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RADIOTRACER IMAGING ALLOWS FOR ASSESSMENT OF SERIAL CHANGES IN ANGIOSOME FOOT PERFUSION FOLLOWING REVASCULARIZATION AND PREDICTS LIMB SALVAGE OUTCOMES IN PATIENTS WITH CRITICAL LIMB ISCHEMIA
1393 JACC March 21, 2017 Volume 69, Issue 11
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) RADIOTRACER IMAGING ALLOWS FOR ASSESSMENT OF SERIAL CHANGES IN ANGIOSOME FOOT PERFUSION FOLLOWING REVASCULARIZATION AND PREDICTS LIMB SALVAGE OUTCOMES IN PATIENTS WITH CRITICAL LIMB ISCHEMIA Oral Contributions Room 140 B Sunday, March 19, 2017, 8:12 a.m.-8:22 a.m. Session Title: Highlighted Original Research: Non Invasive Imaging and the Year in Review Abstract Category: 30. Non Invasive Imaging: Nuclear Presentation Number: 909-04 Authors: Jessica Buckley, Carlos Mena-Hurtado, Sangchoon Jeon, Xenophon Papademetris, Peter A. Blume, Bauer Sumpio, Albert Sinusas, Mitchel Stacy, Yale University School of Medicine, New Haven, CT, USA
Background: Standard tools do not exist for evaluating volumetric microvascular foot perfusion after revascularization. Assessing serial changes in perfusion in critical limb ischemia (CLI) patients could assist in characterizing treatment success and predicting clinical outcomes.
Methods: Diabetic patients with CLI and non-healing ulcers (n=21) underwent single-photon emission computed tomography (SPECT)/ CT perfusion imaging of the feet before and after percutaneous revascularization (Fig. 1A). CT images were segmented into angiosomes and radiotracer uptake was expressed as standardized uptake values (SUVs). Change in SUV of ulcerated angiosomes was quantified and 3-month limb salvage outcomes were assessed. Logistic regression assessed the odds ratio of amputation for every 1% increase in perfusion. The receiver operating characteristic curve provided the area under the curve (AUC) to assess discriminability of amputation using change in perfusion.
Results: Changes in perfusion significantly differed between patients with and patients without amputation in the 3 months post-treament (Fig. 1B). AUC was 0.90, representing excellent discriminability. The estimated odds ratio of 0.60 revealed risk of amputation was 50% when an 8% change in perfusion was observed and risk dropped to 10% when change was 13% or greater (Fig. 1C).
Conclusions: SPECT/CT imaging predicts early outcomes in CLI patients undergoing revascularization and offers a quantitative approach for assessing treatment.
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) RADIOTRACER IMAGING ALLOWS FOR ASSESSMENT OF SERIAL CHANGES IN ANGIOSOME FOOT PERFUSION FOLLOWING REVASCULARIZATION AND PREDICTS LIMB SALVAGE OUTCOMES IN PATIENTS WITH CRITICAL LIMB ISCHEMIA Oral Contributions Room 140 B Sunday, March 19, 2017, 8:12 a.m.-8:22 a.m. Session Title: Highlighted Original Research: Non Invasive Imaging and the Year in Review Abstract Category: 30. Non Invasive Imaging: Nuclear Presentation Number: 909-04 Authors: Jessica Buckley, Carlos Mena-Hurtado, Sangchoon Jeon, Xenophon Papademetris, Peter A. Blume, Bauer Sumpio, Albert Sinusas, Mitchel Stacy, Yale University School of Medicine, New Haven, CT, USA
Background: Standard tools do not exist for evaluating volumetric microvascular foot perfusion after revascularization. Assessing serial changes in perfusion in critical limb ischemia (CLI) patients could assist in characterizing treatment success and predicting clinical outcomes.
Methods: Diabetic patients with CLI and non-healing ulcers (n=21) underwent single-photon emission computed tomography (SPECT)/ CT perfusion imaging of the feet before and after percutaneous revascularization (Fig. 1A). CT images were segmented into angiosomes and radiotracer uptake was expressed as standardized uptake values (SUVs). Change in SUV of ulcerated angiosomes was quantified and 3-month limb salvage outcomes were assessed. Logistic regression assessed the odds ratio of amputation for every 1% increase in perfusion. The receiver operating characteristic curve provided the area under the curve (AUC) to assess discriminability of amputation using change in perfusion.
Results: Changes in perfusion significantly differed between patients with and patients without amputation in the 3 months post-treament (Fig. 1B). AUC was 0.90, representing excellent discriminability. The estimated odds ratio of 0.60 revealed risk of amputation was 50% when an 8% change in perfusion was observed and risk dropped to 10% when change was 13% or greater (Fig. 1C).
Conclusions: SPECT/CT imaging predicts early outcomes in CLI patients undergoing revascularization and offers a quantitative approach for assessing treatment.