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Assessment of Skeletal Muscle Perfusion Using Contrast-Enhanced Ultrasonography

German Cancer Research Center, Heidelberg, Germany; and Departments of Radiological Diagnostics and Therapy (M.K., M.-A.W., S.D., H.-U.K.), Immunochemistry (H.K.-R., W.H.), and Neurology (H.B.H.), University of Heidelberg, Heidelberg, Germany.

Address correspondence and reprint requests to Martin Krix, MD, MSc, German Cancer Research Center, INF 280, D-69120 Heidelberg, Germany. E-mail: m.krix{at}dkfz.de

Objective. The purpose of this study was to develop a clinically applicable examination method to assess perfusion of the skeletal muscle using contrast-enhanced ultrasonography (CEUS) analyzing replenishment kinetics of microbubbles. Methods. Power Doppler sonography (7 MHz) after intravenous bolus injection of 10 mL of a microbubble contrast agent was used to repeatedly examine the perfusion of the right biceps muscle at rest and after defined exercise in 10 healthy volunteers. Parameters of perfusion, such as local blood volume, blood flow velocity, and perfusion, were calculated by a modified analysis of replenishment kinetics. For validation, CEUS was correlated with venous occlusion plethysmography (VOP) examining the right forearm flexor muscles at rest and after defined exercise. Results. The CEUS examination was easily feasible and was able to depict the physiologic large variability of the right biceps muscle perfusion at rest (mean ± SD, 3.0 ± 2.3 [~mL/s • 100 mg]) compared with the results after exercise (22.9 ± 11.0 [~mL/s • 100 mg]). The perfusion calculated with VOP significantly correlated with the CEUS parameters perfusion (r = 0.81; P < .001) and blood volume (r = 0.82; P < .001). The calculated mean blood flow velocity in the right forearm flexor muscles raised from 0.41 ± 0.24 mm/s at rest to 0.64 ± 0.39 mm/s after exercise, showing a significant correlation with the CEUS perfusion (r = 0.72; P < .001). Conclusions. Muscle perfusion can be easily and quantitatively assessed with CEUS. Compared with VOP, CEUS allows for a separate analysis of different muscle groups, unaffected by skin perfusion. Its application may be of particular interest in the diagnosis and monitoring of pathologic microvascularization in myositis or diabetic obstructive disease.

Key Words: contrast-enhanced ultrasonography • muscle perfusion • replenishment kinetics of microbubbles • venous occlusion plethysmography

Abbreviations: CEUS, contrast-enhanced ultrasonography • MI, mechanical index • ROI, region of interest • VOP, venous occlusion plethysmography

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