1
|
Szkodziak F, Wozniak S, Szkodziak PR, Pyra K, Paszkowski T. Noninvasive diagnostic imaging of pelvic venous disorders. Ultraschall Med 2024. [PMID: 38325406 DOI: 10.1055/a-2263-7193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
It is estimated that chronic pelvic pain (CPP) may affect up to 24% of women. Unfortunately, very often, despite extensive diagnostics, the cause of CPP remains unknown. The pathophysiology of CPP could be explained to a large extent by the occurrence of pelvic venous disorders (PVD). Although pelvic venography is still considered the gold standard for the diagnosis of PVD, noninvasive diagnostic imaging techniques seem to be instrumental in the initial identification of patients with PVD. This literature review aimed to analyze and evaluate the usefulness of noninvasive diagnostic imaging techniques like transvaginal ultrasonography, transabdominal ultrasonography, magnetic resonance, and computed tomography in the diagnosis and identification of patients with PVD. Forty-one articles published between 1984 and 2023 were included in this literature review. Based on this literature review, we conclude that the clinical application of noninvasive diagnostic techniques in the diagnosis of PVD seems to be very promising. Future studies investigating the role of noninvasive diagnostic imaging techniques in the diagnosis of PVD are required.
Collapse
Affiliation(s)
- Filip Szkodziak
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - Slawomir Wozniak
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | | | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Paszkowski
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
2
|
Huang YK, Hsu YC, Tseng YH, Kao CC, Ngo YG, Lee CY, Yang TY, Chang KS, Chen PY, Wang SC, Chen SY, Lin YH, Chen CW. Quantitative two-dimensional phase-contrast magnetic resonance imaging characterization of lower extremity venous disease: venous reflux versus venous obstruction. Quant Imaging Med Surg 2023; 13:5153-5167. [PMID: 37581029 PMCID: PMC10423378 DOI: 10.21037/qims-22-1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/12/2023] [Indexed: 08/16/2023]
Abstract
Background Lower extremity venous disease (LEVD) is a complex disorder, and determining the etiology of LEVD is paramount for treatment selection. Two-dimensional phase-contrast magnetic resonance imaging (2D PC-MRI) can provide an objective measure of hemodynamic status and may help differentiate between different etiologies of LEVD. A total of 271 participants, including 256 symptomatic patients with venous lower extremity disease and 15 healthy volunteers, were collected in this cohort study. Methods It is a single-center prospective observational study using 2D PC-MRI analysis to assess the hemodynamic characteristics of patients with LEVD among participants recruited between April 2017 and October 2021 at a tertiary hospital. The approval institutional review board number for this study were 201802137B0, 201901058B0, 202100938B0, and 202102344B0. Participants were classified as venous reflux (VR) and venous obstruction (VO) by standard ultrasonography. 2D PC-MRI by 1.5 T scanner revealed stroke volume (SV), forward flow volume (FFV), absolute stroke volume (ASV), mean flux (MF), velocity time integral (VTI), and mean velocity (MV) for each selected venous segments. Results 2D PC-MRI assessed 167 diseased legs from the 116 VR patients [mean age ± standard deviation (SD): 57.9±12.8 years; 39 males] and 113 diseased legs from the 95 VO patients (mean age ± SD: 66.4±12.8 years; 42 males). 2D PC-MRI analysis demonstrated discrimination ability to differentiate from VR to VO [SV, FFV, ASV, MF, VTI, and MV in the various venous segments, respectively, P≤0.001; area under the curve (AUC) =62-68.8%, P≤0.001 by Mann-Whitney U test]. The ratio data (morbid limb to normal limb) in the same individual with single-leg disease revealed differences between VR and VO (SV, FFV, ASV, and MF in the various venous segments, respectively; P<0.05; AUC =60.2-68.7%, P≤0.05 by Mann-Whitney U test). The most favorable differentiating variables of ratios were FFV in the great saphenous veins [AUC =68.7%, 95% confidence interval (CI): 59.8-77.6%] and ASV in the external iliac veins (AUC =67.4%, 95% CI: 58.7-76.2%). Conclusions Quantitative 2D PC-MRI analysis is capable of differentiating VR from VO. It also provides an important diagnostic capability for preoperative evaluation.
