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Fitian AI, Shieh MC, Gimnich OA, Belousova T, Taylor AA, Ballantyne CM, Bismuth J, Shah DJ, Brunner G. Contrast-Enhanced Magnetic Resonance Imaging Based T1 Mapping and Extracellular Volume Fractions Are Associated with Peripheral Artery Disease. J Cardiovasc Dev Dis 2024; 11:181. [PMID: 38921681 PMCID: PMC11203653 DOI: 10.3390/jcdd11060181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/28/2024] [Accepted: 06/09/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Extracellular volume fraction (ECV), measured with contrast-enhanced magnetic resonance imaging (CE-MRI), has been utilized to study myocardial fibrosis, but its role in peripheral artery disease (PAD) remains unknown. We hypothesized that T1 mapping and ECV differ between PAD patients and matched controls. METHODS AND RESULTS A total of 37 individuals (18 PAD patients and 19 matched controls) underwent 3.0T CE-MRI. Skeletal calf muscle T1 mapping was performed before and after gadolinium contrast with a motion-corrected modified look-locker inversion recovery (MOLLI) pulse sequence. T1 values were calculated with a three-parameter Levenberg-Marquardt curve fitting algorithm. ECV and T1 maps were quantified in five calf muscle compartments (anterior [AM], lateral [LM], and deep posterior [DM] muscle groups; soleus [SM] and gastrocnemius [GM] muscles). Averaged peak blood pool T1 values were obtained from the posterior and anterior tibialis and peroneal arteries. T1 values and ECV are heterogeneous across calf muscle compartments. Native peak T1 values of the AM, LM, and DM were significantly higher in PAD patients compared to controls (all p < 0.028). ECVs of the AM and SM were significantly higher in PAD patients compared to controls (AM: 26.4% (21.2, 31.6) vs. 17.3% (10.2, 25.1), p = 0.046; SM: 22.7% (19.5, 27.8) vs. 13.8% (10.2, 19.1), p = 0.020). CONCLUSIONS Native peak T1 values across all five calf muscle compartments, and ECV fractions of the anterior muscle group and the soleus muscle were significantly elevated in PAD patients compared with matched controls. Non-invasive T1 mapping and ECV quantification may be of interest for the study of PAD.
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Affiliation(s)
- Asem I. Fitian
- Penn State Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Michael C. Shieh
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Olga A. Gimnich
- Penn State Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Tatiana Belousova
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Addison A. Taylor
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Michael E DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Christie M. Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jean Bismuth
- Division of Vascular Surgery, University of South Florida Health Morsani School of Medicine, Tampa, FL 33620, USA
| | - Dipan J. Shah
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Gerd Brunner
- Penn State Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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Elsaid NMH, Peters DC, Galiana G, Sinusas AJ. Clinical physiology: the crucial role of MRI in evaluation of peripheral artery disease. Am J Physiol Heart Circ Physiol 2024; 326:H1304-H1323. [PMID: 38517227 DOI: 10.1152/ajpheart.00533.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 03/23/2024]
Abstract
Peripheral artery disease (PAD) is a common vascular disease that primarily affects the lower limbs and is defined by the constriction or blockage of peripheral arteries and may involve microvascular dysfunction and tissue injury. Patients with diabetes have more prominent disease of microcirculation and develop peripheral neuropathy, autonomic dysfunction, and medial vascular calcification. Early and accurate diagnosis of PAD and disease characterization are essential for personalized management and therapy planning. Magnetic resonance imaging (MRI) provides excellent soft tissue contrast and multiplanar imaging capabilities and is useful as a noninvasive imaging tool in the comprehensive physiological assessment of PAD. This review provides an overview of the current state of the art of MRI in the evaluation and characterization of PAD, including an analysis of the many applicable MR imaging techniques, describing the advantages and disadvantages of each approach. We also present recent developments, future clinical applications, and future MRI directions in assessing PAD. The development of new MR imaging technologies and applications in preclinical models with translation to clinical research holds considerable potential for improving the understanding of the pathophysiology of PAD and clinical applications for improving diagnostic precision, risk stratification, and treatment outcomes in patients with PAD.
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Affiliation(s)
- Nahla M H Elsaid
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
| | - Gigi Galiana
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
| | - Albert J Sinusas
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
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Taso M, Aramendía-Vidaurreta V, Englund EK, Francis S, Franklin S, Madhuranthakam AJ, Martirosian P, Nayak KS, Qin Q, Shao X, Thomas DL, Zun Z, Fernández-Seara MA. Update on state-of-the-art for arterial spin labeling (ASL) human perfusion imaging outside of the brain. Magn Reson Med 2023; 89:1754-1776. [PMID: 36747380 DOI: 10.1002/mrm.29609] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
This review article provides an overview of developments for arterial spin labeling (ASL) perfusion imaging in the body (i.e., outside of the brain). It is part of a series of review/recommendation papers from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group. In this review, we focus on specific challenges and developments tailored for ASL in a variety of body locations. After presenting common challenges, organ-specific reviews of challenges and developments are presented, including kidneys, lungs, heart (myocardium), placenta, eye (retina), liver, pancreas, and muscle, which are regions that have seen the most developments outside of the brain. Summaries and recommendations of acquisition parameters (when appropriate) are provided for each organ. We then explore the possibilities for wider adoption of body ASL based on large standardization efforts, as well as the potential opportunities based on recent advances in high/low-field systems and machine-learning. This review seeks to provide an overview of the current state-of-the-art of ASL for applications in the body, highlighting ongoing challenges and solutions that aim to enable more widespread use of the technique in clinical practice.
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Affiliation(s)
- Manuel Taso
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Erin K Englund
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan Francis
- Sir Peter Mansfield Imaging Center, University of Nottingham, Nottingham, UK
| | - Suzanne Franklin
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ananth J Madhuranthakam
- Department of Radiology, Advanced Imaging Research Center, and Biomedical Engineering, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Petros Martirosian
- Section on Experimental Radiology, Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Zungho Zun
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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Gimnich OA, Belousova T, Short CM, Taylor AA, Nambi V, Morrisett JD, Ballantyne CM, Bismuth J, Shah DJ, Brunner G. Magnetic Resonance Imaging-Derived Microvascular Perfusion Modeling to Assess Peripheral Artery Disease. J Am Heart Assoc 2023; 12:e027649. [PMID: 36688362 PMCID: PMC9973623 DOI: 10.1161/jaha.122.027649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/14/2022] [Indexed: 01/24/2023]
Abstract
Background Computational fluid dynamics has shown good agreement with contrast-enhanced magnetic resonance imaging measurements in cardiovascular disease applications. We have developed a biomechanical model of microvascular perfusion using contrast-enhanced magnetic resonance imaging signal intensities derived from skeletal calf muscles to study peripheral artery disease (PAD). Methods and Results The computational microvascular model was used to study skeletal calf muscle perfusion in 56 individuals (36 patients with PAD, 20 matched controls). The recruited participants underwent contrast-enhanced magnetic resonance imaging and ankle-brachial index testing at rest and after 6-minute treadmill walking. We have determined associations of microvascular model parameters including the transfer rate constant, a measure of vascular leakiness; the interstitial permeability to fluid flow which reflects the permeability of the microvasculature; porosity, a measure of the fraction of the extracellular space; the outflow filtration coefficient; and the microvascular pressure with known markers of patients with PAD. Transfer rate constant, interstitial permeability to fluid flow, and microvascular pressure were higher, whereas porosity and outflow filtration coefficient were lower in patients with PAD than those in matched controls (all P values ≤0.014). In pooled analyses of all participants, the model parameters (transfer rate constant, interstitial permeability to fluid flow, porosity, outflow filtration coefficient, microvascular pressure) were significantly associated with the resting and exercise ankle-brachial indexes, claudication onset time, and peak walking time (all P values ≤0.013). Among patients with PAD, interstitial permeability to fluid flow, and microvascular pressure were higher, while porosity and outflow filtration coefficient were lower in treadmill noncompleters compared with treadmill completers (all P values ≤0.001). Conclusions Computational microvascular model parameters differed significantly between patients with PAD and matched controls. Thus, computational microvascular modeling could be of interest in studying lower extremity ischemia.
