Michael Franz Heinrich Schocke MD, Presenter: Nothing to Disclose

Regina Esterhammer MD, Abstract Co-Author: Nothing to Disclose

Verena Spiss MD, Abstract Co-Author: Nothing to Disclose

Olaf Gorny MD, Abstract Co-Author: Nothing to Disclose

Werner R. Jaschke MD, PhD, Abstract Co-Author: Nothing to Disclose

Gustav Fraedrich MD, Abstract Co-Author: Nothing to Disclose

Andreas Greiner, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

Patients with peripheral arterial disease (PAD) suffer from intermittent claudicatio (IC), resulting in a limited walking distance and life quality. However, a substantial portion of PAD patients is also afflicted by degenerative disorders of musculo-skeletal system that also impairs the mobility, but does not affect the mucle function. Therefore, the purpose of this study was to investigate the phosphocreatine (PCr) kinetics in the exercising calf muscle of PAD patients with a walking distance below 100m.

45 PAD patients (LaFontaine II, age 67.6 ± 6.8 years) with a walking distance below 100m, showing atherosclerotic lesions in magnetic resonance angiography (MRA) and a ankle-brachial pressure index below 0.9 during clinical routine, underwent phosphor-31 MR spectroscopy (31P MRS). Serial 31P MRS measurements using a free induction sequence with a time resolution were performed separately in each leg during incremental calf exercise at 2, 3, 4 and 5 W. The time constants of PCr changes during exercise and recovery were calculated by using a mono-exponential model. Furthermore, the run-off score were determined for each leg with the help of the MRAs.

All patients stopped the exercise during the first increment at 2 W. Progressive PCr breakdowns (PB) were observed in 39 legs, while plateau phases of PCr hydrolysis (PP) were detected in 51 legs. However, the legs with PB did not show significantly increased run-off scores in MRA compared to the legs with PP (both median 11, p = 0.876). The legs with PP exhibited additionally degenerative disorders at the spine (28/51), at the hip (22/51), at the knee (21/51) as well as myositis (5/51).

The management of PAD patients, also suffering from degenerative disorders of the musculo-skeletal system is difficult. The cause for the IC symptoms is often not clear and hard to attribute one of both atherosclerosis or arthrosis. However, PAD patients showing PB of PCr during exercise in 31P MRS suffer from ischemia and need therefore a revascularization therapy.

31P MRS during exercise helps to visualize relevant ischemia in PAD patients.

Schocke, M, Esterhammer, R, Spiss, V, Gorny, O, Jaschke, W, Fraedrich, G, Greiner, A, et al, 0, Different Patterns of PCr Kinetics in Patients with Severe Intermittent Claudication Detected by Dynamic Phosphor-31 Magnetic Resonance Spectroscopy.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8014613.html