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Elsaid NMH, Peters DC, Galiana G, Sinusas AJ. Clinical physiology: the crucial role of MRI in evaluation of peripheral artery disease. Am J Physiol Heart Circ Physiol 2024; 326:H1304-H1323. [PMID: 38517227 DOI: 10.1152/ajpheart.00533.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 03/23/2024]
Abstract
Peripheral artery disease (PAD) is a common vascular disease that primarily affects the lower limbs and is defined by the constriction or blockage of peripheral arteries and may involve microvascular dysfunction and tissue injury. Patients with diabetes have more prominent disease of microcirculation and develop peripheral neuropathy, autonomic dysfunction, and medial vascular calcification. Early and accurate diagnosis of PAD and disease characterization are essential for personalized management and therapy planning. Magnetic resonance imaging (MRI) provides excellent soft tissue contrast and multiplanar imaging capabilities and is useful as a noninvasive imaging tool in the comprehensive physiological assessment of PAD. This review provides an overview of the current state of the art of MRI in the evaluation and characterization of PAD, including an analysis of the many applicable MR imaging techniques, describing the advantages and disadvantages of each approach. We also present recent developments, future clinical applications, and future MRI directions in assessing PAD. The development of new MR imaging technologies and applications in preclinical models with translation to clinical research holds considerable potential for improving the understanding of the pathophysiology of PAD and clinical applications for improving diagnostic precision, risk stratification, and treatment outcomes in patients with PAD.
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Affiliation(s)
- Nahla M H Elsaid
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
| | - Gigi Galiana
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
| | - Albert J Sinusas
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
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Zaeske C, Brueggemann GP, Willwacher S, Maehlich D, Maintz D, Bratke G. The behaviour of T2* and T2 relaxation time in extrinsic foot muscles under continuous exercise: A prospective analysis during extended running. PLoS One 2022; 17:e0264066. [PMID: 35176114 PMCID: PMC8893273 DOI: 10.1371/journal.pone.0264066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 02/02/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives Previous studies on T2* and T2 relaxation time of the muscles have shown that exercise leads to an initial increase, presumably representing different intramuscular physiological processes such as increase in intracellular volume or blood oxygenation level dependent effects with a subsequent decrease after cessation of exercise. Their behaviour during prolonged exercise is still unknown but could provide important information for example about the pathophysiology of overuse injuries. The aim of this study was to evaluate the temporal course of T2* and T2 relaxation time in extrinsic foot muscles during prolonged exercise and determine the optimal mapping technique. Methods Ten participants had to run a total of 75 minutes at their individual highest possible running speed, with interleaved MR scans at baseline and after 2.5, 5, 10, 15, 45 and 75 minutes. The examined extrinsic foot muscles were manually segmented, and relaxation time were analysed regarding its respective time course. Results T2* and T2 relaxation time showed an initial increase, followed by a plateau phase between 2.5 and 15 minutes and a subsequent decrease. For the T2* relaxation time, this pattern was also apparent, but less pronounced, with more muscles not reaching significance (p<0.05) when comparing different time points. Conclusions T2* and T2 relaxation time showed a similar course with an initial rapid increase, a plateau phase and a subsequent decrease under prolonged exercise. Moderate but long-term muscular activity appears to have a weaker effect on T2* relaxation time than on T2 relaxation time.
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Affiliation(s)
- Charlotte Zaeske
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- * E-mail:
| | | | - Steffen Willwacher
- Institute of Biomechanics and Orthopaedics, German Sport University, Cologne, Germany
| | - Daniela Maehlich
- Institute of Biomechanics and Orthopaedics, German Sport University, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Grischa Bratke
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Mahmud SZ, Gladden LB, Kavazis AN, Motl RW, Denney TS, Bashir A. Simultaneous Measurement of Perfusion and T 2* in Calf Muscle at 7T with Submaximal Exercise using Radial Acquisition. Sci Rep 2020; 10:6342. [PMID: 32286372 PMCID: PMC7156440 DOI: 10.1038/s41598-020-63009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/19/2020] [Indexed: 11/09/2022] Open
Abstract
Impairments in oxygen delivery and consumption can lead to reduced muscle endurance and physical disability. Perfusion, a measure of microvascular blood flow, provides information on nutrient delivery. T2* provides information about relative tissue oxygenation. Changes in these parameters following stress, such as exercise, can yield important information about imbalance between delivery and consumption. In this study, we implemented novel golden angle radial MRI acquisition technique to simultaneously quantify muscle perfusion and T2* at 7T with improved temporal resolution, and demonstrated assessment of spatial and temporal changes in these parameters within calf muscles during recovery from plantar flexion exercise. Nine healthy subjects participated the studies. At rest, perfusion and T2* in gastrocnemius muscle group within calf muscle were 5 ± 2 mL/100 g/min and 21.1 ± 3 ms respectively. Then the subjects performed plantar flexion exercise producing a torque of ~8ft-lb. Immediately after the exercise, perfusion was elevated to 79.3 ± 9 mL/100 g/min and T2* was decreased by 6 ± 3%. The time constants for 50% perfusion and T2* recovery were 54.1 ± 10 s and 68.5 ± 7 s respectively. These results demonstrate successful simultaneous quantification of perfusion and T2* in skeletal muscle using the developed technique.
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Affiliation(s)
- Sultan Z Mahmud
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, 36849, USA.
| | - L Bruce Gladden
- School of Kinesiology, Auburn University, Auburn, AL, 36849, USA
| | | | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, 36849, USA
| | - Adil Bashir
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, 36849, USA
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Hurley DM, Williams ER, Cross JM, Riedinger BR, Meyer RA, Abela GS, Slade JM. Aerobic Exercise Improves Microvascular Function in Older Adults. Med Sci Sports Exerc 2019; 51:773-781. [PMID: 30489496 DOI: 10.1249/mss.0000000000001854] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Microvascular function is reduced with age, disease, and inactivity. Exercise is well known to improve vascular health and has the potential to improve microvascular function in aging and disease. PURPOSE The study aimed to assess changes in peripheral microvascular function in sedentary older adults after aerobic exercise training. METHODS Twenty-three sedentary older adults (67 ± 5 yr, body mass index = 29 ± 5, mean ± SD) successfully completed a randomized 12-wk graded treadmill walking intervention. The exercise group (EX) performed 40 min of uphill walking 4 d·wk at 70% heart rate reserve. The control group (CON) maintained a sedentary lifestyle for 12 wk. Blood oxygen level-dependent (BOLD) responses of the soleus measured by magnetic resonance imaging were used to evaluate microvascular function; brief (1 s) maximal plantarflexion contractions were performed. Separately, blood flow in the popliteal artery was measured by ultrasound after brief contraction. Phosphorus magnetic resonance spectroscopy of the calf was used to examine muscle oxidative capacity, and whole-body peak oxygen consumption (V˙O2peak) was used to confirm training-induced cardiorespiratory adaptations. RESULTS Peak postcontraction BOLD response increased by 33% in EX (PRE, 3.3% ± 1.0%; POST, 4.4% ± 1.4%) compared with CON (PRE, 3.0% ± 1.3%; POST, 3.2% ± 1.5%), P < 0.05. EX with hypertension tended to show a blunted peak BOLD increase (n = 6, 15%) compared with EX normotensive (n = 7, 50%), P = 0.056. Peak postcontraction blood flow increased by 39% in EX (PRE, 217 ± 88 mL·min; POST, 302 ± 167 mL·min) compared with CON (PRE, 188 ± 54 mL·min; POST, 184 ± 44 mL·min), P < 0.05. EX muscle oxidative capacity (kPCr) improved by 40% (PRE, 1.60 ± 0.57 min; POST, 2.25 ± 0.80 min) compared with CON (PRE, 1.69 ± 0.28 min; POST, 1.76 ± 0.52 min), P < 0.05. V˙O2peak increased by 9% for EX (PRE, 19.0 ± 3.1 mL·kg·min; POST, 20.8 ± 2.9 mL·kg·min) compared with a 7% loss in CON (PRE, 21.9 ± 3.6 mL·kg·min; POST, 20.4 ± 3.5 mL·kg·min), P < 0.05. CONCLUSION Moderate aerobic exercise significantly improved microvascular function of the leg in older adults.
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Affiliation(s)
- David M Hurley
- Department of Radiology, Michigan State University, East Lansing, MI
| | - Ewan R Williams
- Sport and Health Sciences, University of Exeter, Exeter, UNITED KINGDOM
| | - Jeff M Cross
- Department of Radiology, Michigan State University, East Lansing, MI
| | | | - Ronald A Meyer
- Department of Physiology, Michigan State University, East Lansing, MI
| | - George S Abela
- Department of Medicine, Michigan State University, East Lansing, MI
| | - Jill M Slade
- Department of Radiology, Michigan State University, East Lansing, MI
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Suo S, Zhang L, Tang H, Ni Q, Li S, Mao H, Liu X, He S, Qu J, Lu Q, Xu J. Evaluation of skeletal muscle microvascular perfusion of lower extremities by cardiovascular magnetic resonance arterial spin labeling, blood oxygenation level-dependent, and intravoxel incoherent motion techniques. J Cardiovasc Magn Reson 2018; 20:18. [PMID: 29551091 PMCID: PMC5858129 DOI: 10.1186/s12968-018-0441-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/02/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Noninvasive cardiovascular magnetic resonance (CMR) techniques including arterial spin labeling (ASL), blood oxygenation level-dependent (BOLD), and intravoxel incoherent motion (IVIM), are capable of measuring tissue perfusion-related parameters. We sought to evaluate and compare these three CMR techniques in characterizing skeletal muscle perfusion in lower extremities and to investigate their abilities to diagnose and assess the severity of peripheral arterial disease (PAD). METHODS Fifteen healthy young subjects, 14 patients with PAD, and 10 age-matched healthy old subjects underwent ASL, BOLD, and IVIM CMR perfusion imaging. Healthy young and healthy old participants were subjected to a cuff-induced ischemia experiment with pressures of 20 mmHg and 40 mmHg above systolic pressure during imaging. Perfusion-related metrics, including blood flow, T2* relaxation time, perfusion fraction f, diffusion coefficient D, and pseudodiffusion coefficient D*, were measured in the anterior, lateral, soleus, and gastrocnemius muscle groups. Friedman, Mann-Whitney, Wilcoxon signed rank, and Spearman rank correlation tests were used for statistical analysis. RESULTS In cases of significant differences determined by the Friedman test (P < 0.05), blood flow, T2*, and D values gradually decreased, while f values showed a tendency to increase in healthy subjects under cuff compression. No significant correlations were found among the ASL, BOLD, and IVIM parameters (all P > 0.05). Blood flow and T2* values showed significant positive correlations with transcutaneous oxygen pressure measurements (ρ = 0.465 and 0.522, respectively; both P ≤ 0.001), while f values showed a significant negative correlation in healthy young subjects (ρ = - 0.351; P = 0.018). T2* was independent of age in every muscle group. T2* values were significantly decreased in PAD patients compared with healthy old subjects and severe PAD patients compared with mild-to-moderate PAD patients (all P < 0.0125). Significant correlations were found between T2* and ankle-brachial index values in all muscle groups in PAD patients (ρ = 0.644-0.837; all P < 0.0125). Other imaging parameters failed to show benefits towards the diagnosis and disease severity evaluation of PAD. CONCLUSIONS ASL, BOLD, and IVIM provide complementary information regarding tissue perfusion. Compared with ASL and IVIM, BOLD may be a more reliable technique for assessing PAD in the resting state and could thus be applied together with angiography in clinical studies as a tool to comprehensively assess microvascular and macrovascular properties in PAD patients.
