18F-Sodium Fluoride Positron Emission Tomography and Computed Tomography in Acute Aortic Syndrome

Maaz B.j. Syed; Alexander J. Fletcher; Samuel Debono; Rachel O. Forsythe; Michelle C. Williams; Marc R. Dweck; Anoop S.v. Shah; Mark G. Macaskill; Adriana Tavares; Martin A. Denvir; Kelvin Lim; William A. Wallace; Jakub Kaczynski; Tim Clark; Stephanie L. Sellers; Neil Masson; Orwa Falah; Roderick T.a. Chalmers; Andrew L. Tambyraja; Edwin J.r. Van Beek; David E. Newby

doi:10.1016/j.jcmg.2022.01.003

18F-Sodium Fluoride Positron Emission Tomography and Computed Tomography in Acute Aortic Syndrome

Maaz B.j. Syed, Alexander J. Fletcher, Samuel Debono, Rachel O. Forsythe, Michelle C. Williams, Marc R. Dweck, Anoop S.v. Shah, Mark G. Macaskill, Adriana Tavares, Martin A. Denvir, Kelvin Lim, William A. Wallace, Jakub Kaczynski, Tim Clark, Stephanie L. Sellers, Neil Masson, Orwa Falah, Roderick T.a. Chalmers, Andrew L. Tambyraja, Edwin J.r. Van BeekDavid E. Newby

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

Abstract / Description of output

Background: Acute aortic syndrome is associated with aortic medial degeneration. 18F-Sodium fluoride (18F-NaF) positron emission tomography (PET) detects microscopic tissue calcification as a marker of disease activity.
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 4513 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 1.360.39 (n=20) versus 2.020.42 (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

Original language	English
Journal	JACC: Cardiovascular Imaging
Early online date	16 Mar 2022
DOIs	https://doi.org/10.1016/j.jcmg.2022.01.003
Publication status	E-pub ahead of print - 16 Mar 2022

Access to Document

10.1016/j.jcmg.2022.01.003

Syed-JIMG082421-1322R1Accepted author manuscript, 98.5 KBLicence: Creative Commons: Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND)

https://linkinghub.elsevier.com/retrieve/pii/S1936878X22000468

Research Excellence Award Number 3
Baker, A.
UK-based charities
1/04/19 → 31/03/24
Project: Research
Non-invasive detection of bicuspid aortic valve¿related thoracic aortopathy
Newby, D. & Walker, N.
UK-based charities
1/04/19 → 31/07/21
Project: Research
18F-Sodium Fluoride Positron Emission Tomography in Patients with Acute Aortic Syndrome
Newby, D.
UK-based charities
1/10/18 → 30/09/20
Project: Research

Edinburgh Imaging Facility
Anne Grant (Manager), Edwin van Beek (Manager) & Scott Semple (Manager)
Deanery of Clinical Sciences
Facility/equipment: Facility
Edinburgh Preclinical Imaging
Carmel Moran (Manager), Adrian Thomson (Manager), Ross J Lennen (Manager), Adriana Tavares (Manager), Carlos J. Alcaide-Corral (Manager), Tim Morgan (Other), Islay Cranston (Other) & Kerry O'Rourke (Other)
Deanery of Clinical Sciences
Facility/equipment: Facility

Cite this

Syed, M. B. J., Fletcher, A. J., Debono, S., Forsythe, R. O., Williams, M. C., Dweck, M. R., Shah, A. S. V., Macaskill, M. G., Tavares, A., Denvir, M. A., Lim, K., Wallace, W. A., Kaczynski, J., Clark, T., Sellers, S. L., Masson, N., Falah, O., Chalmers, R. T. A., Tambyraja, A. L., ... Newby, D. E. (2022). 18F-Sodium Fluoride Positron Emission Tomography and Computed Tomography in Acute Aortic Syndrome. JACC: Cardiovascular Imaging. Advance online publication. https://doi.org/10.1016/j.jcmg.2022.01.003

@article{c7db408f3feb4402a1a12daa4cfd506c,

title = "18F-Sodium Fluoride Positron Emission Tomography and Computed Tomography in Acute Aortic Syndrome",

abstract = "Background: Acute aortic syndrome is associated with aortic medial degeneration. 18F-Sodium fluoride (18F-NaF) positron emission tomography (PET) detects microscopic tissue calcification as a marker of disease activity.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 4513 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 1.360.39 (n=20) versus 2.020.42 (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 ",

author = "Syed, {Maaz B.j.} and Fletcher, {Alexander J.} and Samuel Debono and Forsythe, {Rachel O.} and Williams, {Michelle C.} and Dweck, {Marc R.} and Shah, {Anoop S.v.} and Macaskill, {Mark G.} and Adriana Tavares and Denvir, {Martin A.} and Kelvin Lim and Wallace, {William A.} and Jakub Kaczynski and Tim Clark and Sellers, {Stephanie L.} and Neil Masson and Orwa Falah and Chalmers, {Roderick T.a.} and Tambyraja, {Andrew L.} and {Van Beek}, {Edwin J.r.} and Newby, {David E.}",