Collapse
Affiliation(s)
- Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- College of Medicine, Chang Gung University, Taoyuan
- Division of Thoracic and Cardiovascular Surgery, Chiayi Hospital, Ministry of Health and Welfare (MOHW), Chiayi
| | - Yin-Chen Hsu
- College of Medicine, Chang Gung University, Taoyuan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- College of Medicine, Chang Gung University, Taoyuan
- Division of Thoracic and Cardiovascular Surgery, Chiayi Hospital, Ministry of Health and Welfare (MOHW), Chiayi
| | - Chih-Chen Kao
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- College of Medicine, Chang Gung University, Taoyuan
- Division of Thoracic and Cardiovascular Surgery, Chiayi Hospital, Ministry of Health and Welfare (MOHW), Chiayi
| | - Yeh Giin Ngo
- College of Medicine, Chang Gung University, Taoyuan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | - Chung-Yuan Lee
- College of Medicine, Chang Gung University, Taoyuan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
| | - Teng-Yao Yang
- College of Medicine, Chang Gung University, Taoyuan
- Department of Cardiovascular, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
| | - Kuo-Song Chang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei
- Mackay Junior College of Medicine Nursing and Management, Taipei
| | - Pang-Yen Chen
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei
- Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei
| | - Shih-Chung Wang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung
| | - Sheng-Ya Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
| | - Yu-Hui Lin
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
| | - Chien-Wei Chen
- College of Medicine, Chang Gung University, Taoyuan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung
| |
Collapse
|
3
|
Wong MY, Chen CW, Tseng YH, Zhou SK, Lin YH, Huang YK, Lin BS. Noncontrast MRI in assessing venous reflux of legs using QFlow analysis and radial basis function neural network technique. Sci Rep 2023; 13:3263. [PMID: 36828951 DOI: 10.1038/s41598-023-30437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
Since venous reflux is difficult to quantify, triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) is a novel tool for objectively evaluating venous diseases in the lower extremities without using contrast media. This study included 26 pre-intervention patients with superficial venous reflux in the lower extremities and 15 healthy volunteers. The quantitative flow (QFlow) analyzed the phase shift information from the pixels within the region of interest from MRI. The fast and simple radial basis function neural network (RBFNN) learning model is constructed by determining the parameters of the radial basis function and the weights of the neural network. The input parameters were the variables generated through QFlow, while the output variables were morbid limbs with venous reflux and normal limb classification. The stroke volume, forward flow volume, absolute stroke volume, mean flux, stroke distance, and mean velocity of greater saphenous veins from QFlow analysis could be used to discriminate the morbid limbs of pre-intervention patients and normal limbs of healthy controls. The neural network successfully classified the morbid and normal limbs with an accuracy of 90.24% in the training stage. The classification of venous reflux using the RBFNN model may assist physicians in clinical settings.
Collapse
|
4
|
Chen CW, Tseng YH, Kao CC, Ngo YG, Lee CY, Yang TY, Lin YH, Huang YK. Venous Segmental Flow Changes after Superficial Venous Intervention Demonstrating by Quantitative Phase-Contrast Magnetic Resonance Analysis: Preliminary Data from a Longitudinal Cohort Study. J Pers Med 2022; 12:jpm12061000. [PMID: 35743784 PMCID: PMC9224938 DOI: 10.3390/jpm12061000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
The effects of superficial venous intervention on hemodynamics can be quantified using two-dimensional phase-contrast magnetic resonance imaging (2D PC-MRI). Twelve patients received pre- and postintervention 2D PC-MRI analysis using quantitative hemodynamic parameters. Fifteen healthy volunteers served as controls. The 2D PC-MRI results of the target limbs (limbs scheduled for intervention for venous reflux) differed from those of the controls in terms of stroke volume (SV), forward flow volume (FFV), absolute stroke volume (ASV), and mean flux (MF) in all venous segments. The velocity time integral (VTI) and mean velocity (MV) of the popliteal vein (PV) segments were similar between the target limbs and controls preoperatively. After intervention, the target limbs exhibited an increase in VTI and MV in the femoral vein (FV) and PV segments. We compared the target and nontreated limbs of the individual patients preoperatively and postoperatively to minimalize individual bias. All QFlow parameter ratios in the FV segment increased after venous intervention (VTI, p = 0.025; MV, p = 0.024). In the PV segment, FFV and ASV increased significantly (p = 0.035 and 0.024, respectively). After interventions, the volume (FFV and ASV) of the PV segment and the efficiency (VTI and MV) of the FV segment significantly increased.
Collapse
Affiliation(s)
- Chien-Wei Chen
- Department of Diagnostic Radiology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
| | - Yuan-Hsi Tseng
- Department of Obstetrics and Gynecology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Chih-Chen Kao
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Hospital, MOHW, Chiayi 61363, Taiwan
| | - Yeh Giin Ngo
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Department of Obstetrics and Gynecology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Chung-Yuan Lee
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Department of Obstetrics and Gynecology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Teng-Yao Yang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Cardiology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Yu-Hui Lin
- Cardiology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Yao-Kuang Huang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Hospital, MOHW, Chiayi 61363, Taiwan
- Correspondence:
| |
Collapse
|
5
|
Komaki S, Kida K, Hayashi Y, Shouda T, Tabuchi A. [Non-electrocardiogram-gated and Non-contrast-enhanced Magnetic Resonance Angiography of the Lower Limb Arteries Using Three-dimensional Multishot T 1-weighted Fast-field Echo-Echo Planar Imaging]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:333-341. [PMID: 35236790 DOI: 10.6009/jjrt.2022-1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We performed a non-electrocardiogram-gated and non-contrast-enhanced magnetic resonance angiography (MRA) of the lower limb arteries using three-dimensional multishot T1-weighted fast-field echo-echo planar imaging (3D multishot T1-FFE-EPI), and it was optimized the protocol. The image distortion for the change in the EPI factor was calculated using 3.0 T-MRI and MRI phantom. We also calculated the signal-to-noise ratio (SNR) of the femoral artery with a change in the flip angle on images of 8 healthy volunteers. Furthermore, the optimal EPI factor was determined from the SNR of the femoral artery and the contrast ratio between the femoral artery and the adductor magnus. Two radiological technologists performed a retrospective visual assessment of the pelvis, thigh, and leg of 10 patients who underwent lower limb non-contrast-enhanced MRA and contrast-enhanced tomography angiography (CTA). The optimum flip angle and EPI factor were 25° and 3, respectively. In the visual assessment of clinical cases, there was no significant difference between the non-contrast-enhanced MRA and contrast-enhanced CTA in the pelvis and the leg (p=0.52 and p=0.88, respectively). In the thigh, non-contrast-enhanced MRA was significantly higher (p=0.02), namely, the ability to visualize the lower limb arteries was not much difference between this method and contrast-enhanced CTA. Our method without electrocardiogram gated and contrast medium is expected for screening tests or detailed examinations.
