Pilot study of contrast-free MRI reveals significantly impaired calf skeletal muscle perfusion in diabetes with incompressible peripheral arteries

Abstract

Patients with diabetes mellitus (DM) are more likely to have densely calcified lesions in the below-the-knee tibial arteries. However, the relationship between peripheral arterial calcification and local skeletal muscle perfusion has not been explored. Thirty subjects were prospectively recruited into three groups in this pilot study: (1) Non-DM: 10 people without DM; (2) DM, ABI < 1.3: 10 people with DM and normal ankle–brachial index (ABI) (0.9–1.3); and (3) DM, ABI ⩾ 1.3: 10 people with DM and ABI ⩾ 1.3. All subjects underwent calf perfusion measurements at rest and during an isometric plantarflexion contraction exercise within the magnetic resonance imaging (MRI) system. The noncontrast MRI techniques were applied to quantitatively assess skeletal muscle blood flow (SMBF) and oxygen extraction fraction (SMOEF) in medial gastrocnemius and soleus muscles. Both SMBF and SMOEF reserves were calculated as the ratio of the exercise value to the resting value. Exercise SMBF and SMOEF values in the medial gastrocnemius muscle were lower in the two DM groups than in the non-DM group ( p < 0.05). The SMBF reserve in medial gastrocnemius was significantly lower in the DM, ABI ⩾ 1.3 group compared to the DM, ABI < 1.3 group ( p < 0.05). This study demonstrates that people with DM and calcified arteries had lower perfusion in gastrocnemius muscle compared to those without DM and those with DM and a normal ABI.

Quantitative MRI for Evaluation of Musculoskeletal Disease

“…95 Beyond DCE-MRI, arterial spin labeling, blood oxygen level-dependent, and intravoxel incoherent motion MRI techniques have provided complimentary microvascular perfusion information in a cuff-induced ischemia-reperfusion experiment 96 and impaired perfusion in the calf muscles of patients with diabetes using noncontrast arterial spin labeling. 97 Evaluation of muscle T 2 changes after versus before exercise (ΔT 2 ) can be used to assess the shift of muscle water during metabolic processes. 98 31 P-magnetic resonance (MR) and creatine (Cr)-CEST MR can quantitatively evaluate metabolic function.…”

“…As described in the section on inflammation, muscle perfusion can be evaluated by DCE-MRI, providing insight into blood flow and vascularization 95 . Beyond DCE-MRI, arterial spin labeling, blood oxygen level–dependent, and intravoxel incoherent motion MRI techniques have provided complimentary microvascular perfusion information in a cuff-induced ischemia-reperfusion experiment 96 and impaired perfusion in the calf muscles of patients with diabetes using noncontrast arterial spin labeling 97 . Evaluation of muscle T 2 changes after versus before exercise (ΔT 2 ) can be used to assess the shift of muscle water during metabolic processes 98 …”