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 Mitchard; Adriana Tavares; Jennifer M J Robson; David E Newby

doi:10.1016/j.jacc.2017.11.053

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 journal › Article › peer-review

Abstract / Description of output

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 language	English
Pages (from-to)	513-523
Number of pages	11
Journal	Journal of the American College of Cardiology
Volume	71
Issue number	5
Early online date	29 Jan 2018
DOIs	https://doi.org/10.1016/j.jacc.2017.11.053
Publication status	Published - 6 Feb 2018

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Journal Article

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10.1016/j.jacc.2017.11.053

Newby D 18F Sodium Fluoride uptake...
Open Access funded by Chief Scientist Office Under a Creative Commons license
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Philip Adamson
- Centre for Cardiovascular Science
- Edinburgh Imaging
Person: Academic: Research Active
Marc Dweck
- mdweckstaffmail.ed.acuk
- Deanery of Clinical Sciences - Personal Chair of Clinical Cardiology
- Centre for Cardiovascular Science
- Edinburgh Imaging
Person: Academic: Research Active (Research Assistant)
Adriana Tavares
- adriana.tavaresed.acuk
- Deanery of Clinical Sciences - Personal Chair of Translational Molecular Imaging
- Centre for Cardiovascular Science
- Edinburgh Imaging
Person: Academic: Research Active

Cite this

Forsythe, R. O., Dweck, M. R., McBride, O. M. B., Vesey, A. T., Semple, S. I., Shah, A. S. V., Adamson, P. D., Wallace, W. A., Kaczynski, J., Ho, W., van Beek, E. J. R., Gray, C. D., Fletcher, A., Lucatelli, C., Marin, A., Burns, P., Tambyraja, A., Chalmers, R. T. A., Weir, G., ... Newby, D. E. (2018). ¹⁸F–Sodium Fluoride Uptake in Abdominal Aortic Aneurysms: The SoFIA3 Study. Journal of the American College of Cardiology, 71(5), 513-523. https://doi.org/10.1016/j.jacc.2017.11.053

@article{e60c8a782e1f4067ba3479d5f6029400,

title = "18F–Sodium Fluoride Uptake in Abdominal Aortic Aneurysms: The SoFIA3 Study",

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)",

keywords = "Journal Article",

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

year = "2018",

month = feb,

day = "6",

doi = "10.1016/j.jacc.2017.11.053",

language = "English",

volume = "71",

pages = "513--523",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Science",

number = "5",

}

Forsythe, RO, Dweck, MR, McBride, OMB, Vesey, AT, Semple, SI, Shah, ASV, Adamson, PD, Wallace, WA, Kaczynski, J, Ho, W, van Beek, EJR , Gray, CD, Fletcher, A, Lucatelli, C, Marin, A, Burns, P, Tambyraja, A, Chalmers, RTA, Weir, G, Mitchard, N, Tavares, A, Robson, JMJ & Newby, DE 2018, '¹⁸F–Sodium Fluoride Uptake in Abdominal Aortic Aneurysms: The SoFIA3 Study', Journal of the American College of Cardiology, vol. 71, no. 5, pp. 513-523. https://doi.org/10.1016/j.jacc.2017.11.053

TY - JOUR

T1 - 18F–Sodium Fluoride Uptake in Abdominal Aortic Aneurysms: The SoFIA3 Study

AU - Forsythe, Rachael O

AU - Dweck, Marc R

AU - McBride, Olivia M B

AU - Vesey, Alex T

AU - Semple, Scott I

AU - Shah, Anoop S V

AU - Adamson, Philip D

AU - Wallace, William A

AU - Kaczynski, Jakub

AU - Ho, Weiyang

AU - van Beek, Edwin J R

AU - Gray, Calum D

AU - Fletcher, Alison

AU - Lucatelli, Christophe

AU - Marin, Aleksander

AU - Burns, Paul

AU - Tambyraja, Andrew

AU - Chalmers, Roderick T A

AU - Weir, Graeme

AU - Mitchard, Neil

AU - Tavares, Adriana

AU - Robson, Jennifer M J

AU - Newby, David E

PY - 2018/2/6

Y1 - 2018/2/6

N2 - 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)

AB - 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)

KW - Journal Article

U2 - 10.1016/j.jacc.2017.11.053

DO - 10.1016/j.jacc.2017.11.053

M3 - Article

C2 - 29406857

SN - 0735-1097

VL - 71

SP - 513

EP - 523

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 5

ER -

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

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Philip Adamson

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