Dataset Information

Evaluation of foot hypoperfusion and estimation of percutaneous transluminal angioplasty outcome in patients with critical limb ischemia using intravoxel incoherent motion microperfusion MRI.

ABSTRACT:

Objectives

To emerge hypoperfusion of lower limbs in patients with critical limb ischemia (CLI) using Intravoxel Incoherent Motion microperfusion magnetic resonance imaging (IVIM-MRI). Moreover to examine the ability of IVIM-MRI to differentiate patients with severe peripheral arterial disease (PAD) from normal subjects and evaluate the percutaneous transluminal angioplasty (PTA) results in patients with CLI.

Methods

Eight patients who presented with CLI and six healthy volunteers were examined. The patients underwent IVIM-MRI of lower extremity before and following PTA. The imaging protocol included sagittal diffusion-weighted (DW) sequences. DW images were analyzed and color parametric maps of the micro-circulation of blood inside the capillary network (D*) were constructed. The studies were evaluated by two observers to define interobserver reproducibility.

Results

Technical success was achieved in all patients (8/8). The mean ankle-brachial index increased from 0.35 ± 0.2 to 0.76 ± 0.25 (p < 0.05). Successful revascularization improved IVIM microperfusion. Mean D* increased from 279.88 ± 13.47 10^-5 mm²/s to 331.51 ± 31 10^-5 mm²/s, following PTA, p < 0.05. Moreover, PAD patients presented lower D* values as compared to healthy individuals (279.88 ± 13.47 10^-5 mm²/s vs 332.47 ± 22.95 10^-5 mm²/s, p < 0.05, respectively). Good interobserver agreement was obtained with an ICC = 0.84 (95% CI 0.64-0.93).

Conclusions

IVIM-MRI can detect differences in microperfusion between patients with PAD and healthy individuals. Moreover, significant restitution of IVIM microperfusion is found following successful PTA.

Advances in knowledge

IVIM-MRI is a safe, reproducible and effective modality for evaluation of lower limb hypoperfusion in patients with PAD. It seems also to be a helpful tool to detect changes of tissue perfusion in patients with CLI following revascularization.

SUBMITTER: Galanakis N

PROVIDER: S-EPMC9327774 | biostudies-literature | 2021 Sep

REPOSITORIES: biostudies-literature

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Publications

Evaluation of foot hypoperfusion and estimation of percutaneous transluminal angioplasty outcome in patients with critical limb ischemia using intravoxel incoherent motion microperfusion MRI.

Galanakis Nikolaos N Maris Thomas G TG Kalaitzakis Georgios G Kontopodis Nikolaos N Matthaiou Nikolas N Charalambous Stavros S Tsetis Konstantinos K Ioannou Christos V CV Karantanas Apostolos A Tsetis Dimitrios D

The British journal of radiology 20210708 1125

<h4>Objectives</h4>To emerge hypoperfusion of lower limbs in patients with critical limb ischemia (CLI) using Intravoxel Incoherent Motion microperfusion magnetic resonance imaging (IVIM-MRI). Moreover to examine the ability of IVIM-MRI to differentiate patients with severe peripheral arterial disease (PAD) from normal subjects and evaluate the percutaneous transluminal angioplasty (PTA) results in patients with CLI.<h4>Methods</h4>Eight patients who presented with CLI and six healthy volunteers ...[more]

PMID: 34233490

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Project description:IntroductionThe intravoxel incoherent motion (IVIM) model of diffusion weighted imaging (DWI) provides imaging biomarkers for breast tumor characterization. It has been extensively applied for both diagnostic and prognostic goals in breast cancer, with increasing evidence supporting its clinical relevance. However, variable performance exists in literature owing to the heterogeneity in datasets and quantification methods.MethodsThis work used retrospective anonymized breast MRI data (302 patients) from three sites employing three different software utilizing least-squares segmented algorithms and Bayesian fit to estimate 1st order radiomics of IVIM parameters perfusion fraction (fp ), pseudo-diffusion (Dp ) and tissue diffusivity (Dt ). Pearson correlation (r) coefficients between software pairs were computed while logistic regression model was implemented to test malignancy detection and assess robustness of the IVIM metrics.ResultsDt and fp maps generated from different software showed consistency across platforms while Dp maps were variable. The average correlation between the three software pairs at three different sites for 1st order radiomics of IVIM parameters were Dtmin/Dtmax/Dtmean/Dtvariance/Dtskew/Dtkurt: 0.791/0.891/0.98/0.815/0.697/0.584; fpmax/fpmean/fpvariance/fpskew/fpkurt: 0.615/0.871/0.679/0.541/0.433; Dpmax/Dpmean/Dpvariance/Dpskew/Dpkurt: 0.616/0.56/0.587/0.454/0.51. Correlation between least-squares algorithms were the highest. Dtmean showed highest area under the ROC curve (AUC) with 0.85 and lowest coefficient of variation (CV) with 0.18% for benign and malignant differentiation using logistic regression. Dt metrics were highly diagnostic as well as consistent along with fp metrics.DiscussionMultiple 1st order radiomic features of Dt and fp obtained from a heterogeneous multi-site breast lesion dataset showed strong software robustness and/or diagnostic utility, supporting their potential consideration in controlled prospective clinical trials.

