Identification of early vascular calcification with ¹⁸F-sodium fluoride: potential clinical application

ABSTRACT

Vascular calcification plays a prominent role in cardiovascular disease. Once considered to be a passive consequence of aging, this pathological process is now accepted to be dynamic and tightly regulated, its onset triggered by inflammation and necrosis and its progression bearing key similarities to osteogenesis. A major potential advance in our ability to understand the natural history and clinical implications of vascular calcification is the detection of its early and dynamic stages through the use of the positron-emitting radiotracer, ¹⁸F-sodium fluoride. Alongside anatomical information gained from computed tomography, hybrid positron emission and computed tomography (PET/CT) imaging with ¹⁸F-sodium fluoride has, for the first time, enabled the non-invasive detection of microcalcification within the aortic valve, great vessels, and vulnerable coronary plaque. This has raised promise that exploring this process may allow improved risk prediction, better application of current therapies and ultimately the development of novel treatments to target this widespread pathology.

KEYWORDS:

• Microcalcification
• ¹⁸F-sodium fluoride
• hybrid PET/CT imaging
• vulnerable coronary plaque
• cardiovascular disease

Acknowledgements

We would like to thank Dr Philip Adamson, Dr Tania Pawade and Dr Rachael Forsythe for providing images used in Figures 3-5.

Financial and competing interests disclosure

DE Newby is supported by the British Heart Foundation (CH/09/002) and is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). MK Doris is supported by the Heart Diseases Research Trust. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.