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Calf muscle perfusion maps from contrast-enhanced magnetic resonance imaging (CE-MRI) to assess peripheral arterial disease
© Brunner et al.; licensee BioMed Central Ltd. 2014
- Published: 16 January 2014
- Peripheral Arterial Disease
- Arterial Input Function
- Microvascular Perfusion
- Peripheral Arterial Disease Patient
- Muscle Compartment
Peripheral arterial disease (PAD) is associated with impaired function of the lower extremities, manifested clinically as intermittent claudication or rest pain. Previous studies have suggested that alterations in microcirculation due to a paucity of collateralization may contribute to functional impairment in PAD patients. Therefore, small vessel blood flow at the level of leg muscles may be important. We hypothesized that microvascular perfusion can be measured with CE-MRI and will be heterogeneous in calf muscles of PAD patients compared with healthy controls.
Twenty six PAD patients and 14 healthy controls underwent CE-MRI with a 3.0T Siemens Magnetom Verio system using a 36-element dedicated peripheral angio-matrix coil. A state of reactive hyperemia was induced by 3.5-minutes of supra-systolic inflation of a bilateral blood-pressure cuff positioned above the knee. Rapid cuff deflation was synchronized with the administration of a Gadolinium-based contrast agent (Magnevist, Bayer Inc.). Imaging at the mid-calf was commenced with a high resolution saturation recovery gradient echo pulse sequence (repetition time [TR] = 2.7 ms; echo time [TE] = 1.23 ms; and temporal resolution = 409 ms per frame). Microvascular perfusion maps (MVPM) were calculated for each frame and for five semi-automatically segmented skeletal muscle compartments including the anterior, lateral, deep posterior, soleus, and gastrocnemius. The MVPM categorized each voxel as either hypointense (voxel signal intensity (SI) < reference SI - 2*standard deviation [STD]), isointense, or hyperintense (voxel SI > reference SI + 2*STD), based on reference signal intensities for each muscle group that were calculated from all controls using an ensemble means algorithm. Normalized histograms of MVPM representing fractions of hypo-, iso-, and hyperintense voxels were compared for each muscle group between PAD and controls. Analysis was performed for specified times based on the arterial input function (AIF) of one sufficiently patent major artery (anterior tibial artery, posterior tibial artery, or peroneal artery) including pre contrast arrival (CA), peak AIF, and 2 minutes post CA.
The preliminary results of this study suggest that CE-MRI may be useful to assess microvascular perfusion abnormalities in patients with PAD.
This work was supported in part by The Methodist DeBakey Heart & Vascular Center (MDHVC) Research Award 2011, the Society for Vascular Surgery (SVS): 2012 Clinical Research Seed Grant, and NIH grant T32HL07812.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.