Arterial spin labeling magnetic resonance imaging quantifies tissue perfusion around foot ulcers

Pantoja, Joe L.; Ali, Fadil; Baril, Donald T.; Farley, Steven; Boynton, Scott; Finn, J. Paul; Hu, Ping; Lawrence, Peter F.

doi:10.1016/j.jvscit.2022.09.015

Cited by 7 publications

(6 citation statements)

References 29 publications

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“…In DM patients, hyperglycemia damaged the vascular intima, and the increased blood viscosity destroyed the blood vessels, leading to the insufficient blood supply to the tissues and tissue necrosis, thus aggravating the condition ( 20 ). Our results are consistent with other studies ( 16 ). Meanwhile, increased local perfusion of the affected foot was noticed after amputation in patients with diabetic foot ulcers ( 1 ).…”

Section: Discussionsupporting

confidence: 94%

“…The reduced CBF was found in patients with type 2 diabetes mellitus (T2DM) and patients with hypoglycemia ( 12 , 13 ). Besides the CBF, the BF dynamics in skeletal muscle ( 14 ) and foot ulcers ( 15 , 16 ) were also evaluated in diabetes mellitus patients at rest and with physical activity using ASL imaging. However, the results were inconsistent.…”

Section: Introductionmentioning

confidence: 99%

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Amide proton transfer weighted contrast has diagnostic capacity in detecting diabetic foot: an MRI-based case–control study

Lu,

Tian,

Zhao

et al. 2024

Front. Endocrinol.

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ObjectiveTo evaluate the role of foot muscle amide proton transfer weighted (APTw) contrast and tissue rest perfusion in quantifying diabetic foot (DF) infection and its correlation with blood parameters.Materials and methodsWith approval from an ethical review board, this study included 40 diabetes mellitus (DM) patients with DF and 31 DM patients without DF or other lower extremity arterial disease. All subjects underwent MRI, which included foot sagittal APTw and coronal arterial spin labeling (ASL) imaging. The normalized MTRasym (3.5 ppm) and the ratio of blood flow (rBF) in rest status of the affected side lesions to the non-affected contralateral side were determined. The inter-group differences of these variables were evaluated. Furthermore, the association between normalized MTRasym (3.5 ppm), rBF, and blood parameters [fasting blood glucose (FBG), glycosylated hemoglobin content, C-reactive protein, neutrophil percentage, and white blood cell count] was explored. Using an ROC curve, the diagnostic capacity of normalized MTRasym (3.5 ppm), BF, and blood biochemical markers in differentiating with or without DF in DM was assessed.ResultsIn the DF group, MTRasym (3.5 ppm) and BF in lesion and normalized MTRasym (3.5 ppm) were higher than those in the control group (p < 0.05). In addition, correlations were identified between normalized MTRasym (3.5 ppm) and blood parameters, such as C-reactive protein, glycosylated hemoglobin content, FBG, neutrophil ratio, and white blood cell (p < 0.001). Meanwhile, association between BF in lesion and blood parameters, such as C-reactive protein, neutrophil percentage, and FBG (p < 0.01). AUC of normalized MTRasym (3.5 ppm) in identifying with/without DF in patients with DM is 0.986 (95% CI, 0.918–1.00) with the sensitivity of 97.22% and the specificity of 100%.ConclusionNormalized MTRasym (3.5 ppm) and the BF in lesion may be treated as a safer and more convenient new indicator to evaluate the tissue infection without using a contrast agent, which may be useful in monitoring and preoperatively assessing DF patients with renal insufficiency.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Amide proton transfer weighted contrast has diagnostic capacity in detecting diabetic foot: an MRI-based case–control study

Lu,

Tian,

Zhao

et al. 2024

Front. Endocrinol.

