To further develop highly innovative non-invasive fully hybrid vascular 18F-NaF PET/MRI for the identification of vascular microcalcifications as marker of plaque vulnerability in human carotid- and coronary arteries. This will be approached in preclinical experiments and, consecutively, in clinical studies in patients with carotid artery disease, who have to undergo carotid endarterectomy. The results will also be linked to 18F-NaF PET/MRI of the coronaries in patients with known or suspected coronary artery disease (CAD; resection of a plaque and histological evaluation is not an option in CAD).
Preclinical assessment of vascular 18F-NaF uptake will be performed by ESR 11 at the Department of Nuclear Medicine, CARIM, Maastricht, where a highly sophisticated preclinical imaging section is available, which also allows for ex vivo examinations with radioactive probes. MUMC+ has a fully integrated hybrid clinical PET/MRI system available. Human studies with 18F-NaF PET/MRI will focus on identification of microcalcifications as a marker of vulnerability in carotid and coronary plaques. Simultaneous MRI data acquisition will be used to identify morphological characteristics of plaque vulnerability such as endothelial permeability, inflammation, intraplaque haemorrhage and extracellular matrix remodelling in both arterial territories. Here, dedicated imaging protocols will be applied in closed collaboration with ESR10. Patients with known carotid artery disease who need to undergo surgical resection of the arterial plaque will receive a 18F-NaF PET/MRI one day before surgery. Imaging results of the 18F-NaF PET and the MRI will be correlated with each other and with the results of the histological evaluation of the plaque specimen (collaboration with ESR1 and ESR 7). In patients with known or suspected CAD, 18F-NaF PET/MRI will be performed and correlated with clinical risk factors for CAD.