Abstract

ObjectivesThe 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.MethodsTen 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.ResultsResting 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.ConclusionsQuantitative 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.

Highlights

  • The hemodynamic significance of obstructive arterial lesions in peripheral arterial disease (PAD) can be assessed by blood flow velocity measurements [1,2,3,4,5]

  • In patients with intermittent claudication - stage II PAD according to the Fontaine classification - blood flow at rest might be near-normal depending on the severity of the obstructive lesion, or recover quickly to nearnormal values after exercise due to collateral artery formation [6,7,8,9,10,11,12,13]

  • contrast-enhanced MR angiograpy (CE-MRA) CE-MRA revealed significant stenosis (.50%) of the superficial femoral artery (SFA) in 6 out of 10 patients, whereas long occlusions of the SFA were found in the remaining patients

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Summary

Introduction

The hemodynamic significance of obstructive arterial lesions in peripheral arterial disease (PAD) can be assessed by blood flow velocity measurements [1,2,3,4,5]. In patients with intermittent claudication - stage II PAD according to the Fontaine classification - blood flow at rest might be near-normal depending on the severity of the obstructive lesion, or recover quickly to nearnormal values after exercise due to collateral artery formation [6,7,8,9,10,11,12,13]. These (near-)normal resting flow values explain the absence of clinical symptoms at rest in intermittent claudication. Arterial flow reserve correlates well with subjective severity of symptoms in intermittent claudication and is less hampered by day-to-day variations than resting flow [14]

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