Dynamic Contrast-Enhanced MRI Assessment of Hyperemic Fractional Microvascular Blood Plasma Volume in Peripheral Arterial Disease: Initial Findings

OBJECTIVES: The aim of the current study was to describe a method that assesses the hyperemic microvascular blood plasma volume of the calf musculature. The reversibly albumin binding contrast agent gadofosveset was used in dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) to assess the microvascular status in patients with peripheral arterial disease (PAD) and healthy controls. In addition, the reproducibility of this method in healthy controls was determined. MATERIALS AND METHODS: Ten PAD patients with intermittent claudication and 10 healthy control subjects were included. Patients underwent contrast-enhanced MR angiography of the peripheral arteries, followed by one DCE MRI examination of the musculature of the calf. Healthy control subjects were examined twice on different days to determine normative values and the interreader and interscan reproducibility of the technique. The MRI protocol comprised dynamic imaging of contrast agent wash-in under reactive hyperemia conditions of the calf musculature. Using pharmacokinetic modeling the hyperemic fractional microvascular blood plasma volume (V(p), unit: %) of the anterior tibial, gastrocnemius and soleus muscles was calculated. RESULTS: V(p) was significantly lower for all muscle groups in PAD patients (4.3±1.6%, 5.0±3.3% and 6.1±3.6% for anterior tibial, gastrocnemius and soleus muscles, respectively) compared to healthy control subjects (9.1±2.0%, 8.9±1.9% and 9.3±2.1%). Differences in V(p) between muscle groups were not significant. The coefficient of variation of V(p) varied from 10-14% and 11-16% at interscan and interreader level, respectively. CONCLUSIONS: Using DCE MRI after contrast-enhanced MR angiography with gadofosveset enables reproducible assessment of hyperemic fractional microvascular blood plasma volume of the calf musculature. V(p) was lower in PAD patients than in healthy controls, which reflects a promising functional (hemodynamic) biomarker for the microvascular impairment of macrovascular lesions

MRI of Arterial Flow Reserve in Patients with Intermittent Claudication: Feasibility and Initial Experience

Objectives: The aim of this work was to develop a MRI method to determine arterial flow reserve in patients with intermittent claudication and to investigate whether this method can discriminate between patients and healthy control subjects. Methods: Ten consecutive patients with intermittent claudication and 10 healthy control subjects were included. All subjects underwent vector cardiography triggered quantitative 2D cine MR phase-contrast imaging to obtain flow waveforms of the popliteal artery at rest and during reactive hyperemia. Resting flow, maximum hyperemic flow and absolute flow reserve were determined and compared between the two groups by two independent MRI readers. Also, interreader reproducibility of flow measures was reported. Results: Resting flow was lower in patients compared to controls (4.961.6 and 11.163.2 mL/s in patients and controls, respectively (p,0.01)). Maximum hyperemic flow was 7.362.9 and 16.463.2 mL/s (p,0.01) and the absolute flow reserve was 2.461.6 and 5.361.3 mL/s (p,0.01), respectively in patients and controls. The interreader coefficient of variation was below 10 % for all measures in both patients and controls. Conclusions: Quantitative 2D MR cine phase-contrast imaging is a promising method to determine flow reserve measures in patients with peripheral arterial disease and can be helpful to discriminate patients with intermittent claudication fro

Towards a Dutch hybrid quantum/HPC infrastructure

Quantum Inspire has taken important steps to enable quantum applications by developing a setting that allows the execution of hybrid algorithms. Currently, the setting uses a classical server (HPC node) co-located with the quantum computer for the high frequency coupling needed by hybrid algorithms. A fast task manager (dispatcher) has been developed to orchestrate the interaction between the server and the quantum computer. Although successful, the setting imposes a specific hybrid job-structure. This is most likely always going to be the case and we are currently discussing how to make sure this does not hamper the uptake of the setting. Furthermore, first steps have been taken towards the integration with the Dutch National High-Performance Computing (HPC) Center, hosted by SURF. As a first approach we have setup a setting consisting of two SLURM clusters, one in the HPC (C1) and the second (C2) co-located with Quantum Inspire API. Jobs are submitted from C1 to C2. Quantum Inspire can then schedule with C2 the jobs to the quantum computer. With this setting, we enable control from both SURF and Quantum Inspire on the jobs being executed. By using C1 for the jobs submission we remove the accounting burden from Quantum Inspire. By having C2 co-located with Quantum Inspire API, we make the setting more resilient towards network failures. This setting can be extended for other HPC centers to submit jobs to Quantum Inspire backends.Comment: 6 pages, 3 figure

Magnetic resonance imaging-based monitoring of collateral artery development in patients with intermittent claudication during supervised exercise therapy

