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Prior SJ, Chrencik MT, Christensen E, Kundi R, Ryan AS, Addison O, Lal BK. An exercise stress test for contrast-enhanced duplex ultrasound assessment of lower limb muscle perfusion in patients with peripheral arterial disease. J Vasc Surg 2024; 79:397-404. [PMID: 37844848 PMCID: PMC10969459 DOI: 10.1016/j.jvs.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE The aim of the present study was to develop a standardized contrast-enhanced duplex ultrasound (CE-DUS) protocol to assess lower-extremity muscle perfusion before and after exercise and determine relationships of perfusion with clinical and functional measures. METHODS CE-DUS (EPIQ 5G, Philips) was used before and immediately after a 10-minute, standardized bout of treadmill walking to compare microvascular perfusion of the gastrocnemius muscle in older (55-82 years) patients with peripheral arterial disease (PAD) (n = 15, mean ankle-brachial index, 0.78 ± 0.04) and controls (n = 13). Microvascular blood volume (MBV) and microvascular flow velocity (MFV) were measured at rest and immediately following treadmill exercise, and the Modified Physical Performance Test (MPPT) was used to assess mobility function. RESULTS In the resting state (pre-exercise), MBV in patients with PAD was not significantly different than normal controls (5.17 ± 0.71 vs 6.20 ± 0.83 arbitrary units (AU) respectively; P = .36); however, after exercise, MBV was ∼40% lower in patients with PAD compared with normal controls (5.85 ± 1.13 vs 9.53 ± 1.31 AU, respectively; P = .04). Conversely, MFV was ∼60% higher in patients with PAD compared with normal controls after exercise (0.180 ± 0.016 vs 0.113 ± 0.018 AU, respectively; P = .01). There was a significant between-group difference in the exercise-induced changes in both MBV and MFV (P ≤ .05). Both basal and exercise MBV directly correlated with MPPT score in the patients with PAD (r = 0.56-0.62; P < .05). CONCLUSIONS This standardized protocol for exercise stress testing of the lower extremities quantifies calf muscle perfusion and elicits perfusion deficits in patients with PAD. This technique objectively quantifies microvascular perfusion deficits that are related to reduced mobility function and could be used to assess therapeutic efficacy in patients with PAD.
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Affiliation(s)
- Steven J Prior
- Department of Kinesiology, University of Maryland School of Public Health, College Park, MD; Department of Veterans Affairs and Baltimore Veterans Affairs Medical Center Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD; Department of Medicine, Division of Gerontology, Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Matthew T Chrencik
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Eric Christensen
- Department of Veterans Affairs and Baltimore Veterans Affairs Medical Center Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD; Department of Medicine, Division of Gerontology, Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Rishi Kundi
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Alice S Ryan
- Department of Veterans Affairs and Baltimore Veterans Affairs Medical Center Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD; Department of Medicine, Division of Gerontology, Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Odessa Addison
- Department of Veterans Affairs and Baltimore Veterans Affairs Medical Center Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD; Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore
| | - Brajesh K Lal
- Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, MD.
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Chen SY, Wang YW, Chen WS, Hsiao MY. Update of Contrast-enhanced Ultrasound in Musculoskeletal Medicine: Clinical Perspectives - A Review. J Med Ultrasound 2023; 31:92-100. [PMID: 37576422 PMCID: PMC10413398 DOI: 10.4103/jmu.jmu_94_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 08/15/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) uses an intravascular contrast agent to enhance blood flow signals and assess microcirculation in different parts of the human body. Over the past decade, CEUS has become more widely applied in musculoskeletal (MSK) medicine, and the current review aims to systematically summarize current research on the application of CEUS in the MSK field, focusing on 67 articles published between January 2001 and June 2021 in online databases including PubMed, Scopus, and Embase. CEUS has been widely used for the clinical assessment of muscle microcirculation, tendinopathy, fracture nonunions, sports-related injuries, arthritis, peripheral nerves, and tumors, and can serve as an objective and quantitative evaluation tool for prognosis and outcome prediction. Optimal CEUS parameters and diagnostic cut off values for each disease category remain to be confirmed.
