Positron Emission Tomography in Atherosclerotic Imaging
Summary
Positron emission tomography (PET) has emerged as a transformative tool in the non-invasive characterisation of atherosclerotic disease by visualising biological activity within the arterial wall. Rather than relying solely on anatomical narrowing, PET probes molecular processes such as inflammation, microcalcification and cellular proliferation that underpin plaque development, vulnerability and progression. Radiotracers labelled with positron-emitting isotopes—most commonly fluorine-18—accumulate in regions of active disease, producing quantifiable signals when imaged in conjunction with computed tomography or magnetic resonance. This dual-modality approach integrates high-resolution morphology with metabolic and molecular insights, enabling early detection of high-risk plaques, assessment of response to therapy and longitudinal monitoring of disease stability. Ongoing refinements in tracer chemistry, image acquisition and kinetic modelling are enhancing spatial resolution, improving reproducibility and reducing radiation exposure, thereby widening clinical applicability and supporting the development of targeted interventions to reduce cardiovascular events.
Research from Nature Portfolio
Recent studies have elucidated the unique capability of fluoride-based PET to detect nascent microcalcification, a hallmark of unstable atheroma. Investigators combined preclinical electron microscopy, autoradiography and histology with clinical PET/CT to demonstrate that 18F-sodium fluoride binds selectively with high affinity to small crystalline deposits within plaques. This work confirmed the ability to distinguish early microcalcification from established macrocalcification, offering a specific non-invasive marker of active calcific remodelling and potential plaque instability.
Positron Emission Tomography in Atherosclerotic Imaging publication trend
The graph below shows the total number of articles in positron emission tomography in atherosclerotic imaging across all publications each year (not limited to Nature Index journals).
Technical terms
Positron emission tomography (PET): An imaging modality that uses radiolabelled tracers emitting positrons to visualise and measure metabolic or molecular processes in tissues.
Radiotracer: A molecule tagged with a radioactive isotope designed to target specific biological pathways, allowing in vivo imaging of cellular activity.
18F-sodium fluoride (18F-NaF): A PET tracer that binds to hydroxyapatite crystals, enabling detection of active microcalcification in atherosclerotic plaques.
18F-fluorodeoxyglucose (18F-FDG): A glucose analogue taken up by metabolically active cells, commonly used to image inflammation within atherosclerotic lesions.
Target-to-background ratio (TBR): A quantitative metric comparing tracer uptake in a region of interest to that in reference tissue, used to standardise PET signal measurements.
References
- PET Imaging of Atherosclerotic Disease: Advancing Plaque Assessment from Anatomy to Pathophysiology. Current Atherosclerosis Reports (2016).
- Identifying active vascular microcalcification by 18F-sodium fluoride positron emission tomography. Nature Communications (2015).
- Atorvastatin lowers 68Ga-DOTATATE uptake in coronary arteries, bone marrow and spleen in individuals with type 2 diabetes. Diabetologia (2023).
- Temporal Changes in Coronary 18F-Fluoride Plaque Uptake in Patients with Coronary Atherosclerosis. Journal of Nuclear Medicine (2023).
- 18F-NaF and 18F-FDG as molecular probes in the evaluation of atherosclerosis. European Journal of Nuclear Medicine and Molecular Imaging (2018).
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