Mechanism of free fatty acid-induced insulin resistance in humans.

To examine the mechanism by which lipids cause insulin resistance in humans, skeletal muscle glycogen and glucose-6-phosphate concentrations were measured every 15 min by simultaneous 13C and 31P nuclear magnetic resonance spectroscopy in nine healthy subjects in the presence of low (0.18 +/- 0.02 mM [mean +/- SEM]; control) or high (1.93 +/- 0.04 mM; lipid infusion) plasma free fatty acid levels under euglycemic (approximately 5.2 mM) hyperinsulinemic (approximately 400 pM) clamp conditions for 6 h. During the initial 3.5 h of the clamp the rate of whole-body glucose uptake was not affected by lipid infusion, but it then decreased continuously to be approximately 46% of control values after 6 h (P < 0.00001). Augmented lipid oxidation was accompanied by a approximately 40% reduction of oxidative glucose metabolism starting during the third hour of lipid infusion (P < 0.05). Rates of muscle glycogen synthesis were similar during the first 3 h of lipid and control infusion, but thereafter decreased to approximately 50% of control values (4.0 +/- 1.0 vs. 9.3 +/- 1.6 mumol/[kg.min], P < 0.05). Reduction of muscle glycogen synthesis by elevated plasma free fatty acids was preceded by a fall of muscle glucose-6-phosphate concentrations starting at approximately 1.5 h (195 +/- 25 vs. control: 237 +/- 26 mM; P < 0.01). Therefore in contrast to the originally postulated mechanism in which free fatty acids were thought to inhibit insulin-stimulated glucose uptake in muscle through initial inhibition of pyruvate dehydrogenase these results demonstrate that free fatty acids induce insulin resistance in humans by initial inhibition of glucose transport/phosphorylation which is then followed by an approximately 50% reduction in both the rate of muscle glycogen synthesis and glucose oxidation.

Nuclear magnetic resonance studies of muscle and applications to exercise and diabetes.

Natural-abundance 13C nuclear magnetic resonance (NMR) spectroscopy is a noninvasive technique that enables in vivo assessments of muscle and/or liver glycogen concentrations. When directly compared with the traditional needle biopsy technique, NMR was found to be more precise. Over the last several years, we have developed and used 13C-NMR to obtain information about human glycogen metabolism both under conditions of altered blood glucose and/or insulin and with exercise. Because NMR is noninvasive, we have been able to obtain more data points over a specified time course, thereby dramatically improving the time resolution. This improved time resolution has enabled us to document subtleties of the resynthesis of muscle glycogen after severe exercise that have not been observed previously. An added advantage of NMR is that we are able to obtain information simultaneously about other nuclei, such as 31P. With interleaved 13C- and 31P-NMR techniques, we have been able to follow simultaneous changes in muscle glucose-6-phosphate and muscle glycogen. In this article, we review some of the work that has been reported by our laboratory and discuss the relevance of our findings for the management of diabetes.

Effect of muscle glycogen content on exercise-induced changes in muscle T2 times.

Effects of gastrocnemius glycogen (Gly) concentration on changes in transverse relaxation time (T2; ms) were studied after 5-min plantar flexion at 25% of maximum voluntary contraction (MVC). Gastrocnemius Gly, phosphorus metabolites, and T2 were measured in seven subjects by using interleaved 13C/31P magnetic resonance spectroscopy (MRS) at 4.7 T and magnetic resonance imaging (MRI; 1.5 T). After baseline MRS/MRI, subjects exercised for 5 min at 25% of MVC and were reexamined (MRS/MRI). Subjects then performed approximately 15 min of single-leg toe raises (50 +/- 2% of MVC), depleting gastrocnemius Gly by 43%. After a 1-h rest (for T2 return to baseline), subjects repeated the 5-min protocol, followed by a final MRI/MRS. After the initial 5-min protocol, T2 values increased by 5.9 +/- 0.8 ms (29.9 +/- 0.4 to 35.8 +/- 0.6 ms), whereas Gly did not change significantly (70.5 +/- 6.8 to 67.6 +/- 7.4 mM). After 15 min of toe raises, gastrocnemius Gly was reduced to 40.4 +/- 5.3 mM (P

13C-NMR measurements of muscle glycogen during low-intensity exercise.

