Abstract
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Introduction: Psoriasis is a systemic inflammatory autoimmune disease that presents with not only dermatologic and joint disease, but also increased incidence of dyslipidemia, coronary artery disease (CAD) and increased mortality. Individuals with this disease have a lifespan that is six years shorter than the average individual, primarily due to their elevated risk of developing CAD. Clinical studies have shown that sodium 18F- sodium fluoride (NaF) positron emission tomography – computed tomography (PET/CT) is highly sensitive for the detection of microcalcifications in coronary artery walls and that these microcalcifications are positively correlated with the risk for development of coronary artery disease). In the past two decades, many studies have investigated the utility of the 18F-fluorodeoxyglucose (FDG) tracer in detecting vascular inflammation associated with atherosclerosis. However, recent research indicates that NaF-PET/CT may be superior to FDG-PET/CT in the detection of early atherosclerosis. While FDG detects metabolic activity in vascular walls that is proportional to inflammation that drives atherosclerosis, NaF tracer uptake is high in vascular walls where an active calcification process is occurring. As opposed to FDG tracer, NaF has minimal background uptake by the heart, so it far more sensitive in detecting early atherogenic change occurring in coronary artery walls. The objective of this review is to map out the extent to which the role of NaF-PET/CT in diagnosis of CAD in psoriasis has been investigated.
Methods: A literature search was performed using the search engine Google scholar; the terms “NaF PET psoriasis atherosclerosis” returned 142 papers. These results were then filtered by including only papers that were the result of scientific studies which looked at CAD or atherosclerosis using PET/CT in patients.
Results: The scoping review search yielded 142 papers. Most of these studies used FDG-PET/CT to analyze vascular inflammation in patients with CAD. A few studies used NaF-PET to detect microcalcification in patients with CAD, but psoriasis was not a parameter evaluated in any of these. None of the papers resulting from this scoping review specifically investigated NaF-PET/CT detection of atherosclerosis in patients diagnosed with psoriasis. This review highlights a deficit in research that utilizes NaF-PET/CT to identify atherosclerotic plaques in coronary arteries of psoriasis patients. Limited research has been performed comparing the efficacy of NaF and FDG tracers in detecting atherosclerotic plaques, and no studies have been published that investigate specifically the use of NaF-PET/CT to detect plaques in confirmed psoriasis patients. A research study named CAMONA, Cardiovascular Molecular Calcification Assessed by NaF-PET/CT, was performed to compare the use of two tracers, NaF and FDG, in evaluating atherosclerotic plaques. Analyses of data from this project has led researchers to conclude that the NaF tracer is far superior to FDG tracer in detecting vascular atherosclerotic plaques. Coronary uptake of NaF positively correlates with CAD risk factors, and NaF-PET/CT is so sensitive that it may be able to distinguish the early stages of developing CAD before it presents clinically. The potential ability of NaF-PET/CT to detect early atherogenic change long before it presents clinically as CAD could be very useful for monitoring CAD development in high-risk patients, such as those with moderate-to-severe psoriasis.
Conclusions: Patients with moderate-to-severe psoriasis have shortened life span due to CAD. NaF uptake is positively correlated with CAD risk factors and is more sensitive than FDG at detecting atherogenesis. NaF-PET/CT may allow earlier detection of atherosclerotic disease, providing time for clinical interventions to reduce morbidity and mortality of psoriasis-induced CAD. More research is needed to investigate whether NaF-PET/CT truly is a superior tracer for earlier detection of atherosclerosis.
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