Review of laser speckle contrast techniques for visualizing tissue perfusion

A curvature-tunable random laser

The application of random lasers has been restricted due to the absence of a well-defined resonant cavity, as the lasing action mainly depends on multiple light scattering induced by intrinsic disorders of the laser medium to establish the required optical feedback that hence increases the difficulty in efficiently tuning and modulating random lasing emissions. This study investigated whether the transport mean free path of emitted photons within disordered scatterers composed of ZnO nanowires is tunable by a curvature bending applied to the flexible polyethylene terephthalate (PET) substrate underneath, thereby creating a unique light source that can be operated above and below the lasing threshold for desirable spectral emissions. For the first time, the developed curvature-tunable random laser is implemented for in vivo biological imaging with much lower speckle noise compared to the non-lasing situation through simple mechanical bending, which is of great potential for studying the fast-moving physiological phenomenon such as blood flow patterns in mouse ear skin. It is expected that the experimental demonstration of the curvature-tunable random laser can provide a new route to develop disorder-based optoelectronic devices.

In vivo imaging for neurovascular disease research

Connections between various cell types in the brain enable cognitive function. The neurovascular unit is a structure composed of different cell types that regulate neurovascular coupling, blood-brain barrier permeability, and other interactions with peripheral systems. The relationship among the components of the neurovascular unit is complex and difficult to study without the use of in vivo neurovascular disease imaging. In this review, we introduce principles and examples of various in vivo optical imaging techniques including laser Doppler flowmetry, laser speckle contrast imaging, intrinsic optical signal imaging, optical coherence tomography, and two-photon microscopy. Furthermore, we introduce recent advances of in vivo imaging and future directions for promoting neurovascular disease research.

The use of laser speckle contrast imaging to predict flap necrosis: An experimental study in a porcine flap model

BACKGROUND

We evaluated the use of laser speckle contrast imaging (LSCI) in the perioperative planning in reconstructive flap surgery. The aim of the study was to investigate whether LSCI can predict regions with a high risk of developing postoperative necrosis. Our hypothesis was that, perioperatively, such regions have perfusion values below a threshold value and show a negative perfusion trend.

METHODS

A porcine flap model based on the cranial gluteal artery perforator was used. Images were acquired before surgery, immediately after surgery (t = 0), after 30 min (t = 30 min), and after 72 h (t = 72 h). Regions of interest (ROIs) were chosen along the central axis of the flap. Clinical evaluation of the flap was made during each time point.

RESULTS

At t = 72 h, a demarcation line could be seen at a distance of 15.8 ± 0.4 cm away from the proximal border of the flaps. At t = 0, perfusion decreased gradually from the proximal to the distal ROI. At t = 30 min, perfusion was significantly lower in the ROI distal to the final demarcation line than that at t = 0, and in all flaps, these ROIs had a perfusion <25 PU. At t = 72 h, perfusion in the ROI proximal to this line returned to baseline levels, whereas perfusion in the distal ROI remained low.

CONCLUSIONS

In our model, a decrease in perfusion during the first 30 min after surgery and a perfusion <25 PU at t = 30 min was a predictor for tissue morbidity 72 h after surgery, which indicates that LSCI is a promising technique for perioperative monitoring in reconstructive flap surgery.

Laser-based Techniques for Microcirculatory Assessment in Orthopedics and Trauma Surgery: Past, Present, and Future

: Microcirculatory integrity and proper function are the cornerstones to tissue nourishment and viability. In the clinical environment extended immobility, injuries, and inflammatory reactions demand local microcirculatory adaption to provide adequate supply. Assessment of endothelial adjustment capability and microcirculatory perfusion status, as direct or surrogate markers of disease, are therefore of uttermost interest to the treating physician. Given the simple, noninvasive, nonradiating nature of laser-based techniques for bedside or intraoperative microcirculatory perfusion assessment, this article's objective is to present a comprehensive overview of available techniques, their technological aspects, and current application. Advantages of individual methods are pointed out and compared with each other. The areas of medical utilization relevant to orthopedics and trauma surgery are exemplified and their available evidence elaborated. A particular focus is put on laser speckle contrast imaging, with its current and future influence on medical practice.