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Affiliation(s)
- Shao-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Wei Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
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3
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Young GM, Krastins D, Chang D, Lam J, Quah J, Stanton T, Russell F, Greaves K, Kriel Y, Askew CD. Influence of cuff‐occlusion duration on contrast‐enhanced ultrasound assessments of calf muscle microvascular blood flow responsiveness in older adults. Exp Physiol 2020; 105:2238-2245. [DOI: 10.1113/ep089065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Grace Marie Young
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Sunshine Coast Hospital and Health Service Sunshine Coast Health Institute Birtinya Queensland Australia
| | - Digby Krastins
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Sunshine Coast Hospital and Health Service Sunshine Coast Health Institute Birtinya Queensland Australia
| | - David Chang
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Jeng Lam
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Jing Quah
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Tony Stanton
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Fraser Russell
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
| | - Kim Greaves
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Yuri Kriel
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
| | - Christopher David Askew
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Sunshine Coast Hospital and Health Service Sunshine Coast Health Institute Birtinya Queensland Australia
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
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Jeon S, Jang J, Lee G, Park S, Lee SK, Kim H, Choi J. Assessment of neovascularization during bone healing using contrast-enhanced ultrasonography in a canine tibial osteotomy model: a preliminary study. J Vet Sci 2020; 21:e10. [PMID: 31940689 PMCID: PMC7000898 DOI: 10.4142/jvs.2020.21.e10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/16/2019] [Accepted: 11/09/2019] [Indexed: 01/08/2023] Open
Abstract
Blood perfusion of skeletal muscle and callus was evaluated using contrast-enhanced ultrasonography (CEUS) in a canine osteotomy model to determine the applicability of CEUS in the assessment of neovascularization during fracture healing and to compare the vascular signals on CEUS between external skeletal fixation and cast-applied dogs. In 6 Beagle dogs, a simple transverse osteotomy was performed at the left tibial shaft and external skeletal fixation (n = 3) or a cast (n = 3) was applied. Radiography, power Doppler ultrasonography (power Doppler), and CEUS were performed until complete union was achieved. On CEUS, vascular changes were quantitatively evaluated by measuring peak intensity (PI) and time to PI in the soft tissue and callus and by counting the vascular signals. Vascular signals from the soft tissue were detected on power Doppler and CEUS on day 2. Significantly more vascular signals were detected by CEUS than by power Doppler. On CEUS, PI in the surrounding soft tissue was markedly increased after the fracture line appeared indistinctively changed on radiography in all dogs. In the cast-applied dogs, vascular signals from the periosteal and endosteal callus were detected on CEUS before mineralized callus was observed on radiography. CEUS was useful in assessing the vascularity of soft tissue and callus, particularly in indirect fracture healing, and provided indications of a normally healing fracture.
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Affiliation(s)
- Sunghoon Jeon
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Jaeyoung Jang
- Haemaru Referral Animal Hospital, Seongnam 13590, Korea
| | - Gahyun Lee
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Seungjo Park
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Sang Kwon Lee
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Hyunwook Kim
- Haemaru Referral Animal Hospital, Seongnam 13590, Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea.
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Lin HC, Wang SH. Window-Modulated Compounding Nakagami Parameter Ratio Approach for Assessing Muscle Perfusion with Contrast-Enhanced Ultrasound Imaging. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3584. [PMID: 32599928 PMCID: PMC7348981 DOI: 10.3390/s20123584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022]
Abstract
The assessment of microvascular perfusion is essential for the diagnosis of a specific muscle disease. In comparison with the current available medical modalities, the contrast-enhanced ultrasound imaging is the simplest and fastest means for probing the tissue perfusion. Specifically, the perfusion parameters estimated from the ultrasound time-intensity curve (TIC) and statistics-based time-Nakagami parameter curve (TNC) approaches were found able to quantify the perfusion. However, due to insufficient tolerance on tissue clutters and subresolvable effects, these approaches remain short of reproducibility and robustness. Consequently, the window-modulated compounding (WMC) Nakagami parameter ratio imaging was proposed to alleviate these effects, by taking the ratio of WMC Nakagami parameters corresponding to the incidence of two different acoustic pressures from an employed transducer. The time-Nakagami parameter ratio curve (TNRC) approach was also developed to estimate perfusion parameters. Measurements for the assessment of muscle perfusion were performed from the flow phantom and animal subjects administrated with a bolus of ultrasound contrast agents. The TNRC approach demonstrated better sensitivity and tolerance of tissue clutters than those of TIC and TNC. The fusion image with the WMC Nakagami parameter ratio and B-mode images indicated that both the tissue structures and perfusion properties of ultrasound contrast agents may be better discerned.
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Affiliation(s)
- Huang-Chen Lin
- Department of Computer Science and Information Engineering, Institute of Medical Informatics, National Cheng Kung University, No. 1, University Road, East District, Tainan City 70101, Taiwan;
| | - Shyh-Hau Wang
- Department of Computer Science and Information Engineering, Institute of Medical Informatics, National Cheng Kung University, No. 1, University Road, East District, Tainan City 70101, Taiwan;
- Intelligent Manufacturing Research Center, National Cheng Kung University, No. 1, University Road, East District, Tainan City 70101, Taiwan
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Pettersen EM, Avdal J, Hisdal J, Torp H, Seternes A. Validation of a novel ultrasound Doppler monitoring device (earlybird) for detection of microvascular circulatory changes. Clin Hemorheol Microcirc 2019; 74:429-440. [PMID: 31743988 DOI: 10.3233/ch-190707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE In this proof-of-concept study we aim to validate a novel ultrasound Doppler monitoring device for evaluating microcirculation (earlybird) against LDF and pulsed Doppler. METHODS In ten healthy subjects, we measured microcirculatory function at rest and during different autonomic tests (forced respiration, isometric exercise, Valsalva maneuver and cold pressor). Earlybird, LDF and pulsed Doppler were recorded simultaneously. We performed a ZNCC to determine correlation. RESULTS The curves for earlybird and LDF or pulsed Doppler correlates visually well. Overall median ZNCC 0.87 (interquartile range 0.77 -0.91) between the LDF and earlybird measurements, and 0.90 (0.82 - 0.95) for pulsed Doppler and earlybird. Median ZNCC for baseline and each provocation test for earlybird against LDF and pulsed Doppler were calculated; baseline: LDF 0.87 (0.73 - 0.97) pulsed Doppler 0.91 (0.81 - 0.94), forced respiration: LDF 0.87 (0.28 - 0.90) pulsed Doppler 0.90 (0.85 - 0.96), isometric exercise: LDF 0.82 (0.59 - 0.90) pulsed Doppler 0.87 (0.68 - 0.94), Valsalva maneuver: LDF 0.88 (0.82 - 0.91) pulsed Doppler 0.94 (0.92 - 0.97) and cold pressor: LDF 0.90 (0.85 - 0.95) pulsed Doppler 0.89 (0.65 - 0.94). CONCLUSION Earlybird records vasoconstrictions in healthy subjects as well as LDF and pulsed Doppler.