Collapse
Affiliation(s)
- Shinsuke Komaki
- Department of Radiology, Kawasaki Medical School General Medical Center
| | | | - Yukako Hayashi
- Department of Radiology, Kawasaki Medical School General Medical Center
| | - Takashi Shouda
- Department of Radiology, Kawasaki Medical School General Medical Center
| | - Akihiko Tabuchi
- Department of Radiology, Kawasaki Medical School General Medical Center.,Graduate School of Medical Technology, Kawasaki University of Medical Welfare
| |
Collapse
|
6
|
Tran TT, Kristiansen CH, Thomas O, Roy S, Haidl F, Ashraf H, Kløw NE, Stavem K, Lauritzen PM. Indirect CT venography of the lower extremities: impact of scan delay and patient factors on contrast enhancement and examination quality. Eur Radiol 2022; 32:7946-7955. [PMID: 35554646 PMCID: PMC9668790 DOI: 10.1007/s00330-022-08841-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Indirect computed tomography venography (CTV) is often the next imaging modality for deep vein thrombosis (DVT) when sonography is inconclusive. Our aim was to investigate the impact of scan delay and patient factors on contrast enhancement (CE) and examination quality in CTV. METHODS Patients with clinical suspicion or clinical mimics of DVT in one large hospital were enrolled. Age, sex, body weight, height, heart rate, systolic blood pressure and cardiac output were registered. CTV of the popliteal veins was obtained at 30 s intervals at 30-210 s delays. The proportions of examinations with CE exceeding predefined cut-offs were estimated and subjective examination quality was rated. Changes in CE with time, and associations between patient factors and time to peak contrast enhancement (TPCE) were modelled with mixed effects non-linear and linear regression, respectively. RESULTS The CE increased with increasing scan delay and reached a plateau from 120 to 210 s. The percentages of examinations achieving enhancement above cut-offs across all thresholds from 70 to 100 HU were higher at 120 s compared to 90 s (p < 0.001). After 120 s, there were no differences across scan delays for any thresholds. No patient factors showed a significant effect on TPCE. The percentage of examinations rated as acceptable was higher at 120 s compared to 90 s (p < 0.001). After 120 s, there were no statistically significant differences across scan delays. CONCLUSIONS No patient factors were associated with TPCE in CTV. A fixed scan delay of 120-210 s yielded the best examination quality. KEY POINTS • Contrast enhancement reached a plateau at scan delay between 90 and 120 s. • A scan delay of 120-210 s yielded the best examination quality. • No patient factors were associated with time to peak contrast enhancement.
Collapse
Affiliation(s)
- Thien Trung Tran
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway.
