Arterial spin labeling perfusion cardiovascular magnetic resonance of the calf in peripheral arterial disease: Cuff occlusion hyperemia vs exercise

David Lopez, Amy W. Pollak, Craig H. Meyer, Frederick H. Epstein, Li Zhao, Arthur J. Pesch, Ronny Jiji, Jennifer R. Kay, Joseph M. DiMaria, John M. Christopher, Christopher M. Kramer

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: Assessment of calf muscle perfusion requires a physiological challenge. Exercise and cuff-occlusion hyperemia are commonly used methods, but it has been unclear if one is superior to the other. We hypothesized that post-occlusion calf muscle perfusion (Cuff) with pulsed arterial spin labeling (PASL) cardiovascular magnetic resonance (CMR) at 3 Tesla (T) would yield greater perfusion and improved reproducibility compared to exercise hyperemia in studies of peripheral arterial disease (PAD). Methods: Exercise and Cuff cohorts were independently recruited. PAD patients had an ankle brachial index (ABI) between 0.4-0.9. Controls (NL) had no risk factors and ABI 0.9-1.4. Subjects exercised until exhaustion (15 NL-Ex, 15 PAD-Ex) or had a thigh cuff inflated for 5 minutes (12 NL-Cuff, 11 PAD-Cuff). Peak exercise and average cuff (Cuffmean) perfusion were compared. Six participants underwent both cuff and exercise testing. Reproducibility was tested in 8 Cuff subjects (5 NL, 3 PAD). Results: Controls had greater perfusion than PAD independent of stressor (NL-Ex 74 ± 21 vs. PAD-Ex 43 ± 10, p = 0.01; NL-Cuffmean 109 ± 39 vs. PAD-Cuffmean 34 ± 17 ml/min-100 g, p < 0.001). However, there was no difference between exercise and Cuffmean perfusion within groups (p > 0.6). Results were similar when the same subjects had the 2 stressors performed. Cuffmean had superior reproducibility (Cuffmean ICC 0.98 vs. Exercise ICC 0.87) and area under the receiver operating characteristic curve (Cuffmean 0.992 vs. Exercise 0.905). Conclusions: Cuff hyperemia differentiates PAD patients from controls, as does exercise stress. Cuffmean and exercise calf perfusion values are similar. Cuff occlusion hyperemia has superior reproducibility and thus may be the preferred stressor.

Original languageEnglish (US)
Article number23
JournalJournal of Cardiovascular Magnetic Resonance
Issue number1
StatePublished - Feb 22 2015


  • Arterial spin labeling
  • Cardiovascular magnetic resonance
  • Cuff occlusion hyperemia
  • Perfusion
  • Peripheral arterial disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Family Practice
  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


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