Deteriorated regional calf microcirculation measured by contrast-free MRI in patients with diabetes mellitus and relation with physical activity

Abstract

Objective: To evaluate regional calf muscle microcirculation in people with diabetes mellitus (DM) with and without foot ulcers, compared to healthy control people without DM, using contrast-free magnetic resonance imaging methods. Methods: Three groups of subjects were recruited: non-DM controls, DM, and DM with foot ulcers (DM + ulcer), all with ankle brachial index (ABI) > 0.9. Skeletal muscle blood flow (SMBF) and oxygen extraction fraction (SMOEF) in calf muscle were measured at rest and during a 5-min isometric ankle plantarflexion exercise. Subjects completed the Yale physical activity survey. Results: The exercise SMBF (ml/min/100 g) of the medial gastrocnemius muscle were progressively impaired: 63.7 ± 18.9 for controls, 42.9 ± 6.7 for DM, and 36.2 ± 6.2 for DM + ulcer, p < 0.001. Corresponding exercise SMOEF was the lowest in DM + ulcers (0.48 ± 0.09). Exercise SMBF in the soleus muscle was correlated moderately with the Yale physical activity survey ( r = 0.39, p < 0.01). Conclusions: Contrast-free MR imaging identified progressively impaired regional microcirculation in medial gastrocnemius muscles of people with DM with and without foot ulcers. Exercise SMBF in the medial gastrocnemius muscle was the most sensitive index and was associated with HbA1c. Lower exercise SMBF in the soleus muscle was associated with lower Yale score.

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

“…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.…”

Molecular Imaging of Lower Extremity Peripheral Arterial Disease: An Emerging Field in Nuclear Medicine

“…However, the last decade has seen an emergence of new applications and methods for using nuclear imaging modalities to quantify lower extremity pathophysiology in PAD. While novel MR- (11)(12)(13)(14)(15) and ultrasound-based (16,17) imaging approaches have also emerged in recent years that offer physiological evaluation of lower extremity skeletal muscle, these techniques are beyond the scope of this article. This perspectives article will discuss current advances and emerging applications of clinical nuclear imaging modalities in recent years in the setting of lower extremity PAD, with particular focus on perfusion imaging and molecular imaging of atherosclerosis and vascular inflammation.…”