A Reperfusion BOLD-MRI Tissue Perfusion Protocol Reliably Differentiate Patients with Peripheral Arterial Occlusive Disease from Healthy Controls

Abstract

There is no established technique that directly quantifies lower limb tissue perfusion. Blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) is an MRI technique that can determine skeletal muscle perfusion. BOLD-MRI relies on magnetic differences of oxygenated and deoxygenated hemoglobin, and regional changes in oxy/deoxyhemoglobin ratio can be recorded by T2* weighted MRI sequences. We aimed to test whether BOLD-MRI can differentiate lower limb tissue perfusion in peripheral arterial occlusive disease (PAOD) patients and healthy controls. Twenty-two PAOD patients and ten healthy elderly volunteers underwent lower limb BOLD-MRI. Reactive hyperemia was provoked by transient cuff compression and images of the gastrocnemius and soleus muscles were continuously acquired at rest, during ischemia and reperfusion. Key BOLD parameters were baseline T2* absolute value and time to T2* peak value after cuff deflation (TTP). Correlations between imaging parameters and ankle-brachial index (ABI) was investigated. The mean TTP was considerably prolonged in PAOD patients compared to healthy controls (m. gastrocnemius: 111 ± 46 versus 48 ± 22 s, p = 0.000253; m. soleus: 100 ± 42 versus 41 ± 30 s, p = 0.000216). Both gastrocnemius and soleus TTP values correlated strongly with ABI (−0.82 and −0.78, p < 0.01). BOLD-MRI during reactive hyperemia differentiated most PAOD patients from healthy controls. TTP was the most decisive parameter and strongly correlated with the ABI.

Approaches to Peripheral Artery Disease in Diabetes: Are There Any Differences?

“…This figure demonstrates the need for unanimity among specialties and for the introduction of these tests in consensuses and guidelines. Moreover, volumetric CT perfusion has recently shown promising results in the assessment of PAD before and after revascularization [ 50 , 51 ], while a new MR perfusion protocol reliably differentiated patients with PAD from healthy controls [ 52 ]. The laser Doppler blood flowmeter is another useful noninvasive tool for detecting PAD at an early stage by recording skin perfusion deterioration [ 53 ].…”

“…At the same time, the ACC guidelines give a Class-IIb recommendation for long-term dual antiplatelet inhibition [ 54 ]. The ACC guidelines also give anticoagulant therapy a Level-III harm recommendation and state that pentoxifylline is not effective for the treatment of claudication (also in Class III) [ 52 ]. Of note, the American guidelines promote the use of cilostazol (Class I, level of evidence A), whereas the European guidelines do not mention this drug.…”

Impaired pedal arch affects the treatment effect in patients with single tibial artery revascularization demonstrated by intraoperative perfusion

“…Besides, we can not observe microvascular occlusion in the DSA, which will also affect the blood supplied to the tissue. Finally, there would be several technics for assessment of perfusion and intrainterventional perfusion values should be correlated with other imaging technics in future studies (11,(27)(28)(29).…”

A lower limb BOLD-MRI tissue perfusion protocol correlate to clinical disease stage, objective functional limitations, and health-related quality of life in patients with peripheral arterial occlusive disease

“…We previously showed the feasibility of this technique in PAOD and found that a tissue reperfusion BOLD-MRI protocol reliably differentiated patients with PAOD from healthy controls without PAOD, with the most discriminative parameter being the time to peak of the T2* signal following the release of a thigh cuff after fi ve minutes of provoked ischemia [2]. However, to be clinically useful, this BOLD-MRI technique ideally should be sensitive also to clinical disease The design of this small feasibility study, as well as details regarding the PAOD BOLD-MRI imaging protocol have been reported previously [2].…”

“…We previously showed the feasibility of this technique in PAOD and found that a tissue reperfusion BOLD-MRI protocol reliably differentiated patients with PAOD from healthy controls without PAOD, with the most discriminative parameter being the time to peak of the T2* signal following the release of a thigh cuff after fi ve minutes of provoked ischemia [2]. However, to be clinically useful, this BOLD-MRI technique ideally should be sensitive also to clinical disease The design of this small feasibility study, as well as details regarding the PAOD BOLD-MRI imaging protocol have been reported previously [2]. In brief, twenty-two patients (mean age 73.5 ± SD 4.1 y; 12 male) with confi rmed intermittent claudication of vascular origin and 10 healthy volunteers (mean age 67.9± SD 6.2 y; 8 male) without PAOD consented to participate, and the study was approved by the Regional Ethical In conclusion, the BOLD-MRI TTP parameter correlated moderately to strongly with a variety of clinically relevant parameters that refl ect PAOD severity.…”