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Regional skeletal muscle perfusion distribution in diabetic feet may differentiate short-term healed foot ulcers from non-healed ulcers

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this study was to leverage a magnetic resonance imaging (MRI) approach to characterize foot perfusion distribution in patients with diabetes, with or without foot ulcers, and determine the ability of the regional perfusion measurements to identify ulcer-healing status.

Methods

Three groups of participants (n = 15 / group) were recruited: controls (without diabetes), type II diabetes, and type II diabetes with foot ulcers. All participants underwent MRI evaluating foot perfusion in three muscle layers (from plantar to dorsal) at rest and during a standardized toe-flexion exercise. The exercise perfusion and perfusion reserve values were analyzed around and away from ulcers. Participants with foot ulcers were followed up 3 months after the MRI exams to determine the foot healing status.

Results

Foot plantar muscle perfusion reserves were progressively lower from controls to diabetes, and to diabetes with foot ulcers (e.g., 2.58 ± 0.67, 1.48 ± 0.71, 1.12 ± 0.35, p < 0.001). In controls, the plantar layer had significantly higher perfusion reserve than the dorsal layer, whereas in either diabetes group, there was no significant difference in perfusion reserve among muscle layers. Using the ratio of total exercise perfusion around ulcers to that away from ulcers, the sensitivity and specificity to differentiate healing from non-healed ulcers were 100% and 86%, respectively.

Conclusions

Our study reveals significantly different foot perfusion distribution among controls, diabetes, and diabetes with foot ulcers. The prognostic value of MRI regional perfusion assessments has the potential to monitor interventions to improve ulcer healing outcomes.

Key Points

• Contrast-free MRI permits quantitative assessment of regional foot muscle perfusion at rest and during isometric exercise.

• Patients with diabetes and foot ulcers, without clinical evidence of peripheral arterial disease, had significantly impaired foot muscle perfusion and perfusion reserve.

• Regional foot perfusion distribution may be used to predict the short-term healing status of foot ulcers in diabetes.

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Data Availability

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

ABI:

Ankle-brachial index

AUC:

Area under the ROC Curve

DFU:

Diabetic foot ulcer

DM:

Diabetes mellitus

MRI:

Magnetic resonance imaging

PAD:

Peripheral arterial disease

ROC:

Receiver operating characteristic

SMBF:

Skeletal muscle blood flow

TBI:

Toe-brachial index

TcPO2 :

Transcutaneous oximetry

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Acknowledgements

The authors would like to thank Christopher Sorensen, Darrah Snozek, Katherine Love, and Dakkota Thies for recruiting the study participants.

Funding

This study was supported in part by National Institutes of Health (NIH) research grants R21 AR065672 and R01DK105322.

Author information

Authors and Affiliations

  1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Room 3114, St. Louis, MO, USA

    Jie Zheng, Ran Li & Erin E. Dickey

  2. Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Yan Yan & Mohamed A. Zayed

  3. Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA

    Jennifer A. Zellers & Mary K. Hastings

Authors
  1. Jie Zheng
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  2. Ran Li
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  3. Erin E. Dickey
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  4. Yan Yan
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  7. Mary K. Hastings
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Corresponding author

Correspondence to Jie Zheng.

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Guarantor

The scientific guarantors of this publication are Professor Jie Zheng and Professor Mary K. Hastings.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Professor Yan Yan has significant statistical expertise and provided all statistical analysis results.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• Observational

• Performed at one institution

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Zheng, J., Li, R., Dickey, E.E. et al. Regional skeletal muscle perfusion distribution in diabetic feet may differentiate short-term healed foot ulcers from non-healed ulcers. Eur Radiol 33, 3303–3311 (2023). https://doi.org/10.1007/s00330-023-09405-6

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  • DOI: https://doi.org/10.1007/s00330-023-09405-6

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