Feasibility of Multiparametric Perfusion Assessment in Diabetic Foot Ulcer Using
Intravoxel Incoherent Motion and Blood Oxygenation-Level Dependent MRI.
Authors Edwards SJ, Yao J, Schechter MC, Fayfman M, Santamarina G, Feiweier T, Blanco G,
Alvarez J, Risk BB, Rajani R, Reiter DA
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?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.