500-P: Assessment of MRI Markers of Foot Perfusion and Microvascular Function in People with Diabetic Foot Ulcers (DFU) and Wound Healing

by sugaradmin



Introduction and Objective: Prediction of wound healing in DFU is clinically important to stratify risk of amputation and target limb salvage interventions. Basic and clinical studies show both initiation of ulcers and incomplete wound healing arising from reduced tissue perfusion and ischemia due to macro- and microvascular disease. Current vascular diagnostic modalities in clinical practice are inadequate in predicting wound healing with 16% of patients having unresolved wounds after one year despite normal vascular indicators. Here, we present preliminary results assessing perfusion with advanced quantitative MRI measures in people with DFUs as it relates to wound healing.Methods: This ongoing prospective observational study enrolled 17 people with unhealed plantar forefoot ulcers for at least 30 days. The affected foot was studied using a non-contrast MRI protocol to quantify resting perfusion. Microvascular function was assessed using a dynamic MRI-cuff-occlusion protocol. Study volunteers received standard wound care, and healing was followed prospectively for 12 weeks post-MRI. MRI perfusion markers were compared between healers and non-healers.Results: Ulcers healed within 12 weeks in 47% (n=8) of volunteers. Qualitatively, MRI markers suggest elevated resting perfusion in non-healers compared with healers. Non-healers showed a trend towards reduced tissue oxygen reserve capacity (-6.5% vs -3.2%; p=.06) in the medial plantar compartment and reduced microvascular reactivity (i.e. increased time to peak hyperemia; 171sec vs 101sec; p=.03) compared with healers.Conclusion: Markers of reduced microvascular function show sensitivity to poor wound healing. Combined use of MRI markers for resting perfusion and microvascular function provides additional information on the microvascular involvement in individuals with DFU and could help stratify risk of poor wound healing. Ongoing work is examining their use in combination with clinical and blood markers to prognosticate DFU healing.

Disclosure

D.A. Reiter: None. S. Edwards: None. N. Soleimanmanesh: None. J. Flores: None. N.Y. Chaudhry: None. G. Santamarina: None. M.C. Schechter: None. M. Fayfman: Research Support; Abbott, Dexcom, Inc.

Funding

NIDDK Diabetic Complications Consortium (DK076169 and DK115255); NIH (DK136983)



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