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Affiliation(s)
- Shiteng Suo
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Rd, Shanghai, 200127 China
| | - Lan Zhang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Tang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Rd, Shanghai, 200127 China
| | - Qihong Ni
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Suqin Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Rd, Shanghai, 200127 China
| | - Haimin Mao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Rd, Shanghai, 200127 China
| | - Xiangyu Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Rd, Shanghai, 200127 China
| | - Shengyun He
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Rd, Shanghai, 200127 China
| | | | - Qing Lu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Rd, Shanghai, 200127 China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Rd, Shanghai, 200127 China
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Carlier PG, Marty B, Scheidegger O, Loureiro de Sousa P, Baudin PY, Snezhko E, Vlodavets D. Skeletal Muscle Quantitative Nuclear Magnetic Resonance Imaging and Spectroscopy as an Outcome Measure for Clinical Trials. J Neuromuscul Dis 2018; 3:1-28. [PMID: 27854210 PMCID: PMC5271435 DOI: 10.3233/jnd-160145] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recent years have seen tremendous progress towards therapy of many previously incurable neuromuscular diseases. This new context has acted as a driving force for the development of novel non-invasive outcome measures. These can be organized in three main categories: functional tools, fluid biomarkers and imagery. In the latest category, nuclear magnetic resonance imaging (NMRI) offers a considerable range of possibilities for the characterization of skeletal muscle composition, function and metabolism. Nowadays, three NMR outcome measures are frequently integrated in clinical research protocols. They are: 1/ the muscle cross sectional area or volume, 2/ the percentage of intramuscular fat and 3/ the muscle water T2, which quantity muscle trophicity, chronic fatty degenerative changes and oedema (or more broadly, “disease activity”), respectively. A fourth biomarker, the contractile tissue volume is easily derived from the first two ones. The fat fraction maps most often acquired with Dixon sequences have proven their capability to detect small changes in muscle composition and have repeatedly shown superior sensitivity over standard functional evaluation. This outcome measure will more than likely be the first of the series to be validated as an endpoint by regulatory agencies. The versatility of contrast generated by NMR has opened many additional possibilities for characterization of the skeletal muscle and will result in the proposal of more NMR biomarkers. Ultra-short TE (UTE) sequences, late gadolinium enhancement and NMR elastography are being investigated as candidates to evaluate skeletal muscle interstitial fibrosis. Many options exist to measure muscle perfusion and oxygenation by NMR. Diffusion NMR as well as texture analysis algorithms could generate complementary information on muscle organization at microscopic and mesoscopic scales, respectively. 31P NMR spectroscopy is the reference technique to assess muscle energetics non-invasively during and after exercise. In dystrophic muscle, 31P NMR spectrum at rest is profoundly perturbed, and several resonances inform on cell membrane integrity. Considerable efforts are being directed towards acceleration of image acquisitions using a variety of approaches, from the extraction of fat content and water T2 maps from one single acquisition to partial matrices acquisition schemes. Spectacular decreases in examination time are expected in the near future. They will reinforce the attractiveness of NMR outcome measures and will further facilitate their integration in clinical research trials.
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Affiliation(s)
- Pierre G Carlier
- Institute of Myology, Pitie-Salpetriere University Hospital, Paris, France.,CEA, DSV, I2BM, MIRCen, NMR Laboratory, Paris, France.,National Academy of Sciences, United Institute for Informatics Problems, Minsk, Belarus
| | - Benjamin Marty
- Institute of Myology, Pitie-Salpetriere University Hospital, Paris, France.,CEA, DSV, I2BM, MIRCen, NMR Laboratory, Paris, France
| | - Olivier Scheidegger
- Institute of Myology, Pitie-Salpetriere University Hospital, Paris, France.,Support Center for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | | | | | - Eduard Snezhko
- National Academy of Sciences, United Institute for Informatics Problems, Minsk, Belarus
| | - Dmitry Vlodavets
- N.I. Prirogov Russian National Medical Research University, Clinical Research Institute of Pediatrics, Moscow, Russian Federation
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Tonson A, Noble KE, Meyer RA, Rozman MR, Foley KT, Slade JM. Age Reduces Microvascular Function in the Leg Independent of Physical Activity. Med Sci Sports Exerc 2018; 49:1623-1630. [PMID: 28709153 DOI: 10.1249/mss.0000000000001281] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The microvasculature is critical in the control of blood flow. Aging and reduced physical activity (PA) may both decrease microvascular function. PURPOSE The primary aim was to evaluate the influence of age on microvascular function in adults with similar PA levels. Secondary aims were to assess the reliability of muscle functional magnetic resonance imaging in older adults (OA) and the relationship between PA and microvascular function in OA. METHODS Microvascular blood-oxygen-level dependent (BOLD) responses were measured in young adults (YA, n = 12, mean ± SD age = 21 ± 1 yr old, PA = 239 ± 73 × 10 counts per day) and OA (n = 13, 64 ± 4 yr old, PA = 203 ± 48 × 10 counts per day). Functional magnetic resonance images (3T, echo planar BOLD) of the leg were acquired after brief (1 s) maximal voluntary isometric contractions. The test-retest reliability of BOLD responses and the Pearson correlation between peak BOLD and PA were assessed in a group of OA (OA-r) with a broad range of PA (66 ± 5 yr old, n = 9, PA range = 54 × 10 to 674 × 10 counts per day). RESULTS Peak BOLD microvascular responses were reduced for OA compared with YA. OA peak BOLD was 27% lower in the soleus (3.3% ± 0.8% OA vs 4.5% ± 1.4% YA; P = 0.017) and 40% lower in the anterior compartment (1.6% ± 0.6% OA vs 2.7% ± 1.1% YA; P = 0.006). Coefficients of variation were 8.6% and 11.8% for peak BOLD in the soleus and anterior compartment, respectively, with an intraclass correlation of 0.950 for both muscle regions. The correlation between peak BOLD and PA was r ≥ 0.715, P ≤ 0.030. CONCLUSIONS Aging was associated with reduced microvascular function in leg muscles, independent of PA. The findings also revealed good reliability for BOLD magnetic resonance imaging in OA for the soleus and anterior compartment muscles.
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Affiliation(s)
- Anne Tonson
- 1Department of Physiology, Michigan State University, East Lansing, MI; 2Department of Radiology, Michigan State University, East Lansing, MI; and 3Department of Family Medicine, Michigan State University, East Lansing, MI
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Day J, Patel S, Limaye V. The role of magnetic resonance imaging techniques in evaluation and management of the idiopathic inflammatory myopathies. Semin Arthritis Rheum 2017; 46:642-649. [DOI: 10.1016/j.semarthrit.2016.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
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Kogan F, Stafford RB, Englund EK, Gold GE, Hariharan H, Detre JA, Reddy R. Perfusion has no effect on the in vivo CEST effect from Cr (CrCEST) in skeletal muscle. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3673. [PMID: 27898185 PMCID: PMC5518925 DOI: 10.1002/nbm.3673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/13/2016] [Accepted: 10/25/2016] [Indexed: 05/08/2023]
Abstract
Creatine, a key component of muscle energy metabolism, exhibits a chemical exchange saturation transfer (CEST) effect between its amine group and bulk water, which has been exploited to spatially and temporally map creatine changes in skeletal muscle before and after exercise. In addition, exercise leads to an increase in muscle perfusion. In this work, we determined the effects of perfused blood on the CEST effects from creatine in skeletal muscle. Experiments were performed on healthy human subjects (n = 5) on a whole-body Siemens 7T magnetic resonance imaging (MRI) scanner with a 28-channel radiofrequency (RF) coil. Reactive hyperemia, induced by inflation and subsequent deflation of a pressure cuff secured around the thigh, was used to increase tissue perfusion whilst maintaining the levels of creatine kinase metabolites. CEST, arterial spin labeling (ASL) and 31 P MRS data were acquired at baseline and for 6 min after cuff deflation. Reactive hyperemia resulted in substantial increases in perfusion in human skeletal muscle of the lower leg as measured by the ASL mean percentage difference. However, no significant changes in CrCEST asymmetry (CrCESTasym ) or 31 P MRS-derived PCr levels of skeletal muscle were observed following cuff deflation. This work demonstrates that perfusion changes do not have a major confounding effect on CrCEST measurements.
