RESEARCH ARTICLE

Use of Blood Oxygenation Level-Dependent MRI to Predict Clinical Outcomes After Endovascular Revascularization in Peripheral Artery Disease

Shiteng Suo,

Shiteng Suo

orcid.org/0000-0003-2528-2836

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Hui Tang,

Hui Tang

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Mengqiu Cao,

Mengqiu Cao

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Qihong Ni,

Qihong Ni

Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Jianxun Qu,

Jianxun Qu

GE Healthcare China, Shanghai, China

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Jianrong Xu,

Jianrong Xu

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Bo Li,

Bo Li

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Lan Zhang,

Corresponding Author

Lan Zhang

[email protected]

Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

Correspondence:

Lan Zhang ([email protected])

Qing Lu ([email protected])

Yan Zhou ([email protected]; [email protected])

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Qing Lu,

Corresponding Author

Qing Lu

[email protected]

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

Correspondence:

Lan Zhang ([email protected])

Qing Lu ([email protected])

Yan Zhou ([email protected]; [email protected])

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Yan Zhou,

Corresponding Author

Yan Zhou

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

Correspondence:

Lan Zhang ([email protected])

Qing Lu ([email protected])

Yan Zhou ([email protected]; [email protected])

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Shiteng Suo,

Shiteng Suo

orcid.org/0000-0003-2528-2836

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Hui Tang,

Hui Tang

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Mengqiu Cao,

Mengqiu Cao

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Qihong Ni,

Qihong Ni

Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Jianxun Qu,

Jianxun Qu

GE Healthcare China, Shanghai, China

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Jianrong Xu,

Jianrong Xu

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Bo Li,

Bo Li

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

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Lan Zhang,

Corresponding Author

Lan Zhang

[email protected]

Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

Correspondence:

Lan Zhang ([email protected])

Qing Lu ([email protected])

Yan Zhou ([email protected]; [email protected])

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Qing Lu,

Corresponding Author

Qing Lu

[email protected]

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

Correspondence:

Lan Zhang ([email protected])

Qing Lu ([email protected])

Yan Zhou ([email protected]; [email protected])

Search for more papers by this author

Yan Zhou,

Corresponding Author

Yan Zhou

Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

Correspondence:

Lan Zhang ([email protected])

Qing Lu ([email protected])

Yan Zhou ([email protected]; [email protected])

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First published: 09 July 2025

https://doi.org/10.1002/jmri.70038

Funding: This study was funded in part by Natural Science Foundation of Shanghai (24ZR1445300) and Renji Hospital (IIT-2024-0068).

Shiteng Suo and Hui Tang contributed equally to this work.

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ABSTRACT

Background

Blood oxygenation level-dependent (BOLD) MRI can noninvasively quantify lower extremity perfusion in peripheral artery disease (PAD) patients. However, its ability to reflect perfusion change in response to lower extremity revascularization (LER) and its prognostic value for clinical outcomes are not fully understood.

Purpose

To evaluate BOLD MRI response to LER and its predictive value for major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in PAD patients.

Study Type

Prospective.

Population

Forty-one patients (median age, 73 years; 29 men) undergoing LER for symptomatic PAD.

Field Strength/Sequence

3.0 T/BOLD MRI with a multi-echo gradient-recalled echo sequence.

Assessment

Pre- and post-LER BOLD MRI was performed under an ischemia-hyperemia paradigm. Normalized T2* time course curves were generated in each of 5 calf muscle compartments (anterior, lateral, deep posterior, soleus, and gastrocnemius) and times to peak (TTP), minimum/maximum values, and gradients during hyperemia (Grad) analyzed. Follow-up was every 6–12 months via hospital records and telephone interviews for MACE and MALE outcomes. Model 1 (clinical factors) and Model 2 (+BOLD MRI) were compared.

Statistical Tests

Chi-square test or Fisher's exact test, Student's t-test or Wilcoxon rank-sum test, area under the receiver operating characteristic curve (AUC), Kaplan–Meier survival analysis, and Cox proportional hazards regression analysis. Significance was set at p < 0.05.

Results

During a median 38-month follow-up, 9 patients experienced MACE and 20 experienced MALE. Successful LER improved TTP and Grad in all muscle compartments. Grad change (ΔGrad_sol) and post-LER TTP (TTP_sol) in the soleus muscle achieved the highest AUC values of 0.92 and 0.80 in predicting MACE and MALE, respectively. In multivariable Cox regression analysis, ΔGrad_sol and TTP_sol were independent predictors of MACE (hazard ratio [HR] per standard deviation [SD] increase, 0.23) and MALE (HR per SD increase, 1.62), respectively. BOLD MRI added incremental prognostic value to clinical factors, increasing C-index by 0.06 for MACE and 0.05 for MALE.

Data Conclusion

BOLD MRI showed perfusion changes in skeletal muscles following revascularization and provided incremental prognostic value in PAD patients.

Evidence Level

Technical Efficacy

Stage 4.

Supporting Information

References

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Use of Blood Oxygenation Level-Dependent MRI to Predict Clinical Outcomes After Endovascular Revascularization in Peripheral Artery Disease

ABSTRACT

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Evidence Level

Technical Efficacy

Supporting Information

References

References

Information

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Use of Blood Oxygenation Level-Dependent MRI to Predict Clinical Outcomes After Endovascular Revascularization in Peripheral Artery Disease

ABSTRACT

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Evidence Level

Technical Efficacy

Supporting Information

References

References

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