Reactive hyperemia and BOLD MRI demonstrate that VEGF inhibition, age, and atherosclerosis adversely affect functional recovery in a murine model of peripheral artery disease

Multi-modality imaging for assessment of the microcirculation in peripheral artery disease: Bench to clinical practice

Peripheral artery disease (PAD) is a highly prevalent disorder with a high risk of mortality and amputation despite the introduction of novel medical and procedural treatments. Microvascular disease (MVD) is common among patients with PAD, and despite the established role as a predictor of amputations and mortality, MVD is not routinely assessed as part of current standard practice. Recent pre-clinical and clinical perfusion and molecular imaging studies have confirmed the important role of MVD in the pathogenesis and outcomes of PAD. The recent advancements in the imaging of the peripheral microcirculation could lead to a better understanding of the pathophysiology of PAD, and result in improved risk stratification, and our evaluation of response to therapies. In this review, we will discuss the current understanding of the anatomy and physiology of peripheral microcirculation, and the role of imaging for assessment of perfusion in PAD, and the latest advancements in molecular imaging. By highlighting the latest advancements in multi-modality imaging of the peripheral microcirculation, we aim to underscore the most promising imaging approaches and highlight potential research opportunities, with the goal of translating these approaches for improved and personalized management of PAD in the future.

Magnetic Resonance Imaging Techniques in Peripheral Arterial Disease

Significance: Peripheral arterial disease (PAD) leads to a significant burden of morbidity and impaired quality of life globally. Diabetes is a significant risk factor accelerating the development of PAD with an associated increase in the risk of chronic wounds, tissue, and limb loss. Various magnetic resonance imaging (MRI) techniques are being increasingly acknowledged as useful methods of accurately assessing PAD. Recent Advances: Conventionally utilized MRI techniques for assessing macrovascular disease have included contrast enhanced magnetic resonance angiography (MRA), noncontrast time of flight MRA, and phase contrast MRI, but have significant limitations. In recent years, novel noncontrast MRI methods assessing skeletal muscle perfusion and metabolism such as arterial spin labeling (ASL), blood-oxygen-level dependent (BOLD) imaging, and chemical exchange saturation transfer (CEST) have emerged. Critical Issues: Conventional non-MRI (such as ankle-brachial index, arterial duplex ultrasonography, and computed tomographic angiography) and MRI based modalities image the macrovasculature. The underlying mechanisms of PAD that result in clinical manifestations are, however, complex, and imaging modalities that can assess the interaction between impaired blood flow, microvascular tissue perfusion, and muscular metabolism are necessary. Future Directions: Further development and clinical validation of noncontrast MRI methods assessing skeletal muscle perfusion and metabolism, such as ASL, BOLD, CEST, intravoxel incoherent motion microperfusion, and techniques that assess plaque composition, are advancing this field. These modalities can provide useful prognostic data and help in reliable surveillance of outcomes after interventions.

Hemodynamic response to thermal stress varies with sex and age: a murine MRI study

PURPOSE

The cardiovascular (CV) system plays a vital role in thermoregulation because of its influence on heat transfer via forced convection and conduction by changes in blood distribution, blood velocity, and proximity of vessels to surrounding tissues. To fully understand the cardiovascular system's role in thermoregulation, blood distribution (influenced by cardiac output, vessel size, blood flow, and pressure) must be quantified, ideally across sex and age. Additionally, wall shear stress is quantified because it is an important metric in cardiovascular disease localization and progression. By investigating the effect of thermal conditions on wall shear stress at a healthy baseline, researchers can begin to study the confluence of thermal condition with pathology or exercise. The purpose of this study is to determine the influence of sex and age on the CV response to temperature. In this work, the effect of core body temperature on hemodynamics of the murine arterial and venous systems has been studied non-invasively, at multiple locations across age and sex.