| | - Cathrine Helgestad Kristiansen
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway
- Department of Life Sciences and Health Radiography, Oslo Metropolitan University, Oslo, Norway
| | - Owen Thomas
- Health Services Research Department (HØKH), Akershus University Hospital, Lørenskog, Norway
| | - Sumit Roy
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway
| | - Felix Haidl
- Department of Anaesthesiology, Akershus University Hospital, Lørenskog, Norway
| | - Haseem Ashraf
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway
| | - Nils Einar Kløw
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Knut Stavem
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Health Services Research Department (HØKH), Akershus University Hospital, Lørenskog, Norway
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Peter M Lauritzen
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway
- Division of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| |
Collapse
|
7
|
Chen CW, Fang YF, Tseng YH, Wong MY, Lin YH, Hsu YC, Lin BS, Huang YK. A Novel Tool for a Challenging Disease: Stasis Leg Ulcers Assessed Using QFlow in Triggered Angiography Noncontrast Enhanced Magnetic Resonance Imaging. J Pers Med 2021; 11:857. [PMID: 34575634 DOI: 10.3390/jpm11090857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023] Open
Abstract
Imaging characteristics of stasis leg ulcers (SLUs) are not easily demonstrated through existing diagnostic tools. Early diagnosis and treatment are crucial. This pilot study was conducted to assess the quantitative flow (QFlow) in triggered angiography noncontrast enhanced (TRANCE) magnetic resonance imaging (MRI) to identify the hemodynamics of victims with stasis leg ulcers (SLUs). This study included 33 patients with SLUs and 14 healthy controls (HC). The 33 patients with SLUs were divided into a reflux (15 patients) and a nonreflux group (18 patients). QFlow was done in the reflux, the nonreflux, and the HC. The stroke volume (SV), forward flow volume (FFV), absolute flow volume (AFV), mean flow (MF), and mean velocity (MV) were higher in the reflux than in the HC group in most segments, namely the external iliac vein (EIV), popliteal vein (PV), and great saphenous vein (GSV) (SV, p = 0.008; FFV, p = 0.008; absolute stroke volume (ASV), p = 0.008; MF, p = 0.002; MV, p = 0.009). No differences in the QFlow patterns were found in the GSV segment between the nonreflux group and the HC. Excellent performance in discriminating SLU with superficial venous reflux was reported for SV in the EIV and the PV (area under the curve (AUC) = 0.851 and 0.872), FFV in the EIV and PV (AUC = 0.854 and 0.869), ASV in the EIV and PV (AUC = 0.848 and 0.881), and MF in the EIV and PV (AUC = 0.866 and 0.868). The cutoff levels of SV/FFV/ASV/MF in the EIV/FV/PV/GSV for discriminating the SLU with superficial venous reflux were identified (p < 0.005). In conclusion, SLUs present different QFlow patterns by different etiology. The QFlow parameters of all vessel segments were higher in the morbid limbs of the reflux group than HC. The GSV segment of the nonreflux group displayed a pattern like the HC.
Collapse
|
8
|
Tseng YH, Chen CW, Wong MY, Yang TY, Lin YH, Lin BS, Huang YK. Reduced External Iliac Venous Blood Flow Rate Is Associated with Asymptomatic Compression of the Common Iliac Veins. Medicina (Kaunas) 2021; 57:835. [PMID: 34441041 DOI: 10.3390/medicina57080835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Compression of the common iliac veins (CIV) is not always associated with lower extremity symptoms. This study analyzed this issue from the perspective of patient venous blood flow changes using quantitative flow magnetic resonance imaging. Materials and Methods: After we excluded patients with active deep vein thrombosis, the mean flux (MF) and mean velocity (MV) of the popliteal vein, femoral vein, and external iliac vein (EIV) were compared between the left and right sides. Results: Overall, 26 of the patients had unilateral CIV compression, of which 16 patients had symptoms. No significant differences were noted in the MF or MV of the veins between the two sides. However, for the 10 patients without symptoms, the EIV MF of the compression side was significantly lower than the EIV MF of the non-compression side (p = 0.04). The receiver operating characteristic curve and chi-squared analyses showed that when the percentage difference of EIV MF between the compression and non-compression sides was ≤-18.5%, the relative risk of associated lower extremity symptoms was 0.44 (p = 0.016). Conclusions: If a person has compression of the CIV, a decrease in EIV blood flow rate on the compression side reduces the rate of symptom occurrence.
Collapse
|
9
|
Shen S, Lan Y, He L, Li J, Li M, Chen Y. Non-contrast-enhanced magnetic resonance imaging technique diagnoses DVT and classifies thrombus. J Thromb Thrombolysis 2021. [PMID: 34378117 DOI: 10.1007/s11239-021-02538-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
The accuracy of non-contrast MRI in diagnosing acute deep vein thrombosis (DVT) of the lower extremities is different. To explore the application of high-resolution non-contrast 3D CUBE T1-weighted MRI in the lower extremities DVT. We recruited 26 patients suspected DVT of the lower extremities from Hebei General Hospital in China. All patients underwent high-resolution non-contrast 3D CUBE T1-weighted MRI. We evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of diagnosing thrombosis. And we divided thrombi into two parts: filling thrombus (FT) and non-filling thrombus (NFT), compared the agreement between MRI and Ultrasound (US) and analysed the locations of thrombi. Compared with US, MRI yielded a sensitivity of 79%, a specificity of 94.2% in mean value, a sensitivity of 85.7%, 97.4%, and 51.7% in iliac, femoral-popliteal, and calf segments respectively, a specificity of 97.6%, 88.3%, and 98.2% in iliac, femoral-popliteal, and in calf segments respectively. The accuracy of MRI in the diagnosis of lower extremity DVT was in very good agreement (κ = 0.711, 95% CI 0.627, 0.795). The FT was the most part in US and CUBE (68/56), CUBE can detect more NFT in femoral vein than US (22/4). 3D CUBE T1-weighted MRI can be used to accurately diagnose acute DVT and detect more NFT. It has the potential of follow-up at the end of treatment to establish a new baseline to stop anticoagulant drug.
