European journal of nuclear medicine and molecular imaging · 2025
Prognostic value of [18F]FAZA PET/MR imaging pre and post revascularization in chronic limb-threatening ischemia: a prospective pilot study on tissue microcirculation.
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Mirshahvalad Seyed Ali, Farag Adam, Sekine Tetsuro, Kohan Andres, Mafeld Sebastian, Roche-Nagle Graham, Byrne John, Metser Ur, Tan Kongteng, Veit-Haibach Patrick
Аннотация
PURPOSE: To evaluate the prognostic value of [18F]FAZA PET in predicting long-term clinical outcomes of critical limb-threatening ischemia (CLTI) patients undergoing endovascular revascularization.
METHODS: This prospective pilot study received IRB and ethics committee approval. Patients who were planned to undergo revascularization were recruited. All patients underwent both dynamic and static [18F]FAZA PET at two different time points, before and after revascularization. After modelling, dynamic [18F]FAZA PET-derived parameters (including K1, K2, K3, K4, Ki, and total volume distribution [VT]) were extracted from each scan, and delta parameters were calculated. Also, standardized uptake values were calculated from the static [18F]FAZA PET. Furthermore, ankle-brachial indices (ABIs) were measured before and after revascularization. Patients were followed up clinically. All major events were documented, and patients were classified into two groups accordingly: "sustained response" and "therapy failure".
RESULTS: From the 12 prospectively recruited patients (mean age = 69 years), five patients were diagnosed with therapy failure during follow-up. K1 (p = 0.012) and ABI (p = 0.006) were significantly different in the post-angioplasty setting versus pre-angioplasty evaluations, being significantly lower and higher, respectively. In patients who experienced sustained clinical response, K1 (p = 0.028; significantly lower after treatment), VT (p = 0.018; significantly higher after treatment), and ABI (p = 0.028; significantly higher after treatment) were significantly different after angioplasty versus before angioplasty. In patients with therapy failure, only VT (p = 0.043; significantly lower after treatment) was significantly different. Considering between-group differences, ΔVT was significantly different between those who experienced sustained response versus those with therapy failure (p = 0.003).
CONCLUSION: Our findings could support the potential prognostic value of changes in dynamic [18F]FAZA's initial volume distribution in the pre- versus post-revascularization setting. Unlike traditional measures, such as ABI, which show tissue's macrovasculature patency, dynamic [18F]FAZA PET could capture tissue-level microcirculation by VT mapping.
METHODS: This prospective pilot study received IRB and ethics committee approval. Patients who were planned to undergo revascularization were recruited. All patients underwent both dynamic and static [18F]FAZA PET at two different time points, before and after revascularization. After modelling, dynamic [18F]FAZA PET-derived parameters (including K1, K2, K3, K4, Ki, and total volume distribution [VT]) were extracted from each scan, and delta parameters were calculated. Also, standardized uptake values were calculated from the static [18F]FAZA PET. Furthermore, ankle-brachial indices (ABIs) were measured before and after revascularization. Patients were followed up clinically. All major events were documented, and patients were classified into two groups accordingly: "sustained response" and "therapy failure".
RESULTS: From the 12 prospectively recruited patients (mean age = 69 years), five patients were diagnosed with therapy failure during follow-up. K1 (p = 0.012) and ABI (p = 0.006) were significantly different in the post-angioplasty setting versus pre-angioplasty evaluations, being significantly lower and higher, respectively. In patients who experienced sustained clinical response, K1 (p = 0.028; significantly lower after treatment), VT (p = 0.018; significantly higher after treatment), and ABI (p = 0.028; significantly higher after treatment) were significantly different after angioplasty versus before angioplasty. In patients with therapy failure, only VT (p = 0.043; significantly lower after treatment) was significantly different. Considering between-group differences, ΔVT was significantly different between those who experienced sustained response versus those with therapy failure (p = 0.003).
CONCLUSION: Our findings could support the potential prognostic value of changes in dynamic [18F]FAZA's initial volume distribution in the pre- versus post-revascularization setting. Unlike traditional measures, such as ABI, which show tissue's macrovasculature patency, dynamic [18F]FAZA PET could capture tissue-level microcirculation by VT mapping.