BRIEF RESEARCH REPORT article
Front. Nucl. Med.
Sec. PET and SPECT
This article is part of the Research TopicTotal Body Positron Emission Tomography: Science and Clinical ApplicationsView all 5 articles
Feasibility of [¹⁵O]H₂O PET-CT for Quantifying Lower Limb Muscle Perfusion in Peripheral Arterial Occlusive Disease: A Pilot Study
Provisionally accepted
Goudje L. Van Leeuwen*
Richte C L Schuurmann
Charalampos TsoumpasMilah N Baumann
Riemer SlartJean-Paul P.M. de Vries- University Medical Center Groningen, Groningen, Netherlands
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Assessing muscle tissue perfusion in patients with peripheral arterial occlusive disease (PAOD) is challenging, as conventional techniques such as computed tomography angiography and transcutaneous oxygen pressure (TcPO₂) do not capture perfusion within deeper muscle compartments, which are clinically relevant because symptoms such as claudication manifest in the muscles. [¹⁵O]H₂O positron emission tomography computed tomography (PET-CT) enables quantitative measurement of tissue blood flow but has not yet been systematically applied in PAOD. This exploratory study investigated the feasibility and reproducibility of using long axial field of view (LAFOV) [¹⁵O]H₂O PET-CT to quantify calf muscle perfusion in PAOD patients, comparing two VOI selection strategies. Methods: Patients with Rutherford stage 3–6 PAOD undergoing endovascular revascularization underwent [¹⁵O]H₂O PET-CT imaging before and after treatment. Muscle perfusion (K1 in mL/100 cm³/min) was calculated using a 1-tissue compartment model and image-derived input functions. VOIs were defined using either full muscle contours or standardized spherical volumes. Ten legs from five scanning sessions were analyzed twice by two observers. Agreement and variability between methods and observers were assessed. Results: K1 values ranged from 1.54 to 5.22 mL/100 cm³/min. Both VOI methods enabled reproducible quantification of calf muscle perfusion. Intrarater intraclass correlation coefficients (ICCs) were ≥0.94; interrater ICCs were 0.90 for spherical VOIs and 0.96 for muscle contours. Bland–Altman analysis showed no systematic bias. Muscle contours showed slightly higher reproducibility, likely due to anatomical accuracy. Conclusions: [¹⁵O]H₂O LAFOV PET-CT enables robust quantification of muscle perfusion in PAOD and is promising for future studies on treatment response and pathophysiology.
Keywords: [15O]H2O, Perfusion Imaging, Peripheral Arterial Disease, Positron emission tomography computed tomography, Reliability
Received: 23 Jul 2025; Accepted: 02 Dec 2025.
Copyright: © 2025 Van Leeuwen, Schuurmann, Tsoumpas, Baumann, Slart and de Vries. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Goudje L. Van Leeuwen
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.