Collapse
|
10
|
Chen CW, Tseng YH, Wong MY, Lin YH, Yang TY, Hsu YC, Lin BS, Huang YK. Using Non-Contrast MRA to Discriminate between Obstructive and Nonobstructive Venous Diseases of the Legs. Diagnostics (Basel) 2021; 11:1392. [PMID: 34441326 PMCID: PMC8394703 DOI: 10.3390/diagnostics11081392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/25/2021] [Accepted: 07/29/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Venous interventions of the legs are less predictable owing to a lock of objective tools. METHODS One hundred and twenty patients with lower extremity venous disease were evaluated anatomically using TRANCE MRI. Then, a QFlow analysis was performed in 53 patients with only one leg affected for hemodynamic evaluation. Those patients with complete QFlow were classified into obstructive and nonobstructive. RESULTS The QFlow-namely, stroke volume, forward flow volume, mean flux, stroke distance (SD), and mean velocity (MV) in the external iliac vein (EIV), femoral vein (FV), popliteal vein (PV), and great saphenous vein (GSV). The obstructed group had a shorter SD and lower MV in the EIV, EIV/FV, and GSV/PV (SD: p-values of 0.025, 0.05, and 0.043, respectively; MV: p-values of 0.02, 0.05, and 0.048, respectively). A good performance in discriminating obstructive venous disease was reported for SD in the EIV (area under the curve (AUC) = 67.9%, 95% confidence interval (CI) = 53.2-82.7%), EIV/FV (AUC = 72.4%, 95% CI = 58.2-86.5%), and GSV/PV (AUC = 67.9%, 95% CI = 51.7-84.1%). The SD in the EIV, EIV/FV, and GSV/PV had the ability to discriminate between obstructive and nonobstructive diseases (p-values of 0.025, 0.005, and 0.043). The MV in the EIV, EIV/FV, and GSV/PV had ability to discriminate between obstructive and nonobstructive venous diseases (p-values of 0.02, 0.005, and 0.048). CONCLUSIONS The SD and MV were lower for obstructive than nonobstructive disease in the EIV.
Collapse
Affiliation(s)
- Chien-Wei Chen
- Department of Diagnostic Radiology, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Chiayi 61363, Taiwan; (C.-W.C.); (Y.-C.H.)
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yu-Hui Lin
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Teng-Yao Yang
- Department of Cardiology, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan;
| | - Yin-Chen Hsu
- Department of Diagnostic Radiology, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Chiayi 61363, Taiwan; (C.-W.C.); (Y.-C.H.)
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University and Department of Medical Research, Chi-Mei Medical Center, Tainan 71004, Taiwan;
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| |
Collapse
|
11
|
Chen CW, Tseng YH, Fang YF, Wong MY, Lin YH, Huang YK. Superficial Venous Reflux Intervention Guided by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging: Different QFlow Pattern from Health Controls. J Pers Med 2021; 11:jpm11080751. [PMID: 34442395 PMCID: PMC8398290 DOI: 10.3390/jpm11080751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: To assess the effectiveness of triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) in superficial venous reflux and its difference from health controls. (2) Methods: Thirty patients underwent TRANCE MRI before surgical intervention of their superficial venous reflux of the legs. Ten healthy volunteers were included as a control. (3) Results: TRANCE MRI involves the major tributaries, thus enhances the additional ablations in 20% of patients. QFlow pattern of superficial venous reflux (QFlow GSV/PV MF ratio > 1) was compared with the duplex scan (SFJ reflux) using Cohen’s kappa coefficient at 0.967. The 30 morbid legs undergoing TRANCE MRI-guide interventions and the healthy volunteers’ legs on the same side were compared. The stroke volumes (SV) are higher in EIV (p = 0.021) in the left-leg-intervention group. The mean flux (MF) is higher in the EIV (p = 0.012) and trend of increasing in GSV segment (p = 0.087) in the left-leg-intervention group. The QFlow of 10 patients with right leg intervention are higher in GSV in the right-leg-intervention group (SV p = 0.002; FFV p = 0.001; MF p = 0.001). QFlow data is shown for all legs for superficial venous intervention with GSV/PV (MF) ratio > 1. (4) Conclusions: Typical figures in QFlow (GSV/PV MF ratio > 1) could be observed in the morbid limbs but not in the controls.
Collapse
Affiliation(s)
- Chien-Wei Chen
- Department of Diagnostic Radiology, Chia-Yi Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan;
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yueh-Fu Fang
- Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan;
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yu-Hui Lin
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
- Correspondence:
| |
Collapse
|
12
|
Abstract
For years, magnetic resonance angiography (MRA) has been a leading imaging modality in the assessment of venous disease involving the pelvis and lower extremities. Current advancement in noncontrast MRA techniques enables imaging of a larger subset of patients previously excluded due to allergy or renal insufficiency, allowing for preintervention assessment and planning. In this article, the current status of MR venography, with a focus on current advancements, will be presented. Protocols and parameters for MR venographic imaging of the pelvis and lower extremities, including contrast and noncontrast enhanced techniques, will be reviewed based on a recent literature review of applied MR venographic techniques. Finally, several disease-specific entities, including pelvic congestion and compression syndromes, will be discussed with a focus on imaging parameters that may best characterize these disease processes and optimize anatomical planning prior to intervention.