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Affiliation(s)
- Erik Mulder Pettersen
- Department of Surgery, Sørlandet Sykehus Kristiansand, Kristiansand, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jørgen Avdal
- Department of Circulation and Medical Imaging, CIUS/NTNU/St. Olavs Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Section of Vascular Investigations, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, CIUS/NTNU/St. Olavs Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Seternes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway
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7
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Chen LL, Zhai JX, Kang J, Li YS. Utility of Contrast-Enhanced Ultrasound for the Assessment of Skeletal Muscle Perfusion in Diabetes Mellitus: A Meta-Analysis. Med Sci Monit 2019; 25:4535-4543. [PMID: 31211767 PMCID: PMC6597144 DOI: 10.12659/msm.915252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study evaluated the effectiveness of contrast-enhanced ultrasonography for the assessment of skeletal muscle perfusion in diabetes mellites. MATERIAL AND METHODS Electronic databases (Embase, Google Scholar, Ovid, and PubMed) were searched for required articles, and studies were selected by following pre-determined eligibility criteria. Meta-analyses of mean differences or standardized mean differences (SMD) were performed to evaluate the significance of difference in contrast-enhanced ultrasonography measured muscle perfusion indices between patients with diabetes and healthy individuals or between basal and final values of perfusion indices after insulin manipulation or physical exercise in patients with diabetes or healthy individuals. RESULTS There were 15 studies included, with 279 patients with diabetes and 230 healthy individuals in total. The age of the study patients with diabetes mellitus was 55.8 years (95% CI: 49.6 years, 61.9 years) and these patients had disease for 11.4 years (95% CI: 7.7 years, 15.1 years). The percentage of males in group of patients with diabetes was 66% (95% CI: 49%, 84%), body mass index was 29.4 kg/m² (95% CI: 26.5 kg/m², 32.3 kg/m²), hemoglobin A1c was 7.3% (95% CI: 6.7%, 7.9%), and fasting plasma glucose was 149 kg/m² (95% CI: 118 kg/m², 179 kg/m²). Time to peak intensity after provocation was significantly higher in patients with diabetes than in healthy individuals (SMD 1.18 [95% CI: 0.60, 1.76]; P<0.00001). In patients with diabetes, insulin administration did not improve contrast-enhanced ultrasonography measured muscle perfusion indices but exercise improved muscle perfusion but at a level that was statistically non-significant (SMD between basal and post-exercise values (1.03 [95% CI: -0.14, 2.20]; P=0.08). In healthy individuals, lipids in addition to insulin administration was associated with significantly reduced blood volume and blood flow. CONCLUSIONS Our review showed that the use of contrast-enhanced ultrasonography showed that diabetes mellitus was associated with altered muscle perfusion in which insulin-mediated metabolic changes played an important role.
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Affiliation(s)
- Lin-Lin Chen
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Jun-Xiu Zhai
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Jie Kang
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - You-Shan Li
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
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8
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Hou XX, Chu GH, Yu Y. Prospects of Contrast-Enhanced Ultrasonography for the Diagnosis of Peripheral Arterial Disease: A Meta-analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1081-1090. [PMID: 29064120 DOI: 10.1002/jum.14451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/03/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Contrast-enhanced ultrasonography (CEUS) is a modern diagnostic method that can also be used to study microperfusion. This study compared the time to peak intensity measured by CEUS in patients with peripheral arterial disease (PAD) and healthy control participants. METHODS After a comprehensive literature search in multiple electronic databases and study selection, a random-effect meta-analysis was performed to compare the time to peak intensity measured by CEUS in patients with PAD and healthy controls, which followed meta-regression analyses for identification of factors affecting the outcomes. RESULTS Fourteen studies (data for 322 patients with PAD and 314 healthy individuals) were used for the meta-analysis. The age of this sample of patients with PAD was 64.92 (95% confidence interval, 62.53, 67.31) years, and that of the healthy controls was 55.32 (51.67, 58.98) years. The times to peak intensity were 18.55 (15.62, 21.48) seconds in healthy controls, 33.40 (27.65, 39.15) seconds in patients with PAD, and 76.22 (36.23, 116.22) seconds in patients with PAD and diabetes mellitus. The difference between patients with PAD and healthy controls in the time to peak intensity was statistically significant (mean difference, 24.80 [10.16, 39.44] seconds; P < .00009). The ABI was not significantly associated with the time to peak intensity in patients with PAD. Age and sex were also not significantly associated with the time to peak intensity. CONCLUSIONS Contrast-enhanced ultrasonography is a valuable tool for the diagnosis of PAD based on its ability to differentiate the time to peak intensity between patients with PAD and healthy individuals, but little data are yet available to assess its diagnostic ability in clinical practice.
