18F-NaF uptake by atherosclerotic plaque on PET/CT imaging: Inverse correlation between calcification density and mineral metabolic activity

Francesco Fiz, Silvia Morbelli, Arnoldo Piccardo, Matteo Bauckneht, Giulia Ferrarazzo, Emanuela Pestarino, Manlio Cabria, Alessia Democrito, Mattia Riondato, Giampiero Villavecchia, Cecilia Marini, Gianmario Sambuceti

Research output: Contribution to journalArticlepeer-review


Several studies have highlighted the role of vascular 18F-NaF uptake as a marker of ongoing calcium deposition. However, accumulation of 18F-NaF is often inconsistent with localization of arterial plaque. Calcification activity and thus 18F-NaF uptake might prevail in the earlier plaque stages. To test this hypothesis, we evaluated 18F-NaF uptake in plaque of 3 different densities, using density as a marker of calcification progression. We also tested whether attenuationweighted image reconstruction affects 18F-NaF uptake in the different plaque stages. Methods: Sixty-four oncologic patients (14 men and 50 women; mean age, 65.3 ± 8.2 y; range, 26-81 y) underwent 18F-NaF PET/CT. A volume of interest was drawn on each plaque within the infrarenal aorta to assess mean standardized uptake value and attenuation (in Hounsfield units [HU]). Plaque was then categorized as light (,210 HU), medium (211-510 HU), or heavy (.510 HU). Standardized uptake value was normalized for blood 18F-NaF activity to obtain the plaque target-to-background ratio (TBR). During this process, several focal, noncalcified areas of 18F-NaF were identified (hot spots). The TBR of the hot spots was computed after isocontour thresholding. The TBR of a noncalcified control region was also calculated. In 35 patients, the TBR of non- attenuation-corrected images was calculated. Results: The average TBR was highest in light plaque (2.21 ± 0.88), significantly lower in medium plaque (1.59 ± 0.63, P18FNaF is a feasible option in imaging molecular calcium deposition in the early stages of plaque formation, when active uptake mechanisms are the main determinants of calcium presence, but that retention of 18F-NaF progressively decreases with increasing calcium deposition in the arterial wall. Our data suggest that non- attenuation-corrected reconstruction does not significantly affect evaluation of plaque of any thickness.

Original languageEnglish
Pages (from-to)1019-1023
Number of pages5
JournalJournal of Nuclear Medicine
Issue number7
Publication statusPublished - Jul 1 2015


  • <sup>18</sup>F-natrium fluoride
  • PET/CT
  • Plaque imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)


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