TY  - JOUR
A1  - Bajwa, Adnan
A1  - Wesolowski, Roman
A1  - Patel, Ashish
A1  - Saha, Prakash
A1  - Ludwinski, Francesca
A1  - Ikram, Mohammed
A1  - Albayati, Mostafa
A1  - Smith, Alberto
A1  - Nagel, Eike
A1  - Modarai, Bijan
T1  - Blood oxygenation level-dependent cmr-derived measures in critical limb ischemia and changes with revascularization
T2  - Journal of the American College of Cardiology
N2  - Background: Use of blood oxygenation level-dependent cardiovascular magnetic resonance (BOLD-CMR) to assess perfusion in the lower limb has been hampered by poor reproducibility and a failure to reliably detect post-revascularization improvements in patients with critical limb ischemia (CLI).
Objectives: This study sought to develop BOLD-CMR as an objective, reliable clinical tool for measuring calf muscle perfusion in patients with CLI.
Methods: The calf was imaged at 3-T in young healthy control subjects (n = 12), age-matched control subjects (n = 10), and patients with CLI (n = 34). Signal intensity time curves were generated for each muscle group and curve parameters, including signal reduction during ischemia (SRi) and gradient during reactive hyperemia (Grad). BOLD-CMR was used to assess changes in perfusion following revascularization in 12 CLI patients. Muscle biopsies (n = 28), obtained at the level of BOLD-CMR measurement and from healthy proximal muscle of patients undergoing lower limb amputation (n = 3), were analyzed for capillary-fiber ratio.
Results: There was good interuser and interscan reproducibility for Grad and SRi (all p < 0.0001). The ischemic limb had lower Grad and SRi compared with the contralateral asymptomatic limb, age-matched control subjects, and young control subjects (p < 0.001 for all comparisons). Successful revascularization resulted in improvement in Grad (p < 0.0001) and SRi (p < 0.0005). There was a significant correlation between capillary-fiber ratio (p < 0.01) in muscle biopsies from amputated limbs and Grad measured pre-operatively at the corresponding level.
Conclusions: BOLD-CMR showed promise as a reliable tool for assessing perfusion in the lower limb musculature and merits further investigation in a clinical trial.
KW  - angioplasty
KW  - cardiovascular magnetic resonance
KW  - perfusion
KW  - surgery
Y1  - 2016
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/50608
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-506087
SN  - 1558-3597
SN  - 0735-1097
N1  - © 2016 by the American College of Cardiology Foundation. Published by Elsevier. This is an open access article under the cc by license (http://creativecommons.org/licenses/by/4.0/) .
VL  - 67
IS  - 4
SP  - 420
EP  - 431
PB  - Elsevier ; American College of Cardiology
CY  - New York, NY
ER  -