METHODS

Male and female, adult and aged, mice (n = 20) were anesthetized and underwent MRI at 7 T. Data were acquired from four co-localized vessel pairs (the neck [carotid/jugular], torso [suprarenal and infrarenal aorta/inferior vena cava (IVC)], periphery [femoral artery/vein]) at core temperatures of 35, 36, 37, and 38 °C. Sixteen CINE, ECG-gated, phase contrast frames with one-directional velocity encoding (through plane) were acquired perpendicular to each vessel. Each frame was analyzed to quantify blood velocity and volumetric flow using a semi-automated in-house MATLAB script. Wall shear stress (WSS) was calculated using the Hagen-Poiseulle formula. A multivariable regression for WSS in the femoral artery was fitted with temperature, sex, age, body weight, and heart rate as variables.

RESULTS

Blood velocity and volumetric flow were quantified in eight vessels at four core body temperatures. Flow in the infrarenal IVC linearly increased with temperature for all groups (p = .002; adjusted means of slopes: male vs. female, 0.37 and 0.28 cm/(s × °C); adult vs. aged, 0.22 and 0.43 cm/(s × °C)). Comparing average volumetric flow response to temperature, groups differed for the suprarenal aorta (adult < aged, p < .05), femoral artery (adult < aged, p < .05), and femoral vein (adult male < aged male, p < .001). The two-way interaction terms of temperature and body weight and temperature and sex had the largest effect on wall shear stress.

CONCLUSIONS

Age, in particular, had a significant impact on hemodynamic response as measured by volumetric flow (e.g., aged males > adult males) and WSS at peak-systole (e.g., aged males < adult males). The hemodynamic data can provide physiologically-relevant parameters, including sex and age difference, to computational fluid dynamics models and provide baseline data for the healthy murine vasculature to use as a benchmark for investigations of a variety of physiological (thermal stress) and pathophysiological conditions of the cardiovascular system.

Anatomical location, sex, and age influence murine arterial circumferential cyclic strain before and during dobutamine infusion

Background

One of the primary biomechanical factors influencing arterial health is their deformation across the cardiac cycle, or cyclic strain, which is often associated with arterial stiffness. Deleterious changes in the cardiovascular system, e.g., increased arterial stiffness, can remain undetected until the system is challenged, such as under a cardiac stressor like dobutamine.

Purpose

To quantify cyclic strain in mice at different locations along the arterial tree prior to and during dobutamine infusion, while evaluating the effects of sex and age.

Study Type

Control/cohort study.

Animal Model

Twenty C57BL/6 mice; male, female; ∼12 and 24 weeks of age; n = 5 per group.

Field Strength/Sequence

7T; CINE MRI with 12 frames, velocity compensation, and prospective cardiac gating.

Assessment

Prior to and during the infusion of dobutamine, Green–Lagrange circumferential cyclic strain was calculated from perimeter measurements derived from CINE data acquired at the carotid artery, suprarenal and infrarenal abdominal aorta, and iliac artery.

Statistical Tests

Analysis of variance (ANOVA) followed by post‐hoc tests was used to evaluate the influence of dobutamine, anatomical location, sex, and age.

Results

Heart rates did not differ between groups prior to or during dobutamine infusion (P = 0.87 and P = 0.08, respectively). Dobutamine increased cyclic strain in each group. Within a group, increases in strain were similar across arteries. At the suprarenal aorta, strain was reduced in older mice at baseline (young 27.6 > mature 19.3%, P = 0.01) and during dobutamine infusion (young 53.0 > mature 36.2%, P = 0.005). In the infrarenal aorta, the response (dobutamine – baseline) was reduced in older mice (young 21.9 > mature 13.5%, P = 0.04).

Data Conclusion

Dobutamine infusion increases circumferential cyclic strain throughout the arterial tree of mice. This effect is quantifiable using CINE MRI. The results demonstrate that strain prior to and during dobutamine is influenced by anatomical location, sex, and age.

Level of Evidence: 3

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019;49:69–80.

