Authors |
Edwards SJ, Yao J, Schechter MC, Fayfman M, Santamarina G, Feiweier T, Blanco G, Alvarez J, Risk BB, Rajani R, Reiter DA
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Submitted By |
Submitted Externally on 8/28/2023 |
Status |
Published |
Journal |
Journal of magnetic resonance imaging : JMRI, References |
Year |
2023 |
Date Published |
8/1/2023 |
Volume : Pages |
Not Specified : Not Specified |
PubMed Reference |
37596872 |
Abstract |
Patients with type-2 diabetes (T2DM) are at increased risk of developing diabetic foot ulcers (DFU) and experiencing impaired wound healing related to underlying microvascular disease., To evaluate the sensitivity of intra-voxel incoherent motion (IVIM) and blood oxygen level dependent (BOLD) MRI to microvascular changes in patients with DFUs., Case-control., 20 volunteers who were age and body mass index matched, including T2DM patients with DFUs (N?=?10, mean age?=?57.5?years), T2DM patients with controlled glycemia and without DFUs (DC, N?=?5, mean age?=?57.4?years) and healthy controls (HC, N?=?5, mean age?=?52.8?years)., 3T/multi-b-value IVIM and dynamic BOLD., Resting IVIM parameters were obtained using a multi-b-value diffusion-weighted imaging sequence and two IVIM models were fit to obtain diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and microvascular volume fraction (MVF) parameters. Microvascular reactivity was evaluated by inducing an ischemic state in the foot with a blood pressure cuff during dynamic BOLD imaging. Perfusion indices were assessed in two regions of the foot: the medial plantar (MP) and lateral plantar (LP) regions., Effect sizes of group mean differences were assessed using Hedge's g adjusted for small sample sizes., DFU participants exhibited elevated D*, f, and MVF values in both regions (g?=?1.10) and increased D (g?=?1.07) in the MP region compared to DC participants. DC participants showed reduced f and MVF compared to HC participants in the MP region (g?=?1.06). Finally, the DFU group showed reduced tolerance for ischemia in the LP region (g?=?-1.51) and blunted reperfusion response in both regions (g?-2.32) compared to the DC group during the cuff-occlusion challenge., The combined use of IVIM and BOLD MRI shows promise in differentiating perfusion abnormalities in the feet of diabetic patients and suggests hyperperfusion in DFU patients., 1 TECHNICAL EFFICACY: Stage 1.
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