18 F–Sodium Fluoride Uptake in Abdominal Aortic Aneurysms

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Abstract

Background

Fluorine-18–sodium fluoride ( ¹⁸F-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 ¹⁸F-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, ¹⁸F-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 ¹⁸F-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 ¹⁸F-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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Most cited references 22

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Article: not found

Intensification of statin therapy results in a rapid reduction in atherosclerotic inflammation: results of a multicenter fluorodeoxyglucose-positron emission tomography/computed tomography feasibility study.

James H F Rudd, Achilles Alon, Michael E Farkouh … (2013)

The study sought to test whether high-dose statin treatment would result in greater reductions in plaque inflammation than low-dose statins, using fluorodeoxyglucose-positron emission tomography/computed tomographic imaging (FDG-PET/CT). Intensification of statin therapy reduces major cardiovascular events. Adults with risk factors or with established atherosclerosis, who were not taking high-dose statins (n = 83), were randomized to atorvastatin 10 versus 80 mg in a double-blind, multicenter trial. FDG-PET/CT imaging of the ascending thoracic aorta and carotid arteries was performed at baseline, 4, and 12 weeks after randomization and target-to-background ratio (TBR) of FDG uptake within the artery wall was assessed while blinded to time points and treatment. Sixty-seven subjects completed the study, providing imaging data for analysis. At 12 weeks, inflammation (TBR) in the index vessel was significantly reduced from baseline with atorvastatin 80 mg (% reduction [95% confidence interval]: 14.42% [8.7% to 19.8%]; p 0.1). Atorvastatin 80 mg resulted in significant additional relative reductions in TBR versus atorvastatin 10 mg (10.6% [2.2% to 18.3%]; p = 0.01) at week 12. Reductions from baseline in TBR were seen as early as 4 weeks after randomization with atorvastatin 10 mg (6.4% reduction, p < 0.05) and 80 mg (12.5% reduction, p < 0.001). Changes in TBR did not correlate with lipid profile changes. Statin therapy produced significant rapid dose-dependent reductions in FDG uptake that may represent changes in atherosclerotic plaque inflammation. FDG-PET imaging may be useful in detecting early treatment effects in patients at risk or with established atherosclerosis. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Record: found
Abstract: found
Article: not found

Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance.

Weston Powell, Mitchell G. Thompson, Roger Greenhalgh … (2004)

Intervention to reduce abdominal aortic aneurysm (AAA) expansion and optimization of screening intervals would improve current surveillance programs. The aim of this study was to characterize AAA growth in a national cohort of patients with AAA both overall and by cardiovascular risk factors. In this study, 1743 patients were monitored for changes in AAA diameter by ultrasonography over a mean follow-up of 1.9 years. Mean initial AAA diameter and growth rate were 43 mm (range 28 to 85 mm) and 2.6 mm/year (95% range, -1.0 to 6.1 mm/year), respectively. Baseline diameter was strongly associated with growth, suggesting that AAA growth accelerates as the aneurysm enlarges. AAA growth rate was lower in those with low ankle/brachial pressure index and diabetes but higher for current smokers (all P<0.001). No other factor (including lipids and blood pressure) was associated with AAA growth. Intervals of 36, 24, 12, and 3 months for aneurysms of 35, 40, 45, and 50 mm, respectively, would restrict the probability of breaching the 55-mm limit at rescreening to below 1%. Annual, or less frequent, surveillance intervals are safe for all AAAs < or =45 mm in diameter. Smoking increases AAA growth, but atherosclerosis plays a minor role.

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Is Open Access

Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair

(2017)

Supplemental Digital Content is available in the text.

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Author and article information

Contributors

Rachael O. Forsythe

Journal

Journal ID (nlm-ta): J Am Coll Cardiol

Journal ID (iso-abbrev): J. Am. Coll. Cardiol

Title: Journal of the American College of Cardiology

Publisher: Elsevier Biomedical

ISSN (Print): 0735-1097

ISSN (Electronic): 1558-3597

Publication date PMC-release: 06 February 2018

Publication date (Print): 06 February 2018

Volume: 71

Issue: 5

Pages: 513-523

Affiliations

[a ]British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom

[b ]Edinburgh Imaging Facility, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom

[c ]National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

Author notes

[∗ ] Address for correspondence: Dr. Rachael O. Forsythe, British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom.British Heart Foundation Centre for Cardiovascular ScienceUniversity of Edinburgh49 Little France CrescentEdinburgh EH16 4SBUnited Kingdom rachael.forsythe@ 123456ed.ac.uk

Article

Publisher ID: S0735-1097(17)41779-7

DOI: 10.1016/j.jacc.2017.11.053

PMC ID: 5800891

PubMed ID: 29406857

SO-VID: 60dd3600-6052-461f-b1a5-33e8b370ed57

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

History

Date received : 11 September 2017

Date revision received : 6 November 2017

Date accepted : 20 November 2017

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