SPECT/CT Imaging: A Noninvasive Approach for Evaluating Serial Changes in Angiosome Foot Perfusion in Critical Limb Ischemia

Autor: Michael R. Go, Said Atway, Timur P. Sarac, Ting-Heng Chou, Mitchel R. Stacy, Adam J Bobbey
Rok vydání: 2020
Předmět:
Male
critical limb ischemia
0301 basic medicine
Single Photon Emission Computed Tomography Computed Tomography
Critical Illness
perfusion imaging
angiosome
Perfusion scanning
Critical Care and Intensive Care Medicine
030207 dermatology & venereal diseases
03 medical and health sciences
0302 clinical medicine
Ischemia
peripheral arterial disease
medicine
Humans
Ankle Brachial Index
Popliteal Artery
angiography
Forum Technology Advances
skin and connective tissue diseases
Foot Ulcer
Angiosome
medicine.diagnostic_test
Foot
business.industry
Microcirculation
Angiography
Digital Subtraction
Critical limb ischemia
Middle Aged
body regions
Femoral Artery
Microvascular perfusion
030104 developmental biology
Regional Blood Flow
diabetes mellitus
Angiography
Emergency Medicine
sense organs
medicine.symptom
Ct imaging
Nuclear medicine
business
Perfusion
Angioplasty
Balloon
Foot (unit)
Zdroj: Advances in Wound Care
ISSN: 2162-1934
2162-1918
Popis: Objective: To investigate the feasibility of serial radiotracer-based imaging as a noninvasive approach for quantifying volumetric changes in microvascular perfusion within angiosomes of the foot following lower extremity revascularization in the setting of critical limb ischemia (CLI). Approach: A CLI patient with a nonhealing foot ulcer underwent single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging of the feet before and after balloon angioplasty of the superficial femoral artery (SFA) and popliteal artery. SPECT/CT imaging was used to evaluate serial changes in angiosome perfusion, which was compared to quantitative changes in peripheral vascular anatomy and hemodynamics, as assessed by standard clinical tools that included digital subtraction angiography (DSA), ankle-brachial index (ABI), and toe-brachial index (TBI). Results: Following revascularization, upstream quantitative improvements in stenosis of the SFA (pre: 35.4% to post: 11.9%) and popliteal artery (pre: 59.1% to post: 21.7%) shown by DSA were associated with downstream angiosome-dependent improvements in SPECT microvascular foot perfusion that ranged from 2% to 16%. ABI measurement was not possible due to extensive arterial calcification, while TBI values decreased from 0.26 to 0.16 following revascularization. Innovation: This is the first study to demonstrate the feasibility of assessing noninvasive volumetric changes in angiosome foot perfusion in response to lower extremity revascularization in a patient with CLI by utilizing radiotracer-based imaging. Conclusion: SPECT/CT imaging allows for quantification of serial perfusion changes within angiosomes containing nonhealing ulcers and provides physiological assessment that is complementary to conventional anatomical (DSA) and hemodynamic (ABI/TBI) measures in the evaluation of lower extremity revascularization.
Databáze: OpenAIRE
Externí odkaz: