1. Common Carotid Artery Molecular Calcification Assessed by 18F-NaF PET/CT is Associated with Increased Cardiovascular Disease Risk: Results from the CAMONA Study.
Simon A Castro,MD1,2; Daniele Muser,MD2; Oswaldo Acosta,MD1; Sahra Emamzadehfard,MD1; Tomas J Werner,MSE1; Anders Thomassen,MD3,, Poul Flemming Høilund-Carlsen,MD3; Abass Alavi 1 MD, MD (Hon), PhD (Hon), DSc (Hon).
1Department of Radiology, University of Pennsylvania, Philadelphia, PA.
2Department of Cardiovascular Electrophysiology, University of Pennsylvania, Philadelphia, PA.
3Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.

2. Introduction
Cardiovascular events are a major health concern worldwide, methods for early identification of a vulnerable patient is an ongoing challenge in the medical community.
18F-sodium fluoride (NaF) PET/CT has been recently proposed to detect and quantify cardiovascular molecular calcification in early stages of atherogenesis.
Correlation between arterial wall NaF uptake and cardiovascular risk has not been investigated.
The pathophysiologic process involved in the development of atherosclerotic plaque includes inflammation, necrosis and mineralization of the arterial wall
We sought to investigate the relationship between molecular arterial mineral deposition in the common carotid artery assessed by NaF PET/CT and cardiovascular risk factors.

3. Methods 128 patients (mean age 48±14 years, 51% males).
All patients underwent hybrid PET/CT imaging 90-min after 18F-NaF administration.
Tracer uptake in the common carotid arteries was quantitatively assessed by drawing regions of interest comprising the whole artery, maximum and mean standardized uptake values (SUVmax and SUVmean, respectively).
Average SUVmax and SUVmean were calculated over all slices and were compared with cardiovascular risk factors and with 10-year risk of cardiovascular events assessed by the Framingham model.

4. Results
18F-NaF uptake was significantly correlated with major cardiovascular risk factors
SUVmean
SUVmax
Spearman’s ρ p
Age
0.276
0.002
0.236
0.007
Gender
0.055
0.536
0.014
0.878
Physical activity level
-0.345
0.001
-0.387
<0.001
History of smoking
0.084
0.350
0.111
0.216
Arterial hypertension
0.261
0.004
0.272
BP lowering medications
0.296
0.281
Hypercholesterolemia
0.277
0.295
Diabetes type II
0.148
0.096
0.124
0.164
Chronic kidney disease
0.200
0.024
0.176
0.048
BMI
0.337
0.375
10-year cardiovascular risk, %
0.247
0.006
0.008
Table 1. Correlation of Cardiovascular Risk Factors and Common Carotid Artery Molecular Calcification

5. SUVmean
SUVmax

6. Inverse correlation was observed with the level of physical activity

7. Linear relationship was observed between 18F-NaF uptake and 10-year estimated risk of cardiovascular events (β=0.008; p=0.015 and β=0.011; p=0.008 for SUVmean and SUVmax, respectively)

8. Value of SUVmean ≥0. 94 (AUC 0. 697; p=0. 020) and value of SUVmax ≥1
Value of SUVmean ≥0.94 (AUC 0.697; p=0.020) and value of SUVmax ≥1.14 (AUC 0.719; p=0.010) were able to identify patients at high risk of cardiovascular events with a Sensitivity of 54% and 77% and a Specificity of 82% and 68% for SUVmean and SUVmax respectively

9. Conclusion
Carotid 18F-NaF uptake correlates with common cardiovascular risk factors and is more frequent in patients with high risk profile. Therefore, 18F-NaF PET/CT can provide a valuable tool to for predicting cardiovascular events.