18F-Sodium Fluoride Positron Emission Tomography

Coronary atherosclerosis is a progressive disease that involves vascular inflammation, development of cholesterol burdened atheroma, mechanisms of injury and repair, and subsequent calcification (1). Coronary artery calcification (CAC) detected with cardiac computed tomography has been shown to correlate well with overall plaque burden and is an independent predictor of cardiovascular events (2,3). It is well known that traditional cardiovascular risk factors contribute to the first incidence of CAC and CAC progression (4,5). Once present, CAC is diagnostic of the presence of coronary atherosclerosis, with increasing CAC burden correlating with increasing atherosclerosis burden and inferring different risks for cardiovascular events dependent on age, sex, race, and ethnicity (6). Once CAC is present, the atherosclerotic disease process is firmly established and therapies to induce plaque progression, although effective, are modest at best and inevitably leave a substantial residual risk of coronary events (7).