A Clinical Feasibility Study to Image Angiogenesis in Patients with Arteriovenous Malformations Using ⁶⁸Ga-RGD PET/CT

Abstract

A Clinical Feasibility Study to Image Angiogenesis in Patients with Arteriovenous http://jnm.snmjournals.org/content/61/2/270 This article and updated information are available at: http://jnm.snmjournals.org/site/subscriptions/online.xhtml Information about subscriptions to JNM can be found at: http://jnm.snmjournals.org/site/misc/permission.xhtml

Imaging of peripheral vascular malformations — current concepts and future perspectives

“…Gallium-68 labeled dimeric RGD ( 68 Ga-RGD) is binding integrin αvβ3 with high affinity, as manifold demonstrated in tumor imaging [ 95 – 97 ]. A recently published [ 86 ] pilot study aiming to image proliferative angiogenesis in patients with AVMs using 68 Ga-RGD PET/CT showed increased 68 Ga-RGD uptake with good contrast to noise ratio in the nidus of peripheral AVMs, validated by immunohistochemical analysis confirming cytoplasmatic and cell membranous expression of αvβ3 integrins in endothelial cells (Fig. 5 ).…”

“…For this purpose, novel imaging techniques targeting specific molecular markers may be the most prolific approach. Consequently, there is an increasing demand for imaging enabling visualization of angiogenesis to provide quantitative outcome measures which may be used to predict the response to targeted therapy and the risk of recurrence as well as to monitor the follow-up of treatment efficacy [ 86 ]. Using a single technological platform including anatomical, functional, and (patho-)genetic information for diagnosis and therapy (theranostics) of VA is broadly desired.…”

“…Furthermore, auspicious findings were additional detected foci of integrin αvβ3 expression in comparison to conventional angiographic imaging and a well-defined nidus in a complex AVM which was not identified on “conventional” imaging. Thereby, this novel imaging approach has the potential to identify treatment targets of active AVM parts, especially in patients showing no clear nidus on conventional imaging as well as in patients with large size or complex AVMs [ 86 ]. However, it will need further studies whether 68 Ga-RGD PET/CT or prospectively PET/MRI could be used to assess the angiogenic “activity” of AVMs, which may also be of prognostic value.…”

Illuminating the nidus: The role of FDG PET/CT in high flow arteriovenous vascular malformations

“…Furthermore, a recent feasibility study by Lobeek et al. demonstrated increased uptake in AVMs with angiogenic activity compared with the surrounding tissues with absent angiogenic activity on 68 Ga-labeled arginine-glycine-aspartate tripeptide sequence (RGD) PET/CT imaging [5] .…”

“…Since the nidus of a HFAVM is a proliferative, highly angiogenic core, it is likely to demonstrate increased radiotracer uptake in on fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) [5] . We describe a unique case in which we non–invasively evaluated a complex HFAVM, using FDG PET/CT to successfully delineate the nidus which subsequently assisted with targeted embolization.…”