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F-18-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial

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    Rights statement: Copyright © 2013 Joshi et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.

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Original languageEnglish
Pages (from-to)705-713
Number of pages9
JournalThe Lancet
Volume383
Issue number9918
Early online date11 Nov 2013
DOIs
Publication statusPublished - 22 Feb 2014

Abstract

Background The use of non-invasive imaging to identify ruptured or high-risk coronary atherosclerotic plaques would represent a major clinical advance for prevention and treatment of coronary artery disease. We used combined PET and CT to identify ruptured and high-risk atherosclerotic plaques using the radioactive tracers F-18-sodium fluoride (F-18-NaF) and F-18-fluorodeoxyglucose (F-18-FDG).

Methods In this prospective clinical trial, patients with myocardial infarction (n=40) and stable angina (n=40) underwent F-18-NaF and F-18-FDG PET-CT, and invasive coronary angiography. F-18-NaF uptake was compared with histology in carotid endarterectomy specimens from patients with symptomatic carotid disease, and with intravascular ultrasound in patients with stable angina. The primary endpoint was the comparison of F-18-fluoride tissue-to-background ratios of culprit and non-culprit coronary plaques of patients with acute myocardial infarction.

Findings In 37 (93%) patients with myocardial infarction, the highest coronary F-18-NaF uptake was seen in the culprit plaque (median maximum tissue-to-background ratio: culprit 1.66 [IQR 1.40-2.25] vs highest non-culprit 1.24 [1.06-1.38], p

Interpretation F-18-NaF PET-CT is the first non-invasive imaging method to identify and localise ruptured and high-risk coronary plaque. Future studies are needed to establish whether this method can improve the management and treatment of patients with coronary artery disease.

    Research areas

  • ACUTE MYOCARDIAL-INFARCTION, VULNERABLE PLAQUE, VASCULAR CALCIFICATION, ARTERY-DISEASE, INTRAVASCULAR ULTRASOUND, AORTIC-STENOSIS, F-18-FDG UPTAKE, FLUORIDE UPTAKE, IN-VIVO, INFLAMMATION

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