Feasibility of Multiparametric Perfusion Assessment in Diabetic Foot Ulcer Using Intravoxel Incoherent Motion and Blood Oxygenation‐Level Dependent MRI
Scott J. Edwards, Jingting Yao, Marcos C. Schechter, Maya Fayfman, Gabriel Santamarina, Thorsten Feiweier, Gerardo Blanco, Jessica Alvarez, Benjamin B. Risk, Ravi Rajani, David A. Reiter - Radiology, Nuclear Medicine and imaging
Background
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.
Purpose
To evaluate the sensitivity of intra‐voxel incoherent motion (IVIM) and blood oxygen level dependent (BOLD) MRI to microvascular changes in patients with DFUs.
Study Type
Case–control.
Population
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).
Field strength/Sequence
3T/multi‐b‐value IVIM and dynamic BOLD.
Assessment
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.
Statistical Tests
Effect sizes of group mean differences were assessed using Hedge's g adjusted for small sample sizes.
Results
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.
Data Conclusion
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.
Level of Evidence
1
Technical Efficacy
Stage 1