ObjectiveThe purpose of the current study was to determine whether supervised exercise therapy (SET) leads to measurable vascular adaptations in patients with intermittent claudication using contrast-enhanced magnetic resonance angiography and flow measurements.MethodsTen patients with clinical symptoms of intermittent claudication and proven obstructive arterial lesions of the superficial femoral artery were included and underwent SET for a period of 6 months. At baseline, all patients underwent a treadmill test to assess pain free walking distance, ankle brachial index measurement, and magnetic resonance imaging to determine the number of arteries in the upper leg using contrast-enhanced magnetic resonance angiography and arterial peak flow in the popliteal artery using cine phase contrast angiography. All examinations were repeated after 3 and 6 months of SET, respectively, to evaluate vascular responses relative to baseline.ResultsAfter 6 months of SET, mean pain free walking distance (395 ± 46 m) was improved by 71% compared with baseline (230 ± 42 m; P < .01). No statistically significant changes were found for mean values of ankle brachial index (81 ± 4 and 77 ± 4, respectively, at baseline and after 6 months of SET), number of arteries at the level of the arterial lesion (18 ± 2 and 19 ± 2, respectively) nor arterial peak flow (5.3 ± 0.6 and 5.3 ± 0.8 mL/s, respectively).ConclusionsSET in patients with intermittent claudication results in an increase in pain free walking distance, whereas with magnetic resonance imaging no macrovascular adaptations in terms of additional collateral artery formation or flow increases could be observed

MR Angiography of Collateral Arteries in a Hind Limb Ischemia Model: Comparison between Blood Pool Agent Gadomer and Small Contrast Agent Gd-DTPA

The objective of this study was to compare the blood pool agent Gadomer with a small contrast agent for the visualization of ultra-small, collateral arteries (diameter0.10). Inter-observer variation was 24% and 18% for Gadomer and Gd-DTPA, respectively. In conclusion, blood pool agent Gadomer improved vessel conspicuity compared to Gd-DTPA. Steady-state MRA can be considered as an excellent non-invasive alternative to intra-arterial XRA for the visualization of ultra-small collateral arteries

MR Angiography of Collateral Arteries in a Hind Limb Ischemia Model: Comparison between Blood Pool Agent Gadomer and Small Contrast Agent Gd-DTPA

The objective of this study was to compare the blood pool agent Gadomer with a small contrast agent for the visualization of ultra-small, collateral arteries (diameter<1 mm) with high resolution steady-state MR angiography (SS-MRA) in a rabbit hind limb ischemia model. Ten rabbits underwent unilateral femoral artery ligation. On days 14 and 21, high resolution SS-MRA (voxel size 0.49×0.49×0.50 mm(3)) was performed on a 3 Tesla clinical system after administration of either Gadomer (dose: 0.10 mmol/kg) or a small contrast agent (gadopentetate dimeglumine (Gd-DTPA), dose: 0.20 mmol/kg). All animals received both contrast agents on separate days. Selective intra-arterial x-ray angiograms (XRAs) were obtained in the ligated limb as a reference. The number of collaterals was counted by two independent observers. Image quality was evaluated with the contrast-to-noise ratio (CNR) in the femoral artery and collateral arteries. CNR for Gadomer was higher in both the femoral artery (Gadomer: 73±5 (mean ± SE); Gd-DTPA: 40±3; p<0.01) and collateral arteries (Gadomer: 18±4; Gd-DTPA: 9±1; p = 0.04). Neither day of acquisition nor contrast agent used influenced the number of identified collateral arteries (p = 0.30 and p = 0.14, respectively). An average of 4.5±1.0 (day 14, mean ± SD) and 5.3±1.2 (day 21) collaterals was found, which was comparable to XRA (5.6±1.7, averaged over days 14 and 21; p>0.10). Inter-observer variation was 24% and 18% for Gadomer and Gd-DTPA, respectively. In conclusion, blood pool agent Gadomer improved vessel conspicuity compared to Gd-DTPA. Steady-state MRA can be considered as an excellent non-invasive alternative to intra-arterial XRA for the visualization of ultra-small collateral arteries

Equilibrium-phase high spatial resolution contrast-enhanced MR angiography at 1.5T in preoperative imaging for perforator flap breast reconstruction

OBJECTIVES: The aim was (i) to evaluate the accuracy of equilibrium-phase high spatial resolution (EP) contrast-enhanced magnetic resonance angiography (CE-MRA) at 1.5T using a blood pool contrast agent for the preoperative evaluation of deep inferior epigastric artery perforator branches (DIEP), and (ii) to compare image quality with conventional first-pass CE-MRA. METHODS: Twenty-three consecutive patients were included. All patients underwent preoperative CE-MRA to determine quality and location of DIEP. First-pass imaging after a single bolus injection of 10 mL gadofosveset trisodium was followed by EP imaging. MRA data were compared to intra-operative findings, which served as the reference standard. RESULTS: There was 100% agreement between EP CE-MRA and surgical findings in identifying the single best perforator branch. All EP acquisitions were of diagnostic quality, whereas in 10 patients the quality of the first-pass acquisition was qualified as non-diagnostic. Both signal- and contrast-to-noise ratios were significantly higher for EP imaging in comparison with first-pass acquisitions (p<0.01). CONCLUSIONS: EP CE-MRA of DIEP in the preoperative evaluation of patients undergoing a breast reconstruction procedure is highly accurate in identifying the single best perforator branch at 1.5Tesla (T). Besides accuracy, image quality of EP imaging proved superior to conventional first-pass CE-MRA