Abstract
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Introduction: The major role players involved in the pathogenesis of atherosclerosis are inflammation and dystrophic calcification whereby calcium is abnormally deposited in the fatty atherosclerotic plaques. [68Ga]Ga-NODAGAZOL is a radiolabeled bisphosphonate that localizes to areas of calcification. In this study we correlated [68Ga]Ga-NODAGAZOL uptake in atherosclerotic lesions and the cardiovascular risk profile of patients imaged with positron emission tomography (PET).
Methods: Thirty-four (34) patients(3 women and 31 men; mean age ± SD: 63 ± 10.01 years) who underwent PET/CT imaging post injection of [68Ga] Ga-NODAGAZOL were included in this study. We documented the number of atherosclerotic plaques found in the major arteries on CT and the cardiovascular risks in each patient. We quantified the intensity of tracer uptake in atherosclerotic plaque in the major arteries using maximum standardized uptake value (SUVmax). The SUVmax of the most tracer-avid plaque was documented as representative of the individual arterial bed. We determined background vascular tracer activity using mean standardized uptake value(SUVmean) obtained from the lumen of the superior vena cava. Maximum target to background ratio (TBRmax) was calculated by dividing the SUVmax by the SUVmean. The TBRmax was correlated to the number of atherogenic risk factors and history of cardiovascular events.
Results: All patients had at least two cardiovascular risk factors, the highest number of risk factors that a patient had was seven(7). A total of 2678 atherosclerotic plaques were evaluated across all the major arterial beds of interest. Across all arterial bed of interest most patients had less than or equal to 5 atherosclerotic plaques, with the arch of the aorta dominant in that range;(76.5% of total number of patients).Statistically significant correlation between TBRmax and the number of atherogenic risk factors was noted in the following arteries: Right carotid artery(r= 0.50; p <0.05); left carotid artery(r= 0.,649; p<0.05); ascending aorta(r= 0.375; p<0.05); arch of the aorta(r=0.483; <0.05); Thoracic aorta(r=0.644; p<0.05); left femoral artery(r= 0.552; p< 0.05) and right femoral artery(r= 0.533; p<0.05). History of cardiovascular disease positively correlated to the TBRmax in all arteries (p<0.05) except for the abdominal aorta as follows: We also found a positive correlation between TBRmax and history of cardiovascular event as follows right carotid artery(U= 26.00; p <0.05); left carotid artery(U= 11.00; p<0.05); ascending aorta(U= 49.00; p<0.05); arch of the aorta(U= 37.00; <0.05); Thoracic aorta(U= 16.00; p<0.05); Left common iliac artery(U= 49.500; p<0.05), right common iliac artery(U=43.00; p<0.05)left femoral artery(U= 40.500; p< 0.05) and right femoral artery(U= 37.500; p<0.05).
Conclusions: [68Ga]Ga- NODAGAZOL uptake in atherosclerotic plaques correlates positively with the number of atherogenic risk factors, which translates to risk of atherosclerosis and cardiovascular risk factors. Our results suggest that [68Ga]Ga-NODAGAZOL PET/CT imaging can be used for risk assessment in patients with atherosclerotic cardiovascular disease.