{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T18:37:38Z","timestamp":1788633458711,"version":"build-2803163510"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T00:00:00Z","timestamp":1630108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012283","name":"Chiayi Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CORPG6K0131 and CMRPG6K0341"],"award-info":[{"award-number":["CORPG6K0131 and CMRPG6K0341"]}],"id":[{"id":"10.13039\/501100012283","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Imaging characteristics of stasis leg ulcers (SLUs) are not easily demonstrated through existing diagnostic tools. Early diagnosis and treatment are crucial. This pilot study was conducted to assess the quantitative flow (QFlow) in triggered angiography noncontrast enhanced (TRANCE) magnetic resonance imaging (MRI) to identify the hemodynamics of victims with stasis leg ulcers (SLUs). This study included 33 patients with SLUs and 14 healthy controls (HC). The 33 patients with SLUs were divided into a reflux (15 patients) and a nonreflux group (18 patients). QFlow was done in the reflux, the nonreflux, and the HC. The stroke volume (SV), forward flow volume (FFV), absolute flow volume (AFV), mean flow (MF), and mean velocity (MV) were higher in the reflux than in the HC group in most segments, namely the external iliac vein (EIV), popliteal vein (PV), and great saphenous vein (GSV) (SV, p = 0.008; FFV, p = 0.008; absolute stroke volume (ASV), p = 0.008; MF, p = 0.002; MV, p = 0.009). No differences in the QFlow patterns were found in the GSV segment between the nonreflux group and the HC. Excellent performance in discriminating SLU with superficial venous reflux was reported for SV in the EIV and the PV (area under the curve (AUC) = 0.851 and 0.872), FFV in the EIV and PV (AUC = 0.854 and 0.869), ASV in the EIV and PV (AUC = 0.848 and 0.881), and MF in the EIV and PV (AUC = 0.866 and 0.868). The cutoff levels of SV\/FFV\/ASV\/MF in the EIV\/FV\/PV\/GSV for discriminating the SLU with superficial venous reflux were identified (p &lt; 0.005). In conclusion, SLUs present different QFlow patterns by different etiology. The QFlow parameters of all vessel segments were higher in the morbid limbs of the reflux group than HC. The GSV segment of the nonreflux group displayed a pattern like the HC.<\/jats:p>","DOI":"10.3390\/jpm11090857","type":"journal-article","created":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T22:49:51Z","timestamp":1630363791000},"page":"857","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Novel Tool for a Challenging Disease: Stasis Leg Ulcers Assessed Using QFlow in Triggered Angiography Noncontrast Enhanced Magnetic Resonance Imaging"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5085-9919","authenticated-orcid":false,"given":"Chien-Wei","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Diagnostic Radiology, Chia-Yi Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2211-3076","authenticated-orcid":false,"given":"Yueh-Fu","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan-Hsi","family":"Tseng","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Chiayi Chan Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Yi","family":"Wong","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Chiayi Chan Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Hui","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Chiayi Chan Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin-Chen","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Chia-Yi Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8653-2571","authenticated-orcid":false,"given":"Bor-Shyh","family":"Lin","sequence":"additional","affiliation":[{"name":"Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan 700, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao-Kuang","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Chiayi Chan Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/j.jvs.2014.04.049","article-title":"Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery (R) and the American Venous Forum","volume":"60","author":"Passman","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_2","first-page":"298","article-title":"Venous Ulcers: Diagnosis and Treatment","volume":"100","author":"Gan","year":"2019","journal-title":"Am. Fam. Physic."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1055\/s-0038-1676362","article-title":"Differentiating Lower Extremity Wounds: Arterial, Venous, Neurotrophic","volume":"35","author":"Star","year":"2018","journal-title":"Semin. Interv. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"k3115","DOI":"10.1136\/bmj.k3115","article-title":"Diagnosis and management of venous leg ulcers","volume":"362","author":"Lim","year":"2018","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1148\/radiology.154.2.3966131","article-title":"Blood flow: Magnetic resonance imaging","volume":"154","author":"Bradley","year":"1985","journal-title":"Radiology"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Chen, C.W., Tseng, Y.H., Lin, C.C., Kao, C.C., Wong, M.Y., Lin, B.S., and Huang, Y.K. (2020). Novel Diagnostic Options without Contrast Media or Radiation: Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging in Treating Different Leg Venous Diseases. Diagnostics, 10.","DOI":"10.3390\/diagnostics10060355"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Huang, Y.K., Tseng, Y.H., Lin, C.H., Tsai, Y.H., Hsu, Y.C., Wang, S.C., and Chen, C.W. (2019). Evaluation of venous pathology of the lower extremities with triggered angiography non-contrast-enhanced magnetic resonance imaging. BMC Med. Imaging, 19.","DOI":"10.1186\/s12880-019-0395-4"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"838","DOI":"10.2214\/AJR.16.16995","article-title":"Phase-Contrast MRI CSF Flow Measurements for the Diagnosis of Normal-Pressure Hydrocephalus: Observer Agreement of Velocity Versus Volume Parameters","volume":"208","author":"Tawfik","year":"2017","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"von Spiczak, J., Crelier, G., Giese, D., Kozerke, S., Maintz, D., and Bunck, A.C. (2015). Quantitative Analysis of Vortical Blood Flow in the Thoracic Aorta Using 4D Phase Contrast MRI. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0139025"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"490","DOI":"10.21037\/qims-20-670","article-title":"Aortic dissection assessment by 4D phase-contrast MRI with hemodynamic parameters: The impact of stent type","volume":"11","author":"Chen","year":"2021","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Tseng, Y.H., Chen, C.W., Wong, M.Y., Yang, T.Y., Lin, B.S., Ting, H., and Huang, Y.K. (2021). Discriminating Reflux from Non-Reflux Diseases of Superficial Veins in Legs by Novel Non-Contrast MR with QFlow Technique. J. Pers. Med., 11.","DOI":"10.3390\/jpm11040242"},{"key":"ref_12","first-page":"1S","article-title":"Clinical practice guidelines of the Society for Vascular Surgery (SVS) and the American Venous Forum (AVF)--Management of venous leg ulcers. Introduction","volume":"60","author":"Passman","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/WON.0000000000000622","article-title":"2019 Guideline for Management of Wounds in Patients With Lower-Extremity Venous Disease (LEVD): An Executive Summary","volume":"47","author":"Kelechi","year":"2020","journal-title":"J. Wound Ostomy Cont. Nurs."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"443","DOI":"10.23736\/S0392-9590.20.04440-5","article-title":"What is new in the 2020 update of the CEAP classification?","volume":"39","author":"Lurie","year":"2020","journal-title":"Int. Angiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1177\/0268355520961239","article-title":"CEAP: A review of the 2020 revision","volume":"35","author":"Khilnani","year":"2020","journal-title":"Phlebology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jvsv.2019.12.075","article-title":"The 2020 update of the CEAP classification system and reporting standards","volume":"8","author":"Lurie","year":"2020","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1177\/0267659118791682","article-title":"Chronic venous insufficiency: A new concept to understand pathophysiology at the microvascular level\u2014A pilot study","volume":"34","author":"Mutlak","year":"2019","journal-title":"Perfusion"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1524-475X.2007.00283.x","article-title":"Why chronic wounds will not heal: A novel hypothesis","volume":"16","author":"Bjarnsholt","year":"2008","journal-title":"Wound Repair Regen."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Morilla-Herrera, J.C., Morales-Asencio, J.M., Gomez-Gonzalez, A.J., Diez-De Los Rios, A., Lupianez-Perez, I., Acosta-Andrade, C., Aranda-Gallardo, M., Moya-Suarez, A.B., Kaknani-Uttumchandani, S., and Garcia-Mayor, S. Effectiveness of a hydrophobic dressing for microorganisms\u2019 colonization of vascular ulcers: Protocol for a randomized controlled trial (CUCO-UV Study). J. Adv. Nurs., 2020.","DOI":"10.1111\/jan.14412"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1111\/iwj.13333","article-title":"Clinical and economic burden of wound care in the tropics: A 5-year institutional population health review","volume":"17","author":"Lo","year":"2020","journal-title":"Int. Wound J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"347","DOI":"10.3111\/13696998.2014.903258","article-title":"Burden of venous leg ulcers in the United States","volume":"17","author":"Rice","year":"2014","journal-title":"J. Med. Econ."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1002\/jcu.20236","article-title":"Current approaches and controversial issues in the diagnosis of deep vein thrombosis via duplex Doppler ultrasound","volume":"34","author":"Gaitini","year":"2006","journal-title":"J. Clin. Ultrasound"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S39","DOI":"10.1259\/bjr\/17627958","article-title":"Multislice CT pulmonary angiography and CT venography","volume":"77","author":"Reid","year":"2004","journal-title":"Br. J. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"399","DOI":"10.3400\/avd.oa.14-00068","article-title":"MR Venography for the Assessment of Deep Vein Thrombosis in Lower Extremities with Varicose Veins","volume":"7","author":"Tamura","year":"2014","journal-title":"Ann. Vasc. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1148\/radiology.215.2.r00ap27421","article-title":"Pelvic and lower extremity veins: Contrast-enhanced three-dimensional MR venography with a dedicated vascular coil-initial experience","volume":"215","author":"Ruehm","year":"2000","journal-title":"Radiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s13760-017-0835-2","article-title":"Time-of-flight MR angiography in cerebral venous sinus thrombosis","volume":"117","author":"Renard","year":"2017","journal-title":"Acta Neurol. Belg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1148\/radiology.187.3.8497608","article-title":"Atherosclerotic occlusive disease of the lower extremity: Prospective evaluation with two-dimensional time-of-flight MR angiography","volume":"187","author":"Yucel","year":"1993","journal-title":"Radiology"},{"key":"ref_28","first-page":"29","article-title":"Non-invasive ECG-triggered 2D TOF MR angiography of the pelvic and leg arteries in an open 1.0-tesla high-field MRI system in comparison to conventional DSA","volume":"59","author":"Suttmeyer","year":"2014","journal-title":"Biomed. Tech. Biomed. Eng."