Glycogen metabolism in exercising gastrocnemius muscles was examined by natural abundance 13C nuclear magnetic resonance (NMR) spectroscopy. Five-minute 13C-NMR measurement of muscle glycogen had a reproducibility of +/- 6.5% (+/- 4.8 mM). Experiments were performed on healthy fed male and female subjects. Two protocols were followed. 1) Subjects performed plantar flexion from rest at 15, 20, or 25% of maximum voluntary contraction for up to 9 h. 2) Subjects predepleted gastrocnemius glycogen with heavy exercise and then either performed low-intensity exercise as before or rested. Gastrocnemius glycogen was measured by NMR at rest and after each hour of exercise. In some sessions, both the exercised leg and the nonexercised leg were monitored with 13C-NMR. In protocol 1, blood velocity in the femoral artery was similarly assessed with ultrasonography. During low-intensity exercise from rest (protocol 1) muscle glycogen fell to a new steady-state value after several hours and then remained constant despite continued exercise. Mean blood velocity increased ninefold within 2 min of onset of exercise and remained constant thereafter. After predepletion (protocol 2), muscle glycogen was repleted both during low-intensity exercise and at rest. After 1 h the amount of glycogen repletion was greater when coupled with light exercise [48.5 +/- 2.8 mM after 1 h of exercise, 39.7 +/- 1.1 mM after 1 h of rest (P less than 0.05)]. During subsequent light exercise, glycogen reached a steady-state value similar to that obtained in protocol 1, while in resting, recovery glycogen levels continued to increase (+2.7 mM/h) over a 7-h period.(ABSTRACT TRUNCATED AT 250 WORDS)

Glycogen loading alters muscle glycogen resynthesis after exercise.

This study compared muscle glycogen recovery after depletion of approximately 50 mmol/l (DeltaGly) from normal (Nor) resting levels (63.2 +/- 2.8 mmol/l) with recovery after depletion of approximately 50 mmol/l from a glycogen-loaded (GL) state (99.3 +/- 4.0 mmol/l) in 12 healthy, untrained subjects (5 men, 7 women). To glycogen load, a 7-day carbohydrate-loading protocol increased muscle glycogen 1.6 +/- 0.2-fold (P < or = 0.01). GL subjects then performed plantar flexion (single-leg toe raises) at 50 +/- 3% of maximum voluntary contraction (MVC) to yield DeltaGly = 48.0 +/- 1.3 mmol/l. The Nor trial, performed on a separate occasion, yielded DeltaGly = 47.5 +/- 4.5 mmol/l. Interleaved natural abundance (13)C-(31)P-NMR spectra were acquired and quantified before exercise and during 5 h of recovery immediately after exercise. During the initial 15 min after exercise, glycogen recovery in the GL trial was rapid (32.9 +/- 8.9 mmol. l(-1). h(-1)) compared with the Nor trial (15.9 +/- 6.9 mmol. l(-1). h(-1)). During the next 45 min, GL glycogen synthesis was not as rapid as in the Nor trial (0.9 +/- 2.5 mmol. l(-1). h(-1) for GL; 14.7 +/- 3.0 mmol. l(-1). h(-1) for Nor; P < or = 0.005) despite similar glucose 6-phosphate levels. During extended recovery (60-300 min), reduced GL recovery rates continued (1.3 +/- 0.5 mmol. l(-1). h(-1) for GL; 3.9 +/- 0.3 mmol. l(-1). h(-1) for Nor; P < or = 0.001). We conclude that glycogen recovery from heavy exercise is controlled primarily by the remaining postexercise glycogen concentration, with only a transient synthesis period when glycogen levels are not severely reduced.

Human muscle glycogen resynthesis after exercise: insulin-dependent and -independent phases.