Enhancing vascular visualization in laser speckle contrast imaging of blood flow using multi-focus image fusion

Laser speckle contrast imaging (LSCI) is a full-field optical imaging method for monitoring blood flow and vascular morphology with high spatiotemporal resolution. However, due to the limited depth of field of optical system, it is difficult to capture a clear blood flow image with all blood vessels focused, especially for the non-planar biological tissues. In this study, a multi-focus image fusion method based on contourlet transform is introduced to reduce the misfocus effects in LSCI. The experimental results suggest that this method can provide an all-in-focus blood flow image, which is convenient to observe the blood vessels.

Simultaneous Blood Flow Measurement and Dermoscopy of Skin Lesions Using Dual-Mode Dermascope

Dermascopes are commonly utilized for the qualitative visual inspection of skin lesions. While automated image processing techniques and varied illumination strategies have been used to aid in structural analysis of lesions, robust quantification of functional information is largely unknown. To address this knowledge gap, we have developed a compact, handheld dermascope that enables real-time blood flow measurements of skin during conventional visual inspection. In-vitro characterization demonstrated that the dermascope is capable of quantifying changes in flow across a physiologically relevant range even when used in a handheld manner with clinic lighting and dermascope LEDs on. In a small pilot clinical study, we demonstrated the dermascope’s ability to detect flow differences between two distinct lesion types.

Application of optical flow algorithms to laser speckle imaging

Since of its introduction in 1980s, laser speckle imaging has become a powerful tool in flow imaging. Its high performance and low cost made it one of the preferable imaging methods. Initially, speckle contrast measurements were the main algorithm for analyzing laser speckle images in biological flows. Speckle contrast measurements, also referred as Laser Speckle Contrast Imaging (LSCI), use statistical properties of speckle patterns to create mapped image of the blood vessels. In this communication, a new method named Laser Speckle Optical Flow Imaging (LSOFI) is introduced. This method uses the optical flow algorithms to calculate the apparent motion of laser speckle patterns. The differences in the apparent motion of speckle patterns are used to identify the blood vessels from surrounding tissue. LSOFI has better spatial and temporal resolution compared to LSCI. This higher spatial resolution enables LSOFI to be used for autonomous blood vessels detection. Furthermore, Graphics Processing Unit (GPU) based LSOFI can be used for quasi real time imaging.

Painless local pressure application to test microvascular reactivity to ischemia

BACKGROUND

Forearm cutaneous blood flux (CBF) measurement with post-occlusive reactive hyperemia (PORH) is uncomfortable and may not be devoid of risks. We aimed to investigate post-compression reactive hyperemia (PCRH) with a custom-made indenter that was designed to be easily used routinely by inexperienced observers.

METHODS

Medical students evaluated PCRH with 1- to 4-min pressure applications of 16 to 34 kPa and PORH with 3-min forearm cuff occlusion using laser speckle contrast imaging in 15 healthy volunteers. Participants were asked to quantify their discomfort with a visual analogue scale (VAS) of 10 cm. Total ischemia (ISCH) was quantified by the product of CBF during ischemia and ischemia duration (min). We subtracted the CBF changes in the skin from a reference ipsilateral (PCRH) or contralateral (PORH) non-stimulated area.

RESULTS

The average VAS was 1.0 for PCRH vs. 6.0 for PORH (p < 0.001). A strong linear relationship between ISCH and peak PCRH (r² = 0.915, p < 0.001) was noted. Peak PORH values (63.9 laser perfusion units (LPU)) were significantly lower than all values of the 3-min PCRH (72.6 LPU), including the one obtained with 16 kPa.

CONCLUSION

Inexperienced observers could test microvascular reactivity with PCRH without inducing the discomfort that is typically experienced with PORH. Further, PCRH elicits a higher peak response to ischemia compared with PORH. This extremely simple method could influence a broad spectrum of routine cutaneous microcirculation investigations, especially when a painful approach is particularly inadequate or if the patient is fragile.

CLINICAL TRIAL REGISTRATION

NCT02861924.

