Repeatability assessment for simultaneous measurement of arterial blood flow, venous oxygen saturation, and muscle perfusion following dynamic exercise

The purpose of the present study was to demonstrate a new sequence and determine the repeatability of simultaneous dynamic measurements of blood flow, venous oxygen saturation (SvO2), and relative perfusion (change from resting perfusion) in calf muscle during recovery from plantar flexion exercise. The feasibility of near simultaneous measurement of bio‐energetic parameters was also demonstrated. A sequence was developed to simultaneously measure arterial blood flow using flow‐encoded projection, SvO2 using susceptibility‐based oximetry, and relative perfusion using arterial spin labeling in combination with dynamic plantar flexion exercise. The parameters were determined at rest and during recovery from single leg plantar flexion exercise. Test–retest repeatability was analyzed using Bland–Altman analysis and intraclass correlation coefficients (ICC). The mitochondrial capacity of skeletal muscle was also measured immediately afterwards with dynamic phosphorus magnetic resonance spectroscopy. Eight healthy subjects participated in the study for test–retest repeatability. Popliteal artery blood flow at rest was 1.79 ± 0.58 ml/s and increased to 11.18 ± 3.02 ml/s immediately after exercise. Popliteal vein SvO2 decreased to 45.93% ± 6.5% from a resting value of 70.46% ± 4.76% following exercise. Relative perfusion (change from rest value) was 51.83 ± 15.00 ml/100 g/min at the cessation of exercise. The recovery of blood flow and SvO2 was modeled as a single exponential with time constants of 38.03 ± 6.91 and 71.19 ± 14.53 s, respectively. All the measured parameters exhibited good repeatability with ICC ranging from 0.8 to 0.95. Bioenergetics measurements were within normal range, demonstrating the feasibility of near simultaneous measurement of hemodynamic and energetic parameters. Clinical feasibility was assessed with Barth syndrome patients, demonstrating reduced oxygen extraction from the blood and reduced mitochondrial oxidative capacity compared with healthy controls. The proposed protocol allows rapid imaging of multiple parameters in skeletal muscle that might be affected in disease. An interleaved pulse sequence for real‐time simultaneous imaging of arterial blood flow, venous oxygen saturation, and relative perfusion in the lower leg with dynamic plantar flexion exercise was demonstrated. Repeat studies demonstrated excellent test–retest repeatability of measured parameters. The clinical potential of these measurements in combination with near si