Collapse
Affiliation(s)
- Pamela Lombardi
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, Chicago, Illinois
| |
Collapse
|
13
|
Chen CW, Ting H, Chen PY, Weng JC, Hsu YC, Wang SC, Tseng YH, Huang YK. Usefulness of triggered non-contrast-enhanced magnetic resonance angiography in assessing lower extremity venous disease. Medicine (Baltimore) 2021; 100:e25809. [PMID: 34011044 PMCID: PMC8137012 DOI: 10.1097/md.0000000000025809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/15/2021] [Indexed: 01/05/2023] Open
Abstract
Although venous duplex ultrasonography (USG) is reliable for diagnosing lower extremity venous disease (LEVD), cross-sectional imaging studies were usually required before intervention or surgery. Patients of LEVD with renal insufficiency usually restrict the use of contrast-enhanced imaging modalities. In seeking an alternative imaging solution for these patients, we explore the clinical utility of triggered angiography non-contrast-enhanced magnetic resonance imaging (TRANCE-MRI) in the assessment of LEVD.We collected data from patients presenting to a tertiary wound-care center with symptoms of LEVD from April 2017-November 2019. Each participant underwent baseline USG followed by TRANCE-MRI on a 1.5T MR scanner (Philips Ingenia, Philips Healthcare, Best, The Netherlands). Inter-rater reliability was measured using Cohen's kappa (κ).All 80 participants (mean age, 61.9 ± 14.8 years; 35 males, 45 females) were assessed and were classified into one of five disease groups, deep vein thrombosis (n = 38), venous static ulcer (n = 16), symptomatic varicose veins (n = 18), recurrent varicose veins (n = 3), and lymphoedema (n = 5). The inter-rater reliability between TRANCE-MRI and doppler USG showed substantial agreement (κ, 0.73). The sensitivity, specificity, and accuracy of TRANCE-MRI were 90.5%, 88.1%, and 88.8%, respectively. In 59 (73.8%) USG-negative patients, we were able to diagnose positive findings (deep venous thrombosis, n = 7; varicose veins, n = 15; lymphedema, n = 10; iliac vein compression with thrombosis, n = 6; external venous compression, n = 5; vena cava anomaly, n = 2; occult peripheral artery disease, n = 5; ccluded bypass graft, n = 1) by using TRANCE-MRI. Of these, 9 (15.3%) patients underwent additional vascular surgery based on positive TRANCE-MRI findings.TRANCE technique provides the limb's entire venous drainage in clear images without background contamination by associated arterial imaging. Additionally, simultaneous evaluation of bilateral lower extremities can help determine the lesion's exact site. Although TRANCE-MRI can provide MR arteriography and MR venography, we recommend performing only MR venography in symptomatic LEVD patients because the incidence of occult arterial disease is low.
Collapse
Affiliation(s)
- Chien-Wei Chen
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung
| | - Hua Ting
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Physical Medicine and Rehabilitation, Sleep Medicine Center, Chung Shan Medical University Hospital, Taichung
| | - Pang-Yen Chen
- Department of Emergency Medicine, Mackay Memorial Hospital, Institute of Public Health, School of Medicine, National Yang-Ming University, Yuanpei University of Medical Technology, Taipei and Hsinchu
| | - Jun-Cheng Weng
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Psychiatry, Chang Gung Memorial Hospital Chiayi Branch, Department of Medical Imaging and Radiological Sciences
| | - Yin-Chen Hsu
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan
| | - Shih-Chung Wang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan, Taiwan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan, Taiwan
| |
Collapse
|
14
|
Tseng YH, Chen CW, Wong MY, Yang TY, Lin BS, Ting H, Huang YK. Discriminating Reflux from Non-Reflux Diseases of Superficial Veins in Legs by Novel Non-Contrast MR with QFlow Technique. J Pers Med 2021; 11:jpm11040242. [PMID: 33810500 PMCID: PMC8066982 DOI: 10.3390/jpm11040242] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To find an objective diagnostic tool for the superficial veins in legs. Methods: This study included 137 patients who underwent TRANCE-MRI from 2017 to 2020 (IRB: 202001570B0). Among them, 53 with unilateral leg venous diseases underwent a QFlow scan and were classified into the reflux and non-reflux groups according to the status of the great saphenous veins. Results: The QFlow, namely stroke volume (SV), forward flow volume (FFV), mean flux (MF), stroke distance (SD), and mean velocity (MV) measured in the external iliac, femoral, popliteal, and great saphenous vein (GSV). The SV, FFV, SD, MF, SD, and MV in the GSV (morbid/non-morbid limbs) demonstrated a favorable ability to discriminate reflux from non-reflux in the ROC curve. The SD in the GSV and GSV/PV ratio (p = 0.049 and 0.047/cutoff = 86 and 117.1) and the MV in the EIV/FV ratio, GSV, and GSV/PV ratio (p = 0.035, 0.034, and 0.025/cutoff = 100.9, 86.1, and 122.9) exhibited the ability to discriminate between reflux and non-reflux group. The SD, MV, and FFV have better ability to discriminate a reflux from non-reflux group than the SV and MF. Conclusions: QFlow may be used to verify the reflux of superficial veins in the legs. An increasing GSV/PV ratio is a hallmark of reflux of superficial veins in the legs.
