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Updated: Jul 4, 2026
Near-Infrared Spectroscopy During Reactive Hyperemia for the Assessment of Lower Limb Vascular Function
Published on: March 22, 2024
Foot dynamic contrast-enhanced MRI for assessing microcirculatory changes after endovascular therapy in peripheral
Keqian Zhou1, Cong Chen2, Sha Du1
1Department of Vascular Surgery, Huadong Hospital, Fudan University, Shanghai, China.
Background:
Peripheral artery disease (PAD) impairs foot perfusion, whereas successful restoration of macroscopic arterial patency does not necessarily indicate normalization of distal foot microcirculation.
Objective:
To evaluate the feasibility, interobserver reproducibility, and postprocedural responsiveness of foot dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with extended Tofts modeling for assessing distal foot microcirculatory changes after technically successful endovascular therapy (EVT) in symptomatic PAD.
Methods:
In this prospective single-center pilot study, symptomatic PAD patients who underwent technically successful EVT and completed paired pre- and post-EVT foot DCE-MRI were included. Baseline clinical characteristics and ankle-brachial index (ABI) were collected. DCE-MRI pharmacokinetic parameters, including Ktrans, Kep, and Ve, were quantified in predefined foot soft-tissue regions of interest (ROIs). Interobserver reproducibility was assessed using intraclass correlation coefficients (ICCs). Pre- and post-EVT values were compared using paired t-tests or Wilcoxon signed-rank tests according to normality. Exploratory associations between DCE-MRI parameters and ABI were assessed using Spearman correlation. Sensitivity analysis was performed after excluding patients with chronic limb-threatening ischemia (CLTI) and ulceration.
Results:
Fourteen patients were included in the final paired analysis. ABI improved post-EVT (0.48 [interquartile range (IQR) 0.37-0.58] vs. 0.69 [IQR 0.56-0.76], p = 0.004). In the treated limb, Ktrans increased significantly post-EVT (0.0102 [IQR 0.0078-0.0121] vs. 0.0224 [IQR 0.0186-0.0263] min-1, p = 0.001), whereas Kep and Ve did not. No significant treatment-related changes were observed in the untreated limb. Ktrans showed exploratory positive associations with ABI pre-EVT (ρ = 0.56, p = 0.037) and post-EVT (ρ = 0.66, p = 0.011). In sensitivity analysis excluding the two patients with CLTI and ulceration, Ktrans remained significantly increased post-EVT (0.0100 [IQR 0.0058-0.0112] vs. 0.0200 [IQR 0.0158-0.0244] min-1, p = 0.003).
Conclusions:
Foot DCE-MRI was feasible and reproducible in this pilot PAD cohort. Ktrans showed the most consistent post-EVT increase and may represent a candidate imaging marker of post-EVT microcirculatory change.
