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Relationship between coronary arterial 18F-sodium fluoride uptake and epicardial adipose tissue analyzed using computed tomography

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Abstract

Purpose

18F-Sodium fluoride (18F-NaF) positron emission tomography (PET) has the potential to detect high-risk coronary plaques. Epicardial adipose tissue (EAT) reportedly correlates with coronary atherosclerosis progression. We evaluated the relationship between coronary arterial 18F-NaF uptake and EAT findings using computed tomography (CT).

Methods

We studied 40 patients with ≥ 1 coronary plaque detected on cardiac CT who underwent 18F-NaF PET/CT. EAT volume was measured using CT and indexed to body surface area in each patient. Each plaque was evaluated for CT-based luminal stenosis and high-risk features. The mean EAT density surrounding each plaque was calculated as perilesional EAT density (PLED) using non-contrast CT images. Focal 18F-NaF uptake in each plaque was quantified using the maximum tissue-to-background ratio (TBRmax).

Results

EAT volume index was similar between patients with TBRmax ≥ 1.28 (previously reported optimal cutoff to predict coronary events) and those with lower TBRmax, but patients with TBRmax ≥ 1.28 showed higher maximum PLED per patient (− 86 ± 12 Hounsfield units (HU) versus − 98 ± 11 HU, P = 0.0044). In the lesion-based analysis (n = 92), PLED was positively correlated with TBRmax, and the optimal PLED cutoff to identify TBRmax ≥ 1.28 was − 97 HU. On multivariate analysis adjusted for lesion location, obstructive stenosis, and high-risk plaque on CT, PLED ≥ − 97 HU remained a significant predictor of TBRmax ≥ 1.28.

Conclusions

Increased PLED was associated with significant coronary arterial 18F-NaF uptake. Step-by-step analyses of EAT density on CT and coronary arterial 18F-NaF uptake on PET may offer novel strategies for risk prediction in coronary artery disease.

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Acknowledgments

We acknowledge the help and support of the radiography and radiochemistry staffs of the Hiroshima Heiwa Clinic. We thank Jane Charbonneau, DVM, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Funding

This study was financially supported by a Takeda Science Foundation Research Grant, SENSHIN Medical Research Foundation Grant, and a JSPS KAKENHI Grant-in-Aid for Scientific Research (Grant Number 17K09502).

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan

    Toshiro Kitagawa, Yumiko Nakamoto, Yuto Fujii & Yasuki Kihara

  2. Hiroshima Heiwa Clinic, Hiroshima, Japan

    Ko Sasaki & Yutaka Hirokawa

  3. Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan

    Fuminari Tatsugami & Kazuo Awai

Authors
  1. Toshiro Kitagawa
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  2. Yumiko Nakamoto
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  3. Yuto Fujii
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  5. Fuminari Tatsugami
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Correspondence to Toshiro Kitagawa.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Kitagawa, T., Nakamoto, Y., Fujii, Y. et al. Relationship between coronary arterial 18F-sodium fluoride uptake and epicardial adipose tissue analyzed using computed tomography. Eur J Nucl Med Mol Imaging 47, 1746–1756 (2020). https://doi.org/10.1007/s00259-019-04675-z

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