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Affiliation(s)
- Xiao-Xia Hou
- Department of Medical Ultrasound Center, Northwest Women and Children's Hospital, Xi'an, China
| | - Guang-Hua Chu
- Department of Gynecology, Northwest Women and Children's Hospital, Xi'an, China
| | - Yuan Yu
- Department of Hand and Foot Micro-Surgery, Ankang Central Hospital of Shaanxi Province, Ankang, China
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9
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Vascular applications of contrast-enhanced ultrasound imaging. J Vasc Surg 2017; 66:266-274. [DOI: 10.1016/j.jvs.2016.12.133] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/16/2016] [Indexed: 01/29/2023]
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10
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Klenze H, Köhler TC, Farquharson F, Walterspacher S, Duerschmied D, Roecker K, Kabitz HJ, Walker DJ. Resting limb muscle perfusion during inspiratory muscle loading in hypoxia and normoxia. Respir Physiol Neurobiol 2017. [PMID: 28625661 DOI: 10.1016/j.resp.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Fatiguing of respiratory muscles reduces peripheral muscle perfusion. Further, acute hypoxia enhances respiratory muscle fatigue. This study investigated the effects of inspiratory muscle loading (IML) on resting locomotor muscle perfusion in hypoxia compared to normoxia. METHODS Ten subjects completed two study days of fatiguing IML (blinded, randomized) in normobaric hypoxia (targeted oxygen saturation 80%) and normoxia, respectively. Contrast-enhanced ultrasound (CEUS) of the gastrocnemius muscle and popliteal doppler ultrasonography were used to monitor muscle perfusion. Based on CEUS and monitored cardiac output, perfusion surrogate parameters (CLPaer and CLPap) were established. RESULTS Muscle perfusion declines early during IML in normoxia (CLPaer: -54±25%, p<0.01; CLPap: -58±32%, p<0.01) and hypoxia (CLPaer: -43±23%, p<0.01; CLPap: -41±20%, p<0.01). Hypoxia compared to normoxia increased cardiac output before (+23±19%, p<0.01 ANOVA) and during (+22±20%, p<0.01 ANOVA) IML, while local muscle perfusion during IML remained unchanged (CLPaer: p=0.41 ANOVA; CLPap: p=0.29 ANOVA). CONCLUSION Acute hypoxia compared to normoxia does not affect locomotor muscle perfusion during fatiguing IML.
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Affiliation(s)
- Hannes Klenze
- Department of Pneumology and Intensive Care Medicine, Academic Teaching Hospital Klinikum Konstanz, Germany.
| | | | - Franziska Farquharson
- Department of Pneumology and Intensive Care Medicine, Academic Teaching Hospital Klinikum Konstanz, Germany
| | - Stephan Walterspacher
- Department of Pneumology and Intensive Care Medicine, Academic Teaching Hospital Klinikum Konstanz, Germany; Department of Medicine/Pneumology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Daniel Duerschmied
- Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen and Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Kai Roecker
- Department of Applied Public Health (AGW), Furtwangen University, Germany
| | - Hans-Joachim Kabitz
- Department of Pneumology and Intensive Care Medicine, Academic Teaching Hospital Klinikum Konstanz, Germany
| | - David Johannes Walker
- Department of Pneumology and Intensive Care Medicine, Academic Teaching Hospital Klinikum Konstanz, Germany; Department of Medicine/Pneumology, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Kundi R, Prior SJ, Addison O, Lu M, Ryan AS, Lal BK. Contrast-Enhanced Ultrasound Reveals Exercise-Induced Perfusion Deficits in Claudicants. ACTA ACUST UNITED AC 2017; 2. [PMID: 28691118 PMCID: PMC5501290 DOI: 10.21767/2573-4482.100041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Contrast-Enhanced Ultrasonography (CEUS) is an imaging modality allowing
perfusion quantification in targeted regions of interest of the lower extremity that has
not been possible with color-flow imaging or with measurement of ankle brachial indices.
We developed a protocol to quantify lower extremity muscle perfusion impairment in PAD
patients in response to exercise. Methods and findings Thirteen patients with Rutherford Class I-III Peripheral Arterial Disease (PAD)
and no prior revascularization procedures were recruited from the Baltimore Veterans
Affairs Medical Center and compared with eight control patients without PAD. CEUS
interrogation of the index limb gastrocnemius muscle was performed using an intravenous
bolus of lipid-stabilized microsphere contrast before and after a standardized treadmill
protocol. Peak perfusion (PEAK) and time to peak perfusion (TTP) were measured before
and after exercise. Between and within group differences were assessed. Control subjects
demonstrated a more rapid TTP (p<0.01) and an increase in peak perfusion (PEAK,
p=0.02) after exercise, when compared to their baseline measures. Patients with
PAD demonstrated TTP and PEAK measures equivalent to controls at baseline
(p=0.39, p=0.71, respectively). However, they exhibited no significant
exercise-induced changes in perfusion (TTP p=0.49 and PEAK 0.67, respectively
compared to baseline). After exercise, normal subjects had significantly shorter TTP
(p=0.04) and greater PEAK (p=0.02) than PAD patients. Conclusion Consistent with their lack of ischemic symptoms at rest, class I to III
claudicant PAD patients showed similar perfusion measures (TTP and PEAK) at rest. PAD
patients, however, were unable to increase perfusion in response to exercise, whereas
controls increased perfusion significantly. This corresponds with claudication and
limited walking capacity observed in PAD. CEUS with bolus injection offers a convenient,
objective, quantitative and visual physiologic assessment of perfusion limitation in
specific muscle groups of PAD patients. This has the potential for substantial clinical
and research utility.
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Affiliation(s)
- Rishi Kundi
- Department of Surgery, Division of Vascular Surgery, Baltimore VA Medical Center, University of Maryland School of Medicine, Baltimore, USA
| | - Steven J Prior
- Department of Veterans Affairs and Baltimore Veterans Affairs Medical Center Geriatric Research, Education and Clinical Center (GRECC), USA.,Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Odessa Addison
- Department of Veterans Affairs and Baltimore Veterans Affairs Medical Center Geriatric Research, Education and Clinical Center (GRECC), USA.,Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Michael Lu
- Department of Veterans Affairs and Baltimore Veterans Affairs Medical Center Geriatric Research, Education and Clinical Center (GRECC), USA.,Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Alice S Ryan
- Department of Veterans Affairs and Baltimore Veterans Affairs Medical Center Geriatric Research, Education and Clinical Center (GRECC), USA.,Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Brajesh K Lal
- Department of Surgery, Division of Vascular Surgery, Baltimore VA Medical Center, University of Maryland School of Medicine, Baltimore, USA
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12
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Fadini GP, Ciciliot S, Albiero M. Concise Review: Perspectives and Clinical Implications of Bone Marrow and Circulating Stem Cell Defects in Diabetes. Stem Cells 2016; 35:106-116. [PMID: 27401837 DOI: 10.1002/stem.2445] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/27/2016] [Accepted: 05/28/2016] [Indexed: 12/12/2022]
Abstract
Diabetes mellitus is a complex systemic disease characterized by severe morbidity and excess mortality. The burden of its multiorgan complications relies on an imbalance between hyperglycemic cell damage and defective endogenous reparative mechanisms. Inflammation and abnormalities in several hematopoietic components are typically found in diabetes. The discovery that diabetes reduces circulating stem/progenitor cells and impairs their function has opened an entire new field of study where diabetology comes into contact with hematology and regenerative medicine. It is being progressively recognized that such rare circulating cell populations mirror finely regulated processes involved in hematopoiesis, immunosurveillance, and peripheral tissue homeostasis. From a clinical perspective, pauperization of circulating stem cells predicts adverse outcomes and death. Furthermore, studies in murine models and humans have identified the bone marrow (BM) as a previously neglected site of diabetic end-organ damage, characterized by microangiopathy, neuropathy, fat deposition, and inflammation. As a result, diabetes impairs the mobilization of BM stem/progenitor cells, a defect known as mobilopathy or myelokathexis, with negative consequences for physiologic hematopoiesis, immune regulation, and tissue regeneration. A better understanding of the molecular and cellular processes that govern the BM stem cell niche, cell mobilization, and kinetics in peripheral tissues may uncover new therapeutic strategies for patients with diabetes. This concise review summarizes the current knowledge on the interplay between the BM, circulating stem cells, and diabetes, and sets the stages for future developments in the field. Stem Cells 2017;35:106-116.
