18F–Sodium Fluoride Uptake in Abdominal Aortic Aneurysms: The SoFIA3 Study

Rachael O Forsythe, Marc R Dweck, Olivia M B McBride, Alex T Vesey, Scott I Semple, Anoop S V Shah, Philip D Adamson, William A Wallace, Jakub Kaczynski, Weiyang Ho, Edwin J R van Beek, Calum D Gray, Alison Fletcher, Christophe Lucatelli, Aleksander Marin, Paul Burns, Andrew Tambyraja, Roderick T A Chalmers, Graeme Weir, Neil MitchardAdriana Tavares, Jennifer M J Robson, David E Newby

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Fluorine-18–sodium fluoride (18F-NaF) uptake is a marker of active vascular calcification associated with high-risk atherosclerotic plaque.

Objectives: In patients with abdominal aortic aneurysm (AAA), the authors assessed whether 18F-NaF positron emission tomography (PET) and computed tomography (CT) predicts AAA growth and clinical outcomes.

Methods: In prospective case-control (n = 20 per group) and longitudinal cohort (n = 72) studies, patients with AAA (aortic diameter >40 mm) and control subjects (aortic diameter <30 mm) underwent abdominal ultrasound, 18F-NaF PET-CT, CT angiography, and calcium scoring. Clinical endpoints were aneurysm expansion and the composite of AAA repair or rupture.

Results: Fluorine-18-NaF uptake was increased in AAA compared with nonaneurysmal regions within the same aorta (p = 0.004) and aortas of control subjects (p = 0.023). Histology and micro-PET-CT demonstrated that 18F-NaF uptake localized to areas of aneurysm disease and active calcification. In 72 patients within the longitudinal cohort study (mean age 73 ± 7 years, 85% men, baseline aneurysm diameter 48.8 ± 7.7 mm), there were 19 aneurysm repairs (26.4%) and 3 ruptures (4.2%) after 510 ± 196 days. Aneurysms in the highest tertile of 18F-NaF uptake expanded 2.5× more rapidly than those in the lowest tertile (3.10 [interquartile range (IQR): 2.34 to 5.92 mm/year] vs. 1.24 [IQR: 0.52 to 2.92 mm/year]; p = 0.008) and were nearly 3× as likely to experience AAA repair or rupture (15.3% vs. 5.6%; log-rank p = 0.043).

Conclusions: Fluorine-18-NaF PET-CT is a novel and promising approach to the identification of disease activity in patients with AAA and is an additive predictor of aneurysm growth and future clinical events. (Sodium Fluoride Imaging of Abdominal Aortic Aneurysms [SoFIA3]; NCT02229006; Magnetic Resonance Imaging [MRI] for Abdominal Aortic Aneurysms to Predict Rupture or Surgery: The MA3RS Trial; ISRCTN76413758)
Original languageEnglish
Pages (from-to)513-523
Number of pages11
JournalJournal of the American College of Cardiology
Volume71
Issue number5
Early online date29 Jan 2018
DOIs
Publication statusPublished - 6 Feb 2018

Keywords

  • Journal Article

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