Rationale and Objectives
This paper describes an ongoing investigation of imaging and characterization of ischemia-reperfusion (IR) and investigated the use of color-coded digital subtraction angiography (DSA) to assess reperfusion injury or potential injury.
Methods
New Zealand white rabbits were subjected to right hindlimb ischemia (IR, n = 24) or sham operation (control, n = 6). After 3 hours, the IR rabbits underwent reperfusion and were assessed at 0, 6, 12, or 24 hours ( n = 6 each). DSA of the bilateral vastus lateralis muscle of each animal was performed. The maximum contrast enhancement value of a consistent region of interest in the right and left hind limbs (peak enhancement-R/L) was determined. Associations between the relative ratio of the peak right limb to the peak left limb (peak-R/L) and the following blood indicators of IR injury were analyzed: lactic dehydrogenase (LDH), creatine kinase (CK), malondialdehyde (MDA), and superoxide dismutase (SOD).
Results
Serum LDH, CK, and MDA values in each IR group were significantly higher than those of the control group and were positively associated with the IR interval, whereas SOD was significantly lower and negatively associated. The mean peak-R/L decreased linearly with the IR interval from 1.07 ± 0.01 in the control group, and 0.93 ± 0.06, 0.79 ± 0.05, 0.65 ± 0.04, and 0.47 ± 0.04 at 0, 6, 12, and 24 hours in the IR groups. The coefficients of correlation between the peak-R/L and LDH, CK, MDA, SOD serum levels were −0.885, −0.908, −0.541, and 0.832, respectively.
Conclusions
Color-coded DSA may be used for monitoring the dynamics of skeletal muscle IR injury.
Introduction
Ischemia-reperfusion injury (IRI) occurs when there is a return of blood flow after a period of ischemia . IRI leads to cytokine activation and can result in multiple organ dysfunction . The local and systemic sequelae associated with reperfusion is only partially understood, although the technical success of recanalizing occluded arteries and re-establishing perfusion to ischemic limbs has improved significantly .
There are three methods for detecting IRI: clinical observation; biochemical laboratory abnormalities of malondialdehyde (MDA), superoxide dismutase (SOD), creatine kinase (CK), and lactic dehydrogenase (LDH) ; and imaging. Imaging modalities that enable visualization of the lesion, signs of tissue activity, perfusion, and metabolic status can be used to help detect IRI. These include computed tomography , magnetic resonance imaging , and radionuclide imaging , and are widely used for evaluating IRI of the myocardium and brain tissue . In addition to these modalities, digital subtraction angiography (DSA) provides an improved and instantaneous display of the characteristics and lesions of vessels . DSA is commonly used to perform angiography and to guide recanalization procedures in occluded arteries.
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Methods
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Experimental Groups
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Ischemia, Reperfusion, and Angiography
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Blood Indices
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Statistical Analysis
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Results
Animal Model of IR Verification
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Blood Indices and DSA Parameters
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TABLE 1
Serum Levels of LDH, CK, MDA, and SOD in Each Group
LDH (U/L) CK (U/L) MDA (nmol/mL) SOD (U/mL) Control 354.83 ± 40.08 535.65 ± 33.87 1.51 ± 0.24 173.54 ± 5.47 IR-0 495.83 ± 57.25 \* 929.17 ± 75.18 \* 1.99 ± 0.23 \* 165.79 ± 3.78 \* IR-6 1,117.33 ± 166.91 \* 4,330.22 ± 628.87 \* 2.11 ± 0.28 \* 161.06 ± 4.62 \* IR-12 1,574.33 ± 238.20 \* 6,636.88 ± 395.55 \* 2.42 ± 0.35 \* 153.14 ± 4.72 \* IR-24 2,492.33 ± 357.32 \* 10,875.13 ± 926.18 \* 3.07 ± 0.60 \* 140.88 ± 4.49 \*
CK, creatine kinase; IR, ischemia-reperfusion; IR-0, ischemia-reperfusion at 0 hour; IR-6, ischemia-reperfusion at 6 hours; IR-12, ischemia-reperfusion at 12 hours; IR-24, ischemia-reperfusion at 24 hours; LDH, lactic dehydrogenase; MDA, malondialdehyde; SOD, superoxide dismutase.
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Discussion
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Limitations
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Conclusions
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