Collapse
Affiliation(s)
- Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 408, Taiwan;
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 300, Taiwan;
| | - Teng-Yao Yang
- Department of Cardiology, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan;
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 300, Taiwan;
| | - Hua Ting
- Institute of Medicine, Chung Shan Medical University, Taichung 408, Taiwan;
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
- Correspondence:
| |
Collapse
|
15
|
Chang HW, Lin CY, Chen HY, Chen YW, Chen HT, Lin IH, Hsu CJ, Lin TL. Anthropometric Factors on Safe Distances between Popliteal Vessels to the Femur for Cerclage Wiring of the Distal Femoral Fracture: A Magnetic Resonance Imaging Study. ACTA ACUST UNITED AC 2020; 56:E655. [PMID: 33260736 DOI: 10.3390/medicina56120655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/16/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022]
Abstract
Background and Objectives: The proximity of the popliteal vessels in the distal femur may increase the risk of iatrogenic vascular injury during cerclage wiring. In this study, the closest location and distance of the popliteal vessels to the femur was examined using magnetic resonance imaging (MRI). The associations between anthropometric factors and the distance that would guide the placement of wires safely during surgery were also identified. Materials and Methods: We reviewed adult knee magnetic resonance images and recorded: (1) the relation and the shortest horizontal distance (d-H) from the femoral cortex to the popliteal vessels in axial images and (2) the vertical distance (d-V) from the adductor tubercle to the axial level of the d-H values in coronal images. The effects of anthropometric factors (sex, age, body height, body weight, body mass index, thigh circumference, femoral length and femoral width) on these distances were analysed. Results: Analysis of 206 knee magnetic resonance images revealed that the closet locations of popliteal vessels were at the posteromedial aspect of the femur. The d-H and d-V were 7.38 ± 3.22 mm and 57.01 ± 11.14 mm, respectively, and were both shorter in women than in men (p < 0.001). Multivariate analysis identified thigh circumference and femoral length as the most influential factors for the d-H and d-V, respectively (p < 0.001). Linear regression demonstrated a strong positive linear correlation between the thigh circumference and the d-H and between the femoral length and the d-V (Pearson’s r = 0.891 and 0.806, respectively (p < 0.001)). Conclusions: The closet location and distance of the popliteal vessels to the femur provide useful information for wire placement during distal femoral fracture surgery while minimising the risk of vascular injury. Given that patients with a smaller thigh circumference and a shorter femoral length are more likely to have a smaller d-H and a shorter d-V, respectively, cautious measures should be taken in such cases.
Collapse
|
16
|
Chen CW, Tseng YH, Wong MY, Wu CM, Lin BS, Huang YK. Stasis Leg Ulcers: Venous System Revises by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging. Diagnostics (Basel) 2020; 10:E707. [PMID: 32957628 DOI: 10.3390/diagnostics10090707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 01/06/2023] Open
Abstract
Objectives: The distribution of venous pathology in stasis leg ulcers is unclear. The main reason for this uncertainty is the lack of objective diagnostic tools. To fill this gap, we assessed the effectiveness of triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) in determining the venous status of patients with stasis leg ulcers. Methods: This prospective observational study included the data of 23 patients with stasis leg ulcers who underwent TRANCE-MRI between April 2017 and May 2020; the data were retrospectively analyzed. TRANCE MRI utilizes differences in vascular signal intensity during the cardiac cycle for subsequent image subtraction, providing not only a venogram but also an arteriogram without the use of contrast agents or radiation. Results: TRANCE MRI revealed that the stasis leg ulcers of nine of the 23 patients could be attributed to valvular insufficiency and venous occlusion (including deep venous thrombosis [DVT], May–Thurner syndrome, and other external compression). Moreover, TRANCE MRI demonstrated no venous pathology in five patients (21.7%). We analyzed TRANCE MRI hemodynamic parameters, namely stroke volume, forward flow volume, backward flow volume, regurgitant fraction, absolute volume, mean flux, stroke distance, and mean velocity, in the external iliac vein, femoral vein, popliteal vein, and great saphenous vein (GSV) in three of the patients with valvular insufficiency and three of those with venous occlusion. We found that the mean velocity and stroke volume in the GSV was higher than that in the popliteal vein in all patients with venous valvular insufficiency. Conclusions: Stasis leg ulcers may have no underlying venous disease and could be confirmed by TRANCE-MRI. TRANCE MRI has good Interrater reliability between Duplex study in greater saphenous venous insufficiency. It also potentially surpasses existing diagnostic modalities in terms of distinguishable hemodynamic figures. Accordingly, TRANCE-MRI is a safe and useful tool for examining stasis leg ulcers and is extensively applied currently.