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Affiliation(s)
- Gian Paolo Fadini
- Department of Medicine, University of Padova, and Venetian Institute of Molecular Medicine, Padova, 35128, Italy
| | - Stefano Ciciliot
- Department of Medicine, University of Padova, and Venetian Institute of Molecular Medicine, Padova, 35128, Italy
| | - Mattia Albiero
- Department of Medicine, University of Padova, and Venetian Institute of Molecular Medicine, Padova, 35128, Italy
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Arici V, Perotti C, Fabrizio C, Del Fante C, Ragni F, Alessandrino F, Viarengo G, Pagani M, Moia A, Tinelli C, Bozzani A. Autologous immuno magnetically selected CD133+ stem cells in the treatment of no-option critical limb ischemia: clinical and contrast enhanced ultrasound assessed results in eight patients. J Transl Med 2015; 13:342. [PMID: 26526721 PMCID: PMC4630831 DOI: 10.1186/s12967-015-0697-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 10/14/2015] [Indexed: 01/10/2023] Open
Abstract
Objectives Demonstrate the safety and effectiveness of highly purified CD133+ autologous stem cells in critical limb ischemia (CLI). Design Prospective single-center not randomized. Clinicaltrials.gov identifier: NCT01595776 Methods Eight patients with a history of stable CLI were enrolled in a period of 2 years. After bone marrow stimulation and single leukapheresis collection, CD133+ immunomagnetic cell selection was performed. CD133+ cells in buffer phosphate suspension was administered intramuscularly. Muscular and arterial contrast enhanced ultra sound (CEUS), lesion evolution and pain management were assessed preoperatively and 3, 6 and 12 months after the implant. Results No patient had early or late complications related to the procedure. Two patients (25 %) didn’t get any relief from the treatment and underwent major amputation. Six patients (75 %) had a complete healing of the wounds, rest pain cessation and walking recovery. An increase in CEUS values was shown in all eight patients at 6 months and in the six clinical healed patients at 12 months and had statistical relevance. Conclusions Highly purified autologous CD133+ cells can stimulate neo-angiogenesis, as based on clinical and CEUS data. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0697-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vittorio Arici
- Vascular Surgery Unit, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Cesare Perotti
- Haemotransfusional Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Calliada Fabrizio
- Radiology Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Claudia Del Fante
- Haemotransfusional Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Franco Ragni
- Vascular Surgery Unit, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Francesco Alessandrino
- Radiology Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Gianluca Viarengo
- Haemotransfusional Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Michele Pagani
- Anesthesiology and Intensive Care Unit 2, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Alessia Moia
- Vascular Surgery Unit, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Carmine Tinelli
- Statistics and Epidemiology Service, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
| | - Antonio Bozzani
- Vascular Surgery Unit, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
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Thomas KN, Cotter JD, Lucas SJE, Hill BG, van Rij AM. Reliability of contrast-enhanced ultrasound for the assessment of muscle perfusion in health and peripheral arterial disease. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:26-34. [PMID: 25308937 DOI: 10.1016/j.ultrasmedbio.2014.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 06/08/2014] [Accepted: 06/17/2014] [Indexed: 06/04/2023]
Abstract
We investigated the reliability of contrast-enhanced ultrasound (CEUS) in assessing calf muscle microvascular perfusion in health and disease. Response to a post-occlusive reactive hyperaemia test was repeated on two occasions >48 h apart in healthy young (28 ± 7 y) and elderly controls (70 ± 5 y), and in peripheral arterial disease patients (PAD, 69 ± 7 y; n = 10, 9 and 8 respectively). Overall, within-individual reliability was poor (coefficient of variation [CV] range: 15-87%); the most reliable parameter was time to peak (TTP, 15-48% CV). Nevertheless, TTP was twice as long in elderly controls and PAD compared to young (19.3 ± 10.4 and 22.0 ± 8.6 vs. 8.9 ± 6.2 s respectively; p < 0.01), and area under the curve for contrast intensity post-occlusion (a reflection of blood volume) was ∼50% lower in elderly controls (p < 0.01 versus PAD and young). Thus, CEUS assessment of muscle perfusion during reactive hyperaemia demonstrated poor reliability, yet still distinguished differences between PAD patients, elderly and young controls.
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Affiliation(s)
- Kate N Thomas
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Samuel J E Lucas
- Department of Physiology, University of Otago, Dunedin, New Zealand; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Brigid G Hill
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - André M van Rij
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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Aschwanden M, Partovi S, Jacobi B, Fergus N, Schulte AC, Robbin MR, Bilecen D, Staub D. Assessing the end-organ in peripheral arterial occlusive disease-from contrast-enhanced ultrasound to blood-oxygen-level-dependent MR imaging. Cardiovasc Diagn Ther 2014; 4:165-72. [PMID: 24834413 DOI: 10.3978/j.issn.2223-3652.2014.03.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/26/2014] [Indexed: 11/14/2022]
Abstract
Peripheral arterial occlusive disease (PAOD) is a result of atherosclerotic disease which is currently the leading cause of morbidity and mortality in the western world. Patients with PAOD may present with intermittent claudication or symptoms related to critical limb ischemia. PAOD is associated with increased mortality rates. Stenoses and occlusions are usually detected by macrovascular imaging, including ultrasound and cross-sectional methods. From a pathophysiological view these stenoses and occlusions are affecting the microperfusion in the functional end-organs, such as the skin and skeletal muscle. In the clinical arena new imaging technologies enable the evaluation of the microvasculature. Two technologies currently under investigation for this purpose on the end-organ level in PAOD patients are contrast-enhanced ultrasound (CEUS) and blood-oxygen-level-dependent (BOLD) MR imaging (MRI). The following article is providing an overview about these evolving techniques with a specific focus on skeletal muscle microvasculature imaging in PAOD patients.
