Relation of Magnetic Resonance Imaging Based Arterial Signal Enhancement to Markers of Peripheral Artery Disease

Abstract

Peripheral artery disease (PAD) is associated with impaired lower extremity function. We hypothesized that contrast-enhanced magnetic resonance imaging (CE-MRI) based arterial signal enhancement (SE) measures are associated with markers of PAD. A total of 66 participants were enrolled, 10 were excluded due to incomplete data, resulting in 56 participants for the final analyses (36 PAD, 20 matched controls). MR imaging was performed postreactive hyperemia using bilateral thigh blood-pressure cuffs. First pass-perfusion images were acquired at the mid-calf region with a high-resolution saturation recovery gradient echo pulse sequence, and arterial SE was measured for the lower extremity arteries. As expected, peak walking time (PWT) was reduced in PAD patients compared with controls (282 [248 to 317] sec, vs 353 [346 to 360] sec; p = 0.002), and postexercise ankle brachial index (ABI) decreased in PAD patients but not in controls (PAD: 0.75 ± 0.2, 0.60 [0.5 to 0.7]; p <0.001; vs Controls: 1.17 ± 0.1, 1.19 [1.1 to 1.2]; p = 0.50). Intraclass correlation coefficients were excellent for inter- and intraobserver variability of arterial tracings (n = 10: 0.95 (95%-confidence interval [CI]: 0.94 to 0.96), n = 9: 1.0 (CI: 1.0 to 1.0). Minimum arterial SE was reduced in PAD patients compared with matched controls (128 [110 to 147] A.U. vs 192 [149 to 234] A.U., p = 0.003). Among PAD patients but not in controls the maximum arterial SE was associated with the estimated glomerular filtration rate (eGFR), a marker of renal function (n = 36, ß = 1.37, R² = 0.12, p = 0.025). In conclusion, CE-MRI first-pass arterial perfusion is impaired in PAD patients compared with matched controls and associated with markers of lower extremity ischemia.