note = "Funding Information: All funding support is from the United Kingdom. Mr Syed and Drs Fletcher, Dweck, Shah, and Tavares, Mr Kaczynki, and Dr Newby were supported by the British Heart Foundation (FS/18/31/33676, FS/19/15/34155, FS/11/014, FS/14/78/31020, CH/09/002, RG/16/10/32375, RE/18/5/34216). Dr Dweck has received the Sir Jules Thorn Award for Biomedical Research 2015 (15/JTA). Dr Newby has received a Wellcome Trust Senior Investigator Award (WT103782AIA). Dr van Beek has been supported by the Scottish Imaging Network—a Platform of Scientific Excellence (SINAPSE). Edinburgh Clinical Research Facility and Edinburgh Imaging Facility are supported by NHS Research Scotland. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2022",

year = "2022",

month = mar,

day = "16",

doi = "10.1016/j.jcmg.2022.01.003",

language = "English",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier",

}

Syed, MBJ, Fletcher, AJ, Debono, S, Forsythe, RO, Williams, MC , Dweck, MR, Shah, ASV, Macaskill, MG , Tavares, A , Denvir, MA, Lim, K, Wallace, WA, Kaczynski, J, Clark, T, Sellers, SL, Masson, N, Falah, O, Chalmers, RTA, Tambyraja, AL, Van Beek, EJR & Newby, DE 2022, '18F-Sodium Fluoride Positron Emission Tomography and Computed Tomography in Acute Aortic Syndrome', JACC: Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2022.01.003

TY - JOUR

T1 - 18F-Sodium Fluoride Positron Emission Tomography and Computed Tomography in Acute Aortic Syndrome

AU - Syed, Maaz B.j.

AU - Fletcher, Alexander J.

AU - Debono, Samuel

AU - Forsythe, Rachel O.

AU - Williams, Michelle C.

AU - Dweck, Marc R.

AU - Shah, Anoop S.v.

AU - Macaskill, Mark G.

AU - Tavares, Adriana

AU - Denvir, Martin A.

AU - Lim, Kelvin

AU - Wallace, William A.

AU - Kaczynski, Jakub

AU - Clark, Tim

AU - Sellers, Stephanie L.

AU - Masson, Neil

AU - Falah, Orwa

AU - Chalmers, Roderick T.a.

AU - Tambyraja, Andrew L.

AU - Van Beek, Edwin J.r.

AU - Newby, David E.

N1 - Funding Information: All funding support is from the United Kingdom. Mr Syed and Drs Fletcher, Dweck, Shah, and Tavares, Mr Kaczynki, and Dr Newby were supported by the British Heart Foundation (FS/18/31/33676, FS/19/15/34155, FS/11/014, FS/14/78/31020, CH/09/002, RG/16/10/32375, RE/18/5/34216). Dr Dweck has received the Sir Jules Thorn Award for Biomedical Research 2015 (15/JTA). Dr Newby has received a Wellcome Trust Senior Investigator Award (WT103782AIA). Dr van Beek has been supported by the Scottish Imaging Network—a Platform of Scientific Excellence (SINAPSE). Edinburgh Clinical Research Facility and Edinburgh Imaging Facility are supported by NHS Research Scotland. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2022

PY - 2022/3/16

Y1 - 2022/3/16

N2 - Background: Acute aortic syndrome is associated with aortic medial degeneration. 18F-Sodium fluoride (18F-NaF) positron emission tomography (PET) detects microscopic tissue calcification as a marker of disease activity.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 4513 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 1.360.39 (n=20) versus 2.020.42 (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

AB - Background: Acute aortic syndrome is associated with aortic medial degeneration. 18F-Sodium fluoride (18F-NaF) positron emission tomography (PET) detects microscopic tissue calcification as a marker of disease activity.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 4513 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 1.360.39 (n=20) versus 2.020.42 (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

U2 - 10.1016/j.jcmg.2022.01.003

DO - 10.1016/j.jcmg.2022.01.003

M3 - Article

SN - 1936-878X

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

ER -

18F-Sodium Fluoride Positron Emission Tomography and Computed Tomography in Acute Aortic Syndrome

Abstract / Description of output

Access to Document

Fingerprint

Projects

Research Excellence Award Number 3

Non-invasive detection of bicuspid aortic valve¿related thoracic aortopathy

18F-Sodium Fluoride Positron Emission Tomography in Patients with Acute Aortic Syndrome

Equipment

Edinburgh Imaging Facility

Edinburgh Preclinical Imaging

Cite this