Stasis Leg Ulcers: Venous System Revises by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging.

Chien-Wei Chen,Bor-Shyh Lin,Chao-Ming Wu,Yao-Kuang Huang,Min Yi Wong,Yuan-Hsi Tseng

doi:10.3390/diagnostics10090707

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.

Highlights

Stasis leg ulcers are chronic wounds that are characterized by an irregular with well-defined borders are typically located in the distal calf and perimalleolar
Stasisshape leg ulcers are chronic wounds that are characterized by an region
Primary leg ulcers are caused by previous ambulatory venous hypertension of the lower venous valvular reflux, right-sided heart failure, poor lymph drainage, and deep vein thrombosis

Summary

Introduction

Stasis leg ulcers (or venous leg ulcers, formally) are chronic wounds that are characterized by an irregular with well-defined borders are typically located in the distal calf and perimalleolarStasisshape leg ulcers (or venous leg ulcers,and formally) are chronic wounds that are characterized by an region (“gaiter” area).The wounds are usually limited to the subcutaneous plane; irregular shape with well-defined borders and are typically located in the distal calf and perimalleolar secondary infection deep soft tissue.By contrast, leg woundsplane; due to arterialsecondary occlusive region area).canThedestroy wounds are usually limited to the subcutaneous disease are characterized by rapid progression with a high incidence of limb loss [1,2,3].infection can destroy deep soft tissue. Stasis leg ulcers (or venous leg ulcers, formally) are chronic wounds that are characterized by an irregular with well-defined borders are typically located in the distal calf and perimalleolar. Leg wounds due to arterial occlusive disease are Stasis legby ulcers areprogression caused by previous ambulatory characterized rapid with a high incidencevenous of limbhypertension loss [1,2,3]. Primary leg ulcers are caused by previous ambulatory venous hypertension of the lower venous valvular reflux, right-sided heart failure, poor lymph drainage, and deep vein thrombosis. Stasis leg venous valvular reflux,valve right-sided heartor failure, poor lymph drainage, and deep vein thrombosis ulcers are associated with venous occlusion in the pelvic veins, which is not detected by (DVT) with multilevel valve reflux alone or concomitant with venous outflow obstruction.

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Methods

Conclusion