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“…To our knowledge, perfusion in feet has not previously been quanti ed with PET and only a few studies using MRI or CT have been published. Arterial spin labelling MRI appears to yield perfusion approximately 10 times higher than the current study in both lower legs and feet [19][20][21]. Whereas a small dynamic CT study in patients with diabetic foot found perfusion values more in line with the current study (0.5-0.7 mL/min/100mL in healthy tissue of the feet) [22].…”

Section: Resting Perfusion Normal Valuessupporting

confidence: 75%

Repeatability of [15O]H2O PET Imaging for Lower Extremity Skeletal Muscle Perfusion: A Test-Retest Study

Christensen,

Sørensen,

Bouchelouche

et al. 2023

Preprint

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Background [15O]H2O PET/CT allow non-invasive quantification of tissue perfusion and can potentially play a future role in the diagnosis and treatment of peripheral artery disease. We aimed to evaluate the reliability of dynamic [15O]H2O PET imaging for measuring lower extremity skeletal muscle perfusion. Results Ten healthy participants underwent same-day test-retest study with six dynamic [15O]H2O PET scans of lower legs and feet. Manual volume-of-interests were drawn in skeletal muscles, and PET time-activity curves were extracted. K1 values (mL/min/100mL) were estimated using a single-tissue compartment model (1TCM), autoradiography (ARG), and parametric imaging with blood input functions obtained from separate heart scans. Resting perfusion values in the muscle groups of the lower legs ranged from 1.18–5.38 mL/min/100mL (ARG method). In the muscle groups of the feet, perfusion values ranged from 0.41–3.41 mL/min/100mL (ARG method). Test-retest scans demonstrated a strong correlation and good repeatability for skeletal muscle perfusion with an intraclass correlation coefficient (ICC) of 0.88 and 0.87 and a repeatability coefficient of 34% and 53% for lower legs and feet, respectively. An excellent correlation was demonstrated when comparing the VOI-based methods (lower legs: ICC = 0.96, feet: ICC = 0.99). Parametric images were quantitative with excellent agreement with the volume-of-interest-based ARG method (lower legs: ICC = 0.97, feet: ICC = 0.98). Conclusion Parametric images and volume-of-interest-based methods demonstrated comparable resting perfusion values in the lower legs and feet of healthy individuals. The largest variation was seen between individuals, whereas a smaller variation was seen between muscle groups. Repeated measurements of resting blood flow yielded a strong overall correlation for all methods.

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“…Arterial spin labeling (ASL) is another quantitative MRI approach for the non‐invasive assessment of tissue perfusion and yields similar results in diabetes mellitus patients with foot ulcer 9 . Hyperemia in tissue surrounding ulcers was confirmed with ASL 10 …”

mentioning

confidence: 95%

“…9 Hyperemia in tissue surrounding ulcers was confirmed with ASL. 10 Despite worse methodological challenges in applying these MRI approaches to organs other than the brain, non-invasive mapping of quantitative perfusion parameters represents a promising tool to assess tissue alterations in diabetes mellitus in longitudinal studies. These techniques deserve further development and validation.…”

mentioning

confidence: 99%

Editorial for “Feasibility of Multiparametric Perfusion Assessment in Diabetic Foot Ulcer Using Intravoxel Incoherent Motion and Blood Oxygenation‐Level Dependent MRI”

Perles‐Barbacaru

2023

Magnetic Resonance Imaging

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Arterial spin labeling magnetic resonance imaging quantifies tissue perfusion around foot ulcers

Cited by 7 publications

References 29 publications

Amide proton transfer weighted contrast has diagnostic capacity in detecting diabetic foot: an MRI-based case–control study

Amide proton transfer weighted contrast has diagnostic capacity in detecting diabetic foot: an MRI-based case–control study

Repeatability of [15O]H2O PET Imaging for Lower Extremity Skeletal Muscle Perfusion: A Test-Retest Study

Editorial for “Feasibility of Multiparametric Perfusion Assessment in Diabetic Foot Ulcer Using Intravoxel Incoherent Motion and Blood Oxygenation‐Level Dependent MRI”

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