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.clinimag.2012.01.016","article-title":"Non-contrast-enhanced MR venography of the upper limb: A comparative study of acquisitions with fresh blood imaging vs. time-of-flight methods","volume":"36","author":"Harigai","year":"2012","journal-title":"Clin. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/00004728-199901000-00002","article-title":"Lower extremity occlusive disease: Diagnostic imaging with a combination of cardiac-gated 2D phase-contrast and cardiac-gated 2D time-of-flight MRA","volume":"23","author":"Steffens","year":"1999","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.ejrad.2010.04.033","article-title":"Direct contrast-enhanced MR venography in the diagnosis of May-Thurner syndrome","volume":"80","author":"Gurel","year":"2011","journal-title":"Eur. J. Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s003300000586","article-title":"Direct contrast-enhanced 3D MR venography","volume":"11","author":"Ruehm","year":"2001","journal-title":"Eur. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.mri.2020.02.012","article-title":"Incidence of nephrogenic systemic fibrosis after administration of gadoteric acid in patients on renal replacement treatment","volume":"70","author":"Alfano","year":"2020","journal-title":"Magn. Reson. Imaging"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.carj.2019.04.001","article-title":"Updated Clinical Practice Guideline on Use of Gadolinium-Based Contrast Agents in Kidney Disease Issued by the Canadian Association of Radiologists","volume":"70","author":"Schieda","year":"2019","journal-title":"Can. Assoc. Radiol. J."},{"key":"ref_35","first-page":"19","article-title":"Qualitative phase contrast MRA in the normal and abnormal circle of Willis","volume":"14","author":"Ross","year":"1993","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_36","first-page":"68","article-title":"Quantitative phase-contrast MRI study of cerebrospinal fluid flow: A method for identifying patients with normal-pressure hydrocephalus","volume":"29","author":"Florez","year":"2014","journal-title":"Neurologia"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1007\/s00330-011-2132-4","article-title":"ECG-triggered non-contrast-enhanced MR angiography (TRANCE) versus digital subtraction angiography (DSA) in patients with peripheral arterial occlusive disease of the lower extremities","volume":"21","author":"Gutzeit","year":"2011","journal-title":"Eur. Radiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1515\/bmt-2014-0181","article-title":"Initial experience with imaging of the lower extremity arteries in an open 1.0 Tesla MRI system using the triggered angiography non-contrast-enhanced sequence (TRANCE) compared to digital subtraction angiography (DSA)","volume":"61","author":"Suttmeyer","year":"2016","journal-title":"Biomed. Eng. Biomed. Tech."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.ejrad.2010.09.028","article-title":"Triggered non-contrast enhanced MR angiography of peripheral arteries: Optimization of systolic and diastolic time delays for electrocardiographic triggering","volume":"80","author":"Radlbauer","year":"2011","journal-title":"Eur. J. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Ohno, N., Miyati, T., Noda, T., Alperin, N., Hamaguchi, T., Ohno, M., Matsushita, T., Mase, M., Gabata, T., and Kobayashi, S. (2020). Fast Phase-Contrast Cine MRI for Assessing Intracranial Hemodynamics and Cerebrospinal Fluid Dynamics. Diagnostics, 10.","DOI":"10.3390\/diagnostics10040241"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e25809","DOI":"10.1097\/MD.0000000000025809","article-title":"Usefulness of triggered non-contrast-enhanced magnetic resonance angiography in assessing lower extremity venous disease","volume":"100","author":"Chen","year":"2021","journal-title":"Medicine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1177\/0268355520935739","article-title":"Evaluation of static ulcer on lower extremities using wireless wearable near-infrared spectroscopy device: Effect of deep venous thrombosis on TRiggered Angiography Non-Contrast-Enhanced sequence magnetic resonance imaging","volume":"35","author":"Lin","year":"2020","journal-title":"Phlebology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1177\/0268355520939375","article-title":"Non-contrast-enhanced magnetic resonance imaging: Objective figures in differentiation between acute and chronic deep venous thrombosis in the lower extremities","volume":"35","author":"Kao","year":"2020","journal-title":"Phlebology"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Chen, C.W., Tseng, Y.H., Wong, M.Y., Wu, C.M., Lin, B.S., and Huang, Y.K. (2020). Stasis Leg Ulcers: Venous System Revises by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging. Diagnostics, 10.","DOI":"10.3390\/diagnostics10090707"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12880-019-0379-4","article-title":"The use of non-contrast-enhanced MRI to evaluate serial changes in endoleaks after aortic stenting: A case report","volume":"19","author":"Lee","year":"2019","journal-title":"BMC Med. Imaging"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e18427","DOI":"10.1097\/MD.0000000000018427","article-title":"Using non-contrast-enhanced magnetic resonance venography for the evaluation of May-Thurner syndrome in patients with renal insufficiency: A case report","volume":"98","author":"Hsu","year":"2019","journal-title":"Medicine"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/9\/857\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:54:37Z","timestamp":1760165677000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/9\/857"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,28]]},"references-count":46,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["jpm11090857"],"URL":"https:\/\/doi.org\/10.3390\/jpm11090857","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,28]]}}}