Wearable speckle plethysmography (SPG) for characterizing microvascular flow and resistance

In this work we introduce a modified form of laser speckle imaging (LSI) referred to as affixed transmission speckle analysis (ATSA) that uses a single coherent light source to probe two physiological signals: one related to pulsatile vascular expansion (classically known as the photoplethysmographic (PPG) waveform) and one related to pulsatile vascular blood flow (named here the speckle plethysmographic (SPG) waveform). The PPG signal is determined by recording intensity fluctuations, and the SPG signal is determined via the LSI dynamic light scattering technique. These two co-registered signals are obtained by transilluminating a single digit (e.g. finger) which produces quasi-periodic waveforms derived from the cardiac cycle. Because PPG and SPG waveforms probe vascular expansion and flow, respectively, in cm-thick tissue, these complementary phenomena are offset in time and have rich dynamic features. We characterize the timing offset and harmonic content of the waveforms in 16 human subjects and demonstrate physiologic relevance for assessing microvascular flow and resistance.

A large, switchable optical clearing skull window for cerebrovascular imaging

Rationale: Intravital optical imaging is a significant method for investigating cerebrovascular structure and function. However, its imaging contrast and depth are limited by the turbid skull. Tissue optical clearing has a great potential for solving this problem. Our goal was to develop a transparent skull window, without performing a craniotomy, for use in assessing cerebrovascular structure and function. Methods: Skull optical clearing agents were topically applied to the skulls of mice to create a transparent window within 15 min. The clearing efficacy, repeatability, and safety of the skull window were then investigated. Results: Imaging through the optical clearing skull window enhanced both the contrast and the depth of intravital imaging. The skull window could be used on 2-8-month-old mice and could be expanded from regional to bi-hemispheric. In addition, the window could be repeatedly established without inducing observable inflammation and metabolic toxicity. Conclusion: We successfully developed an easy-to-handle, large, switchable, and safe optical clearing skull window. Combined with various optical imaging techniques, cerebrovascular structure and function can be observed through this optical clearing skull window. Thus, it has the potential for use in basic research on the physiopathologic processes of cortical vessels.

Increased visceral tissue perfusion with heated, humidified carbon dioxide insufflation during open abdominal surgery in a rodent model

Tissue perfusion during surgery is important in reducing surgical site infections and promoting healing. This study aimed to determine if insufflation of the open abdomen with heated, humidified (HH) carbon dioxide (CO2) increased visceral tissue perfusion and core body temperature during open abdominal surgery in a rodent model. Using two different rodent models of open abdominal surgery, visceral perfusion and core temperature were measured. Visceral perfusion was investigated using a repeated measures crossover experiment with rodents receiving the same sequence of two alternating treatments: exposure to ambient air (no insufflation) and insufflation with HH CO2. Core body temperature was measured using an independent experimental design with three treatment groups: ambient air, HH CO2 and cold, dry (CD) CO2. Visceral perfusion was measured by laser speckle contrast analysis (LASCA) and core body temperature was measured with a rectal thermometer. Insufflation with HH CO2 into a rodent open abdominal cavity significantly increased visceral tissue perfusion (2.4 perfusion units (PU)/min (95% CI 1.23-3.58); p<0.0001) compared with ambient air, which significantly reduced visceral blood flow (-5.20 PU/min (95% CI -6.83- -3.58); p<0.0001). Insufflation of HH CO2 into the open abdominal cavity significantly increased core body temperature (+1.15 ± 0.14°C) compared with open cavities exposed to ambient air (-0.65 ± 0.52°C; p = 0.037), or cavities insufflated with CD CO2 (-0.73 ± 0.33°C; p = 0.006). Abdominal visceral temperatures also increased with HH CO2 insufflation compared with ambient air or CD CO2, as shown by infrared thermography. This study reports for the first time the use of LASCA to measure visceral perfusion in open abdominal surgery and shows that insufflation of open abdominal cavities with HH CO2 significantly increases visceral tissue perfusion and core body temperature.

