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Journal of Cardiovascular Magnetic Resonance

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Open Access 01-12-2015 | Research

Arterial spin labeling perfusion cardiovascular magnetic resonance of the calf in peripheral arterial disease: cuff occlusion hyperemia vs exercise

Authors: David Lopez, Amy W Pollak, Craig H Meyer, Frederick H Epstein, Li Zhao, Arthur J Pesch, Ronny Jiji, Jennifer R Kay, Joseph M DiMaria, John M Christopher, Christopher M Kramer

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2015

Abstract

Background

Assessment of calf muscle perfusion requires a physiological challenge. Exercise and cuff-occlusion hyperemia are commonly used methods, but it has been unclear if one is superior to the other. We hypothesized that post-occlusion calf muscle perfusion (Cuff) with pulsed arterial spin labeling (PASL) cardiovascular magnetic resonance (CMR) at 3 Tesla (T) would yield greater perfusion and improved reproducibility compared to exercise hyperemia in studies of peripheral arterial disease (PAD).

Methods

Exercise and Cuff cohorts were independently recruited. PAD patients had an ankle brachial index (ABI) between 0.4-0.9. Controls (NL) had no risk factors and ABI 0.9-1.4. Subjects exercised until exhaustion (15 NL-Ex, 15 PAD-Ex) or had a thigh cuff inflated for 5 minutes (12 NL-Cuff, 11 PAD-Cuff). Peak exercise and average cuff (Cuff_mean) perfusion were compared. Six participants underwent both cuff and exercise testing. Reproducibility was tested in 8 Cuff subjects (5 NL, 3 PAD).

Results

Controls had greater perfusion than PAD independent of stressor (NL-Ex 74 ± 21 vs. PAD-Ex 43 ± 10, p = 0.01; NL-Cuff_mean 109 ± 39 vs. PAD-Cuff_mean 34 ± 17 ml/min-100 g, p < 0.001). However, there was no difference between exercise and Cuff_mean perfusion within groups (p > 0.6). Results were similar when the same subjects had the 2 stressors performed. Cuff_mean had superior reproducibility (Cuff_mean ICC 0.98 vs. Exercise ICC 0.87) and area under the receiver operating characteristic curve (Cuff_mean 0.992 vs. Exercise 0.905).

Conclusions

Cuff hyperemia differentiates PAD patients from controls, as does exercise stress. Cuff_mean and exercise calf perfusion values are similar. Cuff occlusion hyperemia has superior reproducibility and thus may be the preferred stressor.

Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. American heart association statistics committee and stroke statistics subcommittee. Executive summary: heart disease and stroke statistics–2012 update: a report from the American heart association. Circulation. 2012;125:188–97.CrossRefPubMed

McDermott MM, Liu K, Greenland P, Guralnik JM, Criqui MH, Chan C, et al. Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms. JAMA. 2004;292:453–61.CrossRefPubMed

Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med. 1992;326:381–6.CrossRefPubMed

Faxon DP, Fuster V, Libby P, Beckman JA, Hiatt WR, Thompson RW, et al. American heart association. Atherosclerotic vascular disease conference: writing group III: pathophysiology. Circulation. 2004;109:2617–25.CrossRefPubMed

Criqui MH, Ninomiya JK, Wingard DL, Ji M, Fronek A. Progression of peripheral arterial disease predicts cardiovascular disease morbidity and mortality. J Am Coll Cardiol. 2008;52:1736–42.CrossRefPubMedCentralPubMed

Gardner AW, Skinner JS, Cantwell BW, Smith LK. Prediction of claudication pain from clinical measurements obtained at rest. Med Sci Sports Exerc. 1992;24:163–70.CrossRefPubMed

Isbell DC, Epstein FH, Zhong X, DiMaria JM, Berr SS, Meyer CH, et al. Calf muscle perfusion at peak exercise in peripheral arterial disease: measurement by first-pass contrast-enhanced magnetic resonance imaging. J Magn Reson Imaging. 2007;25:1013–20.CrossRefPubMedCentralPubMed

Anderson JD, Epstein FH, Meyer CH, Hagspiel KD, Wang H, Berr SS, et al. Multifactorial determinants of functional capacity in peripheral arterial disease: uncoupling of calf muscle perfusion and metabolism. J Am Coll Cardiol. 2009;54:628–35.CrossRefPubMedCentralPubMed

Kribben A, Witzke O, Hillen U, Barkhausen J, Daul AE, Erbel R. Nephrogenic systemic fibrosis: pathogenesis, diagnosis, and therapy. J Am Coll Cardiol. 2009;53:1621–8.CrossRefPubMed

10.

O’Hare AM, Glidden DV, Fox CS, Hsu CY. High prevalence of peripheral arterial disease in persons with renal insufficiency: results from the National Health and Nutrition Examination Survey 1999–2000. Circulation. 2004;109:320–3.CrossRefPubMed

11.

Williams DS, Detre JA, Leigh JS, Koretsky AP. Magnetic resonance imaging of perfusion using spin inversion of arterial water. Proc Natl Acad Sci U S A. 1992;89:212–6.CrossRefPubMedCentralPubMed

12.

