Clinical Relevance of 18F-Sodium Fluoride Positron-Emission Tomography in Noninvasive Identification of High-Risk Plaque in Patients With Coronary Artery Disease

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18F-sodium fluoride (18F-NaF) positron-emission tomography has been introduced as a potential noninvasive imaging tool to identify plaques with high-risk characteristics in patients with coronary artery disease. We sought to evaluate the clinical relevance of 18F-NaF uptake using optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography angiography in patients with coronary artery disease.

Methods and Results—

The target population consisted of 51 prospectively enrolled patients (93 stenoses) who underwent 18F-NaF positron-emission tomography before invasive coronary angiography. 18F-NaF uptake was compared with IVUS- and OCT-derived plaque characteristics. In the coronary computed tomography angiography subgroup (46 lesions), qualitative lesion characteristics were compared between 18F-NaF–positive and 18F-NaF–negative plaques using adverse plaque characteristics. The plaques with 18F-NaF uptake showed significantly higher plaque burden, more frequent posterior attenuation and positive remodeling in IVUS, and significantly higher maximum lipid arc and more frequent microvessels in OCT (all P<0.05). There were no differences in minimum lumen area and area of calcium between 18F-NaF–positive and 18F-NaF–negative lesions. Among 51 lesions with 18F-NaF–positive uptake, 48 lesions (94.1%) had at least one of high-risk characteristics. The 18F-NaF tissue-to-background ratio in plaques with high-risk characteristics was significantly higher than in those without (1.09 [95% confidence interval, 0.85–1.34] versus 0.62 [95% confidence interval, 0.42–0.82], P<0.001 for IVUS definition; 0.76 [95% confidence interval, 0.54–0.98] versus 0.42 [95% confidence interval, 0.21–0.62], P=0.014 for OCT definition). Among the 15 lesions that met both IVUS- and OCT-defined criteria for high-risk plaque, 14 (93.3%) showed 18F-NaF–positive uptake. There was no difference in the prevalence of plaques with any adverse plaque characteristics between 18F-NaF–positive and 18F-NaF–negative plaques in the coronary computed tomography angiography subgroup (85.2% versus 78.9%; P=0.583).


This study’s results suggest that 18F-NaF positron-emission tomography can be a useful noninvasive diagnostic tool to identify and localize plaque with high-risk characteristics.

Clinical Trial Registration—

URL: Unique identifier: NCT02388412.

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