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New approach provides better understanding of atherosclerosis in leg arteries
Cardiovascular experts at UVA Health have found a new way to track peripheral artery disease (PAD), a serious condition involving atherosclerosis in the leg arteries that affects more than 200 million people worldwide. The researchers say the approach will greatly benefit efforts to better understand the condition, which reduces blood flow to the limbs, and improve treatment options for patients. The UVA researchers were able to use a new magnetic resonance imaging (MRI) technique at the end of training to understand the effects of PAD on the calves of patients with the disease and to...
New approach provides better understanding of atherosclerosis in leg arteries
Cardiovascular experts at UVA Health have found a new way to track peripheral artery disease (PAD), a serious condition involving atherosclerosis in the leg arteries that affects more than 200 million people worldwide. The researchers say the approach will greatly benefit efforts to better understand the condition, which reduces blood flow to the limbs, and improve treatment options for patients.
The UVA researchers were able to use a new magnetic resonance imaging (MRI) technique at the end of training to understand the effects of PAD on the calves of patients with the disease and distinguish them from normal volunteers. The approach they used, called Chemical Exchange Saturation Transfer (CEST), produced results comparable to the current gold standard, which does not produce an image. They found that CEST offers additional benefits without requiring highly specialized equipment that is not available to many hospitals and researchers.
The beauty of CEST is that it creates an image of energy stores in the muscle that we can match with images of blood flow. This gives us a new understanding of how atherosclerosis in the leg arteries causes problems in the downstream muscles.”
Christopher M. Kramer, MD, researcher and imaging expert, chief of the Division of Cardiovascular Medicine at UVA Health and professor of cardiology and radiology, University of Virginia School of Medicine
Understanding peripheral arterial disease
PAD affects more than 7% of Americans over 40 and more than 29% of those over 70. The disease can cause pain when walking, coldness or numbness in the lower leg, painful cramps in the legs or arms, trouble sleeping, and erectile dysfunction, among other symptoms, although it can also cause no symptoms at all.
Insufficient blood flow to the limbs can make wound healing difficult and, in severe cases, lead to amputation. Existing treatments include medications to improve blood flow and relieve pain; In appropriate cases, doctors may also consider options such as surgery or inserting a stent to open blocked arteries.
The new diagnostic approach identified at UVA will advance efforts to better understand and treat PAD. To see whether CEST would work for this purpose, the research team conducted a clinical trial comparing CEST to the current gold standard approach, phosphorus magnetic resonance spectroscopy. Researchers used CEST to image 35 volunteers with PAD and compared the results with imaging obtained from 29 control subjects after they performed calf exercises in the MRI scanner. They found that CEST was effective in identifying PAD in the lower legs, distinguished patients from normal subjects, and the results compared favorably with phosphorus magnetic resonance spectroscopy.
CEST, they concluded, could offer many benefits to researchers. CEST has better special resolution, produces an image and does not require expensive equipment needed for phosphorus magnetic resonance spectroscopy. This means more centers could benefit from the approach.
CEST can also be combined with other magnetic resonance imaging methods that measure blood flow in the calf to better understand the effects of PAD, the researchers note.
“Combining CEST with the techniques of measuring muscle blood flow using MRI enables an exciting new approach to studying the potential benefit of established and novel therapies in this disease,” Kramer said.
Results published
Kramer and his colleagues published their results in the medical journal Circulation: Cardiovascular Imaging. The team consisted of Helen L. Sporkin, Toral R. Patel, Yaqub Betz, Roshin Mathew, Christopher L. Schumann, Craig H. Meyer and Kramer.
The work was supported by National Institutes of Health grants R01 HL075792, T32 HL007284, and T32 EB003841.
Source:
University of Virginia Health System
Reference:
Sporkin, H.L., et al. (2022) Chemical Exchange Saturation Transfer Magnetic Resonance Imaging Identifies Abnormal Calf Muscle-Specific Energetics in Peripheral Artery Disease. Circulatory cardiovascular imaging. doi.org/10.1161/CIRCIMAGING.121.013869.
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