Bisgaard M, Houlind K C, Blankholm A D, Ringgaard S, Christensen J, Precht H
Department of Radiology, Kolding Hospital, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Health Sciences Research Centre, UCL University College, Odense M, Denmark.
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Vascular Surgery, Kolding Hospital, Kolding, Denmark.
Radiography (Lond). 2024 Jul;30(4):1116-1124. doi: 10.1016/j.radi.2024.05.007. Epub 2024 May 25.
Information on tissue perfusion in the foot is important when treating patients with chronic limb-threatening ischemia. This study aims to test the reliability of different magnetic resonance sequences when measuring perfusion in the foot.
Sixteen healthy volunteers had their right foot scanned in a test/retest study with six different magnetic resonance sequences (BOLD, multi-echo gradient echo (mGRE), 2D and 3D pCASL, PASL FAIR, and DWI with intravoxel incoherent motion (IVIM) with quantitative measurements of perfusion. For five sequences, cuff-induced ischemia followed by a hyperactive response was measured. Images of the feet were segmented into angiosomes and perfusion data were extracted from the five angiosomes.
BOLD, PASL FAIR, mGRE, and DWI with IVIM had low mean differences between the first and second scans, while the results of 2D and 3D pCASL had the highest differences. Based on a paired t-test, BOLD, and FAIR were able to distinguish between perfusion and no perfusion in all angiosomes with p-values below 0.01. This was not the case with 2D and 3D pCASL with p-values above 0.05 in all angiosomes. The mGRE could not distinguish between perfusion and no perfusion in the lateral side of the foot.
BOLD, mGRE, pASL FAIR, and DWI with IVIM seem to give more robust results compared to 2D and 3D pCASL. Further studies on patients with peripheral artery disease should explore if the sequences can have clinical relevance when assessing tissue ischemia and results of revascularization.
This study provides knowledge that could be used to improve the diagnosis of patient with chronic limb-threatening ischemia to explore tissue perfusion.
在治疗慢性肢体威胁性缺血患者时，足部组织灌注信息非常重要。本研究旨在测试不同磁共振序列在测量足部灌注时的可靠性。
16名健康志愿者参与了一项重测研究，对其右脚进行扫描，采用六种不同的磁共振序列（血氧水平依赖性功能磁共振成像（BOLD）、多回波梯度回波（mGRE）、二维和三维动脉自旋标记（2D和3D pCASL）、相位对比动脉自旋标记法（PASL FAIR）以及体素内不相干运动扩散加权成像（DWI-IVIM））进行灌注定量测量。对于其中五种序列，测量了袖带诱导的缺血及随后的高活性反应。将足部图像分割为血管体，并从五个血管体中提取灌注数据。
BOLD、PASL FAIR、mGRE和DWI-IVIM在首次扫描和第二次扫描之间的平均差异较低，而2D和3D pCASL的差异最大。基于配对t检验，BOLD和FAIR能够在所有血管体中区分灌注和无灌注，p值均低于0.01。而2D和3D pCASL在所有血管体中的p值均高于0.05，无法区分灌注和无灌注。mGRE无法区分足部外侧的灌注和无灌注情况。
与2D和3D pCASL相比，BOLD、mGRE、pASL FAIR和DWI-IVIM似乎能给出更可靠的结果。对于外周动脉疾病患者的进一步研究应探讨这些序列在评估组织缺血和血管重建结果时是否具有临床相关性。
本研究提供的知识可用于改善慢性肢体威胁性缺血患者的诊断，以探索组织灌注情况。
