(68)Ga-DOTA-TOC PET may be superior to (18)F-DOPA PET and diagnostic CT in providing valuable information for pretherapeutic staging of extra-adrenal PGL, particularly in surgically inoperable tumours and metastatic or multifocal disease.

WHAT THIS PAPER ADDS Affected muscle regions in peripheral arterial disease (PAD) are known to be altered by reduced blood supply. Clinical research projects predominantly deal with the investigation of the underlying atherosclerotic lesions and the development of new technical devices for the treatment of those lesions. The investigation of the lower extremity PAD end organ, namely the muscle, has been neglected so far, and in particular the effect of revascularisation on affected muscle regions has not been evaluated. With this study it could be demonstrated that mitochondrial function in affected muscle regions is able to regenerate after revascularisation. Based on these findings, future studies assessing the clinical correlation between maximum walking distance and mitochondrial respiration could give additional information about underlying pathophysiological mechanism of muscle affected by PAD.Objective: Myopathy, characterised by altered mitochondrial function, is a central part of the pathophysiology of peripheral arterial disease and the aim of this study was to investigate the effect of revascularisation on mitochondrial function. Methods: High resolution respirometry was used to investigate mitochondrial respiration and the results were normalised to citrate synthase activity (CSA), a marker of mitochondrial content. Ten patients with symptomatic peripheral arterial disease (study group) and 10 subjects without ischaemia (control group) were included. Ankle brachial index and ultrasound imaging were performed before and after vascular intervention to confirm technically successful revascularisation. Within the study group, muscle biopsies from the gastrocnemius muscle were taken before vascular intervention and six weeks after revascularisation. Within the control group, tissue was harvested once. Results: There were no significant group differences regarding anthropometric data. CSA showed a significant increase after successful revascularisation (CSA pre-operative 281.4 (252.4e391.8) nmol/min/mg protein vs. CSA post-operative 438.5 (361.4e471.3) nmol/min/mg protein; p ¼ .01) with post-operative return of values to the range of control subjects (CSA control 396.6 (308.2e435.9)). Mitochondrial respiration normalised to CSA in oxidative phosphorylation (P) as well as in electron transfer (E) capacity were significantly reduced post-operatively when compared with pre-operative values (P pre-operative 0.218 (0.196e0.266) pmol/(secÂmg) per CSA vs. post-operative 0.132 (0.116e0.150) pmol/(secÂmg) per CSA, p ¼ .007; E pre-operative 0.230 (0.195e0.279) pmol/(secÂmg) per CSA vs. post-operative 0.129 (0.120e0.154) pmol/(secÂmg) per CSA, p ¼ .005) meaning a post-operative return of values to within the range of control subjects (P control 0.124 (0.080e0.155) pmol/(secÂmg) per CSA; E control 0.121 (0.079e0.125) pmol/(secÂmg) per CSA).Conclusion: With these results, it has been shown that the initially impaired mitochondrial function and content can normalise after revascularisation.

Our analysis in this patient cohort indicated that (68)Ga-DOTATOC PET/CT is superior to (123)I-MIBG SPECT/CT, particularly in head and neck and bone lesions, and provides valuable information for staging extraadrenal PGL, particularly in patients with surgically inoperable tumours or multifocal/malignant disease.

Our study revealed both early aortic dilatation and older age as risk factors for increased mortality after conservative treatment of type B dissection.