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Affiliation(s)
- Markus Aschwanden
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Sasan Partovi
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Bjoern Jacobi
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Nathan Fergus
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Anja-Carina Schulte
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Mark R Robbin
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Deniz Bilecen
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Daniel Staub
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
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Zheng J, Hasting MK, Zhang X, Coggan A, An H, Snozek D, Curci J, Mueller MJ. A pilot study of regional perfusion and oxygenation in calf muscles of individuals with diabetes with a noninvasive measure. J Vasc Surg 2013; 59:419-26. [PMID: 24080129 DOI: 10.1016/j.jvs.2013.07.115] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/26/2013] [Accepted: 07/29/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess alterations in the regional perfusion and oxygenation of the calf muscles in individuals with diabetes. METHODS Age-matched individuals with (n = 5) and without diabetes (n = 6) were investigated. Skeletal muscle perfusion, oxygen extraction fraction, and oxygen consumption rate were measured by newly developed noncontrast magnetic resonance imaging (MRI) techniques. The subjects lay supine on the MRI table with their foot firmly strapped to a custom-built isometric exercise device. The measurements were performed at rest and during an isometric plantar flexion muscle contraction. RESULTS Individuals without diabetes had up to a 10-fold increase in muscle perfusion, 25% elevation in muscle oxygen extraction fraction, and a 12-fold increase in oxygen consumption rate in the calf during the plantar flexion isometric contraction. In patients with diabetes, the increases in these parameters were only up to sixfold, 2%, and sixfold, respectively. Exercise oxygen consumption rate was inversely associated with blood HbA1c levels (r(2) = .91). CONCLUSIONS This is the first study to quantify regional skeletal muscle oxygenation in patients with diabetes using noncontrast MRI and warrants additional study. Attenuation of perfusion and oxygenation during exercise may have implications for understanding diabetic complications in the lower extremities.
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Affiliation(s)
- Jie Zheng
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo.
| | - Mary K Hasting
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Mo; Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Xiaodong Zhang
- Department of Radiology, University of North Carolina, Chapel Hill, NC
| | - Andrew Coggan
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo
| | - Hongyu An
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo
| | - Darrah Snozek
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo
| | - John Curci
- Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Michael J Mueller
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo; Program in Physical Therapy, Washington University School of Medicine, St. Louis, Mo
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Grishenkov D, Kari L, Brodin LK, Brismar TB, Paradossi G. In vitro contrast-enhanced ultrasound measurements of capillary microcirculation: comparison between polymer- and phospholipid-shelled microbubbles. ULTRASONICS 2011; 51:40-48. [PMID: 20542310 DOI: 10.1016/j.ultras.2010.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 05/11/2010] [Accepted: 05/17/2010] [Indexed: 05/29/2023]
Abstract
The focus of contrast-enhanced ultrasound research has developed beyond visualizing the blood pool and its flow to new areas such as perfusion imaging, drug and gene therapy, and targeted imaging. In this work comparison between the application of polymer- and phospholipid-shelled ultrasound contrast agents (UCAs) for characterization of the capillary microcirculation is reported. All experiments are carried out using a microtube as a vessel phantom. The first set of experiments evaluates the optimal concentration level where backscattered signal from microbubbles depends on concentration linearly. For the polymer-shelled UCAs the optimal concentration level is reached at a value of about 2×10(4)MB/ml, whereas for the phospholipid-shelled UCAs the optimal level is found at about 1×10(5)MB/ml. Despite the fact that the polymer shell occupies 30% of the radius of microbubble, compared to 0.2% of the phospholipid-shelled bubble, approximately 5-fold lower concentration of the polymer UCA is needed for investigation compared to phospholipid-shelled analogues. In the second set of experiments, destruction/replenishment method with varied time intervals ranging from 2ms to 3s between destructive and monitoring pulses is employed. The dependence of the peak-to-peak amplitude of backscattered wave versus pulse interval is fitted with an exponential function of the time γ=A(1-exp(-βt)) where A represents capillary volume and the time constant β represents velocity of the flow. Taking into account that backscattered signal is linearly proportional to the microbubble concentration, for both types of the UCAs it is observed that capillary volume is linearly proportional to the concentration of the microbubbles, but the estimation of the flow velocity is not affected by the change of the concentration. Using the single capillary model, for the phospholipid-shelled UCA a delay of about 0.2-0.3s in evaluation of the perfusion characteristics is found while polymer-shelled UCA provide response immediately. The latter at the concentration lower than 3.6×10(5)MB/ml have no statistically significant delay (p<0.01), do not cause any attenuation of the backscattered signal or saturation of the receiving part of the system. In conclusion, these results suggest that the novel polymer-shelled microbubbles have a potential to be used for perfusion evaluation.
