Innovative atherosclerosis imaging using 18F-NaF PET/CT: Its clinical potential
Innovative atherosclerosis imaging using 18F-NaF PET/CT: Its clinical potential
复制标题
使用 18F-NaF PET/CT 的创新动脉粥样硬化成像：其临床潜力
DOI：
10.1007/s12350-021-02576-z
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发表时间：
2021
影响因子：
2.4
通讯作者：
Yukiko Nakano
中科院分区：
文献类型：
--
作者：
T. Kitagawa;Yukiko Nakano
动脉粥样硬化是严重心血管疾病的主要原因，包括心肌梗死、中风和外周动脉疾病。氟-氟化钠（F-NaF）正电子发射断层扫描（PET）最近在心血管疾病领域获得了关注，数据显示其在识别具有活动性钙化的高风险动脉粥样硬化病变方面的有用性。Lee等人证明，在血管内成像（血管内超声和光学相干断层扫描）上具有高风险特征的冠状动脉斑块的F-NaF摄取高于不具有此类特征的斑块。Kitagawa等人评估了PET上的F-NaF信号与心脏计算机断层扫描（CT）检查中冠状动脉粥样硬化表现之间的关系，发现：（1）冠状动脉钙评分与每位患者的冠状动脉F-NaF摄取呈正相关;（2）有心肌梗死或不稳定型心绞痛病史的患者冠状动脉F-NaF摄取较高;（3）冠状动脉粥样硬化中F-NaF摄取的局灶性增加与异质性（部分钙化）斑块成分独立相关;（4）冠状动脉CT血管造影（CCTA）显示具有高危特征的冠状动脉斑块在PET上的F-NaF摄取高于无高危特征的斑块。此外，急性心肌梗死患者近期破裂的冠状动脉斑块中显示出强烈的F-NaF摄取。这些点突出了F-NaF PET成像作为监测动脉粥样硬化的创新方法的潜力。为什么F-NaF摄取表明动脉粥样硬化斑块破裂或高危？F-NaF示踪剂与羟磷灰石反应，羟磷灰石是血管钙化的中心成分，并在矿化的最早和最活跃阶段沉积。动脉粥样硬化钙化被描述为对急性和慢性炎症刺激的细胞反应，并且动脉粥样硬化中骨生成和炎症之间的关联被充分描述。因此，动脉粥样硬化炎症先于血管钙化，微钙化的存在与炎性细胞浸润相关，炎性细胞浸润与动脉粥样硬化斑块的其他高危特征共存，包括大脂质核心、向外重塑和薄纤维帽。因此，F-NaF摄取是高风险动脉粥样硬化斑块的综合成像标志物（图1）。在冠状动脉成像中，与F-氟脱氧葡萄糖（F-FDG）不同，F-NaF示踪剂不会在心肌中生理性摄取;因此，可以使用F-NaF PET/CT特异性检测和评估冠状动脉粥样硬化病变。Fiz等人对血管壁中F-NaF摄取与钙负荷连续增加之间的相关性进行了一项有趣的分析。他们重点关注（1）F-NaF摄取与非钙化动脉病变CT密度和新发钙化相关的意义，（2）F-NaF摄取与随后钙化斑块进展（由CT密度和钙评分表示）相关的意义，以及（3）F-NaF摄取在整个主动脉中与钙负荷增加相关的意义。接受两次连续FNaF PET/CT扫描的患者入组研究，并对腹主动脉病变进行评价。他们发现，在非钙化动脉壁中，F-NaF摄取与CT密度增加和相关重印请求共存：Toshiro Kitagawa，MD，PhD，广岛大学生物医学与健康科学研究生院心血管医学系，1-2-3 Kasumi，Minami-ku，Hiroshima 734 -8551，Japan; toshirok@hiroshima-u.ac.jp J Nucl Cardiol 2022;29：1724-8。1071-3581/$34.00版权所有2021美国核心脏病学会。
Atherosclerosis is a major cause of critical cardiovascular disorders, including myocardial infarction, stroke, and peripheral arterial disease. F-sodium fluoride (F-NaF) positron emission tomography (PET) has recently gained attention in the field of cardiovascular diseases and data have shown its usefulness in identifying high-risk atherosclerotic lesions with active calcification. Lee et al. demonstrated that coronary plaques with high-risk characteristics on intravascular imaging (intravascular ultrasound and optical coherence tomography) had higher F-NaF uptake than those without such characteristics. Kitagawa et al. assessed the relationship between the F-NaF signal on PET and the appearance of coronary atherosclerosis on cardiac computed tomography (CT) examination and found the following: (1) The coronary calcium score was positively correlated with coronary arterial F-NaF uptake per patient; (2) patients with a history of myocardial infarction or unstable angina had higher coronary arterial F-NaF uptake; (3) focally increased F-NaF uptake in coronary atherosclerosis was independently correlated with the heterogeneous (partially calcified) plaque component; and (4) coronary plaques with highrisk features on coronary CT angiography (CCTA) had a higher F-NaF uptake on PET than those without. In addition, intense F-NaF uptake was shown in recently ruptured coronary plaques in patients with acute myocardial infarction. These points highlight the potential of F-NaF PET imaging as an innovative approach to monitoring atherosclerosis. Why does F-NaF uptake indicate ruptured or high-risk atherosclerotic plaques? The F-NaF tracer reacts with hydroxyapatite, which is the central component of vascular calcification and is deposited during the earliest and most active stages of mineralization. Atherosclerotic calcification is described as a cellular response to acute and chronic inflammatory stimuli, and the association between osteogenesis and inflammation in atherosclerosis is well described. Therefore, atherosclerotic inflammation precedes vascular calcification, and the presence of microcalcifications are associated with inflammatory cell infiltrate that coexists with other high-risk features of atherosclerotic plaque, including a large lipid core, outward remodeling, and thin fibrous cap. F-NaF uptake is thus a comprehensive imaging marker of high-risk atherosclerotic plaques (Figure 1). In imaging of coronary arteries, F-NaF tracer, unlike F-fluorodeoxyglucose (F-FDG), is not taken up physiologically in the myocardium; therefore, coronary atherosclerotic lesions can be specifically detected and assessed using F-NaF PET/CT. Fiz et al. conducted an interesting analysis on the correlation between F-NaF uptake in the vessel walls and a successive increase in the calcium burden. They focused on (1) the significance of F-NaF uptake with regard to the CT density of noncalcified arterial lesions and new occurrence of calcification, (2) the significance of F-NaF uptake with regard to subsequent calcified plaque progression represented by CT density and calcium score, and (3) the significance of F-NaF uptake in the whole aorta with regard to the increase in calcium burden. Patients who underwent two consecutive FNaF PET/CT scans were enrolled in their study, and lesions on the abdominal aorta were evaluated. They found that in noncalcified arterial walls, F-NaF uptake is colocalized with an increased CT density and related Reprint requests: Toshiro Kitagawa, MD, PhD, Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima734-8551, Japan; toshirok@hiroshima-u.ac.jp J Nucl Cardiol 2022;29:1724–8. 1071-3581/$34.00 Copyright 2021 American Society of Nuclear Cardiology.
影响因子：
14
作者：
Kwiecinski, Jacek;Dey, Damini;Berman, Daniel S.
通讯作者：
Berman, Daniel S.
影响因子：
24
作者：
Kwiecinski, Jacek;Tzolos, Evangelos;Dweck, Marc R.
通讯作者：
Dweck, Marc R.