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Affiliation(s)
- Olga A. Gimnich
- Penn State Heart and Vascular Institute, Pennsylvania State University College of MedicineHersheyPA
| | - Tatiana Belousova
- Methodist DeBakey Heart and Vascular CenterHouston Methodist HospitalHoustonTX
| | - Christina M. Short
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Addison A. Taylor
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
- Michael E DeBakey VA Medical CenterHoustonTX
| | - Vijay Nambi
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
- Department of Medicine, Section of CardiologyBaylor College of MedicineHoustonTX
- Michael E DeBakey VA Medical CenterHoustonTX
| | - Joel D. Morrisett
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Christie M. Ballantyne
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
- Department of Medicine, Section of CardiologyBaylor College of MedicineHoustonTX
| | - Jean Bismuth
- Division of Vascular and Endovascular SurgeryLouisiana State University Health Sciences CenterNew OrleansLA
| | - Dipan J. Shah
- Methodist DeBakey Heart and Vascular CenterHouston Methodist HospitalHoustonTX
| | - Gerd Brunner
- Penn State Heart and Vascular Institute, Pennsylvania State University College of MedicineHersheyPA
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
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5
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Pantoja JL, Ali F, Baril DT, Farley SM, Boynton S, Finn JP, Hu P, Lawrence PF. Arterial spin labeling magnetic resonance imaging quantifies tissue perfusion around foot ulcers. J Vasc Surg Cases Innov Tech 2022; 8:817-824. [PMID: 36510629 PMCID: PMC9735268 DOI: 10.1016/j.jvscit.2022.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Tools that quantify tissue perfusion of the foot are deficient, contributing to the uncertainty in predicting ulcer healing potential. This pilot study aims to quantify peri-wound foot perfusion at various tissue depths using a novel application of pseudo-continuous arterial spin labeling magnetic resonance imaging. Methods Ten diabetic patients with neuropathic wounds and 20 healthy volunteers without wounds were recruited. Wounds were graded according to the Wound, Ischemia, Foot Infection (WIfI) system. All subjects underwent a noncontrasted ASL MRI of the foot for perfusion measurements. For healthy volunteers, perfusion was compared at rest and during sustained toe flexion between four regions: lateral plantar, medial plantar, lateral calcaneal, and medial calcaneal. Evaluations of diabetic volunteers compared perfusion between four zones: wound, near border, far border, and remote. Remote zone perfusion in diabetics was compared with perfusion in the plantar foot of healthy volunteers. Results There were 11 wounds, which were located over the metatarsal heads in five, the stump of a transmetatarsal amputation in three, the heel in two, and the mid foot in one. The median WIfI stage was 2. One patient had a WIfI ischemia grade of 1; the remaining patients' grades were 0. The mean ankle-brachial index was 1.0 ± 0.3. There were two patients with a WIfI foot infection grade of 1; the remaining patients' grades were 0. In healthy volunteers, plantar foot perfusion with sustained toe flexion was 43.9 ± 1.7 mL/100g/min and significantly higher than perfusion at rest (27.3 ± 2.7 mL/100g/min; P < .001). In diabetic patients, perfusion at the wound, near border, far border, and remote regions was 96.1 ± 10.7, 92.7 ± 9.4, 73.4 ± 8.2, and 62.8 ± 2.7 mL/100g/min. Although this perfusion pattern persisted throughout the depth of the wound, perfusion decreased with tissue depth. In the near border, perfusion at 20% of the wound depth was 124.0 ± 35.6 mL/100g/min and 69.9 ± 10.1 mL/100g/min at 100% (P = .006). Lastly, remote perfusion in diabetics was 2.3 times the plantar perfusion in healthy volunteers (27.3 ± 2.7 mL/100g/min; P < .001). Conclusions The pattern of resting tissue perfusion around nonischemic diabetic foot ulcers was successfully quantified with arterial spin labeling magnetic resonance imaging. Diabetic patients with wounds were hyperemic compared with healthy volunteers. There was a 1.5-fold increase in peri-wound tissue perfusion relative to the rest of the foot. This study is the first step in developing a tool to assess the perfusion deficit in ischemic wounds.
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Affiliation(s)
- Joe Luis Pantoja
- Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Correspondence: Dr Joe Luis Pantoja, MD, Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Medical Plaza Driveway, Ste 530, Los Angeles, CA 90095
| | - Fadil Ali
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Donald T. Baril
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Steven M. Farley
- Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Scott Boynton
- Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - J. Paul Finn
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Peng Hu
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Peter F. Lawrence
- Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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6
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Englund EK, Langham MC, Wehrli FW, Fanning MJ, Khan Z, Schmitz KH, Ratcliffe SJ, Floyd TF, Mohler ER. Impact of supervised exercise on skeletal muscle blood flow and vascular function measured with MRI in patients with peripheral artery disease. Am J Physiol Heart Circ Physiol 2022; 323:H388-H396. [PMID: 35802515 PMCID: PMC9359664 DOI: 10.1152/ajpheart.00633.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/21/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
Supervised exercise is a common therapeutic intervention for patients with peripheral artery disease (PAD), however, the mechanism underlying the improvement in claudication symptomatology is not completely understood. The hypothesis that exercise improves microvascular blood flow is herein tested via temporally resolved magnetic resonance imaging (MRI) measurement of blood flow and oxygenation dynamics during reactive hyperemia in the leg with the lower ankle-brachial index. One hundred and forty-eight subjects with PAD were prospectively assigned to standard medical care or 3 mo of supervised exercise therapy. Before and after the intervention period, subjects performed a graded treadmill walking test, and MRI data were collected with Perfusion, Intravascular Venous Oxygen saturation, and T2* (PIVOT), a method that simultaneously quantifies microvascular perfusion, as well as relative oxygenation changes in skeletal muscle and venous oxygen saturation in a large draining vein. The 3-mo exercise intervention was associated with an improvement in peak walking time (64% greater in those randomized to the exercise group at follow-up, P < 0.001). Significant differences were not observed in the MRI measures between the subjects randomized to exercise therapy versus standard medical care based on an intention-to-treat analysis. However, the peak postischemia perfusion averaged across the leg between baseline and follow-up visits increased by 10% (P = 0.021) in participants that were adherent to the exercise protocol (completed >80% of prescribed exercise visits). In this cohort of adherent exercisers, there was no difference in the time to peak perfusion or oxygenation metrics, suggesting that there was no improvement in microvascular function nor changes in tissue metabolism in response to the 3-mo exercise intervention.NEW & NOTEWORTHY Supervised exercise interventions can improve symptomatology in patients with peripheral artery disease, but the underlying mechanism remains unclear. Here, MRI was used to evaluate perfusion, relative tissue oxygenation, and venous oxygen saturation in response to cuff-induced ischemia. Reactive hyperemia responses were measured before and after 3 mo of randomized supervised exercise therapy or standard medical care. Those participants who were adherent to the exercise regimen had a significant improvement in peak perfusion.