Detre JA, Zhang W, Roberts DA, Silva AC, Williams DS, Grandis DJ, et al. Tissue specific perfusion imaging using arterial spin labeling. NMR Biomed. 1994;7:75–82.CrossRefPubMed

13.

Raynaud JS, Duteil S, Vaughan JT, Hennel F, Wary C, Leroy-Willig A, et al. Determination of skeletal muscle perfusion using arterial spin labeling NMRI: validation by comparison with venous occlusion plethysmography. Magn Reson Med. 2001;46:305–11.CrossRefPubMed

14.

Wu WC, Mohler E, 3rd, Ratcliffe SJ, Wehrli FW, Detre JA, Floyd TF. Skeletal muscle microvascular flow in progressive peripheral artery disease: assessment with continuous arterial spin-labeling perfusion magnetic resonance imaging. J Am Coll Cardiol. 2009;53:2372–7.CrossRefPubMed

15.

Pollak AW, Meyer CH, Epstein FH, Jiji RS, Hunter JR, Dimaria JM, et al. Arterial spin labeling MR imaging reproducibly measures peak-exercise calf muscle perfusion: a study in patients with peripheral arterial disease and healthy volunteers. JACC Cardiovasc Imaging. 2012;5:1224–30.CrossRefPubMed

16.

Wong EC, Buxton RB, Frank LR. Implementation of quantitative perfusion imaging techniques for functional brain mapping using pulsed arterial spin labeling. NMR Biomed. 1997;10:237–49.CrossRefPubMed

17.

Wang J, Licht DJ, Jahng GH, Liu CS, Rubin JT, Haselgrove J, et al. Pediatric perfusion imaging using pulsed arterial spin labeling. J Magn Reson Imaging. 2003;18:404–13.CrossRefPubMed

18.

Wu WC, Wang J, Detre JA, Wehrli FW, Mohler E,3rd, Ratcliffe SJ, et al. Hyperemic flow heterogeneity within the calf, foot, and forearm measured with continuous arterial spin labeling MRI. Am J Physiol Heart Circ Physiol. 2008;294:H2129–36.CrossRefPubMedCentralPubMed

19.

Thompson RB, Aviles RJ, Faranesh AZ, Raman VK, Wright V, Balaban RS, et al. Measurement of skeletal muscle perfusion during postischemic reactive hyperemia using contrast-enhanced MRI with a step-input function. Magn Reson Med. 2005;54:289–98.CrossRefPubMedCentralPubMed

20.

Dawson JM, Tyler KR, Hudlicka O. A comparison of the microcirculation in rat fast glycolytic and slow oxidative muscles at rest and during contractions. Microvasc Res. 1987;33:167–82.CrossRefPubMed

21.

Askew CD, Green S, Walker PJ, Kerr GK, Green AA, Williams AD, et al. Skeletal muscle phenotype is associated with exercise tolerance in patients with peripheral arterial disease. J Vasc Surg. 2005;41:802–7.CrossRefPubMed

22.

Grozinger G, Pohmann R, Schick F, Grosse U, Syha R, Brechtel K, et al. 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. 2013.

23.

Alsop DC, Detre JA, Golay X, Gunther M, Hendrikse J, Hernandez-Garcia L, et al. Recommended implementation of arterial spin-labeled perfusion MRI for clinical applications: A consensus of the ISMRM perfusion study group and the European consortium for ASL in dementia. Magn Reson Med. 2014.

24.

Pollock JM, Tan H, Kraft RA, Whitlow CT, Burdette JH, Maldjian JA. Arterial spin-labeled MR perfusion imaging: clinical applications. Magn Reson Imaging Clin N Am. 2009;17:315–38.CrossRefPubMedCentralPubMed

25.

Lee CC, Wu CJ, Chou LH, Shen SM, Chiang SF, Jen PC, et al. Peripheral artery disease in peritoneal dialysis and hemodialysis patients: single-center retrospective study in Taiwan. BMC Nephrol. 2012;13:100.CrossRefPubMedCentralPubMed

26.

Clement-Guinaudeau S, Topel ML, Ali A, Poole JC, Rocco E, Khan SA, et al. MR-based calf muscle perfusion index correlates with treadmill exercise test parameters in patients with peripheral arterial disease. J Cardiovasc Magn Reson. 2013;15(1):O58.CrossRefPubMedCentral

Title: Arterial spin labeling perfusion cardiovascular magnetic resonance of the calf in peripheral arterial disease: cuff occlusion hyperemia vs exercise
Authors: David Lopez
Amy W Pollak
Craig H Meyer
Frederick H Epstein
Li Zhao
Arthur J Pesch
Ronny Jiji
Jennifer R Kay
Joseph M DiMaria
John M Christopher
Christopher M Kramer
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2015
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-015-0128-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Arterial spin labeling perfusion cardiovascular magnetic resonance of the calf in peripheral arterial disease: cuff occlusion hyperemia vs exercise

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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