18 f-sodium fluoride positron emission tomography activity predicts the development of new coronary artery calcifications

Document Type

Journal Article

Publication Title

Arteriosclerosis, Thrombosis, and Vascular Biology

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Wolters Kluwer / Lippincott Williams & Wilkins


School of Medical and Health Sciences




Bellinge, J. W., Francis, R. J., Lee, S. C., Phillips, M., Rajwani, A., Lewis, J. R., ... Schultz, C. J. (2021). 18F-sodium fluoride positron emission tomography activity predicts the development of new coronary artery calcifications. Arteriosclerosis, Thrombosis, and Vascular Biology, 41(1), 534-541. https://doi.org/10.1161/ATVBAHA.120.315364


© 2020 Lippincott Williams and Wilkins. All rights reserved. Objective: The coronary calcium score (CCS) predicts cardiovascular disease risk in individuals with diabetes, and rate of progression of CCS is an additional and incremental marker of risk. 18F-sodium fluoride positron emission tomography (18F-NaF PET) detects early and active calcifications within the vasculature. We aimed to ascertain the relationship between 18F-NaF PET activity and CCS progression in patients with diabetes. Approach and Results: We identified individuals between 50 and 80 years with diabetes and no history of clinical coronary artery disease. Those with a CCS ≥ 10 were invited to undergo 18F-NaF PET scanning and then repeat CCS > 2 years later. 18F-NaF PET and CCS analysis were performed on a per-coronary and a per-patient level. We compared the proportion of CCS progressors in 18F-NaF PET-positive versus 18F-NaF PET-negative coronary arteries. Forty-one participants with 163 coronary arteries underwent follow-up CCS 2.8±0.5 years later. 18F-NaF PET-positive coronary arteries (n=52) were more likely to be CCS progressors, compared with negative coronary arteries (n=111; 86.5% versus 52.3%, P < 0.001). Adjusting for baseline CCS, 18F-NaF PET-positive disease was an independent predictor of subsequent CCS progression (odds ratio, 2.92 [95% CI, 1.32-6.45], P=0.008). All subjects (100%, 15/15) with ≥ 2 18F-NaF-positive coronary arteries progressed in CCS. Conclusions: In subjects with diabetes, 18F-NaF PET positivity at baseline, independently predicted the progression of calcifications within the coronary arteries 2.8 years later. These findings suggest 18F-NaF PET may be a promising technique for earlier identification of patients at higher risk of cardiovascular events.



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