Measurement of skeletal muscle perfusion during postischemic reactive hyperemia using contrast-enhanced MRI with a step-input function

The regional distribution of skeletal muscle blood flow was measured during postischemic reactive hyperemia using Gd-DTPA contrast-enhanced (CE) MRI. The release of an occlusive thigh cuff was used to deliver a step-input of contrast concentration that was coincident with the onset of reactive hyperemia. A first-order tracer kinetic equation was used to estimate the unidirectional influx constant, K_i (ml/100 g/min), and the distribution volume of Gd-DTPA in the tissue, v_e, from T₁-weighted images acquired with saturation recovery (SR) steady-state free precession (SSFP) and spoiled gradient-echo (SPGR) protocols. The capillary permeability surface (PS) area increased significantly during reactive hyperemia, which facilitated rapid extraction of Gd-DTPA during the first pass. Regional muscle group studies from 11 normal volunteers yielded blood flow (K_i) values of 108.3 ± 34.1 ml/100 g/min in the gastrocnemius, 184.3 ± 41.3 ml/100 g/min in the soleus, and 122.4 ± 34.4 ml/100 g/min in the tibialis anterior. The distribution volumes (v_e) in the corresponding muscle groups were respectively 8.3% ± 2.1%, 9.3% ± 1.9%, and 7.9% ± 1.8% from the kinetic model, and 8.8% ± 2.4%, 9.1% ± 1.9%, and 7.2% ± 1.4% from tissue relaxometry studies. Bulk blood flow studies in the same volunteers using phase-contrast velocimetry (popliteal artery) yielded significantly lower flow values, but with a correlation coefficient R ₂ = 0.62 and P = 0.004.