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Affiliation(s)
- Feliks Kogan
- Department of Radiology, Stanford University, Stanford, CA, United States
| | - Randall B. Stafford
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Erin K. Englund
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Garry E. Gold
- Department of Radiology, Stanford University, Stanford, CA, United States
| | - Hari Hariharan
- Center for Magnetic Resonance and Optical Imaging, Department of Radiology, University of Pennsylvania, B1 Stellar-Chance Labs, 422 Curie Boulevard, Philadelphia, PA 19104
| | - John A. Detre
- Center for Magnetic Resonance and Optical Imaging, Department of Radiology, University of Pennsylvania, B1 Stellar-Chance Labs, 422 Curie Boulevard, Philadelphia, PA 19104
- Center for Functional Neuroimaging, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Ravinder Reddy
- Center for Magnetic Resonance and Optical Imaging, Department of Radiology, University of Pennsylvania, B1 Stellar-Chance Labs, 422 Curie Boulevard, Philadelphia, PA 19104
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Muller MD, Li Z, Sica CT, Luck JC, Gao Z, Blaha CA, Cauffman AE, Ross AJ, Winkler NJR, Herr MD, Brandt K, Wang J, Gallagher DC, Karunanayaka P, Vesek J, Leuenberger UA, Yang QX, Sinoway LI. Muscle oxygenation during dynamic plantar flexion exercise: combining BOLD MRI with traditional physiological measurements. Physiol Rep 2016; 4:4/20/e13004. [PMID: 27798357 PMCID: PMC5099966 DOI: 10.14814/phy2.13004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 11/24/2022] Open
Abstract
Blood-oxygen-level-dependent magnetic resonance imaging (BOLD MRI) has the potential to quantify skeletal muscle oxygenation with high temporal and high spatial resolution. The purpose of this study was to characterize skeletal muscle BOLD responses during steady-state plantar flexion exercise (i.e., during the brief rest periods between muscle contraction). We used three different imaging modalities (ultrasound of the popliteal artery, BOLD MRI, and near-infrared spectroscopy [NIRS]) and two different exercise intensities (2 and 6 kg). Six healthy men underwent three separate protocols of dynamic plantar flexion exercise on separate days and acute physiological responses were measured. Ultrasound studies showed the percent change in popliteal velocity from baseline to the end of exercise was 151 ± 24% during 2 kg and 589 ± 145% during 6 kg. MRI studies showed an abrupt decrease in BOLD signal intensity at the onset of 2 kg exercise, indicating deoxygenation. The BOLD signal was further reduced during 6 kg exercise (compared to 2 kg) at 1 min (-4.3 ± 0.7 vs. -1.2 ± 0.4%, P < 0.001). Similarly, the change in the NIRS muscle oxygen saturation in the medial gastrocnemius was -11 ± 4% at 2 kg and -38 ± 11% with 6 kg (P = 0.041). In conclusion, we demonstrate that BOLD signal intensity decreases during plantar flexion and this effect is augmented at higher exercise workloads.
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Affiliation(s)
- Matthew D Muller
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Zhijun Li
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Christopher T Sica
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - J Carter Luck
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Zhaohui Gao
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Cheryl A Blaha
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Aimee E Cauffman
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Amanda J Ross
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Nathan J R Winkler
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Michael D Herr
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Kristen Brandt
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jianli Wang
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - David C Gallagher
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Prasanna Karunanayaka
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jeffrey Vesek
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Urs A Leuenberger
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Qing X Yang
- Department of Radiology, Center for NMR Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Lawrence I Sinoway
- Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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Bajwa A, Wesolowski R, Patel A, Saha P, Ludwinski F, Ikram M, Albayati M, Smith A, Nagel E, Modarai B. Blood Oxygenation Level-Dependent CMR-Derived Measures in Critical Limb Ischemia and Changes With Revascularization. J Am Coll Cardiol 2016; 67:420-431. [PMID: 26821631 PMCID: PMC4728170 DOI: 10.1016/j.jacc.2015.10.085] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 01/16/2023]
Abstract
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.
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Affiliation(s)
- Adnan Bajwa
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Roman Wesolowski
- Department of Cardiovascular Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Ashish Patel
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Prakash Saha
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Francesca Ludwinski
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Mohammed Ikram
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Mostafa Albayati
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Alberto Smith
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Eike Nagel
- Department of Cardiovascular Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at King's Health Partners, St. Thomas' Hospital, London, United Kingdom; Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Bijan Modarai
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King's Health Partners, St. Thomas' Hospital, London, United Kingdom.
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12
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Englund EK, Rodgers ZB, Langham MC, Mohler ER, Floyd TF, Wehrli FW. Measurement of skeletal muscle perfusion dynamics with pseudo-continuous arterial spin labeling (pCASL): Assessment of relative labeling efficiency at rest and during hyperemia, and comparison to pulsed arterial spin labeling (PASL). J Magn Reson Imaging 2016; 44:929-39. [PMID: 27043039 DOI: 10.1002/jmri.25247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/04/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To compare calf skeletal muscle perfusion measured with pulsed arterial spin labeling (PASL) and pseudo-continuous arterial spin labeling (pCASL) methods, and to assess the variability of pCASL labeling efficiency in the popliteal artery throughout an ischemia-reperfusion paradigm. MATERIALS AND METHODS At 3T, relative pCASL labeling efficiency was experimentally assessed in five subjects by measuring the signal intensity of blood in the popliteal artery just distal to the labeling plane immediately following pCASL labeling or control preparation pulses, or without any preparation pulses throughout separate ischemia-reperfusion paradigms. The relative label and control efficiencies were determined during baseline, hyperemia, and recovery. In a separate cohort of 10 subjects, pCASL and PASL sequences were used to measure reactive hyperemia perfusion dynamics. RESULTS Calculated pCASL labeling and control efficiencies did not differ significantly between baseline and hyperemia or between hyperemia and recovery periods. Relative to the average baseline, pCASL label efficiency was 2 ± 9% lower during hyperemia. Perfusion dynamics measured with pCASL and PASL did not differ significantly (P > 0.05). Average leg muscle peak perfusion was 47 ± 20 mL/min/100g or 50 ± 12 mL/min/100g, and time to peak perfusion was 25 ± 3 seconds and 25 ± 7 seconds from pCASL and PASL data, respectively. Differences of further metrics parameterizing the perfusion time course were not significant between pCASL and PASL measurements (P > 0.05). CONCLUSION No change in pCASL labeling efficiency was detected despite the almost 10-fold increase in average blood flow velocity in the popliteal artery. pCASL and PASL provide precise and consistent measurement of skeletal muscle reactive hyperemia perfusion dynamics. J. MAGN. RESON. IMAGING 2016;44:929-939.
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Affiliation(s)
- Erin K Englund
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Zachary B Rodgers
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael C Langham
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emile R Mohler
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas F Floyd
- Department of Anesthesiology, Stony Brook University, Stony Brook, New York, USA
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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Nguyen A, Ledoux JB, Omoumi P, Becce F, Forget J, Federau C. Application of intravoxel incoherent motion perfusion imaging to shoulder muscles after a lift-off test of varying duration. NMR IN BIOMEDICINE 2016; 29:66-73. [PMID: 26684052 DOI: 10.1002/nbm.3449] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/06/2015] [Accepted: 10/26/2015] [Indexed: 06/05/2023]
Abstract
Intravoxel incoherent motion (IVIM) MRI is a method to extract microvascular blood flow information out of diffusion-weighted images acquired at multiple b-values. We hypothesized that IVIM can identify the muscles selectively involved in a specific task, by measuring changes in activity-induced local muscular perfusion after exercise. We tested this hypothesis using a widely used clinical maneuver, the lift-off test, which is known to assess specifically the subscapularis muscle functional integrity. Twelve shoulders from six healthy male volunteers were imaged at 3 T, at rest, as well as after a lift-off test hold against resistance for 30 s, 1 and 2 min respectively, in three independent sessions. IVIM parameters, consisting of perfusion fraction (f), diffusion coefficient (D), pseudo-diffusion coefficient D* and blood flow-related fD*, were estimated within outlined muscles of the rotator cuff and the deltoid bundles. The mean values at rest and after the lift-off tests were compared in each muscle using a one-way ANOVA. A statistically significant increase in fD* was measured in the subscapularis, after a lift-off test of any duration, as well as in D. A fD* increase was the most marked (30 s, +103%; 1 min, +130%; 2 min, +156%) and was gradual with the duration of the test (in 10(-3) mm(2) /s: rest, 1.41 ± 0.50; 30 s, 2.86 ± 1.17; 1 min, 3.23 ± 1.22; 2 min, 3.60 ± 1.21). A significant increase in fD* and D was also visible in the posterior bundle of the deltoid. No significant change was consistently visible in the other investigated muscles of the rotator cuff and the other bundles of the deltoid. In conclusion, IVIM fD* allows the demonstration of a task-related microvascular perfusion increase after a specific task and suggests a direct relationship between microvascular perfusion and the duration of the effort. It is a promising method to investigate non-invasively skeletal muscle physiology and clinical perfusion-related muscular disorders.
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Affiliation(s)
- Audrey Nguyen
- Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Jean-Baptiste Ledoux
- Department of Diagnostic and Interventional Radiology, University Hospital Center and University of Lausanne (CHUV-UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, University Hospital Center and University of Lausanne (CHUV-UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, University Hospital Center and University of Lausanne (CHUV-UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Joachim Forget
- Department of Diagnostic and Interventional Radiology, University Hospital Center and University of Lausanne (CHUV-UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Christian Federau
- Department of Diagnostic and Interventional Radiology, University Hospital Center and University of Lausanne (CHUV-UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Department of Radiology, Division of Neuroradiology, Stanford University, 300 Pasteur Drive, Room S039, Stanford, CA, 94305-5105, United States
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14
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Wang C, Zhang R, Zhang X, Wang H, Zhao K, Jin L, Zhang J, Wang X, Fang J. Noninvasive measurement of lower extremity muscle oxygen extraction fraction under cuff compression paradigm. J Magn Reson Imaging 2015; 43:1148-58. [PMID: 26527473 DOI: 10.1002/jmri.25074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/29/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To demonstrate the feasibility of using a susceptibility-based MRI technique with asymmetric spin-echo (ASE) sequence to assess the lower extremity muscle oxygen extraction fraction (OEF) alternations under cuff compression paradigm. METHODS Approved by the local institutional human study committee, nine healthy young volunteers participated in this study. All the ASE scans were conducted using a 3 Tesla clinical MRI scanner during resting state (pre), 1-3 min (post1) and 3-5 min (post2) after a pressure of 50 mmHg above individual systolic blood pressure imposed on the thigh. Moreover, near-infrared spectroscopy (NIRS) measurements were performed on the same day under the same cuff compression protocol to verify the accuracy of this susceptibility-based method. RESULTS In all volunteers, the mean MRI based OEF in gastrocnemius (GAS) muscle increased significantly from 0.28 ± 0.02 (pre) to 0.31 ± 0.03 (post1, P < 0.05) and 0.31 ± 0.03 (post2, P < 0.05). In addition, mean OEF in soleus (SOL) muscle went up from 0.31 ± 0.01 (pre) to 0.33 ± 0.03 (post1, P = 0.14) and 0.37 ± 0.04 (post2, P < 0.05). For comparison, NIRS measured 1-%HbO2 (percentage of deoxyhemoglobin concentration within total hemoglobin) in GAS rose significantly from 0.29 ± 0.03 (pre) to 0.31 ± 0.04 (post1, P < 0.05) and 0.31 ± 0.04 (post2, P < 0.05), which confirmed the accuracy of the MRI-based OEF. CONCLUSION This susceptibility-based OEF quantification technique together with cuff compression paradigm could provide a noninvasive, quantifiable and effective tool for measuring skeletal muscle oxygenation.
