OBJECTIVES This study determined whether in vivo positron emission tomography (PET) of arterial inflammation (18F-fluorodeoxyglucose [18F-FDG]) or microcalcification (18F-sodium fluoride [18F-NaF]) could predict restenosis following PTA. BACKGROUND Restenosis following lower limb percutaneous transluminal angioplasty (PTA) is common, unpredictable, and challenging to treat. Currently, it is impossible to predict which patient will suffer from restenosis following angioplasty. METHODS In this prospective observational cohort study, 50 patients with symptomatic peripheral arterial disease underwent 18F-FDG and 18F-NaF PET/computed tomography (CT) imaging of the superficial femoral artery before and 6 weeks after angioplasty. The primary outcome was arterial restenosis at 12 months. RESULTS Forty subjects completed the study protocol with 14 patients (35%) reaching the primary outcome of restenosis. The baseline activities of femoral arterial inflammation (18F-FDG tissue-to-background ratio [TBR] 2.43 [interquartile range (IQR): 2.29 to 2.61] vs. 1.63 [IQR: 1.52 to 1.78]; p < 0.001) and microcalcification (18F-NaF TBR 2.61 [IQR: 2.50 to 2.77] vs. 1.69 [IQR: 1.54 to 1.77]; p < 0.001) were higher in patients who developed restenosis. The predictive value of both 18F-FDG (cut-off TBRmax value of 1.98) and 18F-NaF (cut-off TBRmax value of 2.11) uptake demonstrated excellent discrimination in predicting 1-year restenosis (Kaplan Meier estimator, log-rank p < 0.001). CONCLUSIONS Baseline and persistent femoral arterial inflammation and micro-calcification are associated with restenosis following lower limb PTA. For the first time, we describe a method of identifying complex metabolically active plaques and patients at risk of restenosis that has the potential to select patients for intervention and to serve as a biomarker to test novel interventions to prevent restenosis.

中文翻译：

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有症状的外周动脉疾病的血管正电子发射断层扫描和再狭窄：一项前瞻性临床研究。

目标 本研究确定动脉炎症（18F-氟脱氧葡萄糖 [18F-FDG]）或微钙化（18F-氟化钠 [18F-NaF]）的体内正电子发射断层扫描 (PET) 是否可以预测 PTA 后的再狭窄。背景 下肢经皮腔内血管成形术 (PTA) 后的再狭窄是常见的、不可预测的并且治疗起来具有挑战性。目前，不可能预测哪个患者在血管成形术后会遭受再狭窄。方法 在这项前瞻性观察性队列研究中，50 名有症状的外周动脉疾病患者在血管成形术之前和之后 6 周接受了股浅动脉的 18F-FDG 和 18F-NaF PET/计算机断层扫描 (CT) 成像。主要结果是 12 个月时的动脉再狭窄。结果 40 名受试者完成了研究方案，其中 14 名患者 (35%) 达到了再狭窄的主要结果。股动脉炎症的基线活动（18F-FDG 组织背景比 [TBR] 2.43 [四分位距 (IQR)：2.29 至 2.61] 对比 1.63 [IQR：1.52 至 1.78]；p < 0.001）和微钙化 ( 18F-NaF TBR 2.61 [IQR：2.50 至 2.77] 对比 1.69 [IQR：1.54 至 1.77]；p < 0.001) 在发生再狭窄的患者中更高。18F-FDG（截断 TBRmax 值为 1.98）和 18F-NaF（截断 TBRmax 值为 2.11）摄取的预测值在预测 1 年再狭窄方面表现出极好的辨别力（Kaplan Meier 估计，对数秩 p < 0.001）。结论 基线和持续性股动脉炎症和微钙化与下肢 PTA 后的再狭窄有关。