Review Article
Future imaging of atherosclerosis: molecular imaging of coronary atherosclerosis with 18F positron emission tomography
Abstract
Atherosclerosis is characterized by the formation of complex atheroma lesions (plaques) in
arteries that pose risk by their flow-limiting nature and propensity for rupture and thrombotic occlusion.
It develops in the context of disturbances to lipid metabolism and immune response, with inflammation
underpinning all stages of plaque formation, progression and rupture. As the primary disease process
responsible for myocardial infarction, stroke and peripheral vascular disease, atherosclerosis is a leading
cause of morbidity and mortality on a global scale. A precise understanding of its pathogenic mechanisms
is therefore critically important. Integral to this is the role of vascular wall imaging. Over recent years, the
rapidly evolving field of molecular imaging has begun to revolutionize our ability to image beyond just the
anatomical substrate of vascular disease, and more dynamically assess its pathobiology. Nuclear imaging
by positron emission tomography (PET) can target specific molecular and biological pathways involved
in atherosclerosis, with the application of 18Fluoride PET imaging being widely studied for its potential
to identify plaques that are vulnerable or high risk. In this review, we discuss the emergence of 18Fluoride
PET as a promising modality for the assessment of coronary atherosclerosis, focusing on the strengths and
limitations of the two main radionuclide tracers that have been investigated to date: 2-deoxy-2-(18F)fluoro-
D-glucose (18F-FDG) and sodium 18F-fluoride (18F-NaF).
arteries that pose risk by their flow-limiting nature and propensity for rupture and thrombotic occlusion.
It develops in the context of disturbances to lipid metabolism and immune response, with inflammation
underpinning all stages of plaque formation, progression and rupture. As the primary disease process
responsible for myocardial infarction, stroke and peripheral vascular disease, atherosclerosis is a leading
cause of morbidity and mortality on a global scale. A precise understanding of its pathogenic mechanisms
is therefore critically important. Integral to this is the role of vascular wall imaging. Over recent years, the
rapidly evolving field of molecular imaging has begun to revolutionize our ability to image beyond just the
anatomical substrate of vascular disease, and more dynamically assess its pathobiology. Nuclear imaging
by positron emission tomography (PET) can target specific molecular and biological pathways involved
in atherosclerosis, with the application of 18Fluoride PET imaging being widely studied for its potential
to identify plaques that are vulnerable or high risk. In this review, we discuss the emergence of 18Fluoride
PET as a promising modality for the assessment of coronary atherosclerosis, focusing on the strengths and
limitations of the two main radionuclide tracers that have been investigated to date: 2-deoxy-2-(18F)fluoro-
D-glucose (18F-FDG) and sodium 18F-fluoride (18F-NaF).
