Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA.
Adv Wound Care (New Rochelle). 2023 Nov;12(11):611-625. doi: 10.1089/wound.2022.0161. Epub 2023 May 23.
Peripheral arterial disease (PAD) leads to a significant burden of morbidity and impaired quality of life globally. Diabetes is a significant risk factor accelerating the development of PAD with an associated increase in the risk of chronic wounds, tissue, and limb loss. Various magnetic resonance imaging (MRI) techniques are being increasingly acknowledged as useful methods of accurately assessing PAD. Conventionally utilized MRI techniques for assessing macrovascular disease have included contrast enhanced magnetic resonance angiography (MRA), noncontrast time of flight MRA, and phase contrast MRI, but have significant limitations. In recent years, novel noncontrast MRI methods assessing skeletal muscle perfusion and metabolism such as arterial spin labeling (ASL), blood-oxygen-level dependent (BOLD) imaging, and chemical exchange saturation transfer (CEST) have emerged. Conventional non-MRI (such as ankle-brachial index, arterial duplex ultrasonography, and computed tomographic angiography) and MRI based modalities image the macrovasculature. The underlying mechanisms of PAD that result in clinical manifestations are, however, complex, and imaging modalities that can assess the interaction between impaired blood flow, microvascular tissue perfusion, and muscular metabolism are necessary. Further development and clinical validation of noncontrast MRI methods assessing skeletal muscle perfusion and metabolism, such as ASL, BOLD, CEST, intravoxel incoherent motion microperfusion, and techniques that assess plaque composition, are advancing this field. These modalities can provide useful prognostic data and help in reliable surveillance of outcomes after interventions.
外周动脉疾病（PAD）在全球范围内导致了严重的发病负担和生活质量受损。糖尿病是加速 PAD 发展的一个重要危险因素，同时也增加了慢性伤口、组织和肢体丧失的风险。各种磁共振成像（MRI）技术正被越来越多地认为是准确评估 PAD 的有用方法。传统上用于评估大血管疾病的 MRI 技术包括对比增强磁共振血管造影（MRA）、非对比时间飞跃 MRA 和相位对比 MRI，但存在显著的局限性。近年来，新兴的非对比 MRI 方法评估骨骼肌灌注和代谢，如动脉自旋标记（ASL）、血氧水平依赖（BOLD）成像和化学交换饱和转移（CEST）。传统的非 MRI（如踝臂指数、动脉双功能超声和计算机断层血管造影）和基于 MRI 的方式对大血管进行成像。然而，导致临床表现的 PAD 的潜在机制是复杂的，需要能够评估血流受损、微血管组织灌注和肌肉代谢之间相互作用的成像方式。评估骨骼肌灌注和代谢的非对比 MRI 方法（如 ASL、BOLD、CEST、体素内不相干运动微灌注和评估斑块成分的技术）的进一步发展和临床验证正在推动这一领域的发展。这些方式可以提供有用的预后数据，并有助于在干预后可靠地监测结果。
