+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Dynamic contrast-enhanced ultrasound and transient arterial occlusion for quantification of arterial perfusion reserve in peripheral arterial disease



Dynamic contrast-enhanced ultrasound and transient arterial occlusion for quantification of arterial perfusion reserve in peripheral arterial disease



European Journal of Radiology 81(11): 3332-3338



To quantify muscular micro-perfusion and arterial perfusion reserve in peripheral arterial disease (PAD) with dynamic contrast-enhanced ultrasound (CEUS) and transient arterial occlusion. This study had local institutional review board approval and written informed consent was obtained from all subjects. We examined the dominant lower leg of 40 PAD Fontaine stage IIb patients (mean age, 65 years) and 40 healthy volunteers (mean age, 54 years) with CEUS (7 MHz; MI, 0.28) during continuous intravenous infusion of 4.8 mL microbubbles. Transient arterial occlusion at mid-thigh level simulated physical exercise. With time-CEUS-intensity curves obtained from regions of interest within calf muscles, we derived the maximum CEUS signal after occlusion (max) and its time (tmax), slope to maximum (m), vascular response after occlusion (AUC(post)), and analysed accuracy, receiver operating characteristic (ROC) curves, and correlations with ankle-brachial index (ABI) and walking distance. All parameters differed in PAD and volunteers (p<0.014). In PAD, tmax was delayed (31.2±13.6 vs. 16.7±8.5 s, p<0.0001) and negatively correlated with ankle-brachial-index (r=-0.65). m was decreased in PAD (4.3±4.6 mL/s vs. 13.1±8.4 mL/s, p<0.0001) and had highest diagnostic accuracy (sensitivity/specificity, 75%/93%) for detection of diminished muscular micro-perfusion in PAD (cut-off value, m<5∼mL/s). Discriminant analysis and ROC curves revealed m, and AUC(post) as optimal parameter combination for diagnosing PAD and therefore impaired arterial perfusion reserve. Dynamic CEUS with transient arterial occlusion quantifies muscular micro-perfusion and arterial perfusion reserve. The technique is accurate to diagnose PAD.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 036324308

Download citation: RISBibTeXText

PMID: 22285606

DOI: 10.1016/j.ejrad.2011.12.030


Related references

Comparison of transient arterial occlusion and muscle exercise provocation for assessment of perfusion reserve in skeletal muscle with real-time contrast-enhanced ultrasound. European Journal of Radiology 78(3): 419-424, 2011

Reliability of contrast-enhanced ultrasound for the assessment of muscle perfusion in health and peripheral arterial disease. Ultrasound in Medicine and Biology 41(1): 26-34, 2015

PC100. Contrast Ultrasound Quantification of Exercise-Induced Gastrocnemial Perfusion Deficits in Patients With Peripheral Arterial Disease. Journal of Vascular Surgery 63(6): 182s-183s, 2016

Dynamic contrast-enhanced ultrasound for assessment of skeletal muscle microcirculation in peripheral arterial disease. Investigative Radiology 46(8): 504-508, 2011

Low mechanical index contrast-enhanced ultrasound better reflects high arterial perfusion of liver metastases than arterial phase computed tomography. Investigative Radiology 39(4): 216-222, 2004

Peripheral flow response to transient arterial forearm occlusion does not reflect myocardial perfusion reserve. Circulation 103(8): 1109-1114, 2001

Quantification of renal perfusion: comparison of arterial spin labeling and dynamic contrast-enhanced MRI. Journal of Magnetic Resonance Imaging 34(3): 608-615, 2011

Dynamic contrast-enhanced ultrasound for assessment of therapy effects on skeletal muscle microcirculation in peripheral arterial disease: pilot study. European Journal of Radiology 82(4): 640-646, 2013

Arterial spin labeling perfusion cardiovascular magnetic resonance of the calf in peripheral arterial disease: cuff occlusion hyperemia vs exercise. Journal of Cardiovascular Magnetic Resonance 17: 23, 2015

Therapeutic application of contrast-enhanced ultrasound and low-dose urokinase for thrombolysis in a porcine model of acute peripheral arterial occlusion. Journal of Vascular Surgery 62(2): 477-485, 2015

Contrast ultrasound perfusion imaging of lower extremities in peripheral arterial disease: a novel diagnostic method. European Heart Journal 27(3): 310-315, 2005

Limb stress-rest perfusion imaging with contrast ultrasound for the assessment of peripheral arterial disease severity. Jacc. Cardiovascular Imaging 1(3): 343-350, 2008

Assessment and quantification of regional arterial perfusion reserve in patients with peripheral occlusive and small-vessel disease by rubidium 82-positron emission tomography. Vascular Surgery 30(4): 331-336, 1996

Imaging features of gray-scale and contrast-enhanced color Doppler US for the differentiation of transient renal arterial ischemia and arterial infarction. Korean Journal of Radiology 6(3): 179-184, 2005

Preliminary study of contrast-enhanced ultrasound in correlation between muscle perfusion deficits in lower extremity arterial disease and its collateralization. Zhonghua Yi Xue Za Zhi 94(7): 507-509, 2014