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Affiliation(s)
- Erin K Englund
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael C Langham
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Molly J Fanning
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zeeshan Khan
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Penn State University, University Park, Pennsylvania
| | - Sarah J Ratcliffe
- Department of Biostatistics, University of Virginia, Charlottesville, Virginia
| | - Thomas F Floyd
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas
| | - Emile R Mohler
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Zheng J, Sorensen C, Li R, An H, Hildebolt CF, Zayed MA, Mueller MJ, Hastings MK. Deteriorated regional calf microcirculation measured by contrast-free MRI in patients with diabetes mellitus and relation with physical activity. Diab Vasc Dis Res 2021; 18:14791641211029002. [PMID: 34313140 PMCID: PMC8481746 DOI: 10.1177/14791641211029002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate regional calf muscle microcirculation in people with diabetes mellitus (DM) with and without foot ulcers, compared to healthy control people without DM, using contrast-free magnetic resonance imaging methods. METHODS Three groups of subjects were recruited: non-DM controls, DM, and DM with foot ulcers (DM + ulcer), all with ankle brachial index (ABI) > 0.9. Skeletal muscle blood flow (SMBF) and oxygen extraction fraction (SMOEF) in calf muscle were measured at rest and during a 5-min isometric ankle plantarflexion exercise. Subjects completed the Yale physical activity survey. RESULTS The exercise SMBF (ml/min/100 g) of the medial gastrocnemius muscle were progressively impaired: 63.7 ± 18.9 for controls, 42.9 ± 6.7 for DM, and 36.2 ± 6.2 for DM + ulcer, p < 0.001. Corresponding exercise SMOEF was the lowest in DM + ulcers (0.48 ± 0.09). Exercise SMBF in the soleus muscle was correlated moderately with the Yale physical activity survey (r = 0.39, p < 0.01). CONCLUSIONS Contrast-free MR imaging identified progressively impaired regional microcirculation in medial gastrocnemius muscles of people with DM with and without foot ulcers. Exercise SMBF in the medial gastrocnemius muscle was the most sensitive index and was associated with HbA1c. Lower exercise SMBF in the soleus muscle was associated with lower Yale score.
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Affiliation(s)
- Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Jie Zheng, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Room 3114, St. Louis, MO 63130-4899, USA.
| | - Christopher Sorensen
- The Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Ran Li
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles F Hildebolt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mohamed A Zayed
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael J Mueller
- The Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Mary K Hastings
- The Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
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8
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Zheng J, Li R, Zayed MA, Yan Y, An H, Hastings MK. Pilot study of contrast-free MRI reveals significantly impaired calf skeletal muscle perfusion in diabetes with incompressible peripheral arteries. Vasc Med 2021; 26:367-373. [PMID: 33749394 DOI: 10.1177/1358863x21996465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Patients with diabetes mellitus (DM) are more likely to have densely calcified lesions in the below-the-knee tibial arteries. However, the relationship between peripheral arterial calcification and local skeletal muscle perfusion has not been explored. Thirty subjects were prospectively recruited into three groups in this pilot study: (1) Non-DM: 10 people without DM; (2) DM, ABI < 1.3: 10 people with DM and normal ankle-brachial index (ABI) (0.9-1.3); and (3) DM, ABI ⩾ 1.3: 10 people with DM and ABI ⩾ 1.3. All subjects underwent calf perfusion measurements at rest and during an isometric plantarflexion contraction exercise within the magnetic resonance imaging (MRI) system. The noncontrast MRI techniques were applied to quantitatively assess skeletal muscle blood flow (SMBF) and oxygen extraction fraction (SMOEF) in medial gastrocnemius and soleus muscles. Both SMBF and SMOEF reserves were calculated as the ratio of the exercise value to the resting value. Exercise SMBF and SMOEF values in the medial gastrocnemius muscle were lower in the two DM groups than in the non-DM group (p < 0.05). The SMBF reserve in medial gastrocnemius was significantly lower in the DM, ABI ⩾ 1.3 group compared to the DM, ABI < 1.3 group (p < 0.05). This study demonstrates that people with DM and calcified arteries had lower perfusion in gastrocnemius muscle compared to those without DM and those with DM and a normal ABI.
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Affiliation(s)
- Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Ran Li
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Mohamed A Zayed
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Yan Yan
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Mary K Hastings
- Physical Therapy Program, Washington University School of Medicine, St Louis, MO, USA
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9
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Low frequency oscillations assessed by diffuse speckle contrast analysis for foot angiosome concept. Sci Rep 2020; 10:17153. [PMID: 33051486 PMCID: PMC7553923 DOI: 10.1038/s41598-020-73604-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/03/2020] [Indexed: 12/14/2022] Open
Abstract
An angiosome refers to a 3D tissue volume that is vascularized by a single artery and is a relatively new concept that is useful in vascular surgery; however, the direct relationship between arterial blood flow and micro-perfusion is still controversial. Here, we propose a diffuse speckle contrast analysis (DSCA), which is an emerging tissue perfusion monitoring modality, to investigate the correlations among low frequency oscillations (LFOs) measured from different areas on the feet of healthy subjects. We obtained reproducible results from the correlation analyses of LFOs, and their physiological implications were discussed. In order to confirm the changes in the frequency oscillations, we analyzed and compared the power spectral density changes due to heart rate variability in the electrocardiographic signal during reactive hyperemia and head-up tilt protocols.
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10
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Englund EK, Langham MC. Quantitative and Dynamic MRI Measures of Peripheral Vascular Function. Front Physiol 2020; 11:120. [PMID: 32184733 PMCID: PMC7058683 DOI: 10.3389/fphys.2020.00120] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 02/03/2020] [Indexed: 12/31/2022] Open
Abstract
The endothelium regulates and mediates vascular homeostasis, allowing for dynamic changes of blood flow in response to mechanical and chemical stimuli. Endothelial dysfunction underlies many diseases and is purported to be the earliest pathologic change in the progression of atherosclerotic disease. Peripheral vascular function can be interrogated by measuring the response kinetics following induced ischemia or exercise. In the presence of endothelial dysfunction, there is a blunting and delay of the hyperemic response, which can be measured non-invasively using a variety of quantitative magnetic resonance imaging (MRI) methods. In this review, we summarize recent developments in non-contrast, proton MRI for dynamic quantification of blood flow and oxygenation. Methodologic description is provided for: blood oxygenation-level dependent (BOLD) signal that reflect combined effect of blood flow and capillary bed oxygen content; arterial spin labeling (ASL) for quantification of regional perfusion; phase contrast (PC) to quantify arterial flow waveforms and macrovascular blood flow velocity and rate; high-resolution MRI for luminal flow-mediated dilation; and dynamic MR oximetry to quantify oxygen saturation. Overall, results suggest that these dynamic and quantitative MRI methods can detect endothelial dysfunction both in the presence of overt cardiovascular disease (such as in patients with peripheral artery disease), as well as in sub-clinical settings (i.e., in chronic smokers, non-smokers exposed to e-cigarette aerosol, and as a function of age). Thus far, these tools have been relegated to the realm of research, used as biomarkers of disease progression and therapeutic response. With proper validation, MRI-measures of vascular function may ultimately be used to complement the standard clinical workup, providing additional insight into the optimal treatment strategy and evaluation of treatment efficacy.
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Affiliation(s)
- Erin K Englund
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Michael C Langham
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
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11
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Gimnich OA, Singh J, Bismuth J, Shah DJ, Brunner G. Magnetic resonance imaging based modeling of microvascular perfusion in patients with peripheral artery disease. J Biomech 2019; 93:147-158. [PMID: 31331663 PMCID: PMC7390497 DOI: 10.1016/j.jbiomech.2019.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/20/2022]
Abstract
Peripheral artery disease (PAD) is associated with an increased risk of adverse cardiovascular events, impaired lower extremity blood flow and microvascular perfusion abnormalities in the calf muscles which can be determined with contrast-enhanced magnetic resonance imaging (CE-MRI). We developed a computational model of the microvascular perfusion in the calf muscles. We included 20 patients (10 PAD, 10 controls) and utilized the geometry, mean signal intensity and arterial input functions from CE-MRI calf muscle perfusion scans. The model included the microvascular pressure (pv), outflow filtration coefficient (OFC), transfer rate constant (kt), porosity (φ), and the interstitial permeability (Ktissue). Parameters were fitted and the simulations were compared across PAD patients and controls. Intra-observer reproducibility of the simulated mean signal intensities was excellent (intraclass correlation coefficients >0.995). kt and Ktissue were higher in PAD patients compared with controls (4.72 interquartile range (IQR) 3.33, 5.56 vs. 2.47 IQR 2.10, 2.85; p = 0.003; and 3.68 IQR 3.18, 4.41 vs. 1.81 IQR 1.81, 1.81; p < 0.001). Conversely, porosity (φ) was lower in PAD patients compared with controls (0.52 IQR 0.49, 0.54 vs. 0.61 IQR 0.58, 0.64; p = 0.016). Porosity (φ) was correlated with the ankle brachial index (r = 0.64, p = 0.011). The proposed computational microvascular model is robust and reproducible, and essential model parameters differ significantly between PAD patients and controls.
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Affiliation(s)
- Olga A Gimnich
- Cardiovascular Imaging Research and Data Sciences Laboratory, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jaykrishna Singh
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Jean Bismuth
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Dipan J Shah
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Gerd Brunner
- Cardiovascular Imaging Research and Data Sciences Laboratory, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA; Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA..
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12
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Englund EK, Rodgers ZB, Langham MC, Mohler ER, Floyd TF, Wehrli FW. Simultaneous measurement of macro- and microvascular blood flow and oxygen saturation for quantification of muscle oxygen consumption. Magn Reson Med 2017; 79:846-855. [PMID: 28497497 DOI: 10.1002/mrm.26744] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/12/2017] [Accepted: 04/12/2017] [Indexed: 11/06/2022]
Abstract
PURPOSE To investigate the relationship between blood flow and oxygen consumption in skeletal muscle, a technique called "Velocity and Perfusion, Intravascular Venous Oxygen saturation and T2*" (vPIVOT) is presented. vPIVOT allows the quantification of feeding artery blood flow velocity, perfusion, draining vein oxygen saturation, and muscle T2*, all at 4-s temporal resolution. Together, the measurement of blood flow and oxygen extraction can yield muscle oxygen consumption ( V˙O2) via the Fick principle. METHODS In five subjects, vPIVOT-derived results were compared with those obtained from stand-alone sequences during separate ischemia-reperfusion paradigms to investigate the presence of measurement bias. Subsequently, in 10 subjects, vPIVOT was applied to assess muscle hemodynamics and V˙O2 following a bout of dynamic plantar flexion contractions. RESULTS From the ischemia-reperfusion paradigm, no significant differences were observed between data from vPIVOT and comparison sequences. After exercise, the macrovascular flow response reached a maximum 8 ± 3 s after relaxation; however, perfusion in the gastrocnemius muscle continued to rise for 101 ± 53 s. Peak V˙O2 calculated based on mass-normalized arterial blood flow or perfusion was 15.2 ± 6.7 mL O2 /min/100 g or 6.0 ± 1.9 mL O2 /min/100 g, respectively. CONCLUSIONS vPIVOT is a new method to measure blood flow and oxygen saturation, and therefore to quantify muscle oxygen consumption. Magn Reson Med 79:846-855, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Erin K Englund
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zachary B Rodgers
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael C Langham
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emile R Mohler
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas F Floyd
- Department of Anesthesiology, Stony Brook University, Stony Brook, New York, USA
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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Muller MD, Li Z, Sica CT, Luck JC, Gao Z, Blaha CA, Cauffman AE, Ross AJ, Winkler NJR, Herr MD, Brandt K, Wang J, Gallagher DC, Karunanayaka P, Vesek J, Leuenberger UA, Yang QX, Sinoway LI. Muscle oxygenation during dynamic plantar flexion exercise: combining BOLD MRI with traditional physiological measurements. Physiol Rep 2016; 4:4/20/e13004. [PMID: 27798357 PMCID: PMC5099966 DOI: 10.14814/phy2.13004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 11/24/2022] Open
Abstract
Blood-oxygen-level-dependent magnetic resonance imaging (BOLD MRI) has the potential to quantify skeletal muscle oxygenation with high temporal and high spatial resolution. The purpose of this study was to characterize skeletal muscle BOLD responses during steady-state plantar flexion exercise (i.e., during the brief rest periods between muscle contraction). We used three different imaging modalities (ultrasound of the popliteal artery, BOLD MRI, and near-infrared spectroscopy [NIRS]) and two different exercise intensities (2 and 6 kg). Six healthy men underwent three separate protocols of dynamic plantar flexion exercise on separate days and acute physiological responses were measured. Ultrasound studies showed the percent change in popliteal velocity from baseline to the end of exercise was 151 ± 24% during 2 kg and 589 ± 145% during 6 kg. MRI studies showed an abrupt decrease in BOLD signal intensity at the onset of 2 kg exercise, indicating deoxygenation. The BOLD signal was further reduced during 6 kg exercise (compared to 2 kg) at 1 min (-4.3 ± 0.7 vs. -1.2 ± 0.4%, P < 0.001). Similarly, the change in the NIRS muscle oxygen saturation in the medial gastrocnemius was -11 ± 4% at 2 kg and -38 ± 11% with 6 kg (P = 0.041). In conclusion, we demonstrate that BOLD signal intensity decreases during plantar flexion and this effect is augmented at higher exercise workloads.
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Affiliation(s)
- Matthew D Muller
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Zhijun Li
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Christopher T Sica
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - J Carter Luck
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Zhaohui Gao
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Cheryl A Blaha
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Aimee E Cauffman
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Amanda J Ross
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Nathan J R Winkler
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Michael D Herr
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Kristen Brandt
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jianli Wang
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - David C Gallagher
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Prasanna Karunanayaka
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jeffrey Vesek
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Urs A Leuenberger
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Qing X Yang
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Lawrence I Sinoway
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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14
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Englund EK, Rodgers ZB, Langham MC, Mohler ER, Floyd TF, Wehrli FW. Measurement of skeletal muscle perfusion dynamics with pseudo-continuous arterial spin labeling (pCASL): Assessment of relative labeling efficiency at rest and during hyperemia, and comparison to pulsed arterial spin labeling (PASL). J Magn Reson Imaging 2016; 44:929-39. [PMID: 27043039 DOI: 10.1002/jmri.25247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/04/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To compare calf skeletal muscle perfusion measured with pulsed arterial spin labeling (PASL) and pseudo-continuous arterial spin labeling (pCASL) methods, and to assess the variability of pCASL labeling efficiency in the popliteal artery throughout an ischemia-reperfusion paradigm. MATERIALS AND METHODS At 3T, relative pCASL labeling efficiency was experimentally assessed in five subjects by measuring the signal intensity of blood in the popliteal artery just distal to the labeling plane immediately following pCASL labeling or control preparation pulses, or without any preparation pulses throughout separate ischemia-reperfusion paradigms. The relative label and control efficiencies were determined during baseline, hyperemia, and recovery. In a separate cohort of 10 subjects, pCASL and PASL sequences were used to measure reactive hyperemia perfusion dynamics. RESULTS Calculated pCASL labeling and control efficiencies did not differ significantly between baseline and hyperemia or between hyperemia and recovery periods. Relative to the average baseline, pCASL label efficiency was 2 ± 9% lower during hyperemia. Perfusion dynamics measured with pCASL and PASL did not differ significantly (P > 0.05). Average leg muscle peak perfusion was 47 ± 20 mL/min/100g or 50 ± 12 mL/min/100g, and time to peak perfusion was 25 ± 3 seconds and 25 ± 7 seconds from pCASL and PASL data, respectively. Differences of further metrics parameterizing the perfusion time course were not significant between pCASL and PASL measurements (P > 0.05). CONCLUSION No change in pCASL labeling efficiency was detected despite the almost 10-fold increase in average blood flow velocity in the popliteal artery. pCASL and PASL provide precise and consistent measurement of skeletal muscle reactive hyperemia perfusion dynamics. J. MAGN. RESON. IMAGING 2016;44:929-939.
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Affiliation(s)
- Erin K Englund
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Zachary B Rodgers
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael C Langham
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emile R Mohler
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas F Floyd
- Department of Anesthesiology, Stony Brook University, Stony Brook, New York, USA
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Calf muscle perfusion as measured with magnetic resonance imaging to assess peripheral arterial disease. Med Biol Eng Comput 2016; 54:1667-1681. [PMID: 26906279 DOI: 10.1007/s11517-016-1457-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Abstract
We hypothesized that skeletal muscle perfusion is impaired in peripheral arterial disease (PAD) patients compared to healthy controls and that perfusion patterns exhibit marked differences across five leg muscle compartments including the anterior muscle group (AM), lateral muscle group (LM), deep posterior muscle group (DM), soleus (SM), and the gastrocnemius muscle (GM). A total of 40 individuals (26 PAD patients and 14 healthy controls) underwent contrast-enhanced magnetic resonance imaging (CE-MRI) utilizing a reactive hyperemia protocol. Muscle perfusion maps were developed for AM, LM, DM, SM, and GM. Perfusion maps were analyzed over the course of 2 min, starting at local pre-contrast arrival, to study early-to-intermediate gadolinium enhancement. PAD patients had a higher fraction of hypointense voxels at pre-contrast arrival for all five muscle compartments compared with healthy controls (p < 0.0005). Among PAD patients, the fraction of hypointense voxels of the AM, LM, and GM were inversely correlated with the estimated glomerular filtration rate (eGFR; r = -0.509, p = 0.008; r = -0.441, p = 0.024; and r = -0.431, p = 0.028, respectively). CE-MRI-based skeletal leg muscle perfusion is markedly reduced in PAD patients compared with healthy controls and shows heterogeneous patterns across calf muscle compartments.