Application of qualitative biospeckle methods for the identification of scar region in a green orange

This study demonstrates the feasibility of a view-based method, the motion history image (MHI) to map biospeckle activity around the scar region in a green orange fruit. The comparison of MHI with the routine intensity-based methods validated the effectiveness of the proposed method. The results show that MHI can be implementated as an alternative online image processing tool in the biospeckle analysis.

Imaging blood flow inside highly scattering media using ultrasound modulated optical tomography

We report the use of ultrasound modulated optical tomography (UOT) with heterodyne parallel detection to locally sense and image blood flow deep inside a highly scattering medium. We demonstrate that the UOT signal is sensitive to the speed of the blood flow in the ultrasound focus and present an analytical model that relates UOT signals to the optical properties (i. e. scattering coefficient, anisotropy, absorption, and flow speed) of the blood and the background medium. We found an excellent agreement between the experimental data and the analytical model. By varying the integration time of the camera in our setup, we were able to spatially resolve blood flow in a scattering medium with a lateral resolution of 1.5 mm.

Tissue perfusion rate estimation with compression-based photoacoustic-ultrasound imaging

Tissue perfusion is essential for transporting blood oxygen and nutrients. Measurement of tissue perfusion rate would have a significant impact in clinical and preclinical arenas. However, there are few techniques to image this important parameter and they typically require contrast agents. A label-free methodology based on tissue compression and imaging with a high-frequency photoacoustic-ultrasound system is introduced for estimating and visualizing tissue perfusion rates. Experiments demonstrate statistically significant differences in depth-resolved perfusion rates in a human subject with various temperature exposure conditions.

FSOCA-induced switchable footpad skin optical clearing window for blood flow and cell imaging in vivo

The mouse footpad for its feature of hairlessness provides an available window for imaging vascular and cellular structure and function in vivo. Unfortunately, the strong scattering of its skin limits the penetration of light and reduces the imaging contrast and depth. Herein, an innovative footpad skin optical clearing agent (FSOCA) was developed to make the footpad skin transparent quickly by topical application. The results demonstrate that FSOCA treatment not only allowed the cutaneous blood vessels and blood flow distribution to be monitored by laser speckle contrast imaging technique with higher contrast, but also permitted the fluorescent cells to be imaged by laser scanning confocal microscopy with higher fluorescence signal intensity and larger imaging depth. In addition, the physiological saline-treatment could make the footpad skin recover to the initial turbid status, and reclearing would not induce any adverse effects on the distributions and morphologies of blood vessels and cells, which demonstrated a safe and switchable window for biomedical imaging. This switchable footpad skin optical clearing window will be significant for studying blood flow dynamics and cellular immune function in vivo in some vascular and immunological diseases. Picture: Repeated cell imaging in vivo before (a) and after (b) FSOCA treatment. (c) Merged images of 4 h (cyan border) or 72 h (magenta border) over 0 h. (d) Zoom of ROI in 4 h (yellow rectangle) or 72 h (red rectangle).

Prediction of venous wound healing with laser speckle imaging

Introduction Laser speckle imaging is used for noninvasive assessment of blood flow of cutaneous wounds. The aim of this study was to assess if laser speckle imaging can be used as a predictor of venous ulcer healing. Methods After generating the flux speckle images, three regions of interest (ROI) were identified to measure the flow. Sensitivity, specificity, negative predictive value, and positive predictive value for ulcer healing were calculated. Results In total, 17 limbs were included. A sensitivity of 92.3%, specificity of 75.0%, PPV of 80.0%, and NPV 75.0% were found in predicting wound healing based on laser speckle images. Mean flux values were lowest in the center (ROI I) and showed an increase at the wound edge (ROI II, p = 0.03). Conclusion Laser speckle imaging shows acceptable sensitivity and specificity rates in predicting venous ulcer healing. The wound edge proved to be the best probability for the prediction of wound healing.

