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Objective: In a proof-of-concept study, we aimed to establish whether 18F-NaF PET combined with CT angiography could identify aortic medial disease activity in patients with acute aortic syndrome.
Methods: Patients with aortic dissection or intramural haematomas and control subjects underwent 18F-NaF PET and CT angiography of the aorta. Aortic 18F-NaF uptake was measured at the most diseased segment and the maximum value corrected for background blood pool activity (maximum tissue-to-background ratio, TBRmax). Radiotracer uptake was compared with change in aortic size and major adverse aortic events (aortic rupture, aorta-related death or aortic repair) over 4513 months.
Results: Aortic 18F-NaF uptake co-localized with histologically defined regions of microcalcification and elastin disruption. Compared to control subjects, patients with acute aortic syndrome had increased 18F-NaF uptake (TBRmax 1.360.39 (n=20) versus 2.020.42 (n=47) respectively; p<0.001) with enhanced uptake at the site of intimal disruption (+27.5%, p<0.001). 18F-NaF uptake in the false lumen was associated with aortic growth (+7.1 mm/year, p=0.011) and uptake in the outer aortic wall was associated with major adverse aortic events (hazard ratio 8.5 [95% CI, 1.4-50.4], p=0.019).
Conclusion: In patients with acute aortic syndrome, 18F-NaF uptake is enhanced at sites of disease activity and associated with aortic growth and clinical events. 18F-NaF PET-CT holds promise as a non-invasive marker of disease severity and future risk in patients with acute aortic syndrome.
Clinical trial registration: ClinicalTrials.gov (NCT03647566)
Key Words: aortic dissection, intramural hematoma, microcalcification, vascular injury, aortic growth, major adverse aortic events
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1/04/19 → 31/07/21
1/10/18 → 30/09/20