18F-Fluoride Positron Emission Tomographic Imaging of Penile Arteries and Erectile Dysfunction |
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Authors: | Takehiro Nakahara Jagat Narula Jan GP Tijssen Sunil Agarwal Mohammed M Chowdhury Patrick A Coughlin Marc R Dweck James HF Rudd Masahiro Jinzaki John Mulhall H William Strauss |
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Institution: | 1. Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York;2. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York;3. Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan;4. Department of Cardiology, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands;5. Department of Vascular Surgery, University of Cambridge, Cambridge, United Kingdom;6. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom;g. Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom;h. Sexual and Reproductive Medicine Program, Memorial Sloan Kettering Cancer Center, New York, New York |
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Abstract: | BackgroundFluorine-18 sodium fluoride (NaF), a bone-seeking radiopharmaceutical used to detect osseous metastases, localizes in regions of microcalcification in atherosclerosis.ObjectivesTo determine if atherosclerosis of penile arteries plays a role in erectile dysfunction (ED), this study analyzed NaF images in prostate cancer patients.MethodsNaF positron emission tomography–computed tomography bone scans were evaluated in 437 prostate cancer patients (age 66.6 ± 8.7 years). Their urologic histories were reviewed for prevalent ED (diagnosed before the scan date) or incident ED (no ED at first scan, but developed during 1-year follow-up); patients with no ED (neither before the scan nor during follow-up) were included as a control group. A semicircular region of interest was set on the dorsal one-half of the penis (to avoid residual excreted activity in the urethra) on 5 contiguous slices at the base of the penis on positron emission tomography–computed tomography coronal reconstructions, and the average standardized uptake value (SUVmax) was described as NaF uptake.ResultsOf 437 patients, 336 (76.9%) had prevalent ED, 60 incident ED (13.7%), and 41 had no ED (9.4%). SUVmax in patients with prevalent (median 1.88; interquartile range IQR]: 1.67 to 2.16) or incident (median 1.86; IQR: 1.72 to 2.08) ED was significantly higher than no ED (median 1.42; IQR: 1.25 to 1.54) patients (p < 0.001). After adjustment for other risk factors, the odds ratio of prevalent or incident ED was 25.2 (95% confidence interval: 9.5 to 67.0) for every 0.5-U increment in SUVmax with receptor operating characteristic area of 0.91 (95% confidence interval: 0.88 to 0.94).ConclusionsNaF uptake in penile vessels suggests that atherosclerosis is associated with ED in prostate cancer patients. The importance of NaF uptake needs to be tested in noncancer subjects and cause-effect relationship needs to be established. |
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Keywords: | atherosclerosis calcification erectile dysfunction NaF sodium fluoride CAD coronary artery disease EBRT external beam radiotherapy ED erectile dysfunction NaF Fluorine-18 sodium fluoride PET-CT positron emission tomography–computed tomography ROC receptor operating characteristic ROI region of interest SUVmax standardized uptake value |
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