Associations between coronary/aortic ¹⁸F-sodium fluoride uptake and pro-atherosclerosis factors in patients with multivessel coronary artery disease

Background: ¹⁸F-NaF PET/CT is a novel approach to detect and quantify microcalcification in atherosclerosis. We aimed to explore the underlying systematic vascular osteogenesis in the coronary artery and aorta in patients with multivessel coronary artery disease (CAD).

Methods: Patients with multivessel CAD prospectively underwent ¹⁸F-NaF PET/CT. The coronary microcalcification activity (CMA) and aortic microcalcification activity (AMA) were calculated based on both the volume and intensity of ¹⁸F-NaF PET activity. Peri-coronary adipose tissue (PCAT) density was measured in adipose tissue surrounding the coronary arteries and the ¹⁸F-NaF tissue-to-blood ratio (TBR) was measured in the coronary arteries.

Results: 100 patients with multivessel CAD were prospectively recruited. The CMA was significantly associated with the AMA (r = 0.70; P < .001). After multivariable adjustment, the CMA was associated with the AMA (Beta = 0.445 per SD increase; P < .001). The coronary TBR was also significantly associated with the PCAT density (r = 0.56; P < .001). The PCAT density was independently associated with the coronary TBR after adjusting confounding factors.

Conclusions: Coronary ¹⁸F-NaF uptake was significantly associated with the PCAT density. There was a significant relationship between the coronary and the aortic ¹⁸F-NaF uptake. It might indicate an underlying systematic vascular osteogenesis in patients with multivessel CAD.