Calf muscle perfusion at peak exercise in peripheral arterial disease: Measurement by first-pass contrast-enhanced magnetic resonance imaging

Peripheral arterial disease (PAD) is generally attributed to the progressive vascular accumulation of lipoproteins and circulating monocytes in the vessel walls leading to the formation of atherosclerotic plaques. This is known to be regulated by the local vascular geometry, haemodynamics and biophysical conditions. Here, an isogeometric analysis framework is proposed to analyse the blood flow and vascular deposition of circulating nanoparticles (NPs) into the superficial femoral artery (SFA) of a PAD patient. The local geometry of the blood vessel and the haemodynamic conditions are derived from magnetic resonance imaging (MRI), performed at baseline and at 24 months post intervention. A dramatic improvement in blood flow dynamics is observed post intervention. A 500% increase in peak flow rate is measured in vivo as a consequence of luminal enlargement. Furthermore, blood flow simulations reveal a 32% drop in the mean oscillatory shear index, indicating reduced disturbed flow post intervention. The same patient information (vascular geometry and blood flow) is used to predict in silico in a simulation of the vascular deposition of systemically injected nanomedicines. NPs, targeted to inflammatory vascular molecules including VCAM-1, E-selectin and ICAM-1, are predicted to preferentially accumulate near the stenosis in the baseline configuration, with VCAM-1 providing the highest accumulation (approx. 1.33 and 1.50 times higher concentration than that of ICAM-1 and E-selectin, respectively). Such selective deposition of NPs within the stenosis could be effectively used for the detection and treatment of plaques forming in the SFA. The presented MRI-based computational protocol can be used to analyse data from clinical trials to explore possible correlations between haemodynamics and disease progression in PAD patients, and potentially predict disease occurrence as well as the outcome of an intervention.

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Simultaneous bilateral magnetic resonance imaging of the femoral arteries in peripheral arterial disease patients

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.22591 ◽

2011 ◽

Vol 34 (1) ◽

pp. 150-156 ◽

Cited By ~ 5

Author(s):

Ryan Brown ◽

Christof Karmonik ◽

Gerd Brunner ◽

Alan Lumsden ◽

Christie Ballantyne ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Resonance Imaging ◽

Femoral Arteries ◽

Peripheral Arterial

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Does measurement of exercise/rest calf muscle perfusion reserve with first-pass contrast-enhanced MRI in peripheral arterial disease perform better than exercise-only perfusion ?

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-13-s1-p385 ◽

2011 ◽

Vol 13 (S1) ◽

Author(s):

Ronny S Jiji ◽

Amy M West ◽

Frederick H Epstein ◽

Patrick F Antkowiak ◽

Craig H Meyer ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Arterial Disease ◽

Calf Muscle ◽

Muscle Perfusion ◽

Perfusion Reserve ◽

Contrast Enhanced ◽

First Pass ◽

Peripheral Arterial ◽

Contrast Enhanced Mri ◽

Better Than

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Novel Magnetic Resonance Imaging End Points for Physiologic Studies in Peripheral Arterial Disease

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.115.003360 ◽

2015 ◽

Vol 8 (4) ◽

Cited By ~ 5

Author(s):

Christopher M. Kramer

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Resonance Imaging ◽

End Points ◽

Peripheral Arterial

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Guiding peripheral arterial disease management with magnetic resonance imaging

VASA ◽

10.1024/0301-1526/a000742 ◽

2019 ◽

Vol 48 (3) ◽

pp. 217-222

Author(s):

Edwin A. Takahashi ◽

Kristin A. Kinsman ◽

Newton B. Neidert ◽

Phillip M. Young

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Resonance Imaging ◽

Vessel Patency ◽

Magnetic Resonance Imaging Mri ◽

Peripheral Arterial ◽

Important Test

Abstract. Peripheral arterial disease (PAD) management is exceptionally challenging. Despite advances in diagnostic and therapeutic technologies, long-term vessel patency and limb salvage rates are limited. Patients with PAD frequently require extensive workup with noninvasive tests and imaging to delineate their disease and help guide appropriate management. Ultrasound and computed tomography are commonly ordered in the workup of PAD. Magnetic resonance imaging (MRI), on the other hand, is less often acknowledged as a useful tool in this disease. Nevertheless, MRI is an important test that can effectively characterize atherosclerotic plaque, assess vessel patency in highly calcified disease, and measure lower extremity perfusion.

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Abstract 3427: Uncoupling of Skeletal Muscle Perfusion and Metabolism in Peripheral Arterial Disease

Circulation ◽

10.1161/circ.116.suppl_16.ii_774-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Justin D Anderson ◽

Frederick H Epstein ◽

Craig H Meyer ◽

Klaus D Hagspiel ◽

Hongkun Wang ◽

...

Keyword(s):

Skeletal Muscle ◽

Magnetic Resonance ◽

Peripheral Arterial Disease ◽

Cellular Metabolism ◽

Tissue Perfusion ◽

Arterial Disease ◽

Calf Muscle ◽

Peak Exercise ◽

Muscle Perfusion ◽

Peripheral Arterial

Introduction Studies suggests that limb hemodynamics do not correlate with functional capacity in patients with peripheral arterial disease (PAD). Alterations in microcirculatory function and muscle metabolism are postulated to account for part of this inconsistency. We sought to further characterize the relationship between macrovascular obstruction, tissue perfusion and cellular metabolism in patients with PAD. Methods Sixty-two patients with mild-to-moderate PAD (35 males, mean age±S.D. 65±11 years) had their most symptomatic leg studied (resting ankle-brachial index (ABI) 0.68±0.13). To assess macrovascular disease, a runoff magnetic resonance angiogram was segmentally scored (MRAi) according to the number and degree of arterial stenoses distal to the aorta. A calf muscle perfusion index (PI) was measured at peak exercise with a magnetic resonance imaging (MRI) compatible pedal ergometer using first pass gadolinium-enhanced MRI. PI was defined as the ratio of slopes of calf muscle tissue perfusion to arterial input. 31 Phosphorus MR spectroscopy measured calf muscle phosphocreatine recovery time constant (PCr) immediately after peak exercise. Correlations between ABI, MRAi, PI, and PCr were examined by Pearson’s correlation coefficient. Results Mean MRAi was 0.97±0.74, PI was 0.45±0.15, and PCr was 73.1±30.0 sec. For reference, values in normal subjects are 0, 0.69±0.17 and 34.7±16.6 sec, respectively. The ABI correlated with PI (r=0.46, p<0.001), inversely with MRAi (r=−0.39, p<0.005) and modestly inversely with PCr (r=−0.27, p = 0.05). The MRAi showed a trend towards an inverse correlation with PI (r=−0.27, p<0.06), but did not correlate with PCr (p = 0.29). PCr likewise did not correlate with PI (p=0.85). Conclusions In mild to moderate PAD, lower limb blood pressure relates to macrovascular obstruction and both calf muscle perfusion and metabolism at peak exercise. However, calf muscle perfusion does not correlate with cellular metabolism as determined by PCr recovery at peak exercise. Thus, there is uncoupling between calf muscle perfusion and metabolism, supporting the concept that factors independent of blood flow and intrinsic to skeletal muscle are critical in PAD.

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