MRI of Arterial Flow Reserve in Patients with Intermittent Claudication: Feasibility and Initial Experience

Abstract

ObjectivesThe aim of this work was to develop a MRI method to determine arterial flow reserve in patients with intermittent claudication and to investigate whether this method can discriminate between patients and healthy control subjects.MethodsTen consecutive patients with intermittent claudication and 10 healthy control subjects were included. All subjects underwent vector cardiography triggered quantitative 2D cine MR phase-contrast imaging to obtain flow waveforms of the popliteal artery at rest and during reactive hyperemia. Resting flow, maximum hyperemic flow and absolute flow reserve were determined and compared between the two groups by two independent MRI readers. Also, interreader reproducibility of flow measures was reported.ResultsResting flow was lower in patients compared to controls (4.9±1.6 and 11.1±3.2 mL/s in patients and controls, respectively (p<0.01)). Maximum hyperemic flow was 7.3±2.9 and 16.4±3.2 mL/s (p<0.01) and the absolute flow reserve was 2.4±1.6 and 5.3±1.3 mL/s (p<0.01), respectively in patients and controls. The interreader coefficient of variation was below 10% for all measures in both patients and controls.ConclusionsQuantitative 2D MR cine phase-contrast imaging is a promising method to determine flow reserve measures in patients with peripheral arterial disease and can be helpful to discriminate patients with intermittent claudication from healthy controls.

Baseline assessment and comparison of arterial anatomy, hyperemic flow, and skeletal muscle perfusion in peripheral artery disease: The Cardiovascular Cell Therapy Research Network “Patients with Intermittent Claudication Injected with ALDH Bright Cells” (CCTRN PACE) study

“…Arterial flow reserve might provide additional diagnostic and physiologic data as compared to measurements of resting leg blood flow alone, and have shown high reproducibility. (11, 22) Similar to previous demonstrations(11), we showed that both resting flow and peak hyperemic popliteal flow were lower in PAD participants compared to normal participants, indicative of decreased arterial flow reserve in the PAD population. The time-to-peak flow after cuff release (deflation), as demonstrated earlier, was higher in PAD participants, indicative of decreased maximal arteriolar vasodilation.…”

“…Flow curves were generated using QFlow (v5.2, Medis, Leiden, Netherlands) following a methodology described previously. (11) From the generated flow curve, the peak instantaneous cardiac blood flow (characterized for each dynamic) within that cardiac cycle was noted. Measured parameters included resting flow (average peak flow at rest over 3 acquisitions), peak hyperemic popliteal flow (peak flow after cuff deflation as observed over 10 minutes), time-to-peak hyperemic flow (from the point of cuff deflation) and arterial flow reserve (peak hyperemic flow – resting flow).…”

Ultrasound in diagnosis of anatomical variation of anterior and posterior tibial arteries.

“…Studies have shown that the popliteal artery can trifurcate, gives high division or hypoplastic-aplastic branches with altered distal supply. In fact, hypoplastic changes have been reported for the anterior tibial, posterior tibial, and peroneal arteries [1,2,9,10,12,[14][15][16][17][18][19][20][21][22][23][24]. The information about the anatomy of limb arteries is usually obtained via ultrasonography, computer tomography angiography (CTA), magnetic resonance angiography (MRA), and/or anatomical dissection.…”

Quantitative and Dynamic MRI Measures of Peripheral Vascular Function

“…In addition to this baseline characterization of the arterial flow waveform, the dynamics of the arterial blood flow response during reactive hyperemia (Mohiaddin et al, 2002;Langham et al, 2010bLangham et al, , 2013aLangham et al, , 2015 or following exercise (Englund et al, 2017) provide insight into endothelial function, vascular reactivity, and flow reserve (Versluis et al, 2012). By quantifying macrovascular blood flow dynamically in the feeding artery, the time to peak flow and the duration of forward flow can be measured.…”