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 journalArticlepeer-review

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

Original languageEnglish
JournalJACC: Cardiovascular Imaging
Early online date16 Mar 2022
DOIs
Publication statusE-pub ahead of print - 16 Mar 2022

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