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Correlations have been drawn between sodium fluoride uptake and the presence of high-risk plaque features, as well as its association with clinical atherosclerotic sequelae. The aim of this study was to perform a meta-analysis of NaF uptake on PET imaging and its relation to symptomatic and asymptomatic disease.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A systematic review was performed according to PRISMA guidelines, via searching the Ovid MEDLINE, Ovid Embase, Cochrane Library, PubMed, Scopus, and Web of Science Core Collection databases up to May 2024. The search strategy included the terms \u2018NaF\u2019, \u2018PET\u2019, and \u2018plaque\u2019, and all studies with data regarding the degree of microcalcification, as measured by\n                      <jats:sup>18<\/jats:sup>\n                      F-NaF uptake in symptomatic and asymptomatic atherosclerotic plaques, were included. Analysis involved calculating mean differences between uptake values and comparison using a random-effects model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 16 articles, involving 423 participants, were included in the meta-analysis (10 carotid artery studies, five coronary artery studies, and one in peripheral vascular disease). Comparing\n                      <jats:sup>18<\/jats:sup>\n                      F-NaF uptake in symptomatic versus asymptomatic atherosclerotic plaques, a mean difference of 0.43 (95% CI 0.29 to 0.57;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.0001,\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 65%) was noted in studies comparing symptomatic and asymptomatic plaques in the same participant, with a significant difference in effect based on arterial territory studied (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      = 12.68,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.0018). In studies of participants with and without symptomatic disease, there was no significant difference between symptomatic and asymptomatic plaques (mean difference 0.27, 95% CI \u22120.26 to 0.80,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.28,\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 85%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      PET imaging using\n                      <jats:sup>18<\/jats:sup>\n                      F-NaF can detect differences in microcalcification between symptomatic and asymptomatic atherosclerotic plaques within, but not between, individuals, and thus, is a marker of symptomatic disease. The standardization of\n                      <jats:sup>18<\/jats:sup>\n                      F-NaF PET imaging protocols, and its future use as a risk stratification tool or outcome measure, requires further study.\n                      <jats:bold>(PROSPERO Registration ID: CRD42023451363)<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1358863x241287692","type":"journal-article","created":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T14:13:58Z","timestamp":1729174438000},"page":"10-19","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["<sup>18<\/sup>\n                    F-NaF uptake on vascular PET imaging in symptomatic versus asymptomatic atherosclerotic disease: A meta-analysis"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3201-0791","authenticated-orcid":false,"given":"Shiv","family":"Bhakta","sequence":"first","affiliation":[{"name":"Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed M","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M","family":"Tarkin","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James HF","family":"Rudd","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A","family":"Warburton","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas R","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,10,16]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0106-z"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23063346"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab892"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.004080"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(72)90624-8"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000152985.32732.EE"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002354"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2008.10.013"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.108.179739"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2012.07.007"},{"key":"e_1_3_2_12_2","article-title":"Carotid plaque magnetic resonance imaging and recurrent stroke risk: A systematic review and meta-analysis","volume":"99","author":"Deng F","year":"2020","unstructured":"Deng F, Mu C, Yang L, et al. 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