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Background While [ 18 F]-fluordeoxyglucose ([ 18 F]FDG) uptake is associated with arterial inflammation, [ 18 F]-sodium fluoride ([ 18 F]NaF) is a marker for arterial micro-calcification. We aimed to investigate the prospective correlation between both PET markers over time and whether they are prospectively ([ 18 F]FDG) and retrospectively ([ 18 F]NaF) related to progression of systemic arterial disease in a longitudinal study in patients with type 2 diabetes mellitus (T2DM). Methods Baseline [ 18 F]FDG PET/Low Dose (LD) Computed Tomography (CT) scans of ten patients with early T2DM without cardiovascular history (70% men, median age 63 years) were compared with five-year follow-up [ 18 F]NaF/LDCT scans. Systemic activity was expressed as mean target-to-background ratio ( mean TBR) by dividing the maximal standardized uptake value (SUV max ) of ten arteries by SUV mean  of the caval vein. CT-assessed macro-calcifications were scored visually and expressed as calcified plaque (CP) score. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (PWV). Five-year changes were expressed absolutely with delta (Δ) and relatively with %change. Results Baseline  mean TBR[ 18 F]FDG was strongly correlated with five-year follow-up  mean TBR[ 18 F]NaF ( r  = 0.709,  P  = .022).  mean TBR[ 18 F]NaF correlated positively with ΔCPscore, CPscore at baseline, and follow-up ( r  = 0.845,  P  = .002 and  r  = 0.855,  P  = .002, respectively), but not with %change in CPscore and PWV. Conclusion This proof-of-concept study demonstrated that systemic arterial inflammation is an important pathogenetic factor in systemic arterial micro-calcification development.

journal of nuclear cardiology

[18F]FDG and [18F]NaF as PET markers of systemic atherosclerosis progression: A longitudinal descriptive imaging study in patients with type 2 diabetes mellitus