Abstract 12299: Molecular Imaging of Active Vascular Microcalcification in the Lower Extremities of Patients With Diabetes and Peripheral Arterial Disease

Abstract

Introduction: Patients with diabetes mellitus (DM) have accelerated progression of peripheral arterial disease (PAD) with higher prevalence of arterial calcification, which can limit and make options for endovascular revascularization more challenging, contribute to worse treatment outcomes, and result in higher rates of amputation. Positron emission tomography (PET) imaging with fluorine-18 ( 18 F)-sodium fluoride (NaF) has shown utility for detecting active microcalcification of coronary arteries but remains relatively understudied in patients with PAD. We hypothesized that 18 F-NaF PET/CT imaging could be used to quantify DM-induced active microcalcification of lower extremity arteries. Methods: 18 F-NaF PET/CT imaging was performed in PAD patients with type 2 DM (n=11), PAD patients without DM (n=8), and healthy controls (n=6). Regions of interest were manually drawn bilaterally on each axial slice of CT images for the femoral, popliteal, anterior tibial, tibioperoneal trunk, posterior tibial, and peroneal arteries to quantify 18 F-NaF uptake. The maximum target-to-background ratio (TBR max ) was calculated for each artery of interest. Results: 18 F-NaF PET/CT imaging non-invasively detected significantly higher active microcalcification of the femoral-popliteal, anterior tibial, tibioperoneal trunk, and posterior tibial arteries in patients with DM and PAD compared to healthy controls ( Fig. 1 ). A noticeable trend (not significant) in increasing arterial retention of 18 F-NaF was found with increasing disease status (i.e., healthy, PAD only, PAD with DM) ( Fig. 1 ). Conclusions: 18 F-NaF PET/CT quantifies vessel-specific active calcification of above- and below-the-knee arteries in patients with DM and PAD. PET/CT may offer insight into early pathophysiology of peripheral disease in patients with DM, thereby improving personalized therapeutic approaches for a population that suffers from significant morbidity and mortality.