Research Square · Oct 18, 2026
[18F]NaF PET Radiomics and Coronary Calcium Score Progression: Associations Beyond Baseline Calcium Score and TBR
By Li S, Kendrick J, Ebert MA et al.
Background: [ ¹⁸ F]NaF positron emission tomography (PET) can quantify coronary calcification activity before coronary calcium score (CCS) progression, which is a surrogate measure of cardiovascular disease risk. It remains uncertain whether advanced PET quantification, including radiomics, improves prediction of CCS progression. Participants with type 2 diabetes underwent baseline [ ¹⁸ F]NaF PET/CT, baseline CCS and a follow-up CCS after 2 years. CCS progression was evaluated on a per-patient and a per-artery level. [ ¹⁸ F]NaF activity was evaluated using the TBR max , and radiomics features. Logistic regression models were used to determine the features most associated with CCS progression. Results: In total, 91 participants (median age [interquartile range]: 66 [60 – 70], 71.4% male) were examined. In total, 68 patients (74.7%) demonstrated CCS progression. Clinical variables and baseline CCS discriminated CCS progressors and non-progressors modestly (AUC 0.72, 95% CI 0.55–0.86). The TBR max demonstrated good discrimination (AUC 0.83, 95% CI 0.73–0.92), while multi-feature radiomics models achieved the highest discrimination performance (AUC 0.90, 95% CI 0.80–0.97). A total of 211 coronary arteries (58.0%) demonstrated CCS progression. The combined CCS and TBR max model discriminated CCS progressors and non-progressors modestly (AUC of 0.67, 95% CI 0.60–0.73), while the multi-feature radiomics demonstrated good discrimination (AUC 0.77, 95% CI: 0.70–0.84). Conclusions: [ ¹⁸ F]NaF PET radiomics improves prediction of CCS progression compared with baseline CCS, clinical features, and the TBR max .