Collapse
|
17
|
Lin BS, Chen CW, Zhou SK, Tseng YH, Wang SC, Huang YK. Evaluation of static ulcer on lower extremities using wireless wearable near-infrared spectroscopy device: Effect of deep venous thrombosis on TRiggered Angiography Non-Contrast-Enhanced sequence magnetic resonance imaging. Phlebology 2020; 35:814-823. [PMID: 32700650 DOI: 10.1177/0268355520935739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Venous leg ulcers, or static leg ulcers, are chronic wounds associated with ambulatory venous hypertension of the lower extremities as a consequence of venous valve reflux, reduce venous capacitance, poor calf venous pump, heart failure, or in conjunction with venous obstruction. A static ulcer with venous thrombosis in a pelvic or thigh vein responds favorably to anticoagulation agents. However, anticoagulation is less effective and even harmful when ambulatory venous hypertension has another cause such as venous reflux, poorly heart function, and poor calf venous pump. METHOD TRiggered Angiography Non-Contrast-Enhanced (TRANCE) magnetic resonance imaging (MRI) exploits differences in vascular signal intensity during the cardiac cycle for subsequent image subtraction, providing detailed radiation-free venograms without the use of contrast agents. The method is a new tool for evaluating the presence of thrombosis in the venous systems. TRANCE-MRI was employed to document the existence of venous thrombosis within the eight patients in this study. Subsequently, we used a wireless wearable near-infrared spectroscopy device to compare deep vein thrombosis-associated and non-deep vein thrombosis-associated static ulcers. The sampling depths were 5 and 10 mm, representing the dermis and subcutaneous tissue, respectively. RESULT There are four patients with venous leg ulcers proven with venous thrombosis by TRANCE-MRI and are classified as deep vein thrombosis group. Compared with the non-deep vein thrombosis group, the deep vein thrombosis group had less deoxyhemoglobin, less total hemoglobin, and a significantly lower H2O signal in the 5-mm sampling depth (dermis level). And eight health participants were included as control group. Wounded patients (including deep vein thrombosis and non-deep vein thrombosis patients) have higher H2O concentration on the 5-mm depth sampling than control group. In the 10-mm sampling depth (subcutaneous level), the deoxyhemoglobin and tissue oxygen saturation of the deep vein thrombosis group were lower than those of the non-deep vein thrombosis group, and the H2O concentration was higher than non-deep vein thrombosis group. Patients with static foot ulcers and deep vein thrombosis had similar oxyhemoglobin, deoxyhemoglobin, total hemoglobin, and tissue oxygen saturation than did those without deep vein thrombosis in 5-mm depth sampling (dermis level). Notably, the H2O signal of patients with non-deep vein thrombosis-associated static ulcers was higher for the 5-mm sampling depth. CONCLUSION In patients with static ulcers and deep vein thrombosis, the H2O level may be higher in the 10-mm sampling depth, indicating that those patients had more subcutaneous water. In patients with non-deep vein thrombosis static foot ulcer, the near-infrared spectroscopy (NIRS) indicated worse fluid retention in the dermis level. The H2O value in the NIRS may be different owing to underline the cause of the venous leg ulcers.
Collapse
Affiliation(s)
- Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, and Wound Center, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan.,Institute of Medicine, Chung Shan Medical University, Taichung
| | - Shao-Kui Zhou
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
| | - Shih-Chung Wang
- Department of Diagnostic Radiology, and Wound Center, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
| |
Collapse
|
18
|
Chen CW, Tseng YH, Lin CC, Kao CC, Wong MY, Lin BS, Huang YK. Novel Diagnostic Options without Contrast Media or Radiation: Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging in Treating Different Leg Venous Diseases. Diagnostics (Basel) 2020; 10:E355. [PMID: 32485855 DOI: 10.3390/diagnostics10060355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Venous diseases in the lower extremities long lacked an objective diagnostic tool prior to the advent of the triggered angiography non-contrast-enhanced (TRANCE) technique. METHODS An observational study with retrospective data analysis. MATERIALS Between April 2017 and June 2019, 66 patients were evaluated for venous diseases through TRANCE-magnetic resonance imaging (MRI) and were grouped according to whether they had occlusive venous (OV) disease, a static venous ulcer (SU), or symptomatic varicose veins (VV). The clinical appliance of TRANCE-MRI was analysed by groups. RESULTS In total, 63 patients completed the study. TRANCE-MRI could identify venous thrombosis, including that of the abdominal and pelvic vessels, and it enabled the timely treatment of underlying diseases in patients with OV disease. TRANCE-MRI was statistically compared with the duplex scan, the gold standard to exclude deep vein thrombosis (DVT) in the legs, with regard to their abilities to detect venous thrombosis by using Cohen's kappa coefficient at a compatible value of 0.711. It could provide the occlusion degree of the peripheral artery for treating an SU. Finally, TRANCE-MRI can be used to outline all collateral veins and occult thrombi before treating symptomatic or recurrent VV to ensure a perfect surgical plan and to avoid complications. CONCLUSIONS TRANCE-MRI is an innovative tool in the treatment of versatile venous pathology in the lower extremities and is widely used for vascular diseases in our institution.
Collapse
|