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Affiliation(s)
- Chengyan Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Rui Zhang
- College of Engineering, Peking University, Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | | | - Kai Zhao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | | | - Jue Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,College of Engineering, Peking University, Beijing, China
| | - Xiaoying Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,Department of Radiology, Peking University First Hospital, Beijing, China
| | - Jing Fang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,College of Engineering, Peking University, Beijing, China
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15
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Abstract
Multiple nonmorphologic magnetic resonance sequences are available in musculoskeletal imaging that can provide additional information to better characterize and diagnose musculoskeletal disorders and diseases. These sequences include blood-oxygen-level-dependent (BOLD), arterial spin labeling (ASL), diffusion-weighted imaging (DWI), and diffusion-tensor imaging (DTI). BOLD and ASL provide different methods to evaluate skeletal muscle microperfusion. The BOLD signal reflects the ratio between oxyhemoglobin and deoxyhemoglobin. ASL uses selective tagging of inflowing blood spins in a specific region for calculating local perfusion. DWI and DTI provide information about the structural integrity of soft tissue including muscles and fibers as well as pathologies.
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16
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Nishii T, Kono AK, Nishio M, Kyotani K, Nishiyama K, Sugimura K. Evaluation of blood volume by use of blood oxygen level-dependent magnetic resonance imaging in a cuff-compression model: usefulness of calculated echo time image. Jpn J Radiol 2015; 33:441-7. [PMID: 26006707 DOI: 10.1007/s11604-015-0435-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Separate assessment of changes in blood oxygenation and blood volume is required in blood oxygen level-dependent (BOLD) imaging. We developed a calculated echo time (TE) imaging technique designed to minimize effects of blood oxygenation and to evaluate blood volume specifically. MATERIALS AND METHODS Dynamic 3T multi-echo BOLD images of calf muscle were acquired from six healthy volunteers by use of a cuff-compression model. Calculated TE images at TE = 0 ms (cTE0) and T2* map (T2*) were calculated from acquired multi-echo images. The time courses of the mean value for the entire calf muscles in cTE0, in acquired BOLD images at TE = 45.2 ms (aTE45), and in T2* were obtained. The Euclidean distances between the two pairs of time courses were calculated: distance between aTE45 and T2* (D at), and that between cTE0 and T2* (D ct). The difference between D at and D ct was tested by use of the Wilcoxon signed rank test. RESULTS D at was significantly different from D ct (P = 0.031), indicating that the time course of cTE0 was significantly different from that of blood oxygenation-weighted images (T2* and aTE45). CONCLUSION The effect of blood oxygenation could be minimized using cTE0. Thus, signal intensity changes of cTE0 reflected changes in blood volume more specifically.
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Affiliation(s)
- Tatsuya Nishii
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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17
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Nishii T, Kono AK, Nishio M, Kyotani K, Nishiyama K, Sugimura K. Dynamic Blood Oxygen Level-dependent MR Imaging of Muscle: Comparison of Postocclusive Reactive Hyperemia in Young Smokers and Nonsmokers. Magn Reson Med Sci 2015; 14:275-83. [PMID: 25994035 DOI: 10.2463/mrms.2014-0105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The role of early stage functional assessment of muscle blood flow response (MFR) by dynamic muscle blood oxygen level-dependent (BOLD) magnetic resonance (MR) imaging is unknown. We investigated the effect of smoking on vascular function according to MFR derived from dynamic muscle BOLD MR imaging during postocclusive reactive hyperemia in young smokers and nonsmokers. METHODS Sixteen healthy male volunteers (8 smokers, 8 nonsmokers; mean age, 30.4 ± 4.6 years) underwent BOLD MR imaging of the left calf muscle. During reactive hyperemia provoked by a cuff-compression technique, we measured muscle BOLD (mB) using a 3-tesla single-shot multi-echo gradient-echo echo-planar imaging sequence. The 2 key mB variables in the reactive hyperemic phase that we studied were times to half hyperemic peak (T(1/2peak)) and peak (TTP), each measured from cuff deflation. We used the Welch test to assess differences in these between smokers and nonsmokers. RESULTS T(1/2peak) and TTP were significantly longer in smokers (P < 0.05) in reactive hyperemia. T(1/2peak) was 13.8 ± 5.4 s in smokers and 7.6 ± 1.5 s in nonsmokers, and TTP was 67.5 ± 18.8 s in smokers and 45.4 ± 7.1 s in nonsmokers. CONCLUSION Dynamic BOLD MR imaging of calf muscle during postocclusive reactive hyperemia demonstrated statistically significant differences in T(1/2peak) and TTP between young smokers and nonsmokers, indicating the presence of early stage smoking-related deterioration in MFR.
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Affiliation(s)
- Tatsuya Nishii
- Department of Radiology, Kobe University Graduate School of Medicine
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18
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Englund EK, Langham MC, Ratcliffe SJ, Fanning MJ, Wehrli FW, Mohler ER, Floyd TF. Multiparametric assessment of vascular function in peripheral artery disease: dynamic measurement of skeletal muscle perfusion, blood-oxygen-level dependent signal, and venous oxygen saturation. Circ Cardiovasc Imaging 2015; 8:e002673. [PMID: 25873722 PMCID: PMC4399002 DOI: 10.1161/circimaging.114.002673] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endothelial dysfunction present in patients with peripheral artery disease may be better understood by measuring the temporal dynamics of blood flow and oxygen saturation during reactive hyperemia than by conventional static measurements. METHODS AND RESULTS Perfusion, Intravascular Venous Oxygen saturation, and T2* (PIVOT), a recently developed MRI technique, was used to measure the response to an ischemia-reperfusion paradigm in 96 patients with peripheral artery disease of varying severity and 10 healthy controls. Perfusion, venous oxygen saturation SvO2, and T2* were each quantified in the calf at 2-s temporal resolution, yielding a dynamic time course for each variable. Compared with healthy controls, patients had a blunted and delayed hyperemic response. Moreover, patients with lower ankle-brachial index had (1) a more delayed reactive hyperemia response time, manifesting as an increase in time to peak perfusion in the gastrocnemius, soleus, and peroneus muscles, and in the anterior compartment, (2) an increase in the time to peak T2* measured in the soleus muscle, and (3) a prolongation of the posterior tibial vein SvO2 washout time. Intrasession and intersession repeatability were also assessed. Results indicated that time to peak perfusion and time to peak T2* were the most reliable extracted time course metrics. CONCLUSIONS Perfusion, dynamic SvO2, and T2* response times after induced ischemia are highly correlated with peripheral artery disease severity. Combined imaging of peripheral microvascular blood flow and dynamics of oxygen saturation with Perfusion, intravascular SvO2, and T2* may be a useful tool to investigate the pathophysiology of peripheral artery disease.
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Affiliation(s)
- Erin K Englund
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.).
| | - Michael C Langham
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
| | - Sarah J Ratcliffe
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
| | - Molly J Fanning
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
| | - Felix W Wehrli
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
| | - Emile R Mohler
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
| | - Thomas F Floyd
- From the Department of Bioengineering (E.K.E.), Department of Radiology (M.C.L., F.W.W.), Department of Biostatistics & Epidemiology (S.J.R.), Department of Medicine (E.R.M.), University of Pennsylvania, Philadelphia; and Department of Anesthesiology, Stony Brook University, NY (T.F.F.)
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19
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Decorte N, Buehler T, Caldas de Almeida Araujo E, Vignaud A, Carlier PG. Noninvasive estimation of oxygen consumption in human calf muscle through combined NMR measurements of ASL perfusion and T₂ oxymetry. J Vasc Res 2014; 51:360-8. [PMID: 25531648 DOI: 10.1159/000368194] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/03/2014] [Indexed: 11/19/2022] Open
Abstract
The objective of this work was to demonstrate the feasibility of measuring muscle O2 consumption (V˙O2) noninvasively with a combination of functional nuclear magnetic resonance (NMR) imaging methods, and to verify that changes in muscle V˙O2 can be detected with a temporal resolution compatible with physiological investigation and patient ease. T2-based oxymetry of arterial and venous blood was combined with the arterial-spin labeling (ASL)-based determination of muscle perfusion. These measurements were performed on 8 healthy volunteers under normoxic and hypoxic conditions in order to assess the sensitivity of measurements over a range of saturation values. Blood samples were drawn simultaneously and used to titrate blood T2 measurements versus hemoglobin O2 saturation (%HbO2) in vitro. The in vitro calibration curve of blood T2 fitted very well with the %HbO2 (r(2): 0.95). The in vivo venous T2 measurements agreed well with the in vitro measurements (intraclass correlation coefficient 0.82, 95% confidence interval 0.61-0.91). Oxygen extraction at rest decreased in the calf muscles subjected to hypoxia (p = 0.031). The combination of unaltered muscle perfusion and pinched arteriovenous O2 difference (p = 0.038) pointed towards a reduced calf muscle V˙O2 during transient hypoxia (p = 0.018). The results of this pilot study confirmed that muscle O2 extraction and V˙O2 can be estimated noninvasively using a combination of functional NMR techniques. Further studies are needed to confirm the usefulness in a larger sample of volunteers and patients.
