F-18-Natriumfluorid-PET/CT zur Darstellung koronarer Plaquerupturen

Zusammenfassung

Eine der häufigsten Todesursachen weltweit ist die Myokardischämie nach Ruptur eines arteriosklerotischen Plaques in einer Koronararterie. Nicht jeder Plaque ist rupturgefährdet, doch bislang fehlten Möglichkeiten, vulnerable Plaques nicht-invasiv zu identifizieren, um rechtzeitig eine Ruptur abzuwenden oder die betroffene Koronararterie vor einem konsekutiven Verschluss zu schützen. F-18-Natriumfluorid ist ein PET-Radiopharmakon zur Darstellung der Knochenbildung. Man weiß schon länger, dass sich F-18-Natriumfluorid in aktiven Verkalkungen der Aortenwand oder der Koronararterien anreichert. Neueste Studienergebnisse an Patienten kurz nach Myokardinfarkt zeigen, dass Plaque-Rupturen vermehrt Fluorid anreichern. Weiterhin konnte man zeigen, dass bei Patienten mit stabiler Angina pectoris die Fluorid-Aufnahme im Plaque und intrakoronar-sonografisch erfasste Ruptur-Kriterien eng korrelieren. Anhand von Material aus Karotis-Endarterektomien konnte man histologisch bestätigen, dass sich F-18-Fluorid in rupturiertem arteriosklerotischen Gewebe anreichert. Mit der F-18-Natriumfluorid-PET/CT gibt es somit erstmals eine klinisch einsetzbare, nicht-invasive Methode zur Darstellung der beginnenden Plaque-Ruptur. Gerade bei akuten Koronarsyndromen, vielleicht auch bei stabiler Angina pectoris verspricht man sich therapierelevante Zusatzinformation durch diese neue Indikation für F-18-Fluorid-PET/CT.

Abstract

One of the most common causes of death worldwide is myocardial ischemia from a ruptured atherosclerotic plaque in a coronary artery. Not every plaque is at risk for rupture. Up to now there was no imaging modality to non-invasively identify a vulnerable plaque and to initiate treatment needed to prevent rupture or consecutive obstruction. F-18 sodium fluoride is a PET radiopharmaceutical for the imaging of bone forma­tion. A while ago F-18 sodium fluoride was observed to accumulate in active calcifications of the aortic wall and of the coronary arteries. A recent study in patients shortly after myocardial infarction showed that ruptured plaques accumulate F-18 fluoride. In patients with stable angina, a close correlation was found between F-18 fluoride uptake and the signs of a plaque rupture as demonstrated by means of intra-­coronary ultrasound. Based on histological analysis of specimens from carotid endarterectomy it was confirm­ed that F-18 fluoride accumulates in ruptured atherosclerotic tissue. With F-18 sodium fluoride PET/CT, for the first time a non-invasive method for the imaging of incipient plaque rupture is clinically feasible. Especially in acute coronary syndromes, maybe also in patients with stable angina, additional information guiding therapy is expected from this new indication of F-18 sodium fluoride PET/CT.

Schlüsselwörter

arteriosklerotischer Plaque - F-18-Natriumfluorid - PET/CT

Key words

atherosclerotic plaque - F-18 sodium fluoride - PET/CT

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