Author + information
- Received September 11, 2017
- Revision received November 6, 2017
- Accepted November 20, 2017
- Published online January 29, 2018.
- Rachael O. Forsythe, MDa,b,c,∗ (, )
- Marc R. Dweck, MDa,b,c,
- Olivia M.B. McBride, MDa,b,c,
- Alex T. Vesey, MDa,b,
- Scott I. Semple, PhDa,b,c,
- Anoop S.V. Shah, MDa,
- Philip D. Adamson, MDa,
- William A. Wallace, MDc,
- Jakub Kaczynski, MDa,b,c,
- Weiyang Ho, MDa,
- Edwin J.R. van Beek, MDb,c,
- Calum D. Gray, PhDb,
- Alison Fletcher, PhDb,
- Christophe Lucatelli, PhDb,
- Aleksander Marin, MDa,b,
- Paul Burns, MDc,
- Andrew Tambyraja, MDc,
- Roderick T.A. Chalmers, MDc,
- Graeme Weir, MDb,c,
- Neil Mitchard, BSb,c,
- Adriana Tavares, PhDa,b,
- Jennifer M.J. Robson, MDa,c and
- David E. Newby, MDa,b,c
- aBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- bEdinburgh Imaging Facility, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- cNational Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- ↵∗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.
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 [SoFIA3]; NCT02229006; Magnetic Resonance Imaging [MRI] for Abdominal Aortic Aneurysms to Predict Rupture or Surgery: The MA3RS Trial; ISRCTN76413758)
The University of Edinburgh and National Health Service Lothian Health Board were cosponsors of this work. This study was funded by the Chief Scientist Office (ETM/365). The MA3RS study was funded by the Medical Research Council and managed by the National Institute of Healthcare Research (NIHR) on behalf of the Medical Research Council–NIHR partnership (NIHR Efficacy and Mechanism Evaluation Programme; funding reference 11/20/03). The Edinburgh Clinical Research Facility and Edinburgh Imaging Facility are supported by National Health Service Research Scotland. The views expressed in this publication are those of the authors and not necessarily those of the Chief Scientist Office, Medical Research Council, National Health Service, NIHR, or Department of Health. Dr. Dweck is supported by the British Heart Foundation (FS/14/78/31020); and is the recipient of the Sir Jules Thorn Award for Biomedical Research 2015. Dr. McBride is supported by the Academic Department of Military Surgery and Trauma. Dr. Newby is supported by the British Heart Foundation (CH/09/002, RE/13/3/30183, and RM/13/2/30158); and has received a Wellcome Trust Senior Investigator Award (WT103782AIA). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 11, 2017.
- Revision received November 6, 2017.
- Accepted November 20, 2017.
- 2018 The Authors