Foot Perfusion Measurements in Diabetic Patients with Pedal Ulcers Using Multimodal MRI
Author(s)
Edwards, Scott J.
Advisor(s)
Reiter, David A.
Editor(s)
Collections
Supplementary to:
Permanent Link
Abstract
Hyperglycemia, a hallmark of uncontrolled type-2 diabetes mellitus (T2DM), is
associated with several microvascular complications such as calcification of blood vessels,
peripheral neuropathy, and slowed wound healing. In many cases, patients with T2DM will
develop unresolved wounds on their feet called diabetic foot ulcers (DFUs), which are
thought to occur in response to impaired microvascular function starving wound sites of
critical nutrients and oxygen. The goal of this thesis is to examine the feasibility of using
perfusion MRI to determine differences in perfusion in the feet of three age and body mass
index matched groups: diabetic patients with foot ulcers (DFU, N=10), diabetic patients
without DFUs and with controlled glycemia (DP, N=5) and healthy controls (HC, N=5). This
thesis describes a pipeline to analyze the resting microvascular properties, characterized
using intra-voxel incoherent motion imaging, and microvascular reactivity, characterized
using blood-oxygenation level dependent imaging during a reactive hyperemia cuff-
occlusion challenge, in feet with and without DFUs. We find that the DFU patients showed
greater resting microvascular volume fraction (MVF) than DP patients (Hedge’s g MVF, MP =
1.46; g MVF, LP = 1.33), suggesting a hyperperfusion at rest. Additionally, the DFU patients
also showed a greater ischemic reaction (g Min. Isch, LP = 1.50), and a blunted reperfusion
reaction (g peak rep., MP = 2.37, g peak rep., LP = 1.22) compared to the DP during the cuff-occlusion
challenge, suggesting a lowered ability for microvascular reactivity and arteriovenous
shunting within the capillary beds. These findings suggest that parameters derived from
multimodal MRI show a complimentary picture of underlying microvasculature dysfunction in
patients with DFUs.
Sponsor
Date
2023-05-02
Extent
Resource Type
Text
Resource Subtype
Thesis