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20
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Bajwa A, Wesolowski R, Patel A, Saha P, Ludwinski F, Smith A, Nagel E, Modarai B. Assessment of tissue perfusion in the lower limb: current methods and techniques under development. Circ Cardiovasc Imaging 2014; 7:836-43. [PMID: 25227236 DOI: 10.1161/circimaging.114.002123] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Adnan Bajwa
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Roman Wesolowski
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Ashish Patel
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Prakash Saha
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Francesca Ludwinski
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Alberto Smith
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Eike Nagel
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Bijan Modarai
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.).
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Aschwanden M, Partovi S, Jacobi B, Fergus N, Schulte AC, Robbin MR, Bilecen D, Staub D. Assessing the end-organ in peripheral arterial occlusive disease-from contrast-enhanced ultrasound to blood-oxygen-level-dependent MR imaging. Cardiovasc Diagn Ther 2014; 4:165-72. [PMID: 24834413 DOI: 10.3978/j.issn.2223-3652.2014.03.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/26/2014] [Indexed: 11/14/2022]
Abstract
Peripheral arterial occlusive disease (PAOD) is a result of atherosclerotic disease which is currently the leading cause of morbidity and mortality in the western world. Patients with PAOD may present with intermittent claudication or symptoms related to critical limb ischemia. PAOD is associated with increased mortality rates. Stenoses and occlusions are usually detected by macrovascular imaging, including ultrasound and cross-sectional methods. From a pathophysiological view these stenoses and occlusions are affecting the microperfusion in the functional end-organs, such as the skin and skeletal muscle. In the clinical arena new imaging technologies enable the evaluation of the microvasculature. Two technologies currently under investigation for this purpose on the end-organ level in PAOD patients are contrast-enhanced ultrasound (CEUS) and blood-oxygen-level-dependent (BOLD) MR imaging (MRI). The following article is providing an overview about these evolving techniques with a specific focus on skeletal muscle microvasculature imaging in PAOD patients.
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Affiliation(s)
- Markus Aschwanden
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Sasan Partovi
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Bjoern Jacobi
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Nathan Fergus
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Anja-Carina Schulte
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Mark R Robbin
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Deniz Bilecen
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
| | - Daniel Staub
- 1 University Hospital Basel, Department of Angiology, Basel, Switzerland ; 2 University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, Cleveland, Ohio, USA ; 3 University Hospital Mainz, Department of Hematology & Oncology, Mainz, Germany ; 4 University Hospital Bruderholz, Department of Radiology, Bruderholz, Switzerland
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Schewzow K, Fiedler GB, Meyerspeer M, Goluch S, Laistler E, Wolzt M, Moser E, Schmid AI. Dynamic ASL and T2-weighted MRI in exercising calf muscle at 7 T: a feasibility study. Magn Reson Med 2014; 73:1190-5. [PMID: 24752959 DOI: 10.1002/mrm.25242] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/06/2014] [Accepted: 03/16/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE The aim of this study was to develop a measurement protocol for noninvasive simultaneous perfusion quantification and T2 *-weighted MRI acquisition in the exercising calf muscle at 7 Tesla. METHODS Using a nonmagnetic ergometer and a dedicated in-house built calf coil array, dynamic pulsed arterial spin labeling (PASL) measurements with a temporal resolution of 12 s were performed before, during, and after plantar flexion exercise in 16 healthy volunteers. RESULTS Postexercise peak perfusion in gastrocnemius muscle (GAS) was 27 ± 16 ml/100g/min, whereas in soleus (SOL) and tibialis anterior (TA) muscles it remained at baseline levels. T2 *-weighted and ASL time courses in GAS showed comparable times to peak of 161 ± 72 s and 167 ± 115 s, respectively. The T2 *-weighted signal in the GAS showed a minimum during exercise (88 ± 6 % of the baseline signal) and a peak during the recovery (122 ± 9%), whereas in all other muscles only a signal decrease was observed (minimum 91 ± 6% in SOL; 87 ± 8% in TA). CONCLUSION We demonstrate the feasibility of dynamic perfusion quantification in skeletal muscle at 7 Tesla using PASL. This may help to better investigate the physiological processes in the skeletal muscle and also in diseases such as diabetes mellitus and peripheral arterial disease.
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Affiliation(s)
- Kiril Schewzow
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; MR Centre of Excellence, Medical University of Vienna, Vienna, Austria
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23
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Ma HT, Griffith JF, Ye C, Yeung DK, Xing X, Leung PC, Yuan J. BOLD effect on calf muscle groups in elderly females with different bone mineral density. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2014; 2014:5607-5610. [PMID: 25571266 DOI: 10.1109/embc.2014.6944898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examined the BOLD effect on calf muscles in elderly subjects with different bone mineral density. The purpose was to investigate the oxygenation characteristics in different calf muscle groups for the elderly females and compare the muscle oxygenation among groups with different bone mineral density. Temporary vascular occlusion was induced with air-cuff compression of the thigh and BOLD-MRI data curve was fitted to derive quantitative parameters. Three muscle groups, gastrocnemius muscle (lateral head), soleus muscle, and tibialis anterior muscle, were investigated individually. Quantitative CT measurement was conducted on each subject, based on which subjects were classified into normal, osteopenia, and osteoporosis groups. The BOLD signal in soleus muscle showed the lowest minimum ischemic value during ischemia and the steepest slope during hyperemia. As soleus muscle is mainly composed by slow-twitch oxidative muscle fibers, current results may be due to a higher vascular bed density and better endothelial function in such muscle. By t-test, the half-life of the BOLD signal decay during ischemia in both gastrocnemius and soleus muscles was significantly prolonged in osteoporosis group, indicating a degenerated muscular oxygen metabolic capacity in osteoporotic patients.
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Assessment of diffusion tensor imaging indices in calf muscles following postural change from standing to supine position. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2013; 27:387-95. [DOI: 10.1007/s10334-013-0424-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 11/14/2013] [Accepted: 11/15/2013] [Indexed: 10/26/2022]
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Partovi S, Schulte AC, Staub D, Jacobi B, Aschwanden M, Walker UA, Imfeld S, Broz P, Benz D, Zipp L, Takes M, Jäger KA, Huegli RW, Bilecen D. Correlation of skeletal muscle blood oxygenation level-dependent MRI and skin laser doppler flowmetry in patients with systemic sclerosis. J Magn Reson Imaging 2013; 40:1408-13. [DOI: 10.1002/jmri.24503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/10/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sasan Partovi
- University Hospital Bruderholz; Department of Radiology and Nuclear Medicine; Basel Switzerland
| | - Anja-Carina Schulte
- University Hospital Bruderholz; Department of Radiology and Nuclear Medicine; Basel Switzerland
| | - Daniel Staub
- University Hospital Basel; Department of Angiology; Basel Switzerland
| | - Bjoern Jacobi
- Third Department of Internal Medicine; Johannes Gutenberg University Hospital of Mainz; Mainz Germany
| | - Markus Aschwanden
- University Hospital Basel; Department of Angiology; Basel Switzerland
| | - Ulrich A. Walker
- Basel University Department of Rheumatology; Felix Platter-Spital; Basel Switzerland
| | - Stephan Imfeld
- University Hospital Basel; Department of Angiology; Basel Switzerland
| | - Pavel Broz
- University Hospital Basel; Department of Angiology; Basel Switzerland
| | - Daniela Benz
- Basel University Department of Rheumatology; Felix Platter-Spital; Basel Switzerland
| | - Lisa Zipp
- University Hospital Bruderholz; Department of Radiology and Nuclear Medicine; Basel Switzerland
| | - Martin Takes
- University Hospital Basel; Department of Radiology; Basel Switzerland
| | - Kurt A. Jäger
- University Hospital Basel; Department of Angiology; Basel Switzerland
| | - Rolf W. Huegli
- University Hospital Bruderholz; Department of Radiology and Nuclear Medicine; Basel Switzerland
| | - Deniz Bilecen
- University Hospital Bruderholz; Department of Radiology and Nuclear Medicine; Basel Switzerland
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26
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Englund EK, Langham MC, Li C, Rodgers ZB, Floyd TF, Mohler ER, Wehrli FW. Combined measurement of perfusion, venous oxygen saturation, and skeletal muscle T2* during reactive hyperemia in the leg. J Cardiovasc Magn Reson 2013; 15:70. [PMID: 23958293 PMCID: PMC3765712 DOI: 10.1186/1532-429x-15-70] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 07/30/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The function of the peripheral microvascular may be interrogated by measuring perfusion, tissue oxygen concentration, or venous oxygen saturation (SvO2) recovery dynamics following induced ischemia. The purpose of this work is to develop and evaluate a magnetic resonance (MR) technique for simultaneous measurement of perfusion, SvO2, and skeletal muscle T2*. METHODS Perfusion, Intravascular Venous Oxygen saturation, and T2* (PIVOT) is comprised of interleaved pulsed arterial spin labeling (PASL) and multi-echo gradient-recalled echo (GRE) sequences. During the PASL post-labeling delay, images are acquired with a multi-echo GRE to quantify SvO2 and T2* at a downstream slice location. Thus time-courses of perfusion, SvO2, and T2* are quantified simultaneously within a single scan. The new sequence was compared to separately measured PASL or multi-echo GRE data during reactive hyperemia in five young healthy subjects. To explore the impairment present in peripheral artery disease patients, five patients were evaluated with PIVOT. RESULTS Comparison of PIVOT-derived data to the standard techniques shows that there was no significant bias in any of the time-course-derived metrics. Preliminary data show that PAD patients exhibited alterations in perfusion, SvO2, and T2* time-courses compared to young healthy subjects. CONCLUSION Simultaneous quantification of perfusion, SvO2, and T2* is possible with PIVOT. Kinetics of perfusion, SvO2, and T2* during reactive hyperemia may help to provide insight into the function of the peripheral microvasculature in patients with PAD.
