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Assessment of Skeletal Muscle Viability by PET

Biomedical Imaging Center, Department of Radiology, and Department of Surgery, University of Tennessee Medical Center, Knoxville, Tennessee

Correspondence: For correspondence or reprints contact: Gary T. Smith, MD, Department of Radiology, University of Tennessee Medical Center, 1924 Alcoa Hwy., Knoxville, TN 37920.

ABSTRACT

We investigated the use of [¹⁸F]fluoro-2-deoxyglucose (FDG) PET scanning for assessment of skeletal muscle viability in patients with peripheral vascular disease and in patients following free-flap skeletal muscle transfer for closure of open wounds. Methods: We obtained 32 FDG-PET scans from 30 patients, either at the time of admission for peripheral vascular disease (n = 16) or between 1 and 15 days after surgery for skeletal muscle transfer (n = 16). Ratios between injured and contralateral limb FDG tracer activity uptake were correlated with clinical outcome at 1 mo to 3 yr follow-up. Results: Viable muscle uptake ratios ranged from 0.47 to 7.88 (mean: 2.26 ± 1.81; n = 26), while nonviable muscle uptake ratios ranged from 0.12 to 0.46 (mean: 0.27 ± 0.12; n = 6; p < 0.02). After skeletal muscle transfer, two patents with viable tissue, as documented by PET, required amputation due to osteomyelitis, and one patient with peripheral vascular disease who showed viable tissue by PET required amputation 3 mo after the PET scan because of recurrent ulcers. Conclusion: FDG-PET scanning can determine skeletal muscle viability in patients with peripheral vascular disease and in patients following free-flap transfer.

Key Words: skeletal muscle viability • positron emission tomography • glucose metabolism • open wound closure

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