Ergodic and non-ergodic regimes in temporal laser speckle imaging

The non-ergodicity problem of temporal averaging in the laser speckle contrast imaging (LSCI) is discussed both theoretically and numerically. We demonstrate that temporal speckle statistics assessed within a finite time window might differ from the statistics of the speckle ensemble. The dependence of temporal speckle contrast on sample dynamics is non-monotonic and demonstrates regimes of negative (ergodic), as well as positive correlations with dynamics (non-ergodic). The ergodic regime is similar to an ensemble (spatial) averaging case and is typically assumed for interpretation of LSCI measurements. The positive relation in the non-ergodic regime is an artifact of temporal statistics which we further quantify and describe the transition between two regimes.

Use of kurtosis for locating deep blood vessels in raw speckle imaging using a homogeneity representation

Visualization of deep blood vessels in speckle images is an important task as it is used to analyze the dynamics of the blood flow and the health status of biological tissue. Laser speckle imaging is a wide-field optical technique to measure relative blood flow speed based on the local speckle contrast analysis. However, it has been reported that this technique is limited to certain deep blood vessels (about ? = 300 ?? ? m ) because of the high scattering of the sample; beyond this depth, the quality of the vessel’s image decreases. The use of a representation based on homogeneity values, computed from the co-occurrence matrix, is proposed as it provides an improved vessel definition and its corresponding diameter. Moreover, a methodology is proposed for automatic blood vessel location based on the kurtosis analysis. Results were obtained from the different skin phantoms, showing that it is possible to identify the vessel region for different morphologies, even up to 900 ?? ? m in depth.

Pre-clinical longitudinal monitoring of hemodynamic response to anti-vascular chemotherapy by hybrid diffuse optics

The longitudinal effect of an anti-vascular endothelial growth factor receptor 2 (VEGFR-2) antibody (DC 101) therapy on a xenografted renal cell carcinoma (RCC) mouse model was monitored using hybrid diffuse optics. Two groups of immunosuppressed male nude mice (seven treated, seven controls) were measured. Tumor microvascular blood flow, total hemoglobin concentration and blood oxygenation were investigated as potential biomarkers for the monitoring of the therapy effect twice a week and were related to the final treatment outcome. These hemodynamic biomarkers have shown a clear differentiation between two groups by day four. Moreover, we have observed that pre-treatment values and early changes in hemodynamics are highly correlated with the therapeutic outcome demonstrating the potential of diffuse optics to predict the therapy response at an early time point.

Quantitative depth-resolved microcirculation imaging with optical coherence tomography angiography (Part Ι): Blood flow velocity imaging

The research goal of the microvascular network imaging with OCT angiography is to achieve depth-resolved blood flow and vessel imaging in vivo in the clinical management of patents. In this review, we review the main phenomena that have been explored in OCT to image the blood flow velocity vector and the vessels of the microcirculation within living tissues. Parameters that limit the accurate measurements of blood flow velocity are then considered. Finally, initial clinical diagnosis applications and future developments of OCT flow images are discussed.

Neovascularization of hepatocellular carcinoma in a nude mouse orthotopic liver cancer model: a morphological study using X-ray in-line phase-contrast imaging

Background

This study aimed to determine whether synchrotron radiation (SR)-based X-ray in-line phase-contrast imaging (IL-PCI) can be used to investigate the morphological characteristics of tumor neovascularization in a liver xenograft animal model.

Methods

A human hepatocellular carcinoma HCCLM3 xenograft model was established in nude mice. Xenografts were sampled each week for 4 weeks and fixed to analyze tissue characteristics and neovascularization using SR-based X-ray in-line phase contrast computed tomography (IL-XPCT) without any contrast agent.

Results

The effect of the energy level and object–to-detector distance on phase-contrast difference was in good agreement with the theory of IL-PCI. Boundaries between the tumor and adjacent normal tissues at week 1 were clearly observed in two-dimensional phase contrast projection imaging. A quantitative contrast difference was observed from weeks 1 to 4. Moreover, 3D image reconstruction of hepatocellular carcinoma (HCC) samples showed blood vessels inside the tumor were abnormal. The smallest blood vessels measured approximately 20 μm in diameter. The tumor vascular density initially increased and then decreased gradually over time. The maximum tumor vascular density was 4.29% at week 2.

Conclusion

IL-XPCT successfully acquired images of neovascularization in HCC xenografts in nude mice.

