FDG and NaF as markers of disease activity in comorbid rheumatoid arthritis and cardiovascular disease

Objectives: 1. Describe the role of PET/CT in assessing and monitoring rheumatoid arthritis (RA). 2. Discuss the role of FDG and NaF as PET tracers in imaging inflammation and calcium metabolism, respectively. 3. Demonstrate the application of PET/CT quantification to assess cardiovascular disease (CVD) in patients with RA.

Methods: We are demonstrating a method of assessing CVD in the coronary arteries, carotid arteries, thoracic aorta, and abdominal aorta with PET/CT. Manual regions of interest are defined on axial slices, and the SUVmean of each slice in averaged to obtain the global SUVmean of a particular vessel.

Results: FDG and NaF detect joint pathology in RA, but can also be used to assess CVD, which is a known comorbidity. FDG can be used to detect vessel inflammation, and NaF can be used to visualize active calcification. Quantification of these tracers can be used for early detection of vascular pathology in patients at risk of developing complications due to CVD.

Conclusions: FDG-PET/CT is achieving recognition as a powerful modality in assessing CVD, but NaF-PET/CT may also have an important role to play by portraying plaque calcification. The uptake of these tracers can be quantified to detect early disease activity, which may improve patient outcomes by allowing for earlier interventions. These modalities can also play a role in assessing efficacy of therapy and studying the processes involved in CVD.