Determinants of ¹⁸F-NaF uptake in femoral arteries in patients with type 2 diabetes mellitus

Background: The goal of this study was to investigate the potential determinants of ¹⁸F-NaF uptake in femoral arteries as a marker of arterial calcification in patients with type 2 diabetes and a history of arterial disease.

Methods and results: The study consisted of participants of a randomized controlled trial to investigate the effect of vitamin K2 (NCT02839044). In this prespecified analysis, subjects with type 2 diabetes and known arterial disease underwent full body ¹⁸F-NaF PET/CT. Target-to-background ratio (TBR) was calculated by dividing the mean SUV_max from both superficial femoral arteries by the SUV_mean in the superior vena cava (SVC) and calcium mass was measured on CT. The association between ¹⁸F-NaF TBR and cardiovascular risk factors was investigated using uni- and multivariate linear regression corrected for age and sex. In total, 68 patients (mean age: 69 ± 8 years; male: 52) underwent ¹⁸F-NaF PET/CT. Higher CT calcium mass, total cholesterol, and HbA1c were associated with higher ¹⁸F-NaF TBR after adjusting.

Conclusion: This study shows that several modifiable cardiovascular risk factors (total cholesterol, triglycerides, HbA1c) are associated with femoral ¹⁸F-NaF tracer uptake in patients with type 2 diabetes.