TY - JOUR T1 - A Clinical Feasibility Study To Image Angiogenesis in Patients With Arteriovenous Malformations Using <sup>68</sup>Ga-RGD PET/CT. JF - Journal of Nuclear Medicine JO - J Nucl Med DO - 10.2967/jnumed.119.231167 SP - jnumed.119.231167 AU - Daphne Lobeek AU - Frédérique C.M. Bouwman AU - Erik H.J.G. Aarntzen AU - Janneke D.M. Molkenboer-Kuenen AU - Uta E. Flucke AU - Ha-Long Nguyen AU - Miikka Vikkula AU - Laurence M. Boon AU - Willemijn Klein AU - Peter Laverman AU - Wim J.G. Oyen AU - Otto C. Boerman AU - Samantha Y.A. Terry AU - Leo J. SchultzeKool AU - Mark Rijpkema Y1 - 2019/09/01 UR - http://jnm.snmjournals.org/content/early/2019/09/12/jnumed.119.231167.abstract N2 - Objective: Arteriovenous Malformations (AVMs) have an inherent capacity to form new blood vessels resulting in excessive lesion growth and this is further triggered by the release of angiogenic factors. Gallium-68 (68Ga) labeled arginine-glycine-aspartate tripeptide sequence (RGD) positron emission tomography (PET)/computed tomography (CT) imaging (68Ga-RGD PET/CT) may provide insight in the angiogenic and hemodynamic status and treatment response of AVMs. This clinical feasibility study demonstrates that 68Ga-RGD PET/CT imaging can be used to quantitatively assess angiogenesis in peripheral AVMs. Methods: Ten patients with a peripheral AVM (mean age 40 years, four men, six women) and scheduled for endovascular embolization treatment, were prospectively included. All patients underwent 68Ga-RGD PET/CT imaging 60 min after injection (mean dose 207±5 MBq). Radiotracer uptake in AVM, blood-pool, and muscle activity were quantified as Standardized Uptake Values (SUVmax, SUVpeak) and descriptive analysis of the PET/CT images was performed. Furthermore, immunohistochemical analysis was performed on surgical biopsy material of peripheral AVMs to investigate the expression pattern of integrin αvβ3 integrin. Results: 68Ga-RGD PET/CT imaging showed enhanced radiotracer uptake in all AVM lesions (mean SUVmax 3.0±1.1; mean SUVpeak 2.2±0.9). Lesion/blood and lesion/muscle ratios were 3.5±2.2 and 4.6±2.8, respectively. Radiotracer uptake in AVMs was significantly higher compared to uptake in background tissue (p=0.0006 and p=0.0014) for blood and muscle, respectively. Initial observations include identification of radiotracer uptake in (multifocal) AVM lesions and enhanced radiotracer uptake in intra-osseous components in those AVM cases affecting the bone integrity. Immunohistochemical analysis revealed cytoplasmatic and cell membranous integrin αvβ3 integrin expression in endothelial cells of AVMs. Conclusion: This feasibility study showed increased radiotracer uptake in AVM with angiogenic activity compared to surrounding tissue without angiogenic activity, suggesting that 68Ga-RGD PET/CT imaging can be used as a tool to quantitatively determine angiogenesis in AVM. Further studies will be conducted to explore the potential of 68Ga-RGD PET/CT imaging for guiding current treatment decisions and for assessment of response to anti-angiogenic treatment. ER -