18F-Sodium Fluoride PET/CT in Acute Aortic Syndrome

Jul 11, 2022
Font Size
A
A
A
Authors:
Syed MB, Fletcher AJ, Debono S, et al.
Citation:
18F-Sodium Fluoride Positron Emission Tomography and Computed Tomography in Acute Aortic Syndrome. JACC Cardiovasc Imaging 2022;15:1291-1304.
Summary By:
Venkatesh Locharla Murthy, MD, PhD, FACC

Quick Takes

  • 18F-sodium fluoride PET/CT imaging can identify areas of microcalcification in the aorta.
  • 18F-sodium fluoride uptake is higher in patients with acute aortic syndrome than control subjects.
  • Higher 18F-sodium fluoride uptake in the false lumen is associated with more rapid aortic growth rates.

Study Questions:

Can 18F-sodium fluoride positron emission tomography (PET) combined with computed tomography (CT) identify and quantify risk in patients with acute aortic syndrome?

Methods:

The authors conducted a prospective single-center study of patients presenting with aortic intramural hematoma or dissection within 12 weeks of presentation. Healthy controls were individuals who had been screened for abdominal aortic aneurysm and had normal aortic caliber and no clinical evidence of acute aortic syndrome or aortic aneurysm. Traumatic dissections, infective pseudoaneurysms, and chronic aneurysms were excluded.

Subjects underwent 18F-sodium fluoride PET and CT on a modern PET/CT scanner with 128-row CT and contrast-enhanced CT angiography. 18F-sodium fluoride uptake in the aortic wall was quantified. Serial aortic diameter measurements were made from any available scans and quantified as change in diameter divided by time. Major adverse aortic events including a composite of aortic repair, rupture, or death from aortic causes were also identified.

Results:

A total of 98 patients with acute aortic syndrome presented and 63 were eligible for participation. In the end, 47 acute aortic syndrome patients consented, and 20 controls were also recruited. Several measures of aortic 18F-sodium fluoride uptake were increased in patients with acute aortic syndrome relative to controls (adjusted difference in target to background of 0.36; 95% confidence interval, 0.05-0.67). 18F-sodium fluoride uptake in the wall adjacent to the false lumen was associated with a more rapid increase in aortic diameters (adjusted beta, 7.1; p = 0.01). 18F-sodium fluoride uptake in the aortic wall adjacent to the true lumen was associated with major aortic events (p = 0.02).

Conclusions:

In patients with acute aortic syndrome, 18F-sodium fluoride uptake on PET/CT is higher than in controls and uptake in the false lumen is associated with more rapid change in diameter.

Perspective:

This prospective study shows that microcalcification may have a role in acute aortic syndrome. However, the sample sizes are modest and relatively underpowered. Whether this type of information can be used to guide treatment remains uncertain.

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Vascular Medicine, Interventions and Imaging, Interventions and Vascular Medicine, Computed Tomography, Nuclear Imaging

Keywords: Aneurysm, Aneurysm, Ruptured, Aortic Aneurysm, Abdominal, Calcinosis, Computed Tomography Angiography, Diagnostic Imaging, Hematoma, Positron Emission Tomography Computed Tomography, Sodium Fluoride, Vascular Calcification, Vascular Diseases


< Back to Listings