Evaluation of skeletal muscle microvascular perfusion of lower extremities by cardiovascular magnetic resonance arterial spin labeling, blood oxygenation level-dependent, and intravoxel incoherent motion techniques

Abstract

BackgroundNoninvasive cardiovascular magnetic resonance (CMR) techniques including arterial spin labeling (ASL), blood oxygenation level-dependent (BOLD), and intravoxel incoherent motion (IVIM), are capable of measuring tissue perfusion-related parameters. We sought to evaluate and compare these three CMR techniques in characterizing skeletal muscle perfusion in lower extremities and to investigate their abilities to diagnose and assess the severity of peripheral arterial disease (PAD).MethodsFifteen healthy young subjects, 14 patients with PAD, and 10 age-matched healthy old subjects underwent ASL, BOLD, and IVIM CMR perfusion imaging. Healthy young and healthy old participants were subjected to a cuff-induced ischemia experiment with pressures of 20 mmHg and 40 mmHg above systolic pressure during imaging. Perfusion-related metrics, including blood flow, T2* relaxation time, perfusion fraction f, diffusion coefficient D, and pseudodiffusion coefficient D*, were measured in the anterior, lateral, soleus, and gastrocnemius muscle groups. Friedman, Mann-Whitney, Wilcoxon signed rank, and Spearman rank correlation tests were used for statistical analysis.ResultsIn cases of significant differences determined by the Friedman test (P < 0.05), blood flow, T2*, and D values gradually decreased, while f values showed a tendency to increase in healthy subjects under cuff compression. No significant correlations were found among the ASL, BOLD, and IVIM parameters (all P > 0.05). Blood flow and T2* values showed significant positive correlations with transcutaneous oxygen pressure measurements (ρ = 0.465 and 0.522, respectively; both P ≤ 0.001), while f values showed a significant negative correlation in healthy young subjects (ρ = − 0.351; P = 0.018). T2* was independent of age in every muscle group. T2* values were significantly decreased in PAD patients compared with healthy old subjects and severe PAD patients compared with mild-to-moderate PAD patients (all P < 0.0125). Significant correlations were found between T2* and ankle–brachial index values in all muscle groups in PAD patients (ρ = 0.644–0.837; all P < 0.0125). Other imaging parameters failed to show benefits towards the diagnosis and disease severity evaluation of PAD.ConclusionsASL, BOLD, and IVIM provide complementary information regarding tissue perfusion. Compared with ASL and IVIM, BOLD may be a more reliable technique for assessing PAD in the resting state and could thus be applied together with angiography in clinical studies as a tool to comprehensively assess microvascular and macrovascular properties in PAD patients.Electronic supplementary materialThe online version of this article (10.1186/s12968-018-0441-3) contains supplementary material, which is available to authorized users.

Advancements in magnetic resonance imaging‐based biomarkers for muscular dystrophy

“…Blood oxygenation level‐dependent imaging detects deoxygenated hemoglobin and is most commonly used to detect regional changes in blood flow in the context of functional MRI of the brain. Although preliminary data for these techniques in muscle are promising, neither of these techniques has as yet been studied in the human muscular dystrophy population …”

“…Although preliminary data for these techniques in muscle are promising, neither of these techniques has as yet been studied in the human muscular dystrophy population. 106,107…”

A systematic review of diagnostic techniques to determine tissue perfusion in patients with peripheral arterial disease

“…In PAD, using contact-free methods, such as HSI, LSCI, or MRI, may be preferable, especially when patients have foot ulcers. MR BOLD imaging is the most reliable technique to detect and stratify microvascular function at rest in PAD patients [23]. Disadvantages of BOLD MRI are the limited availability and the high costs [61].…”

“…Baseline T2* values of BOLD MRI (ms), ASL-blood flow (mL/ 100 g/min) and IVIM-f (%) were specified for different muscle groups between age-matched healthy controls and patients with PAD. According to Suo et al [23] T2* was the only perfusion-related parameter that showed significant differences between age-matched healthy controls and patients with PAD. Values derived from four muscle groups in the lower extremity are provided in Table 1.…”

“…Suo et al [23] integrated ASL, BOLD and IVIM MRI imaging in a single-experimental setup and investigated the ability of these techniques to diagnose and asses the severity of PAD. They included 14 patients with PAD and 10 healthy controls.…”