British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.
Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby).
Circ Cardiovasc Imaging. 2020 Dec;13(12):e011438. doi: 10.1161/CIRCIMAGING.120.011438. Epub 2020 Dec 10.
Background Positron emission tomography (PET) using F-sodium fluoride (F-fluoride) to detect microcalcification may provide insight into disease activity in coronary atherosclerosis. This study aimed to investigate the relationship between F-fluoride uptake and progression of coronary calcification in patients with clinically stable coronary artery disease. Methods Patients with established multivessel coronary atherosclerosis underwent F-fluoride PET-computed tomography angiography and computed tomography calcium scoring, with repeat computed tomography angiography and calcium scoring at one year. Coronary PET uptake was analyzed qualitatively and semiquantitatively in diseased vessels by measuring maximum tissue-to-background ratio. Coronary calcification was quantified by measuring calcium score, mass, and volume. Results In a total of 183 participants (median age 66 years, 80% male), 116 (63%) patients had increased F-fluoride uptake in at least one vessel. Individuals with increased F-fluoride uptake demonstrated more rapid progression of calcification compared with those without uptake (change in calcium score, 97 [39-166] versus 35 [7-93] AU; <0.0001). Indeed, the calcium score only increased in coronary segments with F-fluoride uptake (from 95 [30-209] to 148 [61-289] AU; <0.001) and remained unchanged in segments without F-fluoride uptake (from 46 [16-113] to 49 [20-115] AU; =0.329). Baseline coronary F-fluoride maximum tissue-to-background ratio correlated with 1-year change in calcium score, calcium volume, and calcium mass (Spearman ρ=0.37, 0.38, and 0.46, respectively; <0.0001 for all). At the segmental level, baseline F-fluoride activity was an independent predictor of calcium score at 12 months (<0.001). However, at the patient level, this was not independent of age, sex, and baseline calcium score (=0.50). Conclusions Coronary F-fluoride uptake identifies both patients and individual coronary segments with more rapid progression of coronary calcification, providing important insights into disease activity within the coronary circulation. At the individual patient level, total calcium score remains an important marker of disease burden and progression. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02110303.
正电子发射断层扫描（PET）使用 F-氟化钠（F-氟化物）检测微钙化，可能有助于了解冠状动脉粥样硬化中的疾病活动。本研究旨在探讨在临床稳定的冠状动脉疾病患者中，F-氟化物摄取与冠状动脉钙化进展之间的关系。
接受多支血管冠状动脉粥样硬化治疗的患者接受 F-氟化物 PET-计算机断层血管造影术和计算机断层钙评分，在一年时重复计算机断层血管造影术和钙评分。通过测量最大组织与背景的比值，对病变血管中的 F-氟化物摄取进行定性和半定量分析。通过测量钙评分、质量和体积来定量评估冠状动脉钙化。
在总共 183 名参与者中（中位年龄 66 岁，80%为男性），116 名（63%）患者至少在一个血管中有 F-氟化物摄取增加。与无摄取的患者相比，F-氟化物摄取增加的个体显示出更快的钙化进展（钙评分变化，97 [39-166] 与 35 [7-93] AU；<0.0001）。实际上，只有 F-氟化物摄取的冠状动脉节段的钙评分增加（从 95 [30-209] 到 148 [61-289] AU；<0.001），而无 F-氟化物摄取的节段的钙评分不变（从 46 [16-113] 到 49 [20-115] AU；=0.329）。基线冠状动脉 F-氟化物最大组织与背景的比值与 1 年钙评分、钙体积和钙质量的变化呈正相关（Spearman ρ=0.37、0.38 和 0.46；均<0.0001）。在节段水平上，基线 F-氟化物活性是 12 个月时钙评分的独立预测因素（<0.001）。然而，在患者水平上，这与年龄、性别和基线钙评分无关（=0.50）。
冠状动脉 F-氟化物摄取可识别出冠状动脉钙化进展更快的患者和个体冠状动脉节段，为冠状动脉循环中的疾病活动提供重要的见解。在个体患者水平上，总钙评分仍然是疾病负担和进展的重要标志物。
