Association of linear ¹⁸F-sodium fluoride accumulation in femoral arteries as a measure of diffuse calcification with cardiovascular risk factors

BACKGROUND: The aim of this study was to correlate linear (18)F-sodium fluoride accumulation in the femoral arteries as a measure of diffuse mineral deposition in medial elastocalcinosis with cardiovascular risk factors (RFs) and calcified plaque burden (CPB).

METHODS AND RESULTS: In this study, 409 patients were examined by (18)F-sodium fluoride positron emission tomography/computed tomography (PET/CT). Tracer accumulation was analyzed both qualitatively and semiquantitatively by measuring the target-to-background ratio, and compared with cardiovascular RFs and CPB. Linear (18)F-sodium fluoride accumulation was observed in 159 (38.9%) patients and correlated significantly with age (P < .0001), hypertension (P < .0001), hypercholesterolemia (P = .0003), diabetes (P = .0003), history of smoking (P = .0007), prior cardiovascular events (P = .03), and CPB (P < .0001). The prevalence of linear tracer uptake increased as the number of cardiovascular RFs increased (P < .0001).

CONCLUSIONS: Linear (18)F-sodium fluoride uptake in the femoral arteries (1) provides a measure of diffuse mineral deposition, (2) demonstrates a highly significant correlation with cardiovascular RFs and CPB, and (3) is found to accumulate more frequently in patients with a high-risk profile for cardiovascular events. (18)F-sodium fluoride PET/CT may become a unique tool for in vivo visualization and quantification of ongoing calcification in large arteries.