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. 2021 Aug 18;10(16):3643.
doi: 10.3390/jcm10163643.

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

Kristina Törngren  1 , Stefanie Eriksson  2   3 , Jonathan Arvidsson  2   3 , Mårten Falkenberg  4   5 , Åse A Johnsson  4   5 , Carl Sjöberg  6 , Kerstin Lagerstrand  2   3 , Joakim Nordanstig  1   7
Affiliations

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

Kristina Törngren et al. J Clin Med. .

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.

Keywords: BOLD MRI; atherosclerosis; intermittent claudication; peripheral arterial occlusive disease; tissue perfusion.

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Conflict of interest statement

The authors declare no conflict of interest. Carl Sjöberg is employed by the company Antaros Medical. He is involved in the project with scientific interest. We have no financial relationship with the company Antaros itself.

Figures

Figure 1
Figure 1
Schematic illustration of the positioning of the lower limb during the BOLD-MRI examination.
Figure 2
Figure 2
Schematic of image post processing software, where T2* denotes the effective T2 relaxation time. ROI denotes regions of interest.
Figure 3
Figure 3
Regions of interest (ROIs) drawn on a T2*-weighted image. The blue ROIs are drawn in the gastrocnemius muscle (lateral and medial head) and the red ROI is drawn in the soleus muscle.
Figure 4
Figure 4
T2*-time curve of the soleus muscle in a PAOD patient, showing the dynamic response during the three phases of the examination (baseline, ischemia and reperfusion), and corresponding descriptive measures at baseline/resting phase during 60 s (BL), hyperemia peak absolute value (HPV) and reperfusion time to peak (TTP).
Figure 5
Figure 5
Comparison of the time to peak (TTP) parameter between healthy controls and PAOD patients in the gastrocnemius (blue) and the soleus (red) muscles. Box and whiskers plots revealed significantly prolonged TTP in PAOD patients as compared to healthy controls (p < 0.001); and a high discrimination capacity (PAOD patients versus controls) by the BOLD-MRI protocol. The whiskers indicate observed minimum and maximum values. * and o denotes outliers.
See this image and copyright information in PMC

References

    1. Song P., Rudan D., Zhu Y., Fowkes F.J.I., Rahimi K., Fowkes F.G.R., Rudan I. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: An updated systematic review and analysis. Lancet Glob. Health. 2019;7:e1020–e1030. doi: 10.1016/S2214-109X(19)30255-4. - DOI - PubMed
    1. Aboyans V., Ricco J.B., Bartelink M.E.L., Bjorck M., Brodmann M., Cohnert T., Collet J.P., Czerny M., De Carlo M., Debus S., et al. Editor’s choice-2017 esc guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the european society for vascular surgery (esvs) Eur. J. Vasc. Endovasc. Surg. 2018;55:305–368. doi: 10.1016/j.ejvs.2017.07.018. - DOI - PubMed
    1. Roy T.L., Forbes T.L., Dueck A.D., Wright G.A. Mri for peripheral artery disease: Introductory physics for vascular physicians. Vasc. Med. 2018;23:153–162. doi: 10.1177/1358863X18759826. - DOI - PubMed
    1. Grozinger 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. 2014;40:980–987. doi: 10.1002/jmri.24463. - DOI - PubMed
    1. Ogawa S., Lee T.M., Kay A.R., Tank D.W. Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc. Natl. Acad. Sci. USA. 1990;87:9868–9872. doi: 10.1073/pnas.87.24.9868. - DOI - PMC - PubMed

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