Comparison of transient arterial occlusion and muscle exercise provocation for assessment of perfusion reserve in skeletal muscle with real-time contrast-enhanced ultrasound

作者：Krix Martin^*; Krakowski Roosen Holger; Armarteifio Erick; Fuerstenberger Susanne; Delorme Stefan; Kauczor Hans Ulrich; Weber Marc Andre

来源：European Journal of Radiology, 2011, 78(3): 419-424.

DOI：10.1016/j.ejrad.2009.11.014

• Skeletal muscle perfusion
• Real-time contrast-enhanced ultrasound
• Transient arterial occlusion
• Perfusion reserve

Objective: Contrast-enhanced ultrasound (CEUS) is able to quantify muscle perfusion and changes in perfusion due to muscle exercise in real-time. However, reliable measurement of standardized muscle exercise is difficult to perform in clinical examinations. We compared perfusion reserve assessed by CEUS after transient arterial occlusion and exercise to find the most suitable measurement for clinical application.
Methods: Contrast pulse sequencing (7 MHz) during continuous IV infusion of SonoVue (R) (4.8 mL/300 s) was used in 8 healthy volunteers to monitor muscle perfusion of the gastrocnemius muscle during transient (1 min) arterial occlusion produced by a thigh cuff of a venous occlusion plethysmograph. Isometric muscle exercise (50% of individual maximum strength for 20 s) was subsequently performed during the same examination, and several CEUS parameters obtained from ultrasound-signal-intensity-time curves and its calculation errors were compared.
Results: The mean maximum local blood volume after occlusion was 13.9 [similar to mL] (range, 4.5-28.8 [similar to mL]), and similar values were measured after sub-maximum exercise 13.8 [similar to mL], (range, 4.6-22.2 [similar to mL]. The areas under the curve during reperfusion vs. recovery were also similar (515.2 +/- 257.5 compared to 482.2 +/- 187.5 [similar to mLs]) with a strong correlation (r = 0.65), as were the times tomaximum(15.3 s vs. 15.9 s), with a significantly smaller variation for the occlusion method (+/- 2.1 s vs.+/- 9.0 s, p = 0.03). The mean errors for all calculated CEUS parameters were lower for the occlusion method than for the exercise test.
Conclusions: CEUS muscle perfusion measurements can be easily performed after transient arterial occlusion. It delivers data which are comparable to CEUS measurements after muscle exercise but with a higher robustness. This method can be easily applied in clinical examination of patients with e. g. PAOD or diabetic microvessel diseases to assess perfusion reserve.

• 出版日期2011-6