Dynamic contrast-enhanced ultrasound and transient arterial occlusion for quantification of arterial perfusion reserve in peripheral arterial disease

Amarteifio, Erick; Wormsbecher, S.; Krix, Martin; Demirel, Serdar; Braun, Simone; Delorme, Stefan; Böckler, Dittmar; Kauczor, Hans‐Ulrich; Weber, Marc‐André

doi:10.1016/j.ejrad.2011.12.030

Cited by 36 publications

(33 citation statements)

References 22 publications

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“…An ABI of less than 0.90 indicates major disease (>50% stenosis) with sensitivity of 79% and specificity of 96%, and an ABI of less than 0.85 is found to be an independent predictor of mortality . Amarteifio et al reported that the time to peak intensity was significantly inversely correlated with the ABI ( r = –0.65). In our study, although the relationship between the ABI score and the time to peak intensity was inverse in patients with PAD, it did not achieve statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Prospects of Contrast‐Enhanced Ultrasonography for the Diagnosis of Peripheral Arterial Disease: A Meta‐analysis

Hou

Chu

2017

J of Ultrasound Medicine

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Section: Discussionmentioning

confidence: 99%

Prospects of Contrast‐Enhanced Ultrasonography for the Diagnosis of Peripheral Arterial Disease: A Meta‐analysis

Hou

Chu

2017

J of Ultrasound Medicine

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“…Parameters, such as time to peak (TTP) contrast, maximal contrast, areas under time-signal intensity curves, and gradients, have been used to assess perfusion. 37,39 TTP, maximal signal intensity, and area under the time-signal intensity curves are lower in patients with PAD when compared with healthy controls. [37][38][39] CEUS has been used to assess collateralization, an important compensatory mechanism in patients with PAD.…”

Section: Contrast-enhanced Ultrasoundmentioning

confidence: 99%

“…37,39 TTP, maximal signal intensity, and area under the time-signal intensity curves are lower in patients with PAD when compared with healthy controls. [37][38][39] CEUS has been used to assess collateralization, an important compensatory mechanism in patients with PAD. 39 Patients with extensive collateralization (assessed by angiography) have a shorter TTP when compared with those that collateralize poorly.…”

Section: Contrast-enhanced Ultrasoundmentioning

confidence: 99%

“…[37][38][39] These contrast agents consist of a shell and a gas core, the latter endowing echogenicity to the structure. The outer shell is broken down by the acoustic energy of the ultrasound and eventually metabolized by the body.…”

Section: Contrast-enhanced Ultrasoundmentioning

confidence: 99%

“…37 Microbubble contrast is administered intravenously, either as a bolus injection 37 or by slow continuous infusion 39 with the assumption that signal intensity is a direct measure of microbubble contrast concentration in the ROI (Figure 3). It is not known which method of administration is superior.…”

Section: Contrast-enhanced Ultrasoundmentioning

confidence: 99%

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Assessment of Tissue Perfusion in the Lower Limb

