Abstract
Peripheral arterial disease (PAD) is an atherosclerotic disorder of non-coronary arteries that is associated with vascular stenosis and/or occlusion. PAD affecting the lower extremities is characterized by a variety of health-related consequences, including lifestyle-limiting intermittent claudication, ulceration of the limbs and/or feet, increased risk for lower extremity amputation, and increased mortality. The diagnosis of lower extremity PAD is typically established by using non-invasive tests such as the ankle-brachial index, toe-brachial index, duplex ultrasound, and/or angiography imaging studies. While these common diagnostic tools provide hemodynamic and anatomical vascular assessments, the potential for non-invasive physiological assessment of the lower extremities has more recently emerged through the use of magnetic resonance- and nuclear medicine-based approaches, which can provide insight into the functional consequences of PAD-related limb ischemia. This perspectives article specifically highlights and discusses the emerging applications of clinical nuclear medicine techniques for molecular imaging investigations in the setting of lower extremity PAD.
Highlights
Peripheral arterial disease (PAD) is an atherosclerotic disease affecting non-coronary arteries that is associated with vascular stenosis and/or occlusion
These studies have demonstrated that arterial uptake of 18F-NaF is significantly higher in non-lower extremity arteries of PAD patients compared to non-PAD patients [42] and that femoral artery 18F-NaF uptake is significantly associated with various modifiable cardiovascular risk factors [43], suggesting that 18F-NaF positron emission tomography (PET)/Computed tomography (CT) imaging could be used in the future for non-invasively monitoring the response to treatments focused on cholesterol reduction and/or glucose management
Recent studies have demonstrated that single photon emission computed tomography (SPECT)/CT perfusion imaging may enable the screening, diagnosis, and monitoring of responses to treatment [21, 22, 25], while PET/CT imaging may provide novel opportunities for molecular imaging of atherosclerosis and vascular inflammation [47], which to date, have remained relatively understudied in the setting of lower extremity PAD
Summary
Peripheral arterial disease (PAD) is an atherosclerotic disease affecting non-coronary arteries that is associated with vascular stenosis and/or occlusion. Following an ∼7 year period of time passing without a single study published in this field, an increasing number of studies have emerged in the last 2 years using 18F-NaF to evaluate peripheral atherosclerosis in patients with PAD These studies have demonstrated that arterial uptake of 18F-NaF is significantly higher in non-lower extremity arteries of PAD patients compared to non-PAD patients [42] and that femoral artery 18F-NaF uptake is significantly associated with various modifiable cardiovascular risk factors (i.e., cholesterol, triglycerides, HbA1c) [43], suggesting that 18F-NaF PET/CT imaging could be used in the future for non-invasively monitoring the response to treatments focused on cholesterol reduction and/or glucose management. The applications for 18F-NaF PET/CT are rapidly evolving, with numerous future research directions on the horizon for molecular imaging of atherosclerosis in patients with PAD
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