Department of Cardiology, University Heart Center Berlin and Charité-Universitätsmedizin Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.
Berlin Institute of Health (BIH), Berlin 10117, Germany.
Eur Heart J Cardiovasc Imaging. 2022 Sep 10;23(10):1391-1398. doi: 10.1093/ehjci/jeab276.
18F-sodium fluoride ([18F]fluoride) and gadobutrol are promising probes for positron emission tomography (PET) and magnetic resonance imaging (MRI) characterizing coronary artery disease (CAD) activity. Unlike [18F]fluoride-PET/computed tomography (CT), the potential of PET/MR using [18F]fluoride and gadobutrol simultaneously, has so far not been evaluated. This study assessed feasibility and diagnostic potential of [18F]fluoride and gadobutrol enhanced dual-probe PET/MR in patients with CAD.
Twenty-one patients (age, 66.7 ± 6.7 years) with CAD scheduled for invasive coronary angiography (XCA) underwent simultaneous [18F]fluoride (mean activity/effective dose: 157.2 ± 29.7 MBq/3.77 ± 0.72 mSv) and gadobutrol enhanced PET/MR on an integrated PET/MRI (3 T) scanner. Optical coherence tomography (OCT) was used as reference. Target-to-background ratio (TBR, [18F]fluoride-PET) and contrast-to-noise ratio (CNR) values (MRI, gadobutrol) were calculated for each coronary segment. Previously suggested PET/CT-TBR thresholds for adverse coronary events were evaluated. High-risk plaques, i.e. calcified and non-calcified thin-cap fibroatheromas (TCFAs) were predominantly located in segments with a TBR >1.28 (P = 0.012). Plaques containing a lipid core on OCT, were more frequently detected in segments with a TBR >1.25 (P < 0.001). TBR values significantly correlated with maximum calcification thickness (P = 0.009), while fibrous cap thickness was significantly less in segments with a TBR >1.28 (P = 0.044). Above a TBR threshold of >1.28, CNR values significantly correlated with the presence of calcified TCFAs (P = 0.032).
Simultaneous [18F]fluoride and gadobutrol dual-probe PET/MRI is feasible in clinical practice and may facilitate the identification of high-risk patients. The combination of coronary MR-derived CNR values post gadobutrol and [18F]fluoride based TBR values may improve identification of high-risk plaque features.
18F-氟化钠([18F]氟化物)和钆布醇是正电子发射断层扫描(PET)和磁共振成像(MRI)诊断冠状动脉疾病(CAD)活性的有前途的探针。与[18F]氟化物-PET/计算机断层扫描(CT)不同，同时使用[18F]氟化物和钆布醇的 PET/MR 的潜力尚未得到评估。本研究评估了 CAD 患者中同时使用[18F]氟化物和钆布醇增强双探针 PET/MR 的可行性和诊断潜力。
21 名年龄为 66.7±6.7 岁的 CAD 患者拟行有创冠状动脉造影(XCA)，在集成的 PET/MRI(3T)扫描仪上同时进行[18F]氟化物(平均活度/有效剂量：157.2±29.7MBq/3.77±0.72mSv)和钆布醇增强 PET/MR。采用光学相干断层扫描(OCT)作为参考。为每个冠状动脉节段计算靶标与背景比(TBR,[18F]氟化物-PET)和对比噪声比(CNR)值(MRI，钆布醇)。评估了先前提出的用于不良冠状动脉事件的 PET/CT-TBR 阈值。高风险斑块，即钙化和非钙化薄帽纤维粥样斑块(TCFAs)，主要位于 TBR>1.28 的节段(P=0.012)。在 OCT 上含有脂质核心的斑块，在 TBR>1.25 的节段中更频繁地被检测到(P<0.001)。TBR 值与最大钙化厚度显著相关(P=0.009)，而 TBR>1.28 节段的纤维帽厚度显著较小(P=0.044)。TBR 阈值>1.28 时，CNR 值与钙化 TCFAs 的存在显著相关(P=0.032)。
同时进行[18F]氟化物和钆布醇双探针 PET/MRI 在临床实践中是可行的，可能有助于识别高危患者。联合使用冠状动脉 MRI 衍生的钆布醇后 CNR 值和基于[18F]氟化物的 TBR 值可能有助于识别高危斑块特征。