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Affiliation(s)
- Erin K Englund
- Department of Radiology, Laboratory of Structural NMR Imaging, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Michael C Langham
- Department of Radiology, Laboratory of Structural NMR Imaging, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Cheng Li
- Department of Radiology, Laboratory of Structural NMR Imaging, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Zachary B Rodgers
- Department of Radiology, Laboratory of Structural NMR Imaging, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Thomas F Floyd
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY 11794, USA
| | - Emile R Mohler
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Felix W Wehrli
- Department of Radiology, Laboratory of Structural NMR Imaging, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
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27
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Partovi S, Aschwanden M, Jacobi B, Schulte AC, Walker UA, Staub D, Imfeld S, Broz P, Benz D, Zipp L, Jaeger KA, Takes M, Robbin MR, Huegli RW, Bilecen D. Correlation of muscle BOLD MRI with transcutaneous oxygen pressure for assessing microcirculation in patients with systemic sclerosis. J Magn Reson Imaging 2013; 38:845-51. [PMID: 23441019 DOI: 10.1002/jmri.24046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 12/17/2012] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To prospectively compare calf muscle BOLD MRI with transcutaneous oxygen pressure (TcPO2 ) measurement in patients with systemic sclerosis (SSc) and healthy volunteers and thereby get insight into the pathogenesis of vasculopathy in this connective tissue disorder. MATERIALS AND METHODS Twelve patients with SSc (6 women and 6 men, mean age 53.5 ± 10.0 years) and 12 healthy volunteers (4 men and 8 women, mean age 47 ± 12.1 years) were examined using muscle BOLD MRI and TcPO2. A cuff compression at mid-thigh level was performed to provoke ischemia and reactive hyperemia. BOLD measurements were acquired on a 3 Tesla whole body-scanner in the upper calf region using a multi-echo EPI-sequence with four echo-times (TE: 9/20/31/42 ms) and a repetition time of 2 s. Empirical cross-correlation analysis depending on time lags between BOLD- and TcPO2-measurements was performed. RESULTS Maximal cross-correlation of BOLD T2*- and TcPO2-measurements was calculated as 0.93 (healthy volunteers) and 0.90 (SSc patients) for a time lag of approximately 40 s. Both modalities showed substantial differences regarding time course parameters between the SSc patients and healthy volunteers. CONCLUSION Skeletal muscle BOLD MRI correlated very well with TcPO2 . T2* changes seem to reflect reoxygenation deficits in deeper muscle tissue of SSc patients.
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Affiliation(s)
- Sasan Partovi
- University Hospital Bruderholz, Department of Radiology and Nuclear Medicine, Basel, Switzerland; University Hospitals Case Medical Center/Case Western Reserve University, Department of Radiology, Cleveland, Ohio
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Oxygenation and flow in the limbs: Novel methods to characterize peripheral artery disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013; 6:150-157. [PMID: 23504569 DOI: 10.1007/s12410-013-9191-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Peripheral arterial disease (PAD) affects approximately 8 million Americans and is associated with high morbidity and increased mortality. Current therapies for PAD are limited and development of new therapeutic agents is needed. Present diagnostic methods for PAD are insensitive to the subtle microvascular and metabolic changes that occur beyond macrovacular stenosis and therefore may be less useful endpoints for clinical trials. Phosphorus-31 magnetic resonance (MR) spectroscopy, MR muscle perfusion, and MR oximetry are novel methods capable of evaluating both the macrovascular and microvascular changes that occur in PAD patients.
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29
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Zuo CS, Sung YH, Simonson DC, Habecker E, Wang J, Haws C, Villafuerte RA, Henry ME, Dobbins RL, Hodge RJ, Nunez DJR, Renshaw PF. Reduced T2* values in soleus muscle of patients with type 2 diabetes mellitus. PLoS One 2012. [PMID: 23189142 PMCID: PMC3506632 DOI: 10.1371/journal.pone.0049337] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tissue water transverse relaxation times (T2) are highly sensitive to fluid and lipid accumulations in skeletal muscles whereas the related T2* is sensitive to changes in tissue oxygenation in addition to factors affecting T2. Diabetes mellitus (DM) affects muscles of lower extremities progressively by impairing blood flow at the macrovascular and microvascular levels. This study is to investigate whether T2 and T2* are sensitive enough to detect abnormalities in skeletal muscles of diabetic patients in the resting state. T2 and T2* values in calf muscle of 18 patients with type 2 DM (T2DM), 22 young healthy controls (YHC), and 7 age-matched older healthy controls (OHC) were measured at 3T using multi-TE spin echo and gradient echo sequences. Regional lipid levels of the soleus muscle were also measured using the Dixon method in a subset of the subjects. Correlations between T2, T2*, lipid levels, glycated hemoglobin (HbA1c) and presence of diabetes were evaluated. We found that T2 values were significantly higher in calf muscles of T2DM subjects, as were T2* values in anterior tibialis, and gastrocnemius muscles of T2DM participants. However, soleus T2* values of the T2DM subjects were significantly lower than those of the older, age-matched HC cohort (22.9±0.5 vs 26.7±0.4 ms, p<0.01). The soleus T2* values in the T2DM cohort were inversely correlated with the presence of diabetes (t = −3.46, p<0.001) and with an increase in HbA1c, but not with body mass index or regional lipid levels. Although multiple factors may contribute to changes in T2* values, the lowered T2* value observed in the T2DM soleus muscle is most consistent with a combination of high oxygen consumption and poor regional perfusion. This finding is consistent with results of previous perfusion studies and suggests that the soleus in individuals with T2DM is likely under tissue oxygenation stress.
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Affiliation(s)
- Chun S. Zuo
- Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, United States of America
- * E-mail: (JW); (CZ)
| | - Young-Hoon Sung
- Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, United States of America
| | - Donald C. Simonson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Erin Habecker
- Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, United States of America
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
- * E-mail: (JW); (CZ)
| | - Charlotte Haws
- Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, United States of America
| | - Rosemond A. Villafuerte
- Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, United States of America
| | - Michael E. Henry
- Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, United States of America
| | - Robert L. Dobbins
- GlaxoSmithKline, Research and Development, Research Triangle Park, North Carolina, United States of America
| | - Rebecca J. Hodge
- GlaxoSmithKline, Research and Development, Research Triangle Park, North Carolina, United States of America
| | - Derek J. R. Nunez
- GlaxoSmithKline, Research and Development, Research Triangle Park, North Carolina, United States of America
| | - Perry F. Renshaw
- Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, United States of America
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30
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Schewzow K, Andreas M, Moser E, Wolzt M, Schmid AI. Automatic model-based analysis of skeletal muscle BOLD-MRI in reactive hyperemia. J Magn Reson Imaging 2012; 38:963-9. [DOI: 10.1002/jmri.23919] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kiril Schewzow
- MR Center of Excellence; Medical University of Vienna; Austria
- Department of Clinical Pharmacology; Medical University of Vienna; Austria
- Center of Medical Physics and Biomedical Engineering; Medical University of Vienna; Austria
| | - Martin Andreas
- Department of Clinical Pharmacology; Medical University of Vienna; Austria
- Department of Cardiac Surgery; Medical University of Vienna; Austria
| | - Ewald Moser
- MR Center of Excellence; Medical University of Vienna; Austria
- Center of Medical Physics and Biomedical Engineering; Medical University of Vienna; Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology; Medical University of Vienna; Austria
| | - Albrecht I. Schmid
- MR Center of Excellence; Medical University of Vienna; Austria
- Center of Medical Physics and Biomedical Engineering; Medical University of Vienna; Austria
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31
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Yeung DK, Griffith JF, Li AF, Ma HT, Yuan J. Air pressure-induced susceptibility changes in vascular reactivity studies using BOLD MRI. J Magn Reson Imaging 2012; 38:976-80. [PMID: 23172781 DOI: 10.1002/jmri.23926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 10/01/2012] [Indexed: 11/07/2022] Open
Affiliation(s)
- David K.W. Yeung
- Department of Imaging and Interventional Radiology; Faculty of Medicine; Chinese University of Hong Kong; Prince of Wales Hospital; Shatin Hong Kong SAR China
| | - James F. Griffith
- Department of Imaging and Interventional Radiology; Faculty of Medicine; Chinese University of Hong Kong; Prince of Wales Hospital; Shatin Hong Kong SAR China
| | - Alvin F.W. Li
- Department of Imaging and Interventional Radiology; Faculty of Medicine; Chinese University of Hong Kong; Prince of Wales Hospital; Shatin Hong Kong SAR China
| | - Heather T. Ma
- Department of Electronic and Information Engineering; Harbin Institute of Technology Shenzhen Graduate School; Shenzhen China
| | - Jing Yuan
- Department of Imaging and Interventional Radiology; Faculty of Medicine; Chinese University of Hong Kong; Prince of Wales Hospital; Shatin Hong Kong SAR China
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Baligand C, Jouvion G, Schakman O, Gilson H, Wary C, Thissen JP, Carlier PG. Multiparametric functional nuclear magnetic resonance imaging shows alterations associated with plasmid electrotransfer in mouse skeletal muscle. J Gene Med 2012; 14:598-608. [DOI: 10.1002/jgm.2671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | - Olivier Schakman
- Pôle d'Endocrinologie, de Diabétologie et Nutrition, Institut de Recherches expérimentales et cliniques (IREC); Université catholique de Louvain; Brussels; Belgium
| | - Helene Gilson
- Pôle d'Endocrinologie, de Diabétologie et Nutrition, Institut de Recherches expérimentales et cliniques (IREC); Université catholique de Louvain; Brussels; Belgium
| | | | - Jean-Paul Thissen
- Pôle d'Endocrinologie, de Diabétologie et Nutrition, Institut de Recherches expérimentales et cliniques (IREC); Université catholique de Louvain; Brussels; Belgium
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Jacobi B, Bongartz G, Partovi S, Schulte AC, Aschwanden M, Lumsden AB, Davies MG, Loebe M, Noon GP, Karimi S, Lyo JK, Staub D, Huegli RW, Bilecen D. Skeletal muscle BOLD MRI: from underlying physiological concepts to its usefulness in clinical conditions. J Magn Reson Imaging 2012; 35:1253-65. [PMID: 22588992 DOI: 10.1002/jmri.23536] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Blood oxygenation-level dependent (BOLD) MRI has gained particular attention in functional brain imaging studies, where it can be used to localize areas of brain activation with high temporal resolution. To a higher degree than in the brain, skeletal muscles show extensive but transient alterations of blood flow between resting and activation state. Thus, there has been interest in the application of the BOLD effect in studying the physiology of skeletal muscles (healthy and diseased) and its possible application to clinical practice. This review outlines the potential of skeletal muscle BOLD MRI as a diagnostic tool for the evaluation of physiological and pathological alterations in the peripheral limb perfusion, such as in peripheral arterial occlusive disease. Moreover, current knowledge is summarized regarding the complex mechanisms eliciting BOLD effect in skeletal muscle. We describe technical fundaments of the procedure that should be taken into account when performing skeletal muscle BOLD MRI, including the most often applied paradigms to provoke BOLD signal changes and key parameters of the resulting time courses. Possible confounding effects in muscle BOLD imaging studies, like age, muscle fiber type, training state, and drug effects are also reviewed in detail.
