Three-hour delayed imaging improves assessment of coronary 18F-sodium fluoride PET

Jacek Kwiecinski, Daniel S. Berman, Sang Eun Lee, Damini Dey, Sebastien Cadet, Martin L. Lassen, Guido Germano, Maurits A. Jansen, Marc R. Dweck, David E. Newby, Hyuk Jae Chang, Mijin Yun, Piotr J. Slomka

Research output: Contribution to journalArticlepeer-review

40 Citations (Scopus)


Coronary 18F-sodium fluoride (18F-NaF) PET identifies ruptured plaques in patients with recent myocardial infarction and localizes to atherosclerotic lesions with active calcification. Most studies to date have performed the PET acquisition 1 h after injection. Although qualitative and semiquantitative analysis is feasible with 1-h images, residual blood-pool activity often makes it difficult to discriminate plaques with 18F-NaF uptake from noise. We aimed to assess whether delayed PET performed 3 h after injection improves image quality and uptake measurements. Methods: Twenty patients (67 ± 7 y old, 55% male) with stable coronary artery disease underwent coronary CT angiography (CTA) and PET/CT both 1 h and 3 h after the injection of 266.2 ± 13.3 MBq of 18F-NaF. We compared the visual pattern of coronary uptake, maximal background (blood pool) activity, noise, SUVmax, corrected SUVmax (cSUVmax), and target-to-background (TBR) ratio in lesions defined by CTA on 1-h versus 3-h 18F-NaF PET. Results: On 1-h PET, 26 CTA lesions with 18F-NaF PET uptake were identified in 12 (60%) patients. On 3-h PET, we detected 18F-NaF PET uptake in 7 lesions that were not identified on 1-h PET. The median cSUVmax and TBRs of these lesions were 0.48 (interquartile range [IQR], 0.44–0.51) and 1.45 (IQR, 1.39–1.52), respectively, compared with −0.01 (IQR, −0.03–0.001) and 0.95 (IQR, 0.90–0.98), respectively, on 1-h PET (both P, 0.001). Across the entire cohort, 3-h PET SUVmax was similar to 1-h PET measurements (1.63 [IQR, 1.37–1.98] vs. 1.55 [IQR, 1.43–1.89], P 5 0.30), and the background activity was lower (0.71 [IQR, 0.65–0.81] vs. 1.24 [IQR, 1.05–1.31], P, 0.001). On 3-h PET, TBR, cSUVmax, and noise were significantly higher (respectively: 2.30 [IQR, 1.70–2.68] vs. 1.28 [IQR, 0.98–1.56], P, 0.001; 0.38 [IQR, 0.27–0.70] vs. 0.90 [IQR, 0.64–1.17], P, 0.001; and 0.10 [IQR, 0.09–0.12] vs. 0.07 [IQR, 0.06–0.09], P 5 0.02). Median cSUVmax and TBR increased by 92% (range, 33%–225%) and 80% (range, 20%–177%), respectively. Conclusion: Blood-pool activity decreases on delayed imaging, facilitating the assessment of 18F-NaF uptake in coronary plaques. Median TBR increases by 80%, leading to the detection of more plaques with significant uptake than are detected using the standard 1-h protocol. A greater than 1-h delay may improve the detection of 18F-NaF uptake in coronary artery plaques.

Original languageEnglish
Pages (from-to)530-535
Number of pages6
JournalJournal of Nuclear Medicine
Issue number4
Publication statusPublished - 2019 Apr 1

Bibliographical note

Publisher Copyright:
COPYRIGHT © 2019 by the Society of Nuclear Medicine and Molecular Imaging.

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging


Dive into the research topics of 'Three-hour delayed imaging improves assessment of coronary 18F-sodium fluoride PET'. Together they form a unique fingerprint.

Cite this