Blood Oxygenation Level-Dependent CMR-Derived Measures in Critical Limb Ischemia and Changes With Revascularization

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• 作者：Adnan Bajwa ; BSc^a ; Roman Wesolowski ; PhD^b ; Ashish Patel ; PhD^a ; Prakash Saha ; PhD^a ; Francesca Ludwinski ; PhD^a ; Mohammed Ikram ; PhD^a ; Mostafa Albayati ; MBBS ; BSc^a ; Alberto Smith ; PhD^a ; Eike Nagel ; MD ; PhD^b ; ^c ; Bijan Modarai ; PhD^a ; ^{bijan.modarai@kcl.ac.uk" class="auth_mail" title="E-mail the corresponding author}
• 关键词：angioplasty ; cardiovascular magnetic resonance ; perfusion ; surgery
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：2 February 2016
• 年：2016
• 卷：67
• 期：4
• 页码：420-431
• 全文大小：2205 K

文摘

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.