Stress-rest calf muscle perfusion: a functional diagnostic test for peripheral arterial disease (PAD)

应激-休息小腿肌肉灌注：外周动脉疾病 (PAD) 的功能诊断测试

• 批准号: 9218153
• 负责人: Lei Zhang
• 金额: $ 54.87万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-15 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9218153
• 关键词: Adult; Affect; Age; American; Angiography; Ankle; Arteries; Atherosclerosis; Blood Pressure; Blood Vessels; Cardiac; Clinical; Clinical Management; Coronary Arteriosclerosis; Data; Development; Diagnosis; Diagnostic; Diagnostic tests; Evaluation; Exercise; Exercise Therapy; Fatigue; Gastrocnemius Muscle; Goals; Heterogeneity; Hyperemia; Image; Intermittent Claudication; Leg; MRI Scans; Magnetic Resonance Imaging; Measurable; Measurement; Measures; Muscle; Muscle function; Myocardium; Pain; Pathology; Patients; Pattern; Pelvis; Perfusion; Perfusion Weighted MRI; Peripheral; Peripheral arterial disease; Pilot Projects; Protocols documentation; Quality of life; Questionnaires; Recruitment Activity; Reproducibility; Resolution; Rest; Scanning; Soleus Muscle; Stenosis; Stress; Supervision; Techniques; Testing; Theft; Therapeutic; Therapeutic Intervention; Thigh structure; Time; Vascular blood supply; Walking; anatomic imaging; base; blood perfusion; claudication; cost; exhaustion; experience; image processing; imaging approach; imaging modality; improved; indexing; interest; magnetic therapy; non-invasive imaging; perfusion imaging; standard of care; tool

Peripheral arterial disease (PAD) affects nearly 8 million people and costs >$21B in the U.S. per year. With reduced blood supply to their legs, some patients experience calf pain or fatigue with walking. Although PAD can be reliably detected by a low ankle blood pressure, and anatomic imaging (MRI or CT) of the narrowing arteries, to select the best treatment approach, we need a non-invasive test to assess calf-muscle function. In this project, we propose to use high-resolution magnetic resonance imaging (MRI) to measure blood perfusion in different groups of calf muscle, and repeat the measurement after a low-load and a high-load exercise of calf muscle. This stress-rest imaging approach is standard of care for evaluation of coronary artery disease (CAD), and has never been successfully applied to PAD. Our preliminary results show distinct patterns of muscle perfusion between healthy and PAD patients, and thus great promise of the technique. In this 4-year project, we will first refine the perfusion imaging method, verify its reproducibility, and then compare the calf muscle perfusion measures in PAD patients against healthy age-matched healthy controls. This comparison will test the feasibility of detecting functional abnormality in PAD patients. After the baseline scans, the PAD patients will undergo a 12-week supervised exercise therapy, and then a post-therapy MRI scan. Comparison of the pre- and post-therapy measurement will indicate how the therapy improves the calf-muscle perfusion, and how this perfusion change correlates with increase in patient’s walking ability. The long term goals of this project are to develop an improved diagnostic test for patients with PAD to predict who will benefit from therapeutic intervention. The stress-rest perfusion studies of calf muscle can be performed in conjunction with routine peripheral MRA to assess the functional significance of vascular stenosis. As with the routinely performed cardiac stress imaging methods, improved functional measures of calf perfusion should also prove useful in the testing and development of improved therapeutic approaches.

在美国，外周动脉疾病 (PAD) 影响着近 800 万人，每年造成的费用超过 21B 美元。 尽管 PAD 患者腿部血液供应减少，但一些患者仍会出现小腿疼痛或疲劳。 可以通过低踝血压和狭窄的解剖成像（MRI 或 CT）可靠地检测到 动脉，为了选择最佳的治疗方法，我们需要一种非侵入性测试来评估小腿肌肉功能。 在这个项目中，我们建议使用高分辨率磁共振成像（MRI）来测量血液 不同组小腿肌肉灌注，低负荷和高负荷后重复测量 这种应力休息成像方法是评估冠状动脉的护理标准。 疾病（CAD），但从未成功应用于 PAD，我们的初步结果显示出不同的模式。 健康和 PAD 患者之间的肌肉灌注，因此该技术在这 4 年中前景广阔。 项目中，我们将首先完善灌注成像方法，验证其重现性，然后比较小腿 PAD 患者与健康年龄匹配的健康对照的肌肉灌注测量。 基线扫描后，将测试检测 PAD 患者功能异常的可行性。 患者将接受为期 12 周的监督运动治疗，然后进行治疗后 MRI 扫描比较。 治疗前和治疗后测量结果将表明治疗如何改善小腿肌肉灌注， 以及这种灌注变化如何与患者步行能力的增加相关。 该项目的长期目标是为 PAD 患者开发一种改进的诊断测试，以 可以预测谁将从治疗干预中受益。 与常规外周 MRA 结合进行，以评估血管狭窄的功能意义。 与常规进行的心脏负荷成像方法一样，改善了小腿的功能测量 灌注也应被证明有助于测试和开发改进的治疗方法。