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16
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Nguyen A, Ledoux JB, Omoumi P, Becce F, Forget J, Federau C. Application of intravoxel incoherent motion perfusion imaging to shoulder muscles after a lift-off test of varying duration. NMR IN BIOMEDICINE 2016; 29:66-73. [PMID: 26684052 DOI: 10.1002/nbm.3449] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/06/2015] [Accepted: 10/26/2015] [Indexed: 06/05/2023]
Abstract
Intravoxel incoherent motion (IVIM) MRI is a method to extract microvascular blood flow information out of diffusion-weighted images acquired at multiple b-values. We hypothesized that IVIM can identify the muscles selectively involved in a specific task, by measuring changes in activity-induced local muscular perfusion after exercise. We tested this hypothesis using a widely used clinical maneuver, the lift-off test, which is known to assess specifically the subscapularis muscle functional integrity. Twelve shoulders from six healthy male volunteers were imaged at 3 T, at rest, as well as after a lift-off test hold against resistance for 30 s, 1 and 2 min respectively, in three independent sessions. IVIM parameters, consisting of perfusion fraction (f), diffusion coefficient (D), pseudo-diffusion coefficient D* and blood flow-related fD*, were estimated within outlined muscles of the rotator cuff and the deltoid bundles. The mean values at rest and after the lift-off tests were compared in each muscle using a one-way ANOVA. A statistically significant increase in fD* was measured in the subscapularis, after a lift-off test of any duration, as well as in D. A fD* increase was the most marked (30 s, +103%; 1 min, +130%; 2 min, +156%) and was gradual with the duration of the test (in 10(-3) mm(2) /s: rest, 1.41 ± 0.50; 30 s, 2.86 ± 1.17; 1 min, 3.23 ± 1.22; 2 min, 3.60 ± 1.21). A significant increase in fD* and D was also visible in the posterior bundle of the deltoid. No significant change was consistently visible in the other investigated muscles of the rotator cuff and the other bundles of the deltoid. In conclusion, IVIM fD* allows the demonstration of a task-related microvascular perfusion increase after a specific task and suggests a direct relationship between microvascular perfusion and the duration of the effort. It is a promising method to investigate non-invasively skeletal muscle physiology and clinical perfusion-related muscular disorders.
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Affiliation(s)
- Audrey Nguyen
- Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Jean-Baptiste Ledoux
- Department of Diagnostic and Interventional Radiology, University Hospital Center and University of Lausanne (CHUV-UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, University Hospital Center and University of Lausanne (CHUV-UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, University Hospital Center and University of Lausanne (CHUV-UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Joachim Forget
- Department of Diagnostic and Interventional Radiology, University Hospital Center and University of Lausanne (CHUV-UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Christian Federau
- Department of Diagnostic and Interventional Radiology, University Hospital Center and University of Lausanne (CHUV-UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Department of Radiology, Division of Neuroradiology, Stanford University, 300 Pasteur Drive, Room S039, Stanford, CA, 94305-5105, United States
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17
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Englund EK, Langham MC, Ratcliffe SJ, Fanning MJ, Wehrli FW, Mohler ER, Floyd TF. Multiparametric assessment of vascular function in peripheral artery disease: dynamic measurement of skeletal muscle perfusion, blood-oxygen-level dependent signal, and venous oxygen saturation. Circ Cardiovasc Imaging 2015; 8:e002673. [PMID: 25873722 PMCID: PMC4399002 DOI: 10.1161/circimaging.114.002673] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endothelial dysfunction present in patients with peripheral artery disease may be better understood by measuring the temporal dynamics of blood flow and oxygen saturation during reactive hyperemia than by conventional static measurements. METHODS AND RESULTS Perfusion, Intravascular Venous Oxygen saturation, and T2* (PIVOT), a recently developed MRI technique, was used to measure the response to an ischemia-reperfusion paradigm in 96 patients with peripheral artery disease of varying severity and 10 healthy controls. Perfusion, venous oxygen saturation SvO2, and T2* were each quantified in the calf at 2-s temporal resolution, yielding a dynamic time course for each variable. Compared with healthy controls, patients had a blunted and delayed hyperemic response. Moreover, patients with lower ankle-brachial index had (1) a more delayed reactive hyperemia response time, manifesting as an increase in time to peak perfusion in the gastrocnemius, soleus, and peroneus muscles, and in the anterior compartment, (2) an increase in the time to peak T2* measured in the soleus muscle, and (3) a prolongation of the posterior tibial vein SvO2 washout time. Intrasession and intersession repeatability were also assessed. Results indicated that time to peak perfusion and time to peak T2* were the most reliable extracted time course metrics. CONCLUSIONS Perfusion, dynamic SvO2, and T2* response times after induced ischemia are highly correlated with peripheral artery disease severity. Combined imaging of peripheral microvascular blood flow and dynamics of oxygen saturation with Perfusion, intravascular SvO2, and T2* may be a useful tool to investigate the pathophysiology of peripheral artery disease.
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Affiliation(s)
- Erin K Englund
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.).
| | - Michael C Langham
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
| | - Sarah J Ratcliffe
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
| | - Molly J Fanning
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
| | - Felix W Wehrli
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
| | - Emile R Mohler
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
| | - Thomas F Floyd
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
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18
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Lopez D, Pollak AW, Meyer CH, Epstein FH, Zhao L, Pesch AJ, Jiji R, Kay JR, DiMaria JM, Christopher JM, Kramer CM. Arterial spin labeling perfusion cardiovascular magnetic resonance of the calf in peripheral arterial disease: cuff occlusion hyperemia vs exercise. J Cardiovasc Magn Reson 2015; 17:23. [PMID: 25890198 PMCID: PMC4336689 DOI: 10.1186/s12968-015-0128-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/27/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Assessment of calf muscle perfusion requires a physiological challenge. Exercise and cuff-occlusion hyperemia are commonly used methods, but it has been unclear if one is superior to the other. We hypothesized that post-occlusion calf muscle perfusion (Cuff) with pulsed arterial spin labeling (PASL) cardiovascular magnetic resonance (CMR) at 3 Tesla (T) would yield greater perfusion and improved reproducibility compared to exercise hyperemia in studies of peripheral arterial disease (PAD). METHODS Exercise and Cuff cohorts were independently recruited. PAD patients had an ankle brachial index (ABI) between 0.4-0.9. Controls (NL) had no risk factors and ABI 0.9-1.4. Subjects exercised until exhaustion (15 NL-Ex, 15 PAD-Ex) or had a thigh cuff inflated for 5 minutes (12 NL-Cuff, 11 PAD-Cuff). Peak exercise and average cuff (Cuff mean ) perfusion were compared. Six participants underwent both cuff and exercise testing. Reproducibility was tested in 8 Cuff subjects (5 NL, 3 PAD). RESULTS Controls had greater perfusion than PAD independent of stressor (NL-Ex 74 ± 21 vs. PAD-Ex 43 ± 10, p = 0.01; NL-Cuff mean 109 ± 39 vs. PAD-Cuff mean 34 ± 17 ml/min-100 g, p < 0.001). However, there was no difference between exercise and Cuff mean perfusion within groups (p > 0.6). Results were similar when the same subjects had the 2 stressors performed. Cuff mean had superior reproducibility (Cuff mean ICC 0.98 vs. Exercise ICC 0.87) and area under the receiver operating characteristic curve (Cuff mean 0.992 vs. Exercise 0.905). CONCLUSIONS Cuff hyperemia differentiates PAD patients from controls, as does exercise stress. Cuff mean and exercise calf perfusion values are similar. Cuff occlusion hyperemia has superior reproducibility and thus may be the preferred stressor.
