Coronary 18F-sodium fluoride PET detects high-risk plaque features on optical coherence tomography and CT-angiography in patients with acute coronary syndrome
Coronary 18F-sodium fluoride PET detects high-risk plaque features on optical coherence tomography and CT-angiography in patients with acute coronary syndrome
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DOI：
10.1016/j.atherosclerosis.2020.12.010
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发表时间：
2021-02-08
期刊：
影响因子：
5.3
通讯作者：
Schultz, Carl J.
中科院分区：
文献类型：
--
作者：
Majeed, Kamran;Bellinge, Jamie W.;Schultz, Carl J.
背景和目标：F-18-氟化钠正电子发射断层扫描（F-18-NaF PET）无创检测微钙化活动，动脉粥样硬化动脉钙化的最早阶段。我们研究了冠状动脉内光学相干断层扫描（OCT）和CT血管造影术（CTCA）和潜在的应用程序，以患者水平的风险stratification.Methods：62例前瞻性招募的急性冠状动脉综合征（ACS）患者进行多血管OCT，F-18-NaF PET和CTCA的冠状动脉F-18-NaF摄取和高危斑块特征之间的关联。在F-18-NaF PET扫描上测量每个冠状动脉节段的最大组织背景比（TBRmax =标准化摄取值（SUV）max/SUV血池）。在匹配的冠状动脉节段中比较OCT和CTCA的高危斑块特征。检测呈阳性的患者数量结果：62例患者中，（年龄，平均值+/-标准差（SD）= 61 +/- 9岁，85%男性）F-18-NaF摄取升高的冠状动脉节段具有较高的脂质弧（LA）（中位数[第25 - 75百分位数]：74度[35度-117度] vs 48度[15度-83度]，p=0.021），巨噬细胞的患病率较高[n（%）：37例（62%）与89例（39%），p=0.008]和较低的无菌斑壁（PFW）（50度[7度-110度]对比94度[34度-180度]，p=0.027），与18F-NaF阴性节段相比，CTCA的总斑块负荷（p=0.011）和致密钙化斑块负荷（p= 0.001）更高。按微钙化活性阳性冠状动脉病变数量递增分组的患者（0，1，>= 2）组OCT显示斑块游离壁减少，钙化增加，巨噬细胞增多（分别为p=0.008、p < 0.001和p=0.028）。在因ACS住院的受试者中进行的每节段和每例患者分析中，F-18-NaF摄取与OCT和CTCA上的高风险斑块特征相关。
Background and aims: F-18-Sodium Fluoride Positron Emission Tomography (F-18-NaF PET) non-invasively detects micro-calcification activity, the earliest stage of atherosclerotic arterial calcification. We studied the association between coronary F-18-NaF uptake and high-risk plaque features on intra-coronary optical coherence tomography (OCT) and CT-angiography (CTCA) and the potential application to patient-level risk stratification.Methods: Sixty-two prospectively recruited patients with acute coronary syndrome (ACS) underwent multi-vessel OCT, F-18-NaF PET and CTCA. The maximum tissue to background ratio (TBRmax = standardised uptake value (SUV)max/SUVbloodpool) was measured in each coronary segment on F-18-NaF PET scans. High-risk plaque features on OCT and CTCA were compared in matched coronary segments. The number of patients testing positive (>2SD above the normal range) for micro-calcification activity was determined.Results: In 62 patients (age, mean +/- standard deviation (SD) = 61 +/- 9 years, 85% male) the coronary segments with elevated F-18-NaF uptake had higher lipid arc (LA) (median [25th-75th centile]: 74 degrees [35 degrees-117 degrees] versus 48 degrees [15 degrees-83 degrees], p=0.021), higher prevalence of macrophages [n(%): 37 (62%) versus 89 (39%), p=0.008] and lower plaque free wall (PFW) (50 degrees [7 degrees-110 degrees] versus 94 degrees [34 degrees-180 degrees], p=0.027) on OCT, and a higher total plaque burden (p=0.011) and higher dense calcified plaque burden (p= 0.001) on CTCA, when compared with 18F-NaF negative segments. Patients grouped by increasing number of coronary lesions positive for microcalcification activity (0,1, >= 2) showed decreasing plaque free wall, increasing calcification and increasing macrophages on OCT (respectively p=0.008, p < 0.001 and p=0.028).Conclusions: F-18-NaF uptake is associated with high-risk plaque features on OCT and CTCA in a per-segment and per-patient analysis in subjects hospitalized for ACS.