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Affiliation(s)
- Bjoern Jacobi
- Department of Radiology, University Hospital Bruderholz, Bruderholz, Basel, Switzerland
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Versluis B, Dremmen MHG, Nelemans PJ, Wildberger JE, Schurink GW, Leiner T, Backes WH. MRI of arterial flow reserve in patients with intermittent claudication: feasibility and initial experience. PLoS One 2012; 7:e31514. [PMID: 22412836 PMCID: PMC3297594 DOI: 10.1371/journal.pone.0031514] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 01/11/2012] [Indexed: 01/28/2023] Open
Abstract
Objectives The 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. Methods Ten 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. Results Resting 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. Conclusions Quantitative 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.
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Affiliation(s)
- Bas Versluis
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | | | - Patty J. Nelemans
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joachim E. Wildberger
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Geert-Willem Schurink
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tim Leiner
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Walter H. Backes
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- * E-mail:
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Partovi S, Karimi S, Jacobi B, Schulte AC, Aschwanden M, Zipp L, Lyo JK, Karmonik C, Müller-Eschner M, Huegli RW, Bongartz G, Bilecen D. Clinical implications of skeletal muscle blood-oxygenation-level-dependent (BOLD) MRI. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2012; 25:251-61. [PMID: 22374263 DOI: 10.1007/s10334-012-0306-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 01/31/2012] [Accepted: 02/01/2012] [Indexed: 01/24/2023]
Abstract
Blood-oxygenation-level-dependent (BOLD) contrast in magnetic resonance (MR) imaging of skeletal muscle mainly depends on changes of oxygen saturation in the microcirculation. In recent years, an increasing number of studies have evaluated the clinical relevance of skeletal muscle BOLD MR imaging in vascular diseases, such as peripheral arterial occlusive disease, diabetes mellitus, and chronic compartment syndrome. BOLD imaging combines the advantages of MR imaging, i.e., high spatial resolution, no exposure to ionizing radiation, with functional information of local microvascular perfusion. Due to intrinsic contrast provoked via changes in hemoglobin oxygen saturation, it is a safe and easy applicable procedure on standard whole-body MR devices. Therefore, BOLD MR imaging of skeletal muscle is a potential new diagnostic tool in the clinical evaluation of vascular, inflammatory, and muscular pathologies. Our review focuses on the current evidence concerning the use of BOLD MR imaging of skeletal muscle under pathological conditions and highlights ways for future clinical and scientific applications.
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Affiliation(s)
- Sasan Partovi
- Department of Radiology, University Hospital Bruderholz, Basel, Switzerland.
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Dynamic contrast-enhanced ultrasound for assessment of skeletal muscle microcirculation in peripheral arterial disease. Invest Radiol 2011; 46:504-8. [PMID: 21487300 DOI: 10.1097/rli.0b013e3182183a77] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : This feasibility study was performed to assess whether dynamic contrast-enhanced ultrasound (CEUS) and transient arterial occlusion are able to detect alterations in the microvascular perfusion and arterial perfusion reserve in patients suffering from peripheral arterial disease (PAD) in comparison with healthy volunteers. MATERIALS AND METHODS : Twenty patients with PAD, Rutherford classification grade I, category III (mean age, 64 years; mean height, 173 cm; mean weight, 81.8 kg), and 20 volunteers (mean age, 50 years; mean height, 174 cm; mean weight, 77.8 kg) participated in the study. Low-mechanical index CEUS (7 MHz; MI, 0.28) was performed to the dominant lower leg after start of a continuous automatic intravenous injection of 4.8 mL suspension with microbubbles containing sulfur hexafluoride (SonoVue) within 5 minutes. Perfusion of the calf muscle was monitored by CEUS before, during, and after release of arterial occlusion at the thigh level lasting for 60 seconds. Several parameters, especially the time to maximum enhancement after release of occlusion (tmax), the maximum enhancement after release of occlusion (maxenh), the total vascular response after release of occlusion (AUCpost), and the resulting slope (m2) to maximum enhancement were calculated. RESULTS : After release of the occlusion, a significantly delayed increase of the CEUS signal to maxenh was observed in the patients with PAD (32 ± 17 seconds) compared with volunteers (17 ± 8 seconds, P = 0.0009). maxenh was 66.5 ± 36.6 (∼mL) in PAD versus 135.6 ± 75.1 (∼mL) in volunteers (P = 0.0016). AUCpost was 3016.5 ± 1825.8 (∼mL·s) in PAD versus 5906.4 ± 3173.1 (∼mL·s) in volunteers (P = 0.0013), and m2 was significantly lower in PAD (3.8 ± 5.2 vs. 14.8 ± 9.7 [∼mL/s], P = 0.0001). CONCLUSIONS : Microvascular perfusion deficits and reduced arterial perfusion reserve in patients with PAD are clearly detectable with dynamic CEUS after transient arterial occlusion.
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Skeletal muscle perfusion and oxygenation assessed by dynamic NMR imaging and spectroscopy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2011; 701:341-6. [PMID: 21445807 DOI: 10.1007/978-1-4419-7756-4_46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Muscle perfusion, and capillary and intramyocytic oxygenation can be probed non-invasively in vivo by functional NMR techniques, arterial spin labelling combined with imaging, BOLD imaging and deoxymyoglobin (1)H spectroscopy, respectively. After adequate adaptation of equipment, these measurements can be performed in parallel, together with (31)P spectroscopy and provide a comprehensive analysis of various facets of oxygen metabolism in dynamic protocols, in humans as well as in animal models.
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Andreas M, Schmid AI, Keilani M, Doberer D, Bartko J, Crevenna R, Moser E, Wolzt M. Effect of ischemic preconditioning in skeletal muscle measured by functional magnetic resonance imaging and spectroscopy: a randomized crossover trial. J Cardiovasc Magn Reson 2011; 13:32. [PMID: 21718491 PMCID: PMC3143996 DOI: 10.1186/1532-429x-13-32] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 06/30/2011] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nuclear magnetic resonance (NMR) imaging and spectroscopy have been applied to assess skeletal muscle oxidative metabolism. Therefore, in-vivo NMR may enable the characterization of ischemia-reperfusion injury. The goal of this study was to evaluate whether NMR could detect the effects of ischemic preconditioning (IPC) in healthy subjects. METHODS Twenty-three participants were included in two randomized crossover protocols in which the effects of IPC were measured by NMR and muscle force assessments. Leg ischemia was administered for 20 minutes with or without a subsequent impaired reperfusion for 5 minutes (stenosis model). IPC was administered 4 or 48 hours prior to ischemia. Changes in 31phosphate NMR spectroscopy and blood oxygen level-dependent (BOLD) signals were recorded. 3-Tesla NMR data were compared to those obtained for isometric muscular strength. RESULTS The phosphocreatine (PCr) signal decreased robustly during ischemia and recovered rapidly during reperfusion. In contrast to PCr, the recovery of muscular strength was slow. During post-ischemic stenosis, PCr increased only slightly. The BOLD signal intensity decreased during ischemia, ischemic exercise and post-ischemic stenosis but increased during hyperemic reperfusion. IPC 4 hours prior to ischemia significantly increased the maximal PCr reperfusion signal and mitigated the peak BOLD signal during reperfusion. CONCLUSIONS Ischemic preconditioning positively influenced muscle metabolism during reperfusion; this resulted in an increase in PCr production and higher oxygen consumption, thereby mitigating the peak BOLD signal. In addition, an impairment of energy replenishment during the low-flow reperfusion was detected in this model. Thus, functional NMR is capable of characterizing changes in reperfusion and in therapeutic interventions in vivo. TRIAL REGISTRATION ClinicalTrials.gov: NCT00883467.
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Affiliation(s)
- Martin Andreas
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Albrecht I Schmid
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- MR Center of Excellence, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Daniel Doberer
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Johann Bartko
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Ewald Moser
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- MR Center of Excellence, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Versluis B, Backes WH, van Eupen MGA, Jaspers K, Nelemans PJ, Rouwet EV, Teijink JAW, Mali WPTM, Schurink GW, Wildberger JE, Leiner T. Magnetic resonance imaging in peripheral arterial disease: reproducibility of the assessment of morphological and functional vascular status. Invest Radiol 2011; 46:11-24. [PMID: 21102349 DOI: 10.1097/rli.0b013e3181f2bfb8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the current study was to test the reproducibility of different quantitative magnetic resonance imaging (MRI) methods to assess the morphologic and functional peripheral vascular status and vascular adaptations over time in patients with peripheral arterial disease (PAD). MATERIALS AND METHODS Ten patients with proven PAD (intermittent claudication) and arterial collateral formation within the upper leg and 10 healthy volunteers were included. All subjects underwent 2 identical MR examinations of the lower extremities on a clinical 1.5-T MR system, with a time interval of at least 3 days. The MR protocol consisted of 3D contrast-enhanced MR angiography to quantify the number of arteries and artery diameters of the upper leg, 2D cine MR phase contrast angiography flow measurements in the popliteal artery, dynamic contrast-enhanced (DCE) perfusion imaging to determine the influx constant and area under the curve, and dynamic blood oxygen level-dependent (BOLD) imaging in calf muscle to measure maximal relative T2* changes and time-to-peak. Data were analyzed by 2 independent MRI readers. Interscan and inter-reader reproducibility were determined as outcome measures and expressed as the coefficient of variation (CV). RESULTS Quantification of the number of arteries, artery diameter, and blood flow proved highly reproducible in patients (CV = 2.6%, 4.5%, and 15.8% at interscan level and 9.0%, 8.2%, and 7.0% at interreader level, respectively). Reproducibility of DCE and BOLD MRI was poor in patients with a CV up to 50.9%. CONCLUSIONS Quantification of the morphologic vascular status by contrast-enhanced MR angiography, as well as phase contrast angiography MRI to assess macrovascular blood flow proved highly reproducible in both PAD patients and healthy volunteers and might therefore be helpful in studying the development of collateral arteries in PAD patients and in unraveling the mechanisms underlying this process. Functional assessment of the microvascular status using DCE and BOLD, MRI did not prove reproducible at 1.5 T and is therefore currently not suitable for (clinical) application in PAD.
