Reliability of Contrast-Enhanced Ultrasound for the Assessment of Muscle Perfusion in Health and Peripheral Arterial Disease

Thomas, Kate N.; Cotter, James D.; Lucas, Samuel J. E.; Hill, Brigid G.; Rij, André M. van

doi:10.1016/j.ultrasmedbio.2014.06.012

Cited by 36 publications

(39 citation statements)

References 44 publications

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“…To our knowledge, this is the first report demonstrating that calf muscle perfusion increases linearly with increasing workloads of dynamic plantar flexion exercise in healthy subjects. Most previous studies (2,30,38,50,58) stimulated hyperemia in calf muscles of human subjects with a cuffing-release procedure at rest, which may not reflect the real exercise physiology. Isbell et al (15) used DCE MRI to quantify calf muscle perfusion stimulated with plantar flexion exercise until exhaustion (similar to our exhaustion exercise).…”

Section: Discussionmentioning

confidence: 97%

Exercise-induced calf muscle hyperemia: quantitative mapping with low-dose dynamic contrast enhanced magnetic resonance imaging

Zhang

Layec

Hanrahan

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

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Peripheral artery disease (PAD) in the lower extremities often leads to intermittent claudication. In the present study, we proposed a low-dose DCE MRI protocol for quantifying calf muscle perfusion stimulated with plantar flexion and multiple new metrics for interpreting perfusion maps, including the ratio of gastrocnemius over soleus perfusion (G/S; for assessing the vascular redistribution between the two muscles) and muscle perfusion normalized by whole body perfusion (for quantifying the muscle’s active hyperemia). Twenty-eight human subjects participated in this Institutional Review Board-approved study, with 10 healthy subjects ( group A) for assessing interday reproducibility and 8 healthy subjects ( group B) for exploring the relationship between plantar-flexion load and induced muscle perfusion. In a pilot group of five elderly healthy subjects and five patients with PAD ( group C), we proposed a protocol that measured perfusion for a low-intensity exercise and for an exhaustion exercise in a single MRI session. In group A, perfusion estimates for calf muscles were highly reproducible, with correlation coefficients of 0.90–0.93. In group B, gastrocnemius perfusion increased linearly with the exercise workload ( P < 0.05). With the low-intensity exercise, patients with PAD in group C showed substantially lower gastrocnemius perfusion compared with elderly healthy subjects [43.4 (SD 23.5) vs. 106.7 (SD 73.2) ml·min−1·100 g−1]. With exhaustion exercise, G/S [1.0 (SD 0.4)] for patients with PAD was lower than both its low-intensity level [1.9 (SD 1.3)] and the level in elderly healthy subjects [2.7 (SD 2.1)]. In conclusion, the proposed MRI protocol and the new metrics are feasible for quantifying exercise-induced muscle hyperemia, a promising functional test of PAD. NEW & NOTEWORTHY To quantitatively map exercise-induced hyperemia in calf muscles, we proposed a high-resolution MRI method shown to be highly reproducible and sensitive to exercise load. With the use of low contrast, it is feasible to measure calf muscle hyperemia for both low-intensity and exhaustion exercises in a single MRI session. The newly proposed metrics for interpreting perfusion maps are promising for quantifying intermuscle vascular redistribution or a muscle’s active hyperemia.

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Section: Discussionmentioning

confidence: 97%

Exercise-induced calf muscle hyperemia: quantitative mapping with low-dose dynamic contrast enhanced magnetic resonance imaging

Zhang

Layec

Hanrahan

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

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“…Contrast‐enhanced ultrasound (CEU) perfusion imaging with a variety of tracer kinetic models has been used to quantify limb perfusion in patients with IC . This technique has been shown to be more predictive of symptoms than conventional methods that rely on pressure gradients or pulse volume recordings .…”

Section: Introductionmentioning

confidence: 99%

Exercise versus vasodilator stress limb perfusion imaging for the assessment of peripheral artery disease

et al. 2017

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Purpose Our aim was to determine whether pharmacologic vasodilation is an alternative to exercise stress during limb perfusion imaging for PAD. Methods Quantitative contrast-enhanced ultrasound (CEU) perfusion imaging of the bilateral anterior thigh and calf was performed in 9 control subjects and 9 patients with moderate to severe PAD at rest and during vasodilator stress with dipyridamole. For those who were able, CEU of the calf was then performed during modest plantar flexion exercise (20 Watts). CEU time-intensity data were analyzed to quantify microvascular blood flow (MBF) and its parametric components of microvascular blood volume and flux rate. Results Thigh and calf skeletal muscle MBF at rest was similar between control and PAD patients. During dipyridamole, MBF increased minimally (<2-fold) for all groups and there were only non-significant trends for a reduction in calf MBF in those with PAD (13.5±6.9, 10.0±4.7, and 8.2±6.1 IU/s, for controls, moderate and severe PAD, respectively; p=0.11). In contrast, MBF during modest planar flexion exercise increased markedly in controls but not PAD patients (87.9±79.9 vs. 15.2±12.9 IU/s, P<.05). In three moderate PAD patients restudied after undergoing surgical revascularization, MBF during dipyridamole did not change whereas exercise MBF increased by an average of 7-fold. Conclusions Resting limb skeletal muscle MBF in patients with moderate to severe PAD is similar to that in normal subjects. However, differences in hyperemic flow during contractile exercise but not during dipyridamole allows evaluation of the degree of flow impairment from PAD and the degree of improvement with revascularization.

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“…Fourteen studies [19][20][21][22][23][24][25][26][27][28][29][30][31][32] were found to be eligible ( Figure 1). In these studies, 322 patients with PAD and 314 healthy individuals underwent CEUS to study the muscle perfusion status.…”

Section: Resultsmentioning

confidence: 99%

Prospects of Contrast‐Enhanced Ultrasonography for the Diagnosis of Peripheral Arterial Disease: A Meta‐analysis

Hou

Chu

2017

J of Ultrasound Medicine

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Reliability of Contrast-Enhanced Ultrasound for the Assessment of Muscle Perfusion in Health and Peripheral Arterial Disease

Cited by 36 publications

References 44 publications

Exercise-induced calf muscle hyperemia: quantitative mapping with low-dose dynamic contrast enhanced magnetic resonance imaging

Exercise-induced calf muscle hyperemia: quantitative mapping with low-dose dynamic contrast enhanced magnetic resonance imaging

Exercise versus vasodilator stress limb perfusion imaging for the assessment of peripheral artery disease

Prospects of Contrast‐Enhanced Ultrasonography for the Diagnosis of Peripheral Arterial Disease: A Meta‐analysis

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