Imaging of small animal peripheral artery disease models: recent advancements and translational potential

Peripheral artery disease (PAD) is a broad disorder encompassing multiple forms of arterial disease outside of the heart. As such, PAD development is a multifactorial process with a variety of manifestations. For example, aneurysms are pathological expansions of an artery that can lead to rupture, while ischemic atherosclerosis reduces blood flow, increasing the risk of claudication, poor wound healing, limb amputation, and stroke. Current PAD treatment is often ineffective or associated with serious risks, largely because these disorders are commonly undiagnosed or misdiagnosed. Active areas of research are focused on detecting and characterizing deleterious arterial changes at early stages using non-invasive imaging strategies, such as ultrasound, as well as emerging technologies like photoacoustic imaging. Earlier disease detection and characterization could improve interventional strategies, leading to better prognosis in PAD patients. While rodents are being used to investigate PAD pathophysiology, imaging of these animal models has been underutilized. This review focuses on structural and molecular information and disease progression revealed by recent imaging efforts of aortic, cerebral, and peripheral vascular disease models in mice, rats, and rabbits. Effective translation to humans involves better understanding of underlying PAD pathophysiology to develop novel therapeutics and apply non-invasive imaging techniques in the clinic.

Mouse phenotyping with MRI

The field of mouse phenotyping with magnetic resonance imaging (MRI) is rapidly growing, motivated by the need for improved tools for characterizing and evaluating mouse models of human disease. Image results can provide important comparisons of human conditions with mouse disease models, evaluations of treatment, development or disease progression, as well as direction for histological or other investigations. Effective mouse MRI studies require attention to many aspects of experiment design. In this chapter, we provide details and discussion of important practical considerations: hardware requirements, mouse handling for in vivo imaging, specimen preparation for ex vivo imaging, sequence and contrast agent selection, study size, and quantitative image analysis. We focus particularly on anatomical phenotyping, an important and accessible application that has shown a high potential for impact in many mouse models at our imaging center.

BOLD MRI applied to a murine model of peripheral artery disease

Peripheral artery disease (PAD) is the narrowing or complete occlusion of vessels due to the progression of atherosclerosis. Ultimately, the reduction in blood supply, due to a reduced lumen diameter, results in a functional deficit, e.g., reduced mobility. Because function is closely tied to blood flow through large-caliber vessels, therapeutic development to treat PAD has recently focused on arteriogenesis rather than angiogenesis. Optimally, the preclinical investigations related to such therapeutic development would take place in murine models of PAD to allow for future studies utilizing transgenic strains. However, it can be challenging to quantify functional recovery of the peripheral vascular network in murine models. The purpose of this work is to provide a protocol of temporally and spatially resolved methods for functional assessment of arteriogenesis in a murine model.

The BOLD effect

The purpose of this chapter is to introduce the novice NMR imager to blood oxygen level dependent (BOLD) contrast as well as remind the seasoned veteran of its beauty. Introduction to many of the factors that influence the BOLD signal is given higher priority than pursuing any subset in exquisite detail. Instead, references are given for readers seeking intense investigations into a given aspect. The hope is that this overview inspires the reader with the elegant simplicity of BOLD contrast while not, at first, intimidating too much with the underlying complexity. As one's knowledge of NMR matures so too will one's understanding, appreciation, and application of BOLD MRI. BOLD contrast derives from variations in the magnetic susceptibility of blood due to variations in the concentration of deoxyhemoglobin. These magnetic susceptibility effects produce local magnetic fields around blood vessels that can result in phase dispersion of nearby spins and, therefore, changes in signal intensity in NMR images. After providing brief historical context for BOLD, this chapter will follow the trail of magnetic susceptibility through definition, its source and location in vivo, and how the source and location in vivo interact with anatomical (e.g., blood vessel size) and imaging considerations (e.g., pulse sequence) to influence the BOLD signal. We will conclude by briefly highlighting clinical and preclinical applications using BOLD contrast.