Project description:BackgroundVertebral artery stenosis (narrowing of the vertebral artery) is an important cause of posterior circulation ischaemic stroke. Medical treatment (MT) e.g. controlling risk-factors and drug treatment, surgery, and endovascular treatment (ET) are the prevailing treatment strategies for symptomatic vertebral artery stenosis. ET consist s of percutaneous transluminal angioplasty (balloon catheter through the skin), with or without stenting. However, optimal management of people with symptomatic vertebral artery stenosis has not yet been established.ObjectivesTo assess the safety and efficacy of percutaneous transluminal angioplasty, with or without stenting, combined with MT, compared to MT alone, in people with episodes of cerebral ischaemia due to vertebral artery stenosis.Search methodsWe searched the Cochrane Stroke Group, MEDLINE, Embase, BIOSIS, and two other indexes in Web of Science, China Biological Medicine Database, Chinese Science and Technique Journals Database, China National Knowledge Infrastructure and Wanfang Data, as well as ClinicalTrials.gov trials register and the World Health Organization (WHO) International Clinical Trials Registry Platform to 23 July 2021.Selection criteriaWe included all randomised controlled trials (RCTs) that compared ET plus MT with MT alone in treating people aged 18 years or over with symptomatic vertebral artery stenosis. We included all types of ET modalities (e.g. angioplasty alone, balloon-mounted stenting, and angioplasty followed by placement of a self-expanding stent). MT included risk factor control, antiplatelet therapy, lipid-lowering therapy, and individualised management for people with hypertension or diabetes.Data collection and analysisTwo review authors independently screened potentially eligible studies, extracted data, and assessed trial quality and risk of bias. We applied the GRADE approach to assess the certainty of evidence. The primary outcomes were 30-day post-randomisation death/stroke (short-term outcome) and fatal/non-fatal stroke after 30 days post-randomisation to completion of follow-up (long-term outcome). MAIN RESULTS: We included three RCTs with 349 participants with symptomatic vertebral artery stenosis with a mean age of 64.4 years. The included RCTs were at low risk of bias overall. However, all included studies had a high risk of performance bias because blinding of the ET was not feasible. There was no significant difference in 30-day post-randomisation deaths/strokes between ET plus MT and MT alone (risk ratio (RR) 2.33, 95% confidence interval (CI) 0.77 to 7.07; 3 studies, 349 participants; low-certainty evidence). There were no significant differences between ET plus MT and MT alone in fatal/non-fatal strokes in the territory of the treated vertebral artery stenosis after 30 days post-randomisation to completion of follow-up (RR 0.51, 95% CI 0.26 to 1.01; 3 studies, 349 participants; moderate-certainty evidence), ischaemic or haemorrhagic stroke during the entire follow-up period (RR 0.77, 95% CI 0.44 to 1.32; 3 studies, 349 participants; moderate-certainty evidence), death during the entire follow-up period (RR 0.78, 95% CI 0.37 to 1.62; 3 studies, 349 participants; low-certainty evidence), and stroke or transient ischaemic attack (TIA) during the entire follow-up period (RR 0.65, 95% CI 0.39 to 1.06; 2 studies, 234 participants; moderate-certainty evidence).Authors' conclusionsThis Cochrane Review provides low- to moderate-certainty evidence indicating that there are no significant differences in either short- or long-term risks of stroke, death, or TIA between people with symptomatic vertebral artery stenosis treated with ET plus MT and those treated with MT alone.

Dataset Information

Evaluation of foot hypoperfusion and estimation of percutaneous transluminal angioplasty outcome in patients with critical limb ischemia using intravoxel incoherent motion microperfusion MRI.

Objectives

Methods

Results

Conclusions

Advances in knowledge

Publications

Evaluation of foot hypoperfusion and estimation of percutaneous transluminal angioplasty outcome in patients with critical limb ischemia using intravoxel incoherent motion microperfusion MRI.

Similar Datasets

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