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Affiliation(s)
- David Lopez
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
- Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
| | - Amy W Pollak
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
- Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
| | - Craig H Meyer
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA.
- Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
| | - Frederick H Epstein
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA.
- Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
| | - Li Zhao
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA.
- Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
| | - Arthur J Pesch
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
- Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
| | - Ronny Jiji
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
- Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
| | - Jennifer R Kay
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
- Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
| | - Joseph M DiMaria
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
- Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
| | - John M Christopher
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
- Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
| | - Christopher M Kramer
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
- Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
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Magnetic Resonance Imaging-derived Arterial Peak Flow in Peripheral Arterial Disease: Towards a Standardized Measurement. Eur J Vasc Endovasc Surg 2014; 48:185-92. [DOI: 10.1016/j.ejvs.2014.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/15/2014] [Indexed: 11/21/2022]
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Schewzow K, Fiedler GB, Meyerspeer M, Goluch S, Laistler E, Wolzt M, Moser E, Schmid AI. Dynamic ASL and T2-weighted MRI in exercising calf muscle at 7 T: a feasibility study. Magn Reson Med 2014; 73:1190-5. [PMID: 24752959 DOI: 10.1002/mrm.25242] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/06/2014] [Accepted: 03/16/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE The aim of this study was to develop a measurement protocol for noninvasive simultaneous perfusion quantification and T2 *-weighted MRI acquisition in the exercising calf muscle at 7 Tesla. METHODS Using a nonmagnetic ergometer and a dedicated in-house built calf coil array, dynamic pulsed arterial spin labeling (PASL) measurements with a temporal resolution of 12 s were performed before, during, and after plantar flexion exercise in 16 healthy volunteers. RESULTS Postexercise peak perfusion in gastrocnemius muscle (GAS) was 27 ± 16 ml/100g/min, whereas in soleus (SOL) and tibialis anterior (TA) muscles it remained at baseline levels. T2 *-weighted and ASL time courses in GAS showed comparable times to peak of 161 ± 72 s and 167 ± 115 s, respectively. The T2 *-weighted signal in the GAS showed a minimum during exercise (88 ± 6 % of the baseline signal) and a peak during the recovery (122 ± 9%), whereas in all other muscles only a signal decrease was observed (minimum 91 ± 6% in SOL; 87 ± 8% in TA). CONCLUSION We demonstrate the feasibility of dynamic perfusion quantification in skeletal muscle at 7 Tesla using PASL. This may help to better investigate the physiological processes in the skeletal muscle and also in diseases such as diabetes mellitus and peripheral arterial disease.
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Affiliation(s)
- Kiril Schewzow
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; MR Centre of Excellence, Medical University of Vienna, Vienna, Austria
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Grözinger G, Pohmann R, Schick F, Grosse U, Syha R, Brechtel K, Rittig K, Martirosian P. Perfusion measurements of the calf in patients with peripheral arterial occlusive disease before and after percutaneous transluminal angioplasty using Mr arterial spin labeling. J Magn Reson Imaging 2013; 40:980-7. [DOI: 10.1002/jmri.24463] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/08/2013] [Indexed: 01/14/2023] Open
Affiliation(s)
- Gerd Grözinger
- Division of Diagnostic Radiology Department of Diagnostic and Interventional Radiology; University of Tübingen; Tübingen Germany
- Section on Experimental Radiology Department of Diagnostic and Interventional Radiology; University of Tübingen; Tübingen Germany
| | - Rolf Pohmann
- Max Planck Institute for Biological Cybernetics; Magnetic Resonance Center; Tübingen Tübingen Germany
| | - Fritz Schick
- Section on Experimental Radiology Department of Diagnostic and Interventional Radiology; University of Tübingen; Tübingen Germany
| | - Ulrich Grosse
- Division of Diagnostic Radiology Department of Diagnostic and Interventional Radiology; University of Tübingen; Tübingen Germany
- Section on Experimental Radiology Department of Diagnostic and Interventional Radiology; University of Tübingen; Tübingen Germany
| | - Roland Syha
- Division of Diagnostic Radiology Department of Diagnostic and Interventional Radiology; University of Tübingen; Tübingen Germany
- Section on Experimental Radiology Department of Diagnostic and Interventional Radiology; University of Tübingen; Tübingen Germany
| | - Klaus Brechtel
- Division of Diagnostic Radiology Department of Diagnostic and Interventional Radiology; University of Tübingen; Tübingen Germany
| | - Kilian Rittig
- Department of Internal Medicine Division of Endocrinology Diabetology Angiology Nephrology and Clinical Chemistry; University of Tübingen; Tübingen Germany
| | - Petros Martirosian
- Section on Experimental Radiology Department of Diagnostic and Interventional Radiology; University of Tübingen; Tübingen Germany
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Englund EK, Langham MC, Li C, Rodgers ZB, Floyd TF, Mohler ER, Wehrli FW. Combined measurement of perfusion, venous oxygen saturation, and skeletal muscle T2* during reactive hyperemia in the leg. J Cardiovasc Magn Reson 2013; 15:70. [PMID: 23958293 PMCID: PMC3765712 DOI: 10.1186/1532-429x-15-70] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 07/30/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The function of the peripheral microvascular may be interrogated by measuring perfusion, tissue oxygen concentration, or venous oxygen saturation (SvO2) recovery dynamics following induced ischemia. The purpose of this work is to develop and evaluate a magnetic resonance (MR) technique for simultaneous measurement of perfusion, SvO2, and skeletal muscle T2*. METHODS Perfusion, Intravascular Venous Oxygen saturation, and T2* (PIVOT) is comprised of interleaved pulsed arterial spin labeling (PASL) and multi-echo gradient-recalled echo (GRE) sequences. During the PASL post-labeling delay, images are acquired with a multi-echo GRE to quantify SvO2 and T2* at a downstream slice location. Thus time-courses of perfusion, SvO2, and T2* are quantified simultaneously within a single scan. The new sequence was compared to separately measured PASL or multi-echo GRE data during reactive hyperemia in five young healthy subjects. To explore the impairment present in peripheral artery disease patients, five patients were evaluated with PIVOT. RESULTS Comparison of PIVOT-derived data to the standard techniques shows that there was no significant bias in any of the time-course-derived metrics. Preliminary data show that PAD patients exhibited alterations in perfusion, SvO2, and T2* time-courses compared to young healthy subjects. CONCLUSION Simultaneous quantification of perfusion, SvO2, and T2* is possible with PIVOT. Kinetics of perfusion, SvO2, and T2* during reactive hyperemia may help to provide insight into the function of the peripheral microvasculature in patients with PAD.
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Affiliation(s)
- Erin K Englund
- Department of Radiology, Laboratory of Structural NMR Imaging, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Michael C Langham
- Department of Radiology, Laboratory of Structural NMR Imaging, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Cheng Li
- Department of Radiology, Laboratory of Structural NMR Imaging, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Zachary B Rodgers
- Department of Radiology, Laboratory of Structural NMR Imaging, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Thomas F Floyd
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY 11794, USA
| | - Emile R Mohler
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Felix W Wehrli
- Department of Radiology, Laboratory of Structural NMR Imaging, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Zheng J, An H, Coggan AR, Zhang X, Bashir A, Muccigrosso D, Peterson LR, Gropler RJ. Noncontrast skeletal muscle oximetry. Magn Reson Med 2013; 71:318-25. [PMID: 23424006 DOI: 10.1002/mrm.24669] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/04/2012] [Accepted: 01/09/2013] [Indexed: 11/09/2022]
Abstract
PURPOSE The objective of this study was to develop a new noncontrast method to directly quantify regional skeletal muscle oxygenation. METHODS The feasibility of the method was examined in five healthy volunteers using a 3 T clinical MRI scanner, at rest and during a sustained isometric contraction. The perfusion of skeletal muscle of the calf was measured using an arterial spin labeling method, whereas the oxygen extraction fraction of the muscle was measured using a susceptibility-based MRI technique. RESULTS In all volunteers, the perfusion in soleus muscle increased significantly from 6.5 ± 2.0 mL (100 g min)(-1) at rest to 47.9 ± 7.7 mL (100 g min)(-1) during exercise (P < 0.05). Although the corresponding oxygen extraction fraction did not change significantly, the rate of oxygen consumption increased from 0.43 ± 0.13 to 4.2 ± 1.5 mL (100 g min)(-1) (P < 0.05). Similar results were observed in gastrocnemius muscle but with greater oxygen extraction fraction increase than the soleus muscle. CONCLUSION This is the first MR oximetry developed for quantification of regional skeletal muscle oxygenation. A broad range of medical conditions could benefit from these techniques, including cardiology, gerontology, kinesiology, and physical therapy.
