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Review
. 2014 Apr;4(2):165-72.
doi: 10.3978/j.issn.2223-3652.2014.03.02.

Assessing the end-organ in peripheral arterial occlusive disease-from contrast-enhanced ultrasound to blood-oxygen-level-dependent MR imaging

Markus Aschwanden  1 , Sasan Partovi  1 , Bjoern Jacobi  1 , Nathan Fergus  1 , Anja-Carina Schulte  1 , Mark R Robbin  1 , Deniz Bilecen  1 , Daniel Staub  1
Affiliations
Review

Assessing the end-organ in peripheral arterial occlusive disease-from contrast-enhanced ultrasound to blood-oxygen-level-dependent MR imaging

Markus Aschwanden et al. Cardiovasc Diagn Ther. 2014 Apr.

Abstract

Peripheral arterial occlusive disease (PAOD) is a result of atherosclerotic disease which is currently the leading cause of morbidity and mortality in the western world. Patients with PAOD may present with intermittent claudication or symptoms related to critical limb ischemia. PAOD is associated with increased mortality rates. Stenoses and occlusions are usually detected by macrovascular imaging, including ultrasound and cross-sectional methods. From a pathophysiological view these stenoses and occlusions are affecting the microperfusion in the functional end-organs, such as the skin and skeletal muscle. In the clinical arena new imaging technologies enable the evaluation of the microvasculature. Two technologies currently under investigation for this purpose on the end-organ level in PAOD patients are contrast-enhanced ultrasound (CEUS) and blood-oxygen-level-dependent (BOLD) MR imaging (MRI). The following article is providing an overview about these evolving techniques with a specific focus on skeletal muscle microvasculature imaging in PAOD patients.

Keywords: Duplex ultrasonography; magnetic resonance imaging; microbubbles; peripheral arterial disease.

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Figures

Figure 1
Figure 1
Demonstrates skeletal muscle microperfusion on CEUS in a healthy volunteer (left part of the figure) and a patient with PAOD (right part of the figure). Time-intensity-curves of a region of interest (green square) within the skeletal muscle (gastrocnemius muscle) after bolus injection of the ultrasound contrast agent show a steeper slope in of wash-in-curve in combination with a shorter time-to-peak in the healthy volunteer.
Figure 2
Figure 2
Demonstrates the T2* image (panel A) which is fused with a T1 weighted image (panel B) in order to place the ROIs in the corresponding calf skeletal muscle. The T2* signal is most apparent in the gastrocnemius and soleus muscles.
Figure 3
Figure 3
Shows the T2* time course in a healthy 26-year-old male volunteer (upper part of the figure) and a 36-year-old female PAOD patient (lower part of the figure). The ischemia-hyperemia paradigm was applied. The T2* time course of the patient clearly differs in comparison to the healthy volunteer.
See this image and copyright information in PMC

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