title: Noncontrast MRA of pedal arteries in type II diabetes: effect of disease load on vessel visibility.
abstract: OBJECTIVE
  Noncontrast magnetic resonance angiography (NC-MRA) of pedal artery remains challenging because of the global and regional disease load, tissue integrity, and altered microcirculation. This study aims to investigate the feasibility of the NC-MRA of pedal arteries with flow-sensitive dephasing-prepared steady-state free precession (FSD-SSFP) and to explore the effect of disease load of type II diabetes on the vessel depiction.
  
  
  METHODS
  FSD-SSFP was performed on a 1.5-T magnetic resonance system before the contrast-enhanced MRA (CE-MRA) as a reference standard in 39 consecutive diabetic subjects (29 men and 16 women, aged 57.9 ± 11.4 years). Two experienced radiologists evaluated the overall artery visibility (VA) and the contamination from soft tissue (SC) and veins (VC) with a four-point scale. Chronic complications and measures including random blood glucose (RBG), lipid panel, body mass index, risk of diabetic foot ulcers (RDF), and glycated hemoglobin (HbA1c) by the imaging were recorded as disease load indicators. Spearman rank correlation and ordinal regression were performed to investigate the effect of disease load on the depiction of pedal arteries.
  
  
  RESULTS
  The measurement of RBG and RDF were significantly correlated with the VC in CE-MRA and with the overall visibility of pedal arteries in NC-MRA (P < .025 and P < .001, respectively). Blood pressure was the only parameter that was significantly associated with SC in NC-MRA with FSD-SSFP (P < .025). For CE-MRA the effect of RDF on the overall VA manifested a significant linear trend (P < .001), and the level of RBG was substantially associated with the VC (P < .025) without significantly impacting VA and SC. Hypertension only correlated with SC in NC-MRA. VA was found independent of the presence of diabetic nephropathy, coronary artery disease, abnormal lipid panel, HbA1c (75.0%), or optimized m1 value that ranged from 70 to 160 mT⋅ms(2)/m (mean, 125 ± 18 mT⋅ms(2)/m) in this study.
  
  
  CONCLUSIONS
  FSD-SSFP proved to be a useful modality of NC-MRA for pedal artery imaging in diabetic patients. The vessel depiction is subject to the local and systemic disease load of type II diabetes. Technical optimization of the flow-sensitive dephasing gradient moment and properly choosing candidate would help augment the potential of this technique in patient care of peripheral artery disease.
authors.affiliation: Department of BME, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China 518036; Beijing Center for Mathematics and Information Interdisciplinary Sciences, Beijing, China.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of BME, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China 518036; Beijing Center for Mathematics and Information Interdisciplinary Sciences, Beijing, China. Electronic address: xin.liu@siat.ac.cn.
authors.forename: Xin
authors.initials: X
authors.lastname: Liu
authors.affiliation: Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Zhaoyang
authors.initials: Z
authors.lastname: Fan
authors.affiliation: Department of BME, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China 518036.
authors.forename: Na
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Department of BME, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China 518036.
authors.forename: Yiu-Cho
authors.initials: YC
authors.lastname: Chung
authors.affiliation: Department of BME, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China 518036.
authors.forename: Weiqi
authors.initials: W
authors.lastname: Liao
authors.affiliation: Department of BME, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China 518036; Beijing Center for Mathematics and Information Interdisciplinary Sciences, Beijing, China.
authors.forename: Hairong
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Debiao
authors.initials: D
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D005528:Foot / Q000098:blood supply* / Q000473:pathology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012720:Severity of Illness Index
keywords: Peripheral arterial disease; imaging and diagnostic testing; magnetic resonance angiography; noncontrast