![]() ![]() It is a marker of vascular inflammation and macrophage burden and is extensively used for malignancy staging. ġ8F-fluorodeoxyglucose ( 18F-FDG) is a glucose analogue which accumulates mostly in macrophages due to their high demand for glucose. This discordance between the morphological plaque characteristics assessed by CTCA and the activity of the disease measured by 18F-NaF uptake indicates that the two imaging techniques provide complementary information which may improve the accuracy of predicting coronary atherosclerosis vulnerability. This allows differentiating stable from vulnerable atherosclerotic plaques. Conversely, regions with absent or minimal CT calcium demonstrate intense 18F-NaF uptake. This is confirmed by the observation that large areas of coronary calcium detected by CT scans do not show increased 18F-NaF uptake. The stronger affinity of the radioligand with newly formed hydroxyapatite compared to the old crystals makes it possible to distinguish between actively inflamed coronary calcifications from stable ones. ![]() This allows 18F-NaF to detect active microcalcification which is beyond the resolution of the CT scan. Coronary atherosclerosis is strongly associated with macrophages osteogenic activity in the early stages of atherosclerosis, which results in microcalcifications found in the lipid-rich necrotic core of atherosclerotic plaques. Fluoride ions are incorporated into hydroxyapatite which is a central component of osteogenic mineralization. CT is able to detect large calcifications while PET/CT can detect both macro and microcalcifications which cannot be seen with CT.ġ8F-sodium fluoride ( 18F-NaF) has been originally studied to identify bone metastasis. Schematic representation of (A) CT and (B) PET/CT detection of coronary calcifications. ![]()
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