Reproducibility of 18F-Sodium Fluoride Positron Emission Tomography for Assessing Microcalcification in Coronary Arterial and Thoracic Aortic Atherosclerosis: Is the Signal below the Resolution of PET?

Purpose of review: The rising prevalence of atherosclerosis has prompted the development of novel diagnostic methods capable of identifying early-stage disease when therapeutic interventions may be most effective. ¹⁸F-sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) is a molecular imaging technique that can quantify subclinical microcalcification in arterial plaque. The focus of this review article is to discuss the utility of ¹⁸F-NaF PET/CT in assessing atherosclerotic disease of major susceptible blood vessels, particularly the coronary arteries and thoracic aorta.

Recent findings: ¹⁸F-NaF uptake observed on PET imaging demonstrates promising potential as a marker of atherosclerotic burden in individual coronary arteries, whole heart segmentations, and the thoracic aorta. Global versus focal assessment of ¹⁸F-NaF uptake in small arteries is a significant source of methodological heterogeneity among studies. The accuracy and reproducibility of ¹⁸F-NaF PET/CT may be improved by standardized quantification methods in light of the limited spatial resolution of PET, particularly through the use of techniques to evaluate global atherosclerotic burden.