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Affiliation(s)
- Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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24
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Wu WC, Su MY, Chang CC, Tseng WYI, Liu KL. Renal perfusion 3-T MR imaging: a comparative study of arterial spin labeling and dynamic contrast-enhanced techniques. Radiology 2012; 261:845-53. [PMID: 22095996 DOI: 10.1148/radiol.11110668] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate the feasibility of and correlation between arterial spin-labeling (ASL) and dynamic contrast material-enhanced (DCE) 3-T magnetic resonance (MR) imaging in the measurement of renal blood flow (RBF). MATERIALS AND METHODS The review board approved this study. Nineteen healthy volunteers (seven women, 12 men; age range, 25-68 years) were recruited, and each provided written informed consent. MR imaging was performed with a 3-T whole-body system. Each subject underwent back-to-back ASL and DCE MR imaging. Ten runs of ASL imaging were performed by using the pseudocontinuous tagging scheme, and each run required an 18-second breath hold. For DCE imaging, a gadopentetate dimeglumine bolus (0.0125 mmol per kilogram of body weight) was administrated intravenously in all subjects except two; in the latter subjects, a 0.025 mmol/kg gadopentetate dimeglumine bolus was administered to evaluate the T1 saturation effect. RBF was quantified with both techniques and in both the cortex and the medulla. Agreement was evaluated for RBF measurements obtained with ASL imaging and those obtained with DCE imaging by using correlation analysis. RESULTS RBF was apparently overestimated with 0.025 mmol/kg gadopentetate dimeglumine, which is a concentration that is commonly adopted for 1.5-T DCE. RBF was 227 mL/100 mL/min ± 30 (standard deviation) in the cortex and 101 mL/100 mL/min ± 21 in the medulla, as measured with ASL imaging, and 272 mL/100 mL/min ± 60 in the cortex and 122 mL/100 mL/min ± 30 in the medulla, as measured with DCE imaging. In the cortex, measurements obtained with ASL and DCE imaging exhibited a linear correlation (r = 0.66; statistical power, 0.8 at the 5% significance level) and fair agreement (intraclass correlation coefficient, 0.41). CONCLUSION ASL and DCE 3-T MR imaging are feasible in the quantification of cortical renal perfusion, yielding measurements that are correlated but not entirely comparable. Intermodality differences have yet to be solved.
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Affiliation(s)
- Wen-Chau Wu
- Graduate Institute of Oncology, National Taiwan University, No 1, Sec 1, Ren-Ai Rd, Taipei 100, Taiwan.
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25
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de Sousa PL, Vignaud A, Fleury S, Carlier PG. Fast monitoring of T(1) , T(2) , and relative proton density (M(0) ) changes in skeletal muscles using an IR-TrueFISP sequence. J Magn Reson Imaging 2011; 33:921-30. [PMID: 21448959 DOI: 10.1002/jmri.22511] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate the feasibility of fast and simultaneous assessment of T(1) , T(2) , and M(0) (relative proton density) changes in skeletal muscle studies using an inversion recovery true fast imaging with steady-state precession (TrueFISP) sequence. MATERIALS AND METHODS NMR signal dynamics in calf muscles were analyzed under four different conditions: intravenous injection of a low-molecular weight Gd contrast agent (CA), postarterial occlusion reactive hyperemia, local cooling, and an exercise bout. Experiments were conducted on a clinical 3T whole-body scanner. RESULTS At rest, average muscle T(1) and T(2) values obtained from the IR-TrueFISP experiments were 1.34 ± 0.13 seconds and 45 ± 5 msec, respectively (median ± standard deviation). 1) Noticeable T(1) decreases (ΔT(1) max ≈-30%) were measured in the calf muscles after CA injection, while no significant changes were observed for T(2) and M(0) . 2) T(2) increased rapidly during reactive hyperemia and reached a peak value (+6%) at about 1 minute postischemia. During ischemia, a significant decrease was observed only in the soleus muscle. No significant paradigm-related changes in M(0) and T(1) were noted in all muscle groups, except in the m. soleus (ΔT(1) ≈+1% during reactive hyperemia). 3) Opposite variations in muscle T(1) (ΔT(1) max ≈-30%) and M(0) (ΔM(0) max ≈+25%) associated with local cooling were detected. 4) Concomitant changes in T(1) (ΔT(1) max ≈+15%), T(2) (ΔT(2) max ≈+35%), and M(0) (ΔM(0) max ≈+16%) were observed in the activated muscles following the exercise bout. CONCLUSION IR-TrueFISP was sufficiently fast and sensitive to detect small and transient T(1) , T(2) , and M(0) changes in the calf muscles under different experimental conditions. The sequence offers a time-resolution adequate to track rapid physiological adaptations in skeletal muscle.
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Versluis B, Backes WH, van Eupen MGA, Jaspers K, Nelemans PJ, Rouwet EV, Teijink JAW, Mali WPTM, Schurink GW, Wildberger JE, Leiner T. Magnetic resonance imaging in peripheral arterial disease: reproducibility of the assessment of morphological and functional vascular status. Invest Radiol 2011; 46:11-24. [PMID: 21102349 DOI: 10.1097/rli.0b013e3181f2bfb8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the current study was to test the reproducibility of different quantitative magnetic resonance imaging (MRI) methods to assess the morphologic and functional peripheral vascular status and vascular adaptations over time in patients with peripheral arterial disease (PAD). MATERIALS AND METHODS Ten patients with proven PAD (intermittent claudication) and arterial collateral formation within the upper leg and 10 healthy volunteers were included. All subjects underwent 2 identical MR examinations of the lower extremities on a clinical 1.5-T MR system, with a time interval of at least 3 days. The MR protocol consisted of 3D contrast-enhanced MR angiography to quantify the number of arteries and artery diameters of the upper leg, 2D cine MR phase contrast angiography flow measurements in the popliteal artery, dynamic contrast-enhanced (DCE) perfusion imaging to determine the influx constant and area under the curve, and dynamic blood oxygen level-dependent (BOLD) imaging in calf muscle to measure maximal relative T2* changes and time-to-peak. Data were analyzed by 2 independent MRI readers. Interscan and inter-reader reproducibility were determined as outcome measures and expressed as the coefficient of variation (CV). RESULTS Quantification of the number of arteries, artery diameter, and blood flow proved highly reproducible in patients (CV = 2.6%, 4.5%, and 15.8% at interscan level and 9.0%, 8.2%, and 7.0% at interreader level, respectively). Reproducibility of DCE and BOLD MRI was poor in patients with a CV up to 50.9%. CONCLUSIONS Quantification of the morphologic vascular status by contrast-enhanced MR angiography, as well as phase contrast angiography MRI to assess macrovascular blood flow proved highly reproducible in both PAD patients and healthy volunteers and might therefore be helpful in studying the development of collateral arteries in PAD patients and in unraveling the mechanisms underlying this process. Functional assessment of the microvascular status using DCE and BOLD, MRI did not prove reproducible at 1.5 T and is therefore currently not suitable for (clinical) application in PAD.