Bajwa

Wesolowski

Patel

et al. 2014

Circ: Cardiovascular Imaging

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Downloaded from Bajwa et al Assessment of Lower Limb Perfusion 837when compared with normal limbs and cannot quantify the severity of perfusion deficit. 12 More recent studies show that LDF is a good discriminator of skin flap perfusion and can predict the likelihood of healing after limb amputation.13 LDI is used in preclinical animal models of limb ischemia (eg, the murine hindlimb ischemia model) for high throughput testing of interventions, including angiogenic therapies. The technique allows longitudinal acquisition of data but is limited by motion artifact, ambient temperature variations, and perfusion measurements, which are weighted toward the larger vessels that are shallow and reside on the surface of the limb musculature. 14 Transcutaneous Oxygen PressureThe measurement of transcutaneous oxygen pressure (TcPo 2 ) is a noninvasive technique that allows longitudinal assessment of local oxygen diffusion from the capillary bed through the skin epidermis and provides an indication of the amount of oxygen delivered to the tissue. TcPo 2 measurements can reflect the severity of PAD, 15 assess ulcer healing potential, 16 and determine the optimal level for limb amputation. 17 A TcPo 2 <20 to 30 mm Hg is consistent with CLI, 2,15,18 and levels <40 mm Hg are associated with poor healing after amputation. 18 Inhalation of 100% oxygen would normally result in TcPo 2 >100 mm Hg, but in patients with CLI the TcPo 2 does not rise >30 mm Hg. 18 Oxygen therapy resulting in <10 mm Hg rise in limb TcPo 2 is associated with an >60% chance of an amputation at that level not healing. 18 A rise of >40 mm Hg in TcPo 2 after limb revascularization is considered significant and increases the chances of tissue healing. 15,18 TcPo 2 measurements vary in different tissues and under different physiological conditions. Barriers to diffusion, such as edema, increased oxygen consumption secondary to inflammation, and vasoconstriction, may lead to falsely low TcPo 2 readings falsely. Readings are also affected by temperature, with a 1°C reduction in the thermistor temperature resulting in a 2% to 3% lower TcPo 2 reading. 18 Indocyanine Green Fluorescence AngiographyThis technique has been used for many years to image retinal vessels, 19 and more recently in the assessment of microanastomoses in surgical flap reconstruction surgery, detection of arteriovenous malformations, and measurement of hepatic blood flow. 20 Indocyanine green is a fluorescent dye that is activated by near-infrared laser light at ≈780 nm. 21 This allows a penetrance of 3 mm from the surface of the skin to assess the subdermal microcirculation. 20,22 A semiquantitative measure of perfusion is obtained by measuring pixel fluorescence intensity in different areas of the image from the limb. Perfusion measured by indocyanine green fluorescence angiography correlates with LDI in the hindlimb ischemia model 23 and predicts the likelihood of amputation healing in man. 21 This technique can identify patients with peripheral arterial occlusions who have extensive collater...

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Contrast‐Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair

Kamtchouing

Mick

Groß

et al. 2019

Journal Orthopaedic Research

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Supraspinatus (SSP) tendon tears represent a common indication for shoulder surgery. Yet, prediction of postoperative function and tendon retear remains challenging and primarily relies on morphologic magnetic resonance imaging (MRI)-based parameters, supported by patients' demographic data like age, gender, and comorbidities. Considering continuously high retear rates, especially in patients with larger tears and negative prognostic factors, improved outcome prediction could be of high clinical value. Contrastenhanced ultrasound (CEUS) enables an assessment of dynamic perfusion of the SSP muscle. As a potential surrogate for muscle vitality, CEUS might reflect functional properties of the SSP and support improved outcome prediction after tendon repair. Fifty patients with isolated SSP tendon tears were prospectively enrolled. Preoperatively, SSP muscle perfusion was quantified by CEUS and conventional morphologic parameters like tear size, fatty infiltration, and tendon retraction were assessed by MRI. At six months follow-up, shoulder function, tendon integrity, and muscle perfusion were reassessed. The predictive value of preoperative CEUS for postoperative shoulder function and tendon integrity was evaluated. 35 patients entered the statistical analysis. Preoperative CEUS-based assessment of SSP perfusion significantly correlated with early postoperative shoulder function (Constant, r = 0.48, p < 0.018) and tendon retear (r = 0.67, p < 0.001). CEUS-based subgroup analysis identified patients with exceptionally high, respectively low risk for tendon retear. CEUSbased assessment of the SSP seemed to predict early shoulder function and tendon retear after SSP repair and allowed to identify patient subgroups with exceptionally high or low risk for tendon retear.

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Dynamic contrast-enhanced ultrasound and transient arterial occlusion for quantification of arterial perfusion reserve in peripheral arterial disease

Cited by 36 publications

References 22 publications

Prospects of Contrast‐Enhanced Ultrasonography for the Diagnosis of Peripheral Arterial Disease: A Meta‐analysis

Prospects of Contrast‐Enhanced Ultrasonography for the Diagnosis of Peripheral Arterial Disease: A Meta‐analysis

Assessment of Tissue Perfusion in the Lower Limb

Contrast‐Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair

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