# Radiotracer-Based Imaging for Quantitative Assessment of Angiosome Perfusion Following Lower Extremity Revascularization

> **NIH NIH R01** · RESEARCH INST NATIONWIDE CHILDREN'S HOSP · 2020 · $338,248

## Abstract

Project Abstract
The long-term goal of this work is to non-invasively evaluate regional changes in foot tissue perfusion following
lower extremity revascularization to better predict efficacy of targeted treatment and future rates of wound
healing and limb salvage. Peripheral vascular disease (PVD) is an atherosclerotic disease of the lower limbs
that affects 8 to 10 million Americans, and is more prevalent and progresses more quickly in patients with
diabetes mellitus (DM). In addition to macrovascular complications, DM patients commonly present with
microvascular disease of the lower extremities, which may contribute to high rates of foot ulceration, limb
amputation, and poor treatment outcomes that exist in the setting of DM. Current imaging tools have limitations
for assessing underlying microvascular disease and there is no standard non-invasive approach to evaluate
changes in microvascular perfusion in three-dimensional (3D) vascular territories of the feet, or angiosomes,
following medical treatment in PVD patients. We propose a novel approach for evaluating angiosome
microvascular perfusion under resting conditions in DM patients with critical limb ischemia (CLI) who are
undergoing revascularization. Using hybrid SPECT/CT imaging, we will evaluate microvascular perfusion
within 3D angiosomes of the foot that are targeted for direct revascularization due to pre-existing non-healing
wounds, and relate changes in relative and absolute angiosome perfusion to rates of wound healing and limb
salvage. The central hypothesis of this work is that radiotracer-based imaging of microvascular perfusion can
detect sensitive changes in underlying pathophysiology of the foot in specific vascular territories, which can
assist clinicians with targeted revascularization while also predicting treatment efficacy and limb salvage
outcomes. In Aim 1 we will quantify relative changes in resting microvascular perfusion within 3D angiosomes
of the foot using SPECT/CT imaging to evaluate revascularization procedures targeted at non-healing wounds
in DM patients with CLI, and relate changes in angiosome perfusion to wound healing and limb salvage
outcomes. Aim 2 will validate the utility of dynamic SPECT/CT imaging for quantifying serial changes in
absolute skeletal muscle perfusion in a large animal model of peripheral artery occlusion. Finally, Aim 3 will
translate dynamic SPECT/CT imaging into patients to evaluate the repeatability of this approach and to assess
the value of absolute quantitative perfusion in 3D angiosomes in DM patients undergoing revascularization. We
believe that radiotracer-based imaging will allow for high sensitivity detection of impaired foot tissue perfusion
under resting conditions at baseline and following revascularization. Therefore, this imaging approach may
help to identify patients at risk for wound progression or limb loss and assist in predicting treatment outcomes
in PVD patients.

## Key facts

- **NIH application ID:** 9843689
- **Project number:** 5R01HL135103-04
- **Recipient organization:** RESEARCH INST NATIONWIDE CHILDREN'S HOSP
- **Principal Investigator:** Mitchel R Stacy
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $338,248
- **Award type:** 5
- **Project period:** 2017-01-13 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9843689

## Citation

> US National Institutes of Health, RePORTER application 9843689, Radiotracer-Based Imaging for Quantitative Assessment of Angiosome Perfusion Following Lower Extremity Revascularization (5R01HL135103-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9843689. Licensed CC0.

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