David C. Isbell, Frederick H. Epstein, Xiaodong Zhong, Joseph M. DiMaria, Stuart S. Berr, Craig H. Meyer, Walter J. Rogers, Nancy L. Harthun, Klaus D. Hagspiel, Arthur Weltman, Christopher M. Kramer,
Journal of Magnetic Resonance Imaging. 2007 May; 25(5): 1013–1020.

To develop a contrast-enhanced magnetic resonance (MR) technique to measure skeletal muscle perfusion in peripheral arterial disease (PAD).
Materials and Methods
A total of 11 patients (age = 61 ± 11 years) with moderate symptomatic PAD (ankle-brachial index [ABI] = 0.75 ± 0.08) and 22 normals were studied using an MR-compatible ergometer. PAD and normalmax (Nlmax; N = 11) exercised to exhaustion. Nllow (N = 11) exercised to the same workload achieved by PAD. At peak exercise, 0.1 mm/kg of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) was infused at 3–4 cm3/second followed by a saline flush at the same rate. A dual-contrast gradient echo (GRE) sequence enabled simultaneous acquisition of muscle perfusion and arterial input function (AIF). The perfusion index (PI) was defined as the slope of the time-intensity curve (TIC) in muscle divided by the arterial TIC slope.
Median workload was 120 Joules in PAD, 210 Joules in Nllow, and 698 Joules in Nlmax (P < 0.001 vs. Nllow and PAD). Median PI was 0.29 in PAD (25th and 75th percentiles [%] = 0.20, 0.40), 0.48 in Nllow (25th, 75th % = 0.36, 0.62; P < 0.02 vs. PAD), and 0.69 in Nlmax (25th, 75th % = 0.5, 0.77; P < 0.001 vs. PAD). Area under the ROC-curve for PI differentiating patients from Nlmax was 0.95 (95% confidence interval [CI] = 0.77–0.99).
Peak-exercise measurement of lower limb perfusion with dual-contrast, first-pass MR distinguishes PAD from normals. This method may be useful in the study of novel therapies for PAD.

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