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New Scan Tool Might Predict Heart Attacks

November 12, 2013
Written by: , Filed in: Abdominal Imaging, Cardiac Imaging, Chest Radiology
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A new PET-CT imaging technique could make a “massive difference,” according to the co–senior author of a Lancet article about it. He’s right.

The new technique might be able not only to predict imminent heart attacks but also to pinpoint which atherosclerotic plaques are poised to rupture and cause the attack. Mark Dweck, PhD, the co-author mentioned above, summed up the implications in a BBC News interview:

If we can treat and stabilize the plaques, then we might be able to prevent heart attacks and stop people dying.

Dr. Dweck is a cardiologist and a clinical lecturer at the University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science in Edinburgh, Scotland. The Lancet article was published online Monday, along with an accompanying editorial that, as usual, hails the new discovery but sounds a note of caution.

The researchers discovered that the radioactive tracer 18F-sodium fluoride (18F-NaF), which has been used in bone imaging for 30 years, can mark high-risk plaques in PET-CT scans. Both plaques that had already ruptured and unruptured plaques that had high-risk features (as detected by intravascular ultrasound) showed increased uptake of the tracer.

If further research bears out the findings, this would be the first noninvasive method of finding plaques at high risk of rupture. “It could, for example,” says the article, “permit the identification of the vulnerable patient with single or multiple high-risk or silently ruptured plaques, providing an opportunity to treat and modify their risk to prevent future adverse cardiovascular events.”

But how do you take advantage of that opportunity? As the editorial points out, “Just because a plaque at risk for rupture can be identified does not mean that we know what to do with this information.”

Dr. Dweck suggested to the BBC that treatments might include drugs such as statins or aspirin, major lifestyle changes, or the insertion of stents into the arteries. “I suspect not all plaques detected will cause a heart attack,” he said, “but it could be useful for identifying high-risk patients who need aggressive therapy.”

Therapies need to be improved, and no doubt will be. But a noninvasive way of learning which patients need those therapies would definitely be a massive first step.

Related CME seminar (up to 12 AMA PRA Category 1 credits™): UCSF Cardiovascular & Pulmonary Imaging

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