title: Dynamic contrast-enhanced ultrasound for assessment of therapy effects on skeletal muscle microcirculation in peripheral arterial disease: pilot study.
abstract: OBJECTIVE
  To assess with dynamic contrast-enhanced ultrasound (CEUS) and transient arterial occlusion whether the muscular micro-perfusion in patients with peripheral arterial disease (PAD) is improved after angioplasty or surgery.
  
  
  METHODS
  This study had local institutional review board approval. Written informed consent was obtained from all 20 patients with PAD, Fontaine stage IIb (mean age, 64 years), who participated in the study. Low-MI CEUS (7MHz; MI, 0.28) was applied to the mainly affected lower leg after start of a continuous automatic intravenous injection of 4.8mL SonoVue(®). Muscle-perfusion was monitored by CEUS before, during, and after provocation by arterial occlusion at the thigh level lasting for 60s. CEUS examination was performed a second time within 14 days after angioplasty (n=15), thrombendarterectomy (n=2), angioplasty and thrombendarterectomy (n=1), or bypass (n=2). Clinical amelioration was re-evaluated within 6 months after the intervention using a 4-point scale.
  
  
  RESULTS
  Ankle-brachial-index (ABI) increased from 0.8±0.2 to 0.9±0.3 after treatment (p=0.01). Time to maximum CEUS signal (tmax) shortened from 26±14s to 14±4s (p=0.004). The slope to maximum after transient occlusion (m2) changed to steeper values (6.4±5.8∼mL/s versus 10.2±5.0∼mL/s; p=0.04). Shortened tmax predicted improvement in the patients' intermittent leg pain and therefore successful therapy outcome.
  
  
  CONCLUSIONS
  Dynamic CEUS with transient arterial occlusion can visualize the treatment-induced improvement of muscular micro-perfusion in patients with PAD.
authors.affiliation: University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany. erick.amarteifio@med.uni-heidelberg.de
authors.forename: E
authors.initials: E
authors.lastname: Amarteifio
authors.forename: M
authors.initials: M
authors.lastname: Krix
authors.forename: S
authors.initials: S
authors.lastname: Wormsbecher
authors.forename: S
authors.initials: S
authors.lastname: Demirel
authors.forename: S
authors.initials: S
authors.lastname: Braun
authors.forename: S
authors.initials: S
authors.lastname: Delorme
authors.forename: H-U
authors.initials: HU
authors.lastname: Kauczor
authors.forename: D
authors.initials: D
authors.lastname: Böckler
authors.forename: M-A
authors.initials: MA
authors.lastname: Weber
mesh_terms: D000792:Angiography; D017130:Angioplasty; D055109:Ankle Brachial Index; D019540:Area Under Curve; D003287:Contrast Media; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000000981:diagnostic imaging*; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D010743:Phospholipids; D010865:Pilot Projects; D013459:Sulfur Hexafluoride; D017131:Thrombectomy; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride