Blood oxygenation level-dependent cmr-derived measures in critical limb ischemia and changes with revascularization

  • 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.
Author:Adnan Bajwa, Roman Wesolowski, Ashish Patel, Prakash Saha, Francesca Ludwinski, Mohammed Ikram, Mostafa Albayati, Alberto Smith, Eike NagelORCiDGND, Bijan Modarai
Pubmed Id:
Parent Title (English):Journal of the American College of Cardiology
Publisher:Elsevier ; American College of Cardiology
Place of publication:New York, NY
Document Type:Article
Year of Completion:2016
Date of first Publication:2016/01/25
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2019/07/01
Tag:angioplasty; cardiovascular magnetic resonance; perfusion; surgery
Page Number:12
First Page:420
Last Page:431
© 2016 by the American College of Cardiology Foundation. Published by Elsevier. This is an open access article under the cc by license ( .
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0