Whole-vessel coronary 18F-sodium fluoride PET for assessment of the global coronary microcalcification burden

Purpose 18 F-sodium fluoride ( 18 F-NaF) has shown promise in assessing disease activity in coronary arteries, but currently used measures of activity – such as maximum target to background ratio (TBRmax) – are defined by single pixel count values. We aimed to develop a novel coronary-specific measure of 18 F-NaF PET reflecting activity throughout the entire coronary vasculature (coronary microcalcification activity [CMA]). Methods Patients with recent myocardial infarction and multi-vessel coronary artery disease underwent 18 F-NaF PET and coronary CT angiography. We assessed the association between coronary 18 F-NaF uptake (both TBRmax and CMA) and coronary artery calcium scores (CACS) as well as low attenuation plaque (LAP, attenuation