Key result
Aneurysms in the highest tertile of 18F-NaF uptake expanded more rapidly and had a higher rate of repair or rupture compared to the lowest tertile (15.3% vs. 5.6%; P=0.043).
Why the study?
Does 18F-NaF PET-CT predict aneurysm expansion and clinical outcomes in patients with abdominal aortic aneurysms?
Cohort (n=112)
Does 18F-NaF PET-CT predict aneurysm expansion and clinical outcomes in patients with abdominal aortic aneurysms?
Absolute Event Rate: 15.3% vs 5.6%
p-value: p=0.043
18F-NaF PET-CT identifies active calcification in abdominal aortic aneurysms and serves as a predictor of both aneurysm expansion and the clinical composite of repair or rupture.
18F-NaF uptake may stratify AAA expansion risk; hypothesis-generating and requires prospective validation before guiding practice.
Background Fluorine-18–sodium fluoride ( 18 F-NaF) uptake is a marker of active vascular calcification associated with high-risk atherosclerotic plaque. Objectives In patients with abdominal aortic aneurysm (AAA), the authors assessed whether 18 F-NaF positron emission tomography (PET) and computed tomography (CT) predicts AAA growth and clinical outcomes. Methods In prospective case-control (n = 20 per group) and longitudinal cohort (n = 72) studies, patients with AAA (aortic diameter >40 mm) and control subjects (aortic diameter <30 mm) underwent abdominal ultrasound, 18 F-NaF PET-CT, CT angiography, and calcium scoring. Clinical endpoints were aneurysm expansion and the composite of AAA repair or rupture. Results Fluorine-18-NaF uptake was increased in AAA compared with nonaneurysmal regions within the same aorta (p = 0.004) and aortas of control subjects (p = 0.023). Histology and micro-PET-CT demonstrated that 18 F-NaF uptake localized to areas of aneurysm disease and active calcification. In 72 patients within the longitudinal cohort study (mean age 73 ± 7 years, 85% men, baseline aneurysm diameter 48.8 ± 7.7 mm), there were 19 aneurysm repairs (26.4%) and 3 ruptures (4.2%) after 510 ± 196 days. Aneurysms in the highest tertile of 18 F-NaF uptake expanded 2.5× more rapidly than those in the lowest tertile (3.10 [interquartile range (IQR): 2.34 to 5.92 mm/year] vs. 1.24 [IQR: 0.52 to 2.92 mm/year]; p = 0.008) and were nearly 3× as likely to experience AAA repair or rupture (15.3% vs. 5.6%; log-rank p = 0.043). Conclusions Fluorine-18-NaF PET-CT is a novel and promising approach to the identification of disease activity in patients with AAA and is an additive predictor of aneurysm growth and future clinical events. (Sodium Fluoride Imaging of Abdominal Aortic Aneurysms [SoFIA 3 ]; NCT02229006 ; Magnetic Resonance Imaging [MRI] for Abdominal Aortic Aneurysms to Predict Rupture or Surgery: The MA3RS Trial; ISRCTN76413758 )
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Forsythe et al. (2018) conducted a cohort in Abdominal aortic aneurysm (n=112). High 18F-NaF uptake (highest tertile) vs. Low 18F-NaF uptake (lowest tertile) was evaluated on Composite of AAA repair or rupture (p=0.043). Aneurysms in the highest tertile of 18F-NaF uptake expanded more rapidly and had a higher rate of repair or rupture compared to the lowest tertile (15.3% vs. 5.6%; P=0.043).
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