Key result
At-risk patients show up to ~27% higher carotid 18F-FDG and 18F-NaF uptake versus healthy volunteers.
Why the study?
Carotid artery atherosclerosis develops through arterial inflammation and calcification, but the relationship between these processes and their association with cardiovascular disease and thromboembolic risk in subclinical atherosclerosis needed exploration.
Does 18F-NaF and 18F-FDG PET/CT imaging correlate with cardiovascular and thromboembolic risk in patients with subclinical atherosclerosis?
Cross-Sectional (n=115)
No
Does 18F-NaF and 18F-FDG PET/CT imaging correlate with cardiovascular and thromboembolic risk in patients with subclinical atherosclerosis?
Effect estimate: 10-22% higher NaF and 16-27% higher FDG uptake
p-value: p=<0.05
18F-NaF PET/CT may serve as a useful prognostic imaging biomarker for carotid microcalcification and subclinical atherosclerosis, correlating well with established cardiovascular risk scores.
May support PET tracers for subclinical carotid risk stratification; leaves open whether uptake predicts events or alters management.
PURPOSE: Carotid artery atherosclerosis, a significant manifestation of cardiovascular disease (CVD) and leading cause of stroke, develops through a gradual process of arterial inflammation and calcification. This study explores the relationship between arterial inflammation (18 F-FDG PET/CT) and vascular calcification (18 F-NaF PET/CT) in the left and right common carotid arteries (LCC/RCC) and their association with CVD and thromboembolic risk in patients with subclinical atherosclerosis. METHODS: A cohort of 115 subjects (73 healthy volunteers, 42 at-risk for CVD) underwent 18 F-NaF and 18 F-FDG PET/CT imaging. Radiotracer uptake was quantitatively assessed by measuring the average blood-pool-corrected mean standardized uptake value (aSUVmean). RESULTS: Relative to healthy volunteers, at-risk subjects had greater uptake of NaF and FDG (10-22% and 16-27% higher, respectively, in both arteries, p < 0.05). On multivariate regression, NaF aSUVmean correlated with age and BMI (p < 0.01), and FDG aSUVmean correlated with BMI (p ≤ 0.01), fibrinogen (p < 0.01 in LCC only), and total cholesterol (p = 0.02 in RCC only). NaF aSUVmean increased with elevated 10-year CVD risk (p = 0.003 in LCC only), while no significant trend was seen for FDG. NaF and FDG aSUVmean increased with elevated thromboembolic risk in both arteries (p < 0.05). No correlations between NaF and FDG aSUVmean were observed (p > 0.05). CONCLUSION: 18 F-NaF PET/CT may serve as a prognostic tool for carotid microcalcification and subclinical atherosclerosis, while the utility of 18 F-FDG PET/CT remains uncertain. CLINICAL TRIAL REGISTRATION: "Cardiovascular Molecular Calcification Assessed by 18F-NaF PET CT (CAMONA)", NCT01724749, https://clinicaltrials.gov/study/NCT01724749 .
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Patil et al. (2025) conducted a cross-sectional in Subclinical atherosclerosis (n=115). Elevated cardiovascular disease risk vs. Healthy volunteers was evaluated on Carotid artery radiotracer uptake (aSUVmean) of 18F-NaF and 18F-FDG (10-22% higher NaF and 16-27% higher FDG uptake, p=<0.05). Relative to healthy volunteers, subjects at risk for cardiovascular disease had 10-22% higher 18F-NaF and 16-27% higher 18F-FDG uptake in the carotid arteries.
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