{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T09:24:12Z","timestamp":1787217852026,"version":"build-2736575974"},"reference-count":84,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>Ischemic heart disease is currently diagnosed mainly through cardiac computed tomography (CT) angiography and functional testing, both of which detect only advanced arterial macrocalcification, at a stage when treatment can merely slow disease progression rather than reverse it. Yet, macrocalcification represents the end product of a much earlier molecular process, which is microcalcification. This process is driven by smooth muscle cell and macrophage apoptosis, matrix vesicle release, and osteogenic phenotypic transitions within the arterial intima, occurring years to decades before mineral deposits become visible on CT. [18F]Sodium fluoride (NaF) positron emission tomography (PET) exploits fluoride binding at accessible hydroxyapatite surfaces to detect increased tracer uptake associated with active mineral deposition, including mineralization occurring at a microscopic scale below the direct spatial resolution of clinical PET. Studies demonstrate that anti-atherosclerotic interventions, including statins, and tissue-nonspecific alkaline phosphatase inhibition can suppress NaF uptake even when CT-based calcium scores remain unchanged or continue to rise, a dissociation now also observed in human trials of statins and PCSK9 inhibitors. This review traces the cellular and histological basis of arterial calcification, outlines the principles and limitations of NaF-PET imaging, and evaluates its emerging role\u2014supported by artificial intelligence-based quantification\u2014as a tool for monitoring targeted anti-atherosclerotic treatment.<\/jats:p>","DOI":"10.3390\/cells15161496","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T08:10:20Z","timestamp":1787213420000},"page":"1496","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["NaF-PET Imaging for Detection of Early Arterial Microcalcification and Monitoring of Targeted Therapy: A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6379-3373","authenticated-orcid":false,"given":"Reza","family":"Piri","sequence":"first","affiliation":[{"name":"Department of Radiology, Herlev and Gentofte University Hospital, 2730 Copenhagen, Denmark"},{"name":"Department of Radiology, Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4062-4382","authenticated-orcid":false,"given":"Sepita","family":"Taghizadeh","sequence":"additional","affiliation":[{"name":"Student Research Committee, Tabriz University of Medical Sciences, Tabriz 516615731, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7420-2367","authenticated-orcid":false,"given":"Poul Flemming","family":"H\u00f8ilund-Carlsen","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark"},{"name":"Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4019","DOI":"10.1093\/eurheartj\/ehae466","article-title":"European Society of Cardiology: The 2023 Atlas of Cardiovascular Disease Statistics","volume":"45","author":"Timmis","year":"2024","journal-title":"Eur. 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