Background MRI and fluorine 18-labeled sodium fluoride (18F-NaF) PET can be used to identify features of plaque instability, rupture, and disease activity, but large studies have not been performed. Purpose To evaluate the association between 18F-NaF activity and culprit carotid plaque in acute neurovascular syndrome. Materials and Methods In this prospective observational cohort study (October 2017 to January 2020), participants underwent 18F-NaF PET/MRI. An experienced clinician determined the culprit carotid artery based on symptoms and record review. 18F-NaF uptake was quantified using standardized uptake values and tissue-to-background ratios. Statistical significance was assessed with the Welch, χ2, Wilcoxon, or Fisher test. Multivariable models were used to evaluate the relationship between the imaging markers and the culprit versus nonculprit vessel. Results A total of 110 participants were evaluated (mean age, 68 years ± 10 [SD]; 70 men and 40 women). Of the 110, 34 (32%) had prior cerebrovascular disease, and 26 (24%) presented with amaurosis fugax, 54 (49%) with transient ischemic attack, and 30 (27%) with stroke. Compared with nonculprit carotids, culprit carotids had greater stenoses (≥50% stenosis: 30% vs 15% [P = .02]; ≥70% stenosis: 25% vs 4.5% [P < .001]) and had increased prevalence of MRI-derived adverse plaque features, including intraplaque hemorrhage (42% vs 23%; P = .004), necrotic core (36% vs 18%; P = .004), thrombus (7.3% vs 0%; P = .01), ulceration (18% vs 3.6%; P = .001), and higher 18F-NaF uptake (maximum tissue-to-background ratio, 1.38 [IQR, 1.12-1.82] vs 1.26 [IQR, 0.99-1.66], respectively; P = .04). Higher 18F-NaF uptake was positively associated with necrosis, intraplaque hemorrhage, ulceration, and calcification and inversely associated with fibrosis (P = .04 to P < .001). In multivariable analysis, carotid stenosis at or over 70% (odds ratio, 5.72 [95% CI: 2.2, 18]) and MRI-derived adverse plaque characteristics (odds ratio, 2.16 [95% CI: 1.2, 3.9]) were both associated with the culprit versus nonculprit carotid vessel. Conclusion Fluorine 18-labeled sodium fluoride PET/MRI characteristics were associated with the culprit carotid vessel in study participants with acute neurovascular syndrome. Clinical trial registration no. NCT03215550 and NCT03215563 © RSNA, 2022 Online supplemental material is available for this article.
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From the BHF Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, EH16 4SB, Edinburgh, Scotland (J.K., M.S., G.M., M.J., S.I.S., C.A.C., A.A.S.T., S.D., M.R.D., E.J.R.v.B., D.E.N., M.C.W.); Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, Canada (S.S., J.L.); Laboratory Medicine Program, University Health Network, General Hospital, Toronto, Canada (M.A.S.); Royal Infirmary of Edinburgh, Edinburgh, Scotland (M.D., R.F., A.T., W.W., J.W.); Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, Scotland (G.M., S.I.S., T.M., E.J.R.v.B., D.E.N., M.C.W.); and Department of Medicine, Division of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S.).
Carotid Arteries, Humans, Constriction, Pathologic, Fluorine, Sodium Fluoride, Fluorine Radioisotopes, Positron-Emission Tomography, Magnetic Resonance Imaging, Prospective Studies, Aged, Female, Male, Plaque, Atherosclerotic