18F-Sodium Fluoride Positron Emission Tomography in Cardiac Disease

  • Marwa DaghemEmail author
  • David E. Newby
Part of the Clinicians’ Guides to Radionuclide Hybrid Imaging book series (CGRHI)


Despite the recent advances, cardiovascular disease remains the leading cause of death worldwide. There is a need to improve targeting of existing novel diagnostic investigations. In the last few years, we have seen a rise in the availability of dedicated combined cardiac positron emission tomography scanners which combine molecular information from positron emission tomography with the fine anatomic detail provided by computed tomography or magnetic resonance imaging, which has in turn triggered a growing interest in the development of novel tracers providing new insight into biological disease processes. 18F-Sodium fluoride is a marker of active inflammation and calcification, and has shown promise as a novel radiotracer in cardiac imaging, having been applied in the assessment of a range of cardiac pathologies including atherosclerosis, valvular disease and cardiomyopathy.



MD and DEN are supported by the British Heart Foundation (CH/09/002, RE/18/5/34216) and a Wellcome Trust Senior Investigator Award (WT103782AIA).


  1. 1.
    O'Malley PG, Taylor AJ, Jackson JL, Doherty TM, Detrano RC. Prognostic value of coronary electron-beam computed tomography for coronary heart disease events in asymptomatic populations. Am J Cardiol. 2000;85:945–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Dweck MR, et al. Coronary arterial 18F-sodium fluoride uptake: a novel marker of plaque biology. J Am Coll Cardiol. 2012;59:1539–48.CrossRefGoogle Scholar
  3. 3.
    Fiz F, et al. 18F-NaF uptake by atherosclerotic plaque on PET/CT imaging: inverse correlation between calcification density and mineral metabolic activity. J Nucl Med. 2015;56:1019–23.CrossRefPubMedGoogle Scholar
  4. 4.
    de Oliveira-Santos M, et al. Atherosclerotic plaque metabolism in high cardiovascular risk subjects - a subclinical atherosclerosis imaging study with 18F-NaF PET/CT. Atherosclerosis. 2017;260:41–6.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ehara S, Kobayashi Y, Yoshiyama M. Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study. ACC Curr J Rev. 2005;14:39.CrossRefGoogle Scholar
  6. 6.
    Joshi NV, et al. 18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial. Lancet. 2014;383:705–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Iung B, et al. A prospective survey of patients with valvular heart disease in Europe: the euro heart survey on Valvular heart disease. Eur Heart J. 2003;24:1231–43.CrossRefPubMedGoogle Scholar
  8. 8.
    Pawade TA, Newby DE, Dweck MR. Calcification in aortic stenosis. The skeleton key. J Am Coll Cardiol. 2015;66:561–77.CrossRefPubMedGoogle Scholar
  9. 9.
    Cueff C, et al. Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart. 2011;97:721–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Pawade T, et al. Computed tomography aortic valve calcium scoring in patients with aortic stenosis. Circ Cardiovasc Imaging. 2018;11:e007146.CrossRefPubMedGoogle Scholar
  11. 11.
    Corrigendum to: 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2018;39:1980–1980.Google Scholar
  12. 12.
    Dweck M, et al. 18F-sodium fluoride uptake is a marker of active calcification and disease progression in patients with aortic stenosis. J Am Coll Cardiol. 2013;61:E836.CrossRefGoogle Scholar
  13. 13.
    Chin CWL, Pawade TA, Newby DE, et al. Risk stratification in patients with aortic stenosis using novel imaging approaches. Circ Cardiovasc Imaging. 2015;8:e003421.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Dweck MR, et al. Midwall fibrosis is an independent predictor of mortality in patients with aortic stenosis. J Am Coll Cardiol. 2011;58:1271–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Chin CWL, et al. Myocardial fibrosis and cardiac decompensation in aortic stenosis. JACC Cardiovasc Imaging. 2017;10:1320–33.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Maurer MS, et al. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med. 2018;379:1007–16. Scholar
  17. 17.
    Trivieri MG, et al. 18F-sodium fluoride PET/MR for the assessment of cardiac amyloidosis. J Am Coll Cardiol. 2016;68:2712–4.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Morgenstern R, Yeh R, Castano A, Maurer MS, Bokhari S. 18Fluorine sodium fluoride positron emission tomography, a potential biomarker of transthyretin cardiac amyloidosis. J Nucl Cardiol. 2017;20:117–9.Google Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.British Heart Foundation/University of Edinburgh University Centre for Cardiovascular Science, University of EdinburghEdinburghUK

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