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Affiliation(s)
- Bas Versluis
- Department of Radiology, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
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Baligand C, Wary C, Ménard JC, Giacomini E, Hogrel JY, Carlier PG. Measuring perfusion and bioenergetics simultaneously in mouse skeletal muscle: a multiparametric functional-NMR approach. NMR IN BIOMEDICINE 2011; 24:281-290. [PMID: 20862659 DOI: 10.1002/nbm.1587] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 06/12/2010] [Accepted: 06/15/2010] [Indexed: 05/29/2023]
Abstract
A totally noninvasive set-up was developed for comprehensive NMR evaluation of mouse skeletal muscle function in vivo. Dynamic pulsed arterial spin labeling-NMRI perfusion and blood oxygenation level-dependent (BOLD) signal measurements were interleaved with (31)P NMRS to measure both vascular response and oxidative capacities during stimulated exercise and subsequent recovery. Force output was recorded with a dedicated ergometer. Twelve exercise bouts were performed. The perfusion, BOLD signal, pH and force-time integral were obtained from mouse legs for each exercise. All reached a steady state after the second exercise, justifying the pointwise summation of the last 10 exercises to compensate for the limited (31)P signal. In this way, a high temporal resolution of 2.5 s was achieved to provide a time constant for phosphocreatine (PCr) recovery (τ(PCr)). The higher signal-to-noise ratio improved the precision of τ(PCr) measurement [coefficient of variation (CV) = 16.5% vs CV = 49.2% for a single exercise at a resolution of 30 s]. Inter-animal summation confirmed that τ(PCr) was stable at steady state, but shorter (89.3 ± 8.6 s) than after the first exercise (148 s, p < 0.05). This novel experimental approach provides an assessment of muscle vascular response simultaneously to energetic function in vivo. Its pertinence was illustrated by observing the establishment of a metabolic steady state. This comprehensive tool offers new perspectives for the study of muscle pathology in mice models.
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Affiliation(s)
- C Baligand
- Institute of Myology, NMR Laboratory, Paris, France
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Towse TF, Slade JM, Ambrose JA, DeLano MC, Meyer RA. Quantitative analysis of the postcontractile blood-oxygenation-level-dependent (BOLD) effect in skeletal muscle. J Appl Physiol (1985) 2011; 111:27-39. [PMID: 21330621 DOI: 10.1152/japplphysiol.01054.2009] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Previous studies show that transient increases in both blood flow and magnetic resonance image signal intensity (SI) occur in human muscle after brief, single contractions, and that the SI increases are threefold larger in physically active compared with sedentary subjects. This study examined the relationship between these transient changes by measuring anterior tibial artery flow (Doppler ultrasound), anterior muscle SI (3T, one-shot echo-planar images, TR/TE = 1,000/35), and muscle blood volume and hemoglobin saturation [near-infrared spectroscopy (NIRS)] in the same subjects after 1-s-duration maximum isometric ankle dorsiflexion contractions. Arterial flow increased to a peak 5.9 ± 0.7-fold above rest (SE, n = 11, range 2.6-10.2) within 7 s and muscle SI increased to a peak 2.7 ± 0.6% (range 0.0-6.0%) above rest within 12 s after the contractions. The peak postcontractile SI change was significantly correlated with both peak postcontractile flow (r = 0.61, n = 11) and with subject activity level (r = 0.63, n = 10) estimated from 7-day accelerometer recordings. In a subset of 7 subjects in which NIRS data acquisition was successful, the peak magnitude of the postcontractile SI change agreed well with SI calculated from the NIRS blood volume and saturation changes (r = 0.80, slope = 1.02, intercept = 0.16), confirming the blood-oxygenation-level-dependent (BOLD) mechanism underlying the SI change. The magnitudes of postcontractile changes in blood saturation and SI were reproduced by a simple one-compartment muscle vascular model that incorporated the observed pattern of postcontractile flow, and which assumed muscle O(2) consumption peaks within 2 s after a brief contraction. The results show that muscle postcontractile BOLD SI changes depend critically on the balance between O(2) delivery and O(2) consumption, both of which can be altered by chronic physical activity.
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Affiliation(s)
- Theodore F Towse
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
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Wary C, Nadaj-Pakleza A, Laforêt P, Claeys KG, Carlier R, Monnet A, Fleury S, Baligand C, Eymard B, Labrune P, Carlier PG. Investigating glycogenosis type III patients with multi-parametric functional NMR imaging and spectroscopy. Neuromuscul Disord 2010; 20:548-58. [DOI: 10.1016/j.nmd.2010.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/27/2010] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
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Baligand C, Gilson H, Ménard JC, Schakman O, Wary C, Thissen JP, Carlier PG. Functional assessment of skeletal muscle in intact mice lacking myostatin by concurrent NMR imaging and spectroscopy. Gene Ther 2009; 17:328-37. [DOI: 10.1038/gt.2009.141] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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44
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Simultaneous Dynamic Blood Oxygen Level-Dependent Magnetic Resonance Imaging of Foot and Calf Muscles. Invest Radiol 2009; 44:741-7. [DOI: 10.1097/rli.0b013e3181b248f9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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45
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T2*-Weighted and Arterial Spin Labeling MRI of Calf Muscles in Healthy Volunteers and Patients With Chronic Exertional Compartment Syndrome: Preliminary Experience. AJR Am J Roentgenol 2009; 193:W327-33. [DOI: 10.2214/ajr.08.1579] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lai N, Gladden LB, Carlier PG, Cabrera ME. Models of muscle contraction and energetics. ACTA ACUST UNITED AC 2008; 5:273-288. [PMID: 24421861 DOI: 10.1016/j.ddmod.2009.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
How does skeletal muscle manage to regulate the pathways of ATP synthesis during large-scale changes in work rate while maintaining metabolic homeostasis remains unknown. The classic model of metabolic regulation during muscle contraction states that accelerating ATP utilization leads to increasing concentrations of ADP and Pi, which serve as substrates for oxidative phosphorylation and thus accelerate ATP synthesis. An alternative model states that both the ATP demand and ATP supply pathways are simultaneously activated. Here, we review experimental and computational models of muscle contraction and energetics at various organizational levels and compare them with respect to their pros and cons in facilitating understanding of the regulation of energy metabolism during exercise in the intact organism.
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Affiliation(s)
- Nicola Lai
- Center for Modeling Integrated Metabolic Systems, Case Western Reserve University, Cleveland, Ohio. U.S.A
| | - L Bruce Gladden
- Department of Kinesiology, Auburn University, Auburn, Alabama. U.S.A
| | - Pierre G Carlier
- Institute of Myology, NMR Laboratory, F-75651 Paris, France ; CEA, I BM, MIRCen, IdM NMR Laboratory, F-75651 Paris, France ; UPMC Univ Paris 06, F-75005 Paris, France
| | - Marco E Cabrera
- Center for Modeling Integrated Metabolic Systems, Case Western Reserve University, Cleveland, Ohio. U.S.A
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Huegli RW, Schulte AC, Aschwanden M, Thalhammer C, Kos S, Jacob AL, Bilecen D. Effects of percutaneous transluminal angioplasty on muscle BOLD-MRI in patients with peripheral arterial occlusive disease: preliminary results. Eur Radiol 2008; 19:509-15. [DOI: 10.1007/s00330-008-1168-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Accepted: 08/07/2008] [Indexed: 11/24/2022]
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Schulte AC, Aschwanden M, Bilecen D. Calf muscles at blood oxygen level-dependent MR imaging: aging effects at postocclusive reactive hyperemia. Radiology 2008; 247:482-9. [PMID: 18372453 DOI: 10.1148/radiol.2472070828] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively investigate age-related changes in muscle reperfusion by using blood oxygen level-dependent (BOLD) magnetic resonance (MR) imaging of the calf in young and elderly healthy volunteers during postocclusive reactive hyperemia. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. Eleven healthy elderly (mean age, 64.0 years +/- 6.4 [standard deviation]; six men, five women) and 17 healthy young volunteers (mean age, 30.3 years +/- 6.5; seven men, 10 women) underwent muscle BOLD MR imaging of the calf. A fat-suppressed T2*-weighted single-shot multiecho echo-planar imaging sequence was used. Temporary vascular occlusion was induced with suprasystolic cuff compression of the thigh. T2* time courses of the muscle BOLD MR signal intensity were obtained from four calf muscles and were characterized by the following curve parameters: hyperemia peak value, time to peak, and T2* end value after 360 seconds of hyperemia. Differences in these parameters between the two cohorts were assessed by using a Student t test. RESULTS Considerably lower T2* maxima were observed in the elderly group during hyperemia (P < .005), with a mean hyperemia peak value of 13.1% +/- 3.0 compared with 18.9% +/- 4.8 in young healthy adults. Peaking occurred earlier in the elderly group (P < .05), with a mean time to peak of 32.2 seconds +/- 10.6 compared with 43.1 seconds +/- 10.7 in young adults. Furthermore, the elderly group had a significantly slower decrease of the muscle BOLD signal after the hyperemia peak (P < .001), which led to a higher end value of 8.6% +/- 3.0 compared with 2.6% +/- 2.1 in the young group. CONCLUSION BOLD MR imaging results of the calf demonstrated statistically significant age-dependent differences in the rate, intensity, and recovery of the postocclusive muscle BOLD signal.
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Arumana JM, Li D, Dharmakumar R. Deriving blood-oxygen-level-dependent contrast in MRI withT2*-weighted,T2-prepared and phase-cycled SSFP methods: Theory and experiment. Magn Reson Med 2008; 59:561-70. [DOI: 10.1002/mrm.21511] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Klarhöfer M, Madörin P, Bilecen D, Scheffler K. Assessment of muscle oxygenation with balanced SSFP: A quantitative signal analysis. J Magn Reson Imaging 2008; 27:1169-74. [DOI: 10.1002/jmri.21334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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