To study the effects of glycogen depletion and insulin concentration on glycogen synthesis, gastrocnemius glycogen was measured with 13C-nuclear magnetic resonance at 4.7 T after exercise. Subjects performed single-leg toe raises to deplete gastrocnemius glycogen to 75, 50, or 25% of resting concentration (protocol I). Insulin dependence of glycogen synthesis was assessed after depletion to 25% with (protocol II) and without (protocol III) infusion of somatostatin to inhibit insulin secretion. After depletion to 75 and 50%, glycogen resynthesis rates were similar (2.4 +/- 0.7 and 2.8 +/- 0.6 mM/h, respectively). When glycogen was depleted to 25% (< 30 mM), the resynthesis rate was significantly higher (P < 0.02) at 33 +/- 7 mM/h, and it declined to 3.5 +/- 0.9 mM/h at > 35 mM glycogen. At < 35 mM glycogen, synthesis was not affected by low insulin (24 +/- 4 mM/h, protocol vs. 19 +/- 3 mM/h, protocol III), whereas at > 35 mM glycogen, synthesis ceased without insulin (-0.07 +/- 0.19 mM/h, protocol II). After depletion to 25% (protocol III), plasma lactate transiently increased (0.81 mM at rest, 1.82 mM 0 h after exercise, and 0.76 mM 2 h after exercise), whereas other plasma constituents did not significantly change. We conclude that after depletion to < 30 mM initial glycogen resynthesis is insulin independent and glycogen dependent, which suggests local control.

Isometric and dynamic exercise studied with echo planar magnetic resonance imaging (MRI).

PURPOSE: The effect of different types of exercise upon echo planar (EP) magnetic resonance (MR) images was examined during and after both dynamic and isometric dorsi-flexion exercises at matched workloads and durations. METHODS: Healthy untrained subjects performed either dynamic exercise through a full range of motion and against a constant resistance or isometric exercise at the center of the range of motion and against a constant resistance at 25 or 70% their measured maximum voluntary contraction (MVC). EP MR images were acquired at 1.5 T every 4 s before (4 images), during (27 images), and after (29-65 images) exercise. A spin echo EP sequence was employed with TE = 30 ms, TR = 4000 ms, FOV = 20 x 40 cm, 64 x 128 matrix. The changes in proton transverse relaxation rate (deltaR2, [s(-1)]) relative to values obtained before exercise were calculated from individual images at different times during and after exercise. RESULTS: At both 70 and 25% of MVC, the maximum deltaR2 after dynamic exercise (-8.38+/-0.32 s(-1) (70%), -6.47+/-1.23s(-1) (25%)) was significantly greater (P < or = 0.05) than after isometric exercise (-5.91+/-0.67 s(-1) (70%), -3.80+/-0.87s(-1) (25%)). Throughout the period that recovery was monitored, the recovery patterns of deltaR2 following isometric and dynamic exercise at both workloads remained parallel. CONCLUSIONS: We conclude that exercise-induced changes in MR images are influenced not only by workload and exercise duration but also by the type of exercise, and we postulate that these differences result from the different physiological responses elicited by the different types of exercise.

Changes in magnetic resonance transverse relaxation times of two muscles following standardized exercise.

Magnetic resonance (MR) imaging studies of exercising leg muscles were performed to compare the changes in MR transverse relaxation times (T2) that result from exercise of the anterior tibialis (AT) and extensor digitorum/hallicus longus (E) in the anterior compartment of the lower leg with those T2 changes in the medial and lateral gastrocnemius (G) in the posterior compartment. Spin-echo MR images were obtained at 1.5 Tesla before and during the first 14 min of recovery from dynamic exercise. In order to normalize the exercise, workloads for each subject were set at 25% of the measured maximum voluntary contraction (MVC) of the anterior and posterior compartments. In separate exercise sessions, a nonmagnetic, pneumatic exercise apparatus was employed for either dorsiflexion or plantarflexion against a fixed constant resistance for two different exercise durations (1 min 45 s or 5 min). Transaxial MR images (TR = 1000 ms, TE = 30, 60, 90, 120 ms, 128 x 256 matrix, 1.5 cm slice) were used to calculate T2 values. Although subjects performed approximately 7-fold more work (P < or = 0.001, dorsiflexion vs plantarflexion) during plantarflexion than during dorsiflexion at both exercise duration's, the exercise induced T2, while being greater than those at rest (P < or = 0.001), were not significantly different in the different compartments. We conclude that, when exercised at the same workload (25% of MVC), these two muscles produce T2 changes that are not significantly different from each other.

Turnover of human muscle glycogen with low-intensity exercise.

