Assessing global cardiovascular molecular calcification with ¹⁸F-fluoride PET/CT: will this become a clinical reality and a challenge to CT calcification scoring?

Excerpt

The complex biology of atherosclerosis has been approached by functional imaging from multiple directions, each exploring the specific and distinctive etiopathogenetic mechanisms underlying its formation and progression as well as its subsequent complications [1‐5]. In a review published in this journal [2], the targets and the radiopharmaceuticals with their targeting characteristics were classified into four major groups: (1) atherosclerotic lesion components (targets include foam cells, lipoproteins, lipids, endothelin); (2) inflammation (targeting metabolic glucose activity, macrophages and monocytes, neutrophils, monocytes and lymphocytes, lymphocytes); (3) thrombosis (targeting platelets, activated platelets, fibrins, etc.); and (4) apoptosis. In addition to these aforementioned enumerated targets, there have been recent endeavors to detect and image active arterial calcification with ¹⁸F-fluoride positron emission tomography (PET)/CT [6‐9]. This novel approach, which requires further critical evaluation in experimental and clinical studies, opens up the possibility of a new armamentarium of functional imaging in the evaluation of this complex disease process. In this comment, we explore some demonstrated promises and take a look at future prospects and limitations of this for being translated into a clinical reality. …