Lee Joo Myung, Bang Ji-In, Koo Bon-Kwon, Hwang Doyeon, Park Jonghanne, Zhang Jinlong, Yaliang Tong, Suh Minseok, Paeng Jin Chul, Shiono Yasutsugu, Kubo Takashi, Akasaka Takashi
From the Department of Internal Medicine and Cardiovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.M.L.); Department of Nuclear Medicine (J.-I.B., M.S., J.C.P.), Department of Internal Medicine and Cardiovascular Center (B.-K.K., D.H., J.P., J.Z.), and Institute on Aging (B.-K.K.), Seoul National University Hospital, Republic of Korea; Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun (T.Y.); and Department of Cardiovascular Medicine, Wakayama Medical University, Japan (Y.S., T.K., T.A.).
Circ Cardiovasc Imaging. 2017 Nov;10(11). doi: 10.1161/CIRCIMAGING.117.006704.
F-sodium fluoride (F-NaF) positron-emission tomography has been introduced as a potential noninvasive imaging tool to identify plaques with high-risk characteristics in patients with coronary artery disease. We sought to evaluate the clinical relevance of F-NaF uptake using optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography angiography in patients with coronary artery disease.
The target population consisted of 51 prospectively enrolled patients (93 stenoses) who underwent F-NaF positron-emission tomography before invasive coronary angiography. F-NaF uptake was compared with IVUS- and OCT-derived plaque characteristics. In the coronary computed tomography angiography subgroup (46 lesions), qualitative lesion characteristics were compared between F-NaF-positive and F-NaF-negative plaques using adverse plaque characteristics. The plaques with F-NaF uptake showed significantly higher plaque burden, more frequent posterior attenuation and positive remodeling in IVUS, and significantly higher maximum lipid arc and more frequent microvessels in OCT (all <0.05). There were no differences in minimum lumen area and area of calcium between F-NaF-positive and F-NaF-negative lesions. Among 51 lesions with F-NaF-positive uptake, 48 lesions (94.1%) had at least one of high-risk characteristics. The F-NaF tissue-to-background ratio in plaques with high-risk characteristics was significantly higher than in those without (1.09 [95% confidence interval, 0.85-1.34] versus 0.62 [95% confidence interval, 0.42-0.82], <0.001 for IVUS definition; 0.76 [95% confidence interval, 0.54-0.98] versus 0.42 [95% confidence interval, 0.21-0.62], =0.014 for OCT definition). Among the 15 lesions that met both IVUS- and OCT-defined criteria for high-risk plaque, 14 (93.3%) showed F-NaF-positive uptake. There was no difference in the prevalence of plaques with any adverse plaque characteristics between F-NaF-positive and F-NaF-negative plaques in the coronary computed tomography angiography subgroup (85.2% versus 78.9%; =0.583).
This study's results suggest that F-NaF positron-emission tomography can be a useful noninvasive diagnostic tool to identify and localize plaque with high-risk characteristics.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02388412.
氟-氟化钠（F-NaF）正电子发射断层扫描已作为一种潜在的非侵入性成像工具被引入，用于识别冠状动脉疾病患者具有高危特征的斑块。我们试图使用光学相干断层扫描（OCT）、血管内超声（IVUS）和冠状动脉计算机断层扫描血管造影来评估F-NaF摄取在冠状动脉疾病患者中的临床相关性。
目标人群包括51例前瞻性纳入的患者（93处狭窄），这些患者在进行有创冠状动脉造影之前接受了F-NaF正电子发射断层扫描。将F-NaF摄取与IVUS和OCT得出的斑块特征进行比较。在冠状动脉计算机断层扫描血管造影亚组（46处病变）中，使用不良斑块特征比较F-NaF阳性和F-NaF阴性斑块之间的定性病变特征。摄取F-NaF的斑块在IVUS中显示出明显更高的斑块负荷、更频繁的后壁衰减和正性重构，在OCT中显示出明显更高的最大脂质弧和更频繁的微血管（均P<0.05）。F-NaF阳性和F-NaF阴性病变之间的最小管腔面积和钙化面积没有差异。在51处有F-NaF阳性摄取的病变中，48处病变（94.1%）具有至少一种高危特征。具有高危特征的斑块中F-NaF组织与本底比值明显高于无高危特征的斑块（IVUS定义：1.09[95%置信区间，0.85-1.34]对0.62[95%置信区间，0.42-0.82]，P<0.001；OCT定义：0.76[95%置信区间，0.54-0.98]对0.42[95%置信区间，0.21-0.62]，P=0.014）。在符合IVUS和OCT定义的高危斑块标准的15处病变中，14处（93.3%）显示F-NaF阳性摄取。在冠状动脉计算机断层扫描血管造影亚组中，F-NaF阳性和F-NaF阴性斑块之间具有任何不良斑块特征的斑块患病率没有差异（85.2%对78.9%；P=0.583）。
本研究结果表明，F-NaF正电子发射断层扫描可以成为识别和定位具有高危特征斑块的有用非侵入性诊断工具。