To determine whether glycogen turnover occurs during prolonged low-intensity exercise, five subjects performed plantar flexion of the right leg at 15% MVC for 5 h. At rest and during the initial 2.5 h of exercise gastrocnemius glycogen was monitored in both legs with natural abundance 13C NMR. At 2.5 h exercise, a step-up infusion of 99% enriched 1-13C glucose was begun and maintained over the next 1.5 h of continued exercise to monitor 1-13C glucose incorporation into the exercising muscle's glycogen pool. Exercise was continued for an hour following the infusion, and NMR scans were performed throughout the session. During the first 2 h of exercise, glycogen 1-13C signal amplitudes dropped approximately 30% and remained there at 2.5 h, indicating that glycogen concentration had leveled. Following infusion, glycogen signal amplitudes rose to 123% of resting values, remaining there during an hour of subsequent exercise. There was no change of glycogen 1-13C signal in the nonexercising leg. Venous glucose levels remained stable until the infusion was begun and then rose < 7% (5.57-5.96 mmol.l-1) during the infusion. Venous insulin and C-peptide levels did not change during the infusion. We conclude that the human gastrocnemius can degrade and synthesize glycogen simultaneously during prolonged low-intensity exercise.

Dynamic echo planar imaging of exercised muscle.

Echo planar imaging was used to record dynamic changes in tissue transverse relaxation rates (delta R2) in the anterior tibialis muscle during dorsi-flexion exercise and recovery. Using a single spin-echo technique to calculate the change in relaxation rate produced by the exercise a time resolution of 4 s was achieved for each measurement of delta R2. For a fixed workload of 70% of maximum voluntary contraction (MVC), the duration of dorsi-flexion exercise was varied and measurements of delta R2 were obtained throughout exercise and for at lease 5 min of recovery. Comparisons were made between the single echo results and those obtained using multiple echo measurements of T2 with much lower time resolution, to verify that the two techniques gave the same results. We found on average that delta R2 decreased by an average of 8.7 s-1 within the tibialis with an average rate of decrease during exercise of delta R2/ delta t(ex) = -0.061 s-2. For the high time resolution studies we consistently observed that there was a continued decrease in the measured value of delta R2 after the exercise, reaching a minimum value about a minute after the exercise ceased. This average rate of undershoot during the postexercise period was given by delta R2/ delta t(us) = -0.035 s-2. This effect has not been noted previously in MR imaging studies and may be attributed to increased flow within the tissue as contracting muscle fibers relax following exercise. The results can be interpreted using simple fast exchange or slow exchange models for tissue water relaxation. For the case of rapid exchange the changes in delta R2 may be indicative of an increase in the net water volume within the muscles, whereas in the case of slow exchange delta R2 is primarily a measure of intracellular volume increases.

Thrombosis at the site of interruption of the vena cava: a consideration in prophylactic treatment of pulmonary embolism.

This study confirms the method of Ratnoff in inducing the hypercoagulable state in dogs, and further demonstrates that there is a varying thrombogenic factor when the vena cava is interrupted by ligation, staple plication, suture plication, serrated clip, and a smooth clip. The incidence of thrombosis caused by ligation, staple plication and suture plication would suggest that these are not suitable methods for prophylactic use. That no thrombosis occurred with the smooth clip would suggest that as a prophylactic measure, the smooth clip may be preferable to a serrated clip.

Non-health professionals and the school-age child: early intervention for behavioral problems.

A methodology is described to utilize dormitory parents in direct care activities for the early intervention of behavioral problems of the school-age child. Specific information gathering, assessment, treatment, referral and follow-up tasks were defined and incorporated into a problem-solving protocol which served to guide the dormitory parents through the defined problem-solving process, to promote early identification of students with a behavioral problem, and to expedite referral to a professional for students with more severe problems. The methodology was pilot-tested in a large American Indian boarding school and demonstrated the feasibility and efficacy of dormitory parents in a therapeutic role as one component of a team approach to the management of behavioral problems. The pilot study resulted in a significant reduction in the rates of alcohol abuse and school dropouts and deserves application in a variety of settings.

Immobilization effects in young and older adults.

This experiment compared the effects of disuse on the adductor pollicis (AP) muscle in young (YM) and old (OM) men. The AP of the YM and OM was assessed for strength (MVC), compound muscle action potential (CMAP), and volume, and then immobilized for 2 weeks. MVC decreased approximately 22% in the YM, and OM (P<0.001). AP volume was 4.1% (not significant) and 9.5% (P<0.05) less in the YM and OM, respectively. CMAP increased in the OM 0, 24, and 48 h post-immobilization, and did not change in the YM. However, the YM showed a greater decrease in specific force as compared to the OM. YM and OM experienced similar losses in strength, yet muscle volume loss was only significant in OM. Although OM are more susceptible to immediate losses in muscle volume, muscle activation strategies appear to preserve strength during atrophy.

13C/31P NMR studies on the role of glucose transport/phosphorylation in human glycogen supercompensation.

This study measured muscle glycogen during a 7-day carbohydrate loading protocol. Twenty healthy subjects (12 male, 8 female) performed 1 hr treadmill/toe-raise exercise immediately before a 3-day low carbohydrate (LoCHO) diet (20 % carbohydrate, 60 % fat, 20 % protein). On day 3 they repeated the exercise and began a 4-day high carbohydrate (HiCHO) diet (90 % carbohydrate, 2 % fat, 8 % protein). The order of administration of the diet was reversed in a subpopulation (n = 3). Interleaved natural abundance 13C/ 31P NMR spectra were obtained before and immediately after exercise, and each day during the controlled diets in order to determine concentrations of glycogen (GLY), glucose-6-phosphate (G6P), and muscle pH. Following exercise, muscle GLY and pH were reduced (p < 0.001) while muscle G6P was elevated (p

NMR of glycogen in exercise.

Natural-abundance 13C NMR spectroscopy is a non-invasive technique that enables in vivo assessments of muscle and/or liver glycogen concentrations. Over the last several years, 13C NMR has been developed and used to obtain information about human glycogen metabolism with diet and exercise. Since NMR is non-invasive, more data points are available over a specified time course, dramatically improving the time resolution. This improved time resolution has enabled the documentation of subtleties of muscle glycogen re-synthesis following severe glycogen depletion that were not previously observed. Muscle and liver glycogen concentrations have been tracked in several different human populations under conditions that include: (1) muscle glycogen recovery from intense localized exercise with normal insulin and with insulin suppressed; (2) muscle glycogen recovery in an insulin-resistant population; (3) muscle glycogen depletion during prolonged low-intensity exercise; (4) effect of a mixed meal on postprandial muscle and liver glycogen synthesis. The present review focuses on basic 13C NMR and gives results from selected studies.

Direct measurement of change in muscle glycogen concentration after a mixed meal in normal subjects.

Postprandial storage of carbohydrate as glycogen in muscle was quantitated in normal subjects (n = 8) by natural abundance 13C-nuclear magnetic resonance spectroscopy with proton decoupling in a 4.7-tesla magnet. After an overnight fast three basal measurements of gastrocnemius muscle glycogen were made and a mixed meal was given. Muscle glycogen concentration rose from 83.3 +/- 5.2 to a maximum of 100.2 +/- 6.7 mmol/l muscle at 4.9 h (P < 0.01) and fell thereafter to 90.6 +/- 5.9 mmol/l muscle at 7 h postprandially (P < 0.006). The meal brought about an increase in plasma glucose from 5.4 +/- 0.2 to 7.3 +/- 0.4 mmol/l at 30 min but this was followed by a rapid fall to 6.2 +/- 0.4 mmol/l at 75 min. Plasma insulin rose from 62.4 +/- 11.4 to 900 +/- 216 pmol/l at 30 min and declined steadily thereafter. It was calculated from total muscle mass measurements and estimation of carbohydrate absorption rates that at peak muscle glycogen concentrations between 26 and 35% of the absorbed carbohydrate was stored as muscle glycogen. These data quantitate the role of skeletal muscle glycogen synthesis in postprandial carbohydrate storage and demonstrate that this tissue acts as a dynamic buffer to maintain glucose homeostasis during postprandial substrate storage.

Validation of 13C NMR measurement of human skeletal muscle glycogen by direct biochemical assay of needle biopsy samples.

Recent developments in 13C nuclear magnetic resonance (NMR) spectroscopy have permitted noninvasive assessment of glycogen concentration in human skeletal muscle. Before these indirect measurements could be accepted as accurate, it was essential that validation should be carried out by comparing the widely used method of muscle biopsy and direct biochemical assay for glycogen concentration with measurement by NMR. Eight normal subjects underwent six NMR scans of gastrocnemius and three biopsies of the same muscle on the same day. The overall mean for muscle glycogen concentration was 87.4 mM by NMR and 88.3 mM by biopsy. There was a close correlation between the pairs of observations on each subject (R = 0.95; P less than 0.0001). The mean coefficient of variation for NMR measurement was 4.3 +/- 2.1% and that for biopsy was 9.3 +/- 5.9%. The performance of the muscle biopsies was accompanied by a small but significant rise in plasma-free fatty acids (529 +/- 157 to 667 +/- 250; P less than 0.01), epinephrine (17 +/- 6 to 25 +/- 8 pg/ml; P less than 0.02), and norepinephrine (318 +/- 119 to 400 +/- 140 pg/ml; P less than 0.02) but no change in plasma glucose, plasma insulin, nor muscle glycogen concentration assessed by NMR. The study demonstrates that in vivo 13C NMR measurement of human muscle glycogen can be regarded as accurate, and the technique is associated with a higher precision that biopsy with direct biochemical assessment.

Differential response of muscle phosphocreatine to creatine supplementation in young and old subjects.

This study compared the effects of short-term creatine supplementation on muscle phosphocreatine, blood and urine creatine levels, and urine creatinine levels in elderly and young subjects. Eight young (24 +/- 1.4 years) and seven old (70 +/- 2.9 years) men ingested creatine (20 g day-1) for 5 days. Baseline muscle phosphocreatine measurements were taken pre- and post-supplementation using nuclear magnetic resonance spectroscopy (NMR). On the first day of supplementation subjects had blood samples taken immediately before and hourly for 5 h following ingestion of 5 g of creatine, and a pharmacokinetic analysis of plasma creatine levels was conducted. Twenty-four hour urine collections were conducted for 2 days prior to the supplementation period and for 5 days during supplementation. Old subjects had significantly higher baseline plasma creatine levels than young subjects (68.5 +/- 12.5 vs. 34.9 +/- 4.7 micromol L-1; P < 0.02). There were no significant differences between groups in plasma creatine pharmacokinetic parameters (i.e. area under the curve, elimination rate constant, absorption rate constant, time to maximum concentration, and maximum concentration) following the 5 g oral creatine bolus. Urine creatine, assessed pre and on 5 days of supplementation, increased (P < 0.001), with no difference between groups. Urine creatinine did not change as a result of creatine supplementation. Young subjects showed a significantly greater increase in muscle phosphocreatine compared with old subjects, and post-supplementation muscle phosphocreatine levels were greater in young subjects (young 27.6 +/- 0.5; old 25.7 +/- 0.8 mmol kg-1 ww) (P=0.02). There were no differences in blood or urine creatine between groups in response to supplementation, but old subjects had a relatively small increase (young 35% vs. old 7%) in muscle phosphocreatine after supplementation.

Some factors that influence the plasma lipoprotein 1H NMR spectra of normal and cancer patients: an oncolipid test?

Selected factors have been evaluated in order to determine their influences on the plasma lipoprotein proton NMR spectra of normal and cancer patients. The variables were donor's diet (fasting/non-fasting), temperature and time of sample storage, processing procedure, centrifugation speed, and water pre-saturation time. Plasma samples from fasting individuals that were placed immediately on ice, spun at 1,000 and 3,000 g for 15 minutes, and the proton NMR spectrum acquired with the Carr-Purcell Meiboom-Gill (CPMG) pulse sequence, using a two-second water pre-saturation time, consistently gave reproducible results. Resonances attributed to lactate were minimized under these processing conditions. Centrifugation speed and pre-saturation time did not affect the average line width; however, donor fasting state, processing temperature, and storage time did alter the line width. Most important, blood chemistry analysis revealed an inverse correlation between triglyceride levels and average methyl and methylene line widths. Thus, these factors alone caution against the indiscriminate use of proton NMR spectra to differentiate plasma from normal and cancer patients.

Validation of volume flow measurements with cine phase-contrast MR imaging for peripheral arterial waveforms.

A flow phantom was used to study MR volume flow measurements for monophasic and triphasic waveforms over the flow range expected in peripheral arteries at rest and with exercise (2-24 mL/sec, n = 50). The improvement in accuracy with phase-correction image processing to eliminate errors caused by eddy currents was measured. Volume flow estimates with Doppler sonography were also measured. MR volume flow measurements correlated with volume collection with r = .996 and mean error = 4.6%. Phase-correction processing decreased mean error from 12.6% to 4.6% (P < .001, paired t-test). Doppler sonography had a higher mean error of 10.3% (P < .001, unpaired t-test). Cine phase-contrast MR imaging provides accurate estimates of volume blood flow for waveforms and flow ranges expected in peripheral arteries.