Magnetic resonance imaging-based monitoring of collateral artery development in patients with intermittent claudication during supervised exercise therapy

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Presentation transcript:

Magnetic resonance imaging-based monitoring of collateral artery development in patients with intermittent claudication during supervised exercise therapy Bas Versluis, MD, Tim Leiner, MD, PhD, Patty J. Nelemans, MD, PhD, Joachim E. Wildberger, MD, PhD, Geert-Willem Schurink, MD, PhD, Walter H. Backes, PhD Journal of Vascular Surgery Volume 58, Issue 5, Pages 1236-1243 (November 2013) DOI: 10.1016/j.jvs.2012.11.136 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 Overview of the study and magnetic resonance imaging (MRI) measurements. MRI was performed first, followed by ankle brachial index (ABI) measurements and treadmill tests during each visit of the patient. During the MRI examination, a first-pass contrast-enhanced magnetic resonance angiography (CE-MRA) was performed of the entire muscular volume of the upper leg. CE-MRA was followed by quantitative cine phase-contrast imaging (PCI) to measure the arterial peak flow (APF) at rest and after provoking reactive hyperemia by a cuff paradigm. Journal of Vascular Surgery 2013 58, 1236-1243DOI: (10.1016/j.jvs.2012.11.136) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 Example of the counting procedure of the arteries in the upper leg using first-pass contrast-enhanced magnetic resonance angiography (CE-MRA) data set. Arteries are marked in the right panel by the gray dots. Fifteen arteries were counted in this axial view. Journal of Vascular Surgery 2013 58, 1236-1243DOI: (10.1016/j.jvs.2012.11.136) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Example of a maximum intensity projection of contrast-enhanced magnetic resonance angiography (CE-MRA) (upper panels) and the arterial flow wave form (lower panels) of a responder to supervised exercise therapy (SET) (pain free walking distance increased from 100 to 333 m after 6 months of SET). The arterial obstruction in the superficial femoral artery (SFA) is indicated by the white arrow. The three white lines demarcate the three axial planes where arteries were counted. The white dotted lines represent the location of the arterial peak flow (APF) measurement. No vascular morphologic or APF (black arrows) changes were seen after 6 months of SET. Journal of Vascular Surgery 2013 58, 1236-1243DOI: (10.1016/j.jvs.2012.11.136) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 Progression of arterial lesions (left, white arrow) in the right leg of a patient with intermittent claudication. At the level of the popliteal artery, a new stenosis has developed (right, small white arrows) compared with the baseline magnetic resonance angiography (MRA) (left). Journal of Vascular Surgery 2013 58, 1236-1243DOI: (10.1016/j.jvs.2012.11.136) Copyright © 2013 Society for Vascular Surgery Terms and Conditions