between the imaging markers and the culprit versus nonculprit vessel.ResultsA total of 110 participants were evaluated (mean age, 68 years ± 10 [SD]; 70 men and 40 women). Of the 110, 34 (32%) had prior cerebrovascular disease, and 26 (24%) presented with amaurosis fugax, 54 (49%) with transient ischemic attack, and 30 (27%) with stroke. Compared with nonculprit carotids, culprit carotids had greater stenoses (≥50% stenosis: 30% vs 15% [P = .02]; ≥70% stenosis: 25% vs 4.5% [P < .001]) and had increased prevalence of MRI-derived adverse plaque features, including intraplaque hemorrhage (42% vs 23%; P = .004), necrotic core (36% vs 18%; P = .004), thrombus (7.3% vs 0%; P = .01), ulceration (18% vs 3.6%; P = .001), and higher 18F-NaF uptake (maximum tissue-to-background ratio, 1.38 [IQR, 1.12–1.82] vs 1.26 [IQR, 0.99–1.66], respectively; P = .04). Higher 18F-NaF uptake was positively associated with necrosis, intraplaque hemorrhage, ulceration, and calcification and inversely associated with fibrosis (P = .04 to P < .001). In multivariable analysis, carotid stenosis at or over 70% (odds ratio, 5.72 [95% CI: 2.2, 18]) and MRI-derived adverse plaque characteristics (odds ratio, 2.16 [95% CI: 1.2, 3.9]) were both associated with the culprit versus nonculprit carotid vessel.ConclusionFluorine 18–labeled sodium fluoride PET/MRI characteristics were associated with the culprit carotid vessel in study participants with acute neurovascular syndrome.Clinical trial registration no. NCT03215550 and NCT03215563

AB - Fluorine 18–labeled sodium fluoride PET/MRI characteristics were associated with the culprit atherosclerotic plaques in the carotid circulation of study participants with acute neurovascular syndrome; PET/MRI was also usable in the assessment of carotid stenosis, high-risk plaque features, and plaque biologic activity.BackgroundMRI and fluorine 18–labeled sodium fluoride (18F-NaF) PET can be used to identify features of plaque instability, rupture, and disease activity, but large studies have not been performed.PurposeTo evaluate the association between 18F-NaF activity and culprit carotid plaque in acute neurovascular syndrome.Materials and MethodsIn this prospective observational cohort study (October 2017 to January 2020), participants underwent 18F-NaF PET/MRI. An experienced clinician determined the culprit carotid artery based on symptoms and record review. 18F-NaF uptake was quantified using standardized uptake values and tissue-to-background ratios. Statistical significance was assessed with the Welch, χ2, Wilcoxon, or Fisher test. Multivariable models were used to evaluate the relationship between the imaging markers and the culprit versus nonculprit vessel.ResultsA total of 110 participants were evaluated (mean age, 68 years ± 10 [SD]; 70 men and 40 women). Of the 110, 34 (32%) had prior cerebrovascular disease, and 26 (24%) presented with amaurosis fugax, 54 (49%) with transient ischemic attack, and 30 (27%) with stroke. Compared with nonculprit carotids, culprit carotids had greater stenoses (≥50% stenosis: 30% vs 15% [P = .02]; ≥70% stenosis: 25% vs 4.5% [P < .001]) and had increased prevalence of MRI-derived adverse plaque features, including intraplaque hemorrhage (42% vs 23%; P = .004), necrotic core (36% vs 18%; P = .004), thrombus (7.3% vs 0%; P = .01), ulceration (18% vs 3.6%; P = .001), and higher 18F-NaF uptake (maximum tissue-to-background ratio, 1.38 [IQR, 1.12–1.82] vs 1.26 [IQR, 0.99–1.66], respectively; P = .04). Higher 18F-NaF uptake was positively associated with necrosis, intraplaque hemorrhage, ulceration, and calcification and inversely associated with fibrosis (P = .04 to P < .001). In multivariable analysis, carotid stenosis at or over 70% (odds ratio, 5.72 [95% CI: 2.2, 18]) and MRI-derived adverse plaque characteristics (odds ratio, 2.16 [95% CI: 1.2, 3.9]) were both associated with the culprit versus nonculprit carotid vessel.ConclusionFluorine 18–labeled sodium fluoride PET/MRI characteristics were associated with the culprit carotid vessel in study participants with acute neurovascular syndrome.Clinical trial registration no. NCT03215550 and NCT03215563

U2 - 10.1148/radiol.212283

DO - 10.1148/radiol.212283

M3 - Article

JO - Radiology

JF - Radiology

SN - 0033-8419

ER -

18F-NaF PET-MRI for detection of Carotid Atheroma in acute neurovascular syndrome

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Predicting Endoleaks Following Endovascular Aortic Aneurysm Repair

Incidental coronary calcification on thoracic computed tomography

Myocardial Fibrosis And Left Ventricular Remodelling In Cardiovascular Disease

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