A Novel Tool for a Challenging Disease: Stasis Leg Ulcers Assessed Using QFlow in Triggered Angiography Noncontrast Enhanced Magnetic Resonance Imaging.

Chien-Wei Chen,Min-Yi Wong,Yuan-Hsi Tseng,Yao-Kuang Huang,Yueh-Fu Fang,Bor-Shyh Lin,Yin-Chen Hsu,Yu-Hui Lin

doi:10.3390/jpm11090857

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.

Highlights

This study included 33 stasis leg ulcers (SLUs) patients and 14 healthy volunteers, each participant undergoing the triggered angiography noncontrast enhanced (TRANCE) imaging and completing the quantitative flow (QFlow) scanning. These participants were further classified into the reflux group (15 participants with 15 diseased legs) and the nonreflux group (18 participants with 24 wounded legs) according to their TRANCE
TRANCE magnetic resonance imaging (MRI) is a novel appliance for treating SLUs
This study used QFlow in TRANCE MRI to analyze the hemodynamic patterns of SLUs with different causes

Summary

Introduction

Stasis leg ulcers (SLUs), or venous leg ulcers, account for 80% to 90% of all leg ulcers. The wounds usually persist for more than 6 weeks and are mostly limited to the subcutaneous plane [1]. Leg wounds due to arterial diseases are rapidprogression with high risks of amputations [2,3,4]. SLUs are considered as a sequence after ambulatory venous hypertension of the legs. The cause of the venous hypertension ranged from primary venous valvular reflux, congestive heart failure, and poor lymph drainage to deep vein thrombosis (DVT). SLUs are possibly caused by venous occlusion in the pelvic level, which is not demonstrated through other existed diagnostic tools (i.e., ultrasound and computed tomographic venography)

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Discussion

Conclusion