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Affiliation(s)
- Bas Versluis
- Department of Radiology, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
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Mellon EA, Lee SC, Pickup S, Kim S, Goldstein SC, Floyd TF, Poptani H, Delikatny EJ, Reddy R, Glickson JD. Detection of lactate with a hadamard slice selected, selective multiple quantum coherence, chemical shift imaging sequence (HDMD-SelMQC-CSI) on a clinical MRI scanner: Application to tumors and muscle ischemia. Magn Reson Med 2010; 62:1404-13. [PMID: 19785016 DOI: 10.1002/mrm.22141] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lactate is an important metabolite in normal and malignant tissues detectable by NMR spectroscopy; however, it has been difficult to clinically detect the lactate methyl resonance because it is obscured by lipid resonances. The selective homonuclear multiple quantum coherence transfer technique offers a method for distinguishing lipid and lactate resonances. We implemented a three-dimensional selective homonuclear multiple quantum coherence transfer version with Hadamard slice selection and two-dimensional phase encoding (Hadamard encoded-selective homonuclear multiple quantum coherence transfer-chemical shift imaging) on a conventional clinical MR scanner. Hadamard slice selection is explained and demonstrated in vivo. This is followed by 1-cm(3) resolution lactate imaging with detection to 5-mM concentration in 20 min on a 3-T clinical scanner. An analysis of QSel gradient duration and amplitude effects on lactate and lipid signal is presented. To demonstrate clinical feasibility, a 5-min lactate scan of a patient with a non-Hodgkin's lymphoma in the superficial thigh is reported. The elevated lactate signal coincides with the T(2)-weighted image of this tumor. As a test of selective homonuclear multiple quantum coherence transfer sensitivity, a thigh tourniquet was applied to a normal volunteer and an increase in lactate was detected immediately after tourniquet flow constriction. In conclusion, the Hadamard encoded-selective homonuclear multiple quantum coherence transfer-chemical shift imaging sequence is demonstrated on a phantom and in two lipid-rich, clinically relevant, in vivo conditions.
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Affiliation(s)
- Eric A Mellon
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Forbes SC, Slade JM, Francis RM, Meyer RA. Comparison of oxidative capacity among leg muscles in humans using gated 31P 2-D chemical shift imaging. NMR IN BIOMEDICINE 2009; 22:1063-1071. [PMID: 19579230 DOI: 10.1002/nbm.1413] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In many small animals there are distinct differences in fiber-type composition among limb muscles, and these differences typically correspond to marked disparities in the oxidative capacities. However, whether there are similar differences in the oxidative capacity among leg muscles in humans is less clear. The purpose of this study was to compare the rate of phosphocreatine (PCr) recovery, a functional in vivo marker of oxidative capacity, in the lateral and medial gastrocnemius, soleus, and the anterior compartment of the leg (primarily the tibialis anterior) of humans. Subjects performed plantar flexion and dorsiflexion gated exercise protocols consisting of 70 sets of three rapid dynamic contractions (<2.86 s) at 20 s intervals (total: 23.3 min). Starting after the sixth set of contractions, (31)P 2-D CSI (8 x 8 matrix, 14-16 cm FOV, 3 cm slice, TR 2.86 s) were acquired via a linear transmit/receive surface coil using a GE 3T Excite System. The CSI data were zero-filled (32 x 32) and a single FID was produced for each time point in the lateral and medial gastrocnemius, soleus, and anterior compartment. The time constant for PCr recovery was calculated from tau = -Deltat/ln[D/(D + Q)], where Q is the percentage change in PCr due to contraction during the steady-state portion of the protocol, D the additional drop in PCr from rest, and Deltat is the interval between contractions. The tau of PCr recovery was longer (p < 0.05) in the anterior compartment (32 +/- 3 s) than in the lateral (23 +/- 2 s) and medial gastrocnemius muscles (24 +/- 3 s) and the soleus (22 +/- 3 s) muscles. These findings suggest that the oxidative capacity is lower in the anterior compartment than in the triceps surae muscles and is consistent with the notion that fiber-type phenotypes vary among the leg muscles of humans.
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Affiliation(s)
- Sean C Forbes
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
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Sanchez OA, Louie EA, Copenhaver EA, Damon BM. Repeatability of a dual gradient-recalled echo MRI method for monitoring post-isometric contraction blood volume and oxygenation changes. NMR IN BIOMEDICINE 2009; 22:753-761. [PMID: 19382156 PMCID: PMC4440456 DOI: 10.1002/nbm.1388] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The purpose of this study was to assess the repeatability of a dual gradient-recalled echo (GRE) muscle functional MRI technique. On 2 days, subjects (n = 8) performed 10 s isometric dorsiflexion contractions under conditions of: (1) maximal voluntary contraction (MVC), (2) 50% MVC (50% MVC), or (3) 50% MVC with concurrent proximal arterial cuff occlusion (50% MVC(cuff)). Functional MRI data were acquired using single-slice dual GRE (TR/TE = 1000/6, 46 ms)-echo planar imaging for 20 s before, during, and for 180 s after each contraction. The mean signal intensity (SI) time courses at each TE (SI(6) and SI(46), reflecting variations in blood volume and %HbO(2), respectively) from the tibialis anterior (TA) and extensor digitorum longus (EDL) muscles were characterized with the post-contraction change in SI and the time-to-peak SI (DeltaSI and TTP, respectively). DeltaSI(6) following an MVC was 36% higher than that obtained after a 50% MVC (p = 0.048). For DeltaSI(6), the highest intraclass correlation coefficients (ICCs) were observed for the TA muscle in the 50% MVC and MVC conditions, with values of 0.83 (p = 0.01) and 0.88 (p = 0.005), respectively. Bland-Altman plots revealed repeatability coefficients (RCs) for the 50% MVC and MVC conditions in the TA muscle of 1.9 and 1.4, respectively. The most repeatable measures for DeltaSI(46) were obtained for the 50% MVC and MVC conditions in the EDL muscle (p = 0.01 and p = 0.04, respectively). Bland-Altman plots revealed RC's for 50% MVC and MVC conditions in the EDL muscle of 3.9 and 5.7, respectively. DeltaSI(6) and DeltaSI(46) increased as a function of the contraction intensity. The repeatability of the method depends on the muscle and contraction condition being evaluated, and in general, is higher following an MVC.
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Affiliation(s)
- O A Sanchez
- Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA.
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Wu WC, Mohler E, Ratcliffe SJ, Wehrli FW, Detre JA, Floyd TF. Skeletal muscle microvascular flow in progressive peripheral artery disease: assessment with continuous arterial spin-labeling perfusion magnetic resonance imaging. J Am Coll Cardiol 2009; 53:2372-7. [PMID: 19539149 DOI: 10.1016/j.jacc.2009.03.033] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/24/2009] [Accepted: 03/10/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We present the novel application of continuous arterial spin-labeling (CASL) magnetic resonance imaging (MRI) for the measurement of calf muscle perfusion in subjects with progressive peripheral arterial disease (PAD). BACKGROUND Peripheral arterial disease is largely considered to be a disease of conduit vessels. The impact of PAD upon microvascular flow in the end-organ, muscle, remains unknown. Continuous arterial spin-labeling is a noninvasive MRI method capable of measuring microvascular flow and might assist in our understanding of the impact of PAD upon the microvasculature. METHODS Forty subjects with varying degrees of PAD and 17 age-matched PAD-free subjects were recruited and underwent measurement of the ankle-to-brachial index (ABI) and CASL. Peak hyperemic flow (PHF) and time-to-peak (TTP) were computed and assessed as a function of ABI and calf muscle group. RESULTS An ABI dependence was found in both PHF (p = 0.04) and TTP (p < 10(-4)). Whereas TTP increased almost immediately with increasing PAD severity, PHF was, in contrast, relatively well preserved until later stages of disease. CONCLUSIONS The CASL flow measurements correlate with disease state as measured by ABI and demonstrate preserved microvascular flow reserve in the presence of early to intermediate vascular disease.
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Affiliation(s)
- Wen-Chau Wu
- Department of Radiology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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