Perfusion dynamics assessment with Power Doppler ultrasound in skeletal muscle during maximal and submaximal cycling exercise
Assessment of limitations in the perfusion dynamics of skeletal muscle may provide insight in the pathophysiology of exercise intolerance in, e.g., heart failure patients. Power doppler ultrasound (PDUS) has been recognized as a sensitive tool for the detection of muscle blood flow. In this volunteer study (N = 30), a method is demonstrated for perfusion measurements in the vastus lateralis muscle, with PDUS, during standardized cycling exercise protocols, and the test–retest reliability has been investigated.
Fixation of the ultrasound probe on the upper leg allowed for continuous PDUS measurements. Cycling exercise protocols included a submaximal and an incremental exercise to maximal power. The relative perfused area (RPA) was determined as a measure of perfusion. Absolute and relative reliability of RPA amplitude and kinetic parameters during exercise (onset, slope, maximum value) and recovery (overshoot, decay time constants) were investigated.
A RPA increase during exercise followed by a signal recovery was measured in all volunteers. Amplitudes and kinetic parameters during exercise and recovery showed poor to good relative reliability (ICC ranging from 0.2–0.8), and poor to moderate absolute reliability (coefficient of variation (CV) range 18–60%).
A method has been demonstrated which allows for continuous (Power Doppler) ultrasonography and assessment of perfusion dynamics in skeletal muscle during exercise. The reliability of the RPA amplitudes and kinetics ranges from poor to good, while the reliability of the RPA increase in submaximal cycling (ICC = 0.8, CV = 18%) is promising for non-invasive clinical assessment of the muscle perfusion response to daily exercise.
KeywordsPower Doppler ultrasound Perfusion Exercise Skeletal muscle Test–retest reliability Probe fixation
Cardiopulmonary exercise test
Coefficient of variation
Mean response time
Power Doppler ultrasound
Pulse repetition frequency
Region of interest
Relative perfused area
This study was funded by the European Community’s Seventh Framework Programme (FP7/2007–2013) under Grant Agreement No. 318067.
Author contribution statement
MH, TS, HK, and RL conceived and designed the research. MH and TS conducted experiments and analyzed data. BT contributed to analytical and experimental tools. RL, FV and MR helped supervise the project. MH wrote the manuscript. All authors read and approved the manuscript.
Compliance with ethical standards
Conflict of interest
No conflicts of interest, financial or otherwise, are declared by the authors.
- Krix M, Krakowski-Roosen H, Kauczor HU et al (2009) Real-time contrast-enhanced ultrasound for the assessment of perfusion dynamics in skeletal muscle. Ultrasound Med Biol 35:1587–1595. https://doi.org/10.1016/j.ultrasmedbio.2009.05.006 CrossRefPubMedGoogle Scholar
- Krix M, Krakowski-Roosen H, Armarteifio E et al (2011) Comparison of transient arterial occlusion and muscle exercise provocation for assessment of perfusion reserve in skeletal muscle with real-time contrast-enhanced ultrasound. Eur J Radiol 78:419–424. https://doi.org/10.1016/j.ejrad.2009.11.014 CrossRefPubMedGoogle Scholar
- Raine-Fenning NJ, Nordin NM, Ramnarine KV et al (2008) Determining the relationship between three-dimensional power Doppler data and true blood flow characteristics: an in-vitro flow phantom experiment. Ultrasound Obstet Gynecol 32:540–550. https://doi.org/10.1002/uog.6110 CrossRefPubMedGoogle Scholar
- Spee RF, Niemeijer VM, Wessels B et al (2015) Characterization of exercise limitations by evaluating individual cardiac output patterns: a prospective cohort study in patients with chronic heart failure. BMC Cardiovasc Disord 15:57. https://doi.org/10.1186/s12872-015-0057-6 CrossRefPubMedPubMedCentralGoogle Scholar
- Thomas KN, Cotter JD, Lucas SJE et al (2015) Reliability of contrast-enhanced ultrasound for the assessment of muscle perfusion in health and peripheral arterial disease. Ultrasound Med Biol 41:26–34. https://doi.org/10.1016/j.ultrasmedbio.2014.06.012 CrossRefPubMedGoogle Scholar