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Affiliation(s)
- Dmitry Grishenkov
- School of Engineering Sciences, Royal Institute of Technology, Stockholm, Sweden.
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Hehrlein C. Quantitative myocardial blush grade: prepped for a core lab standardization. Catheter Cardiovasc Interv 2010; 76:511-2. [PMID: 20882654 DOI: 10.1002/ccd.22780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Success of arterial revascularization determined by contrast ultrasound muscle perfusion imaging. J Vasc Surg 2010; 52:1531-6. [PMID: 20843628 DOI: 10.1016/j.jvs.2010.07.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/29/2010] [Accepted: 07/01/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the early postoperative evaluation of the success of arterial revascularization, ankle-brachial index (ABI) and other noninvasive tests lack reliability, especially in patients with incompressible arteries or local edema. Contrast-enhanced ultrasound (CEUS) imaging of limb muscle perfusion may be an alternative to standard tests if it detects treatment success reliably. METHODS We compared a simplified CEUS method with clinical staging, pulse volume recording (PVR), and ABI in patients with lifestyle-limiting peripheral arterial disease undergoing revascularization by percutaneous transluminal angioplasty (PTA) or bypass surgery. Patients underwent staging, PVR, ABI, and CEUS before, directly after, and 3 to 5 months after successful PTA (n = 20) or successful bypass grafting (n = 14). For CEUS, contrast agent was injected into an antecubital vein, and the time from beginning to peak intensity of contrast enhancement (TTP) in the calf muscle was measured. RESULTS Successful revascularization by both PTA and bypass was associated with a significant improvement in staging, PVR, ABI, and TTP directly after intervention and at follow-up. Median ABI increased from 0.60 to 0.85 (P = .001) after PTA and from 0.36 to 0.76 (P = .003) after bypass surgery. Median TTP decreased from 45 seconds to 24 seconds (P = .015) and from 30 seconds to 27 seconds (P = .041), respectively. McNemar analysis revealed unidirectional changes in both ABI and TTP (P = .625 after PTA and P = 1.000 after bypass surgery), and equivalence analysis showed 95% confidence intervals within clinical indifference, indicating that TTP was equivalent to standard tests in detecting successful revascularization. CONCLUSIONS Contrast ultrasound perfusion imaging of calf muscle after arterial revascularization may be a valuable alternative to standard noninvasive tests such as ABI or PVR to determine the success of an arterial revascularization.
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Krix M, Krakowski-Roosen H, Kauczor HU, Delorme S, Weber MA. Real-time contrast-enhanced ultrasound for the assessment of perfusion dynamics in skeletal muscle. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1587-1595. [PMID: 19682788 DOI: 10.1016/j.ultrasmedbio.2009.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/26/2009] [Accepted: 05/04/2009] [Indexed: 05/28/2023]
Abstract
We developed a real-time low-MI contrast-enhanced ultrasound method (CEUS), compared it with venous occlusion plethysmography (VOP) and evaluated its robustness in the quantification of skeletal muscle perfusion during exercise. Contrast pulse sequencing (7 MHz) during continuous intravenous infusion of SonoVue (4.8 mL/300 s) was used repeatedly in eight healthy volunteers to monitor changes of the muscle perfusion before, during and after isometric exercises (10 to 50% of individual maximum strength for 20 to 30 s) of the gastrocnemius muscle in real time. CEUS was correlated with VOP at different time points, and the exactness of several CEUS parameters obtained from ultrasound-signal-intensity-time curves was evaluated. Real-time CEUS depicted a large variability of the skeletal muscle blood volume at rest (mean, 3.48; range, 0.60 to 9.92 [approximately mL]), with a significant reproducibility (r=0.72, p<0.05) and correlation with VOP (r=0.59, p<0.001). Mean blood volume during exercise was 1.58(approximately mL), increased to a mean maximum after exercise of 8.88 (approximately mL), the mean change of the local blood volume during and directly after the exercise was -0.10 and +1.57(approximately mL/s). The average CEUS signal during exercise decreased (mean area under the curve, -50.4 [approximately mL.s]) and subsequently increased post exercise (mean 118.6 [approximately mL.s]). CEUS parameters could be calculated with mean relative errors between 6 and 36%. Continuous assessment of local muscle microcirculation during exercise is possible with real-time CEUS with an acceptable robustness. Its application may be of particular interest in a better understanding of the role of perfusion during muscle training, and the monitoring of pathological vascular response, such as in diabetic microvessel diseases.
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Affiliation(s)
- Martin Krix
- German Cancer Research Center, Research Program Imaging and Radiooncology, Department of Radiology, Heidelberg, Germany.
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Abstract
Diabetic pedal osteomyelitis is primarily a manifestation of vascular insufficiency with resultant tissue ischemia, neuropathy, and infection. Nearly all cases of pedal osteomyelitis arise from a contiguous ulcer and soft tissue infection. MR imaging is the modality of choice to assess for the presence of osteomyelitis and associated soft tissue complications, to guide patient management, and to aid in limited limb resection.
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