The effect of calf neuromuscular electrical stimulation and intermittent pneumatic compression on thigh microcirculation

OBJECTIVE

This study compares the effectiveness of a neuromuscular electrical stimulation (NMES) device and an intermittent pneumatic compression (IPC) device on enhancing microcirculatory blood flow in the thigh of healthy individuals, when stimulation is carried out peripherally at the calf.

MATERIALS AND METHODS

Blood microcirculation of ten healthy individuals was recorded using laser speckle contrast imaging (LSCI) technique. A region of interest (ROI) was marked on each participant thigh. The mean flux within the ROI was calculated at four states: rest, NMES device with visible muscle actuation (VMA), NMES device with no visible muscle actuation (NVMA) and IPC device.

RESULTS

Both NMES and IPC devices increased blood flow in the thigh when stimulation was carried out peripherally at the calf. The NMES device increased mean blood perfusion from baseline by 399.8% at the VMA state and 150.6% at the NVMA state, IPC device increased the mean blood perfusion by 117.3% from baseline.

CONCLUSION

The NMES device at VMA state increased microcirculation by more than a factor of 3 in contrast to the IPC device. Even at the NVMA state, the NMES device increased blood flow by 23% more than the IPC device. Given the association between increased microcirculation and reduced oedema, NMES may be a more effective modality than IPC at reducing oedema, therefore further research is needed to explore this.

The Role of Autophagy in the Correlation Between Neuron Damage and Cognitive Impairment in Rat Chronic Cerebral Hypoperfusion

Pathological changes and cognitive impairment caused by chronic cerebral hypoperfusion (CCH) have been previously reported. However, how these changes progress remains unclear. Additionally, there are few studies regarding the mechanism underlying the involvement of autophagy in these processes. Two-step bilateral common carotid artery occlusion (BCCAO) was performed to replicate CCH in Sprague Dawley rats. The animals were divided into seven groups, including a sham group and 2-, 4-, 8-, 12-, 16-, and 20-week BCCAO groups (n = 7 per group). Five additional rats were used to monitor cerebral blood fluid (CBF) changes via laser speckle contrast imaging (LSCI). We tested for cognitive changes and pathological changes, including neuronal injury, white matter lesions, and β-Amyloid (Aβ) deposition, via acknowledged methods. Autophagy was analyzed via western blotting and immunohistochemistry. Cognitive impairment appeared beginning at 8 weeks after BCCAO despite improvement in CBF. Neuronal damage began at 8 weeks in the hippocampal CA1 region and at 4 weeks in the cortex. White matter injury was detected in all BCCAO groups. Intracellular Aβ accumulation occurred earlier than extracellular plaque formation. The levels of autophagy-related proteins (Beclin-1, light chain 3B, and P62) increased beginning at 2 weeks in the cortex and at 4 weeks in the hippocampus and remained elevated throughout the remainder of the study period. Despite recovery of CBF, autophagy dysfunction occurred early after CCH and played an important role in neuronal deterioration, cognitive decline, and intracellular Aβ aggregation.

Effects of volume resuscitation on the microcirculation in animal models of lipopolysaccharide sepsis: a systematic review

Background

Recent research has identified an increased rate of mortality associated with fluid bolus therapy for severe sepsis and septic shock, but the mechanisms are still not well understood. Fluid resuscitation therapy administered for sepsis and septic shock targets restoration of the macro-circulation, but the pathogenesis of sepsis is complex and includes microcirculatory dysfunction.

Objective

The objective of the study is to systematically review data comparing the effects of different types of fluid resuscitation on the microcirculation in clinically relevant animal models of lipopolysaccharide-induced sepsis.

Methods

A structured search of PubMed/MEDLINE and EMBASE for relevant publications from 1 January 1990 to 31 December 2015 was performed, in accordance with PRISMA guidelines.

Results

The number of published papers on sepsis and the microcirculation has increased steadily over the last 25 years. We identified 11 experimental animal studies comparing the effects of different fluid resuscitation regimens on the microcirculation. Heterogeneity precluded any meta-analysis.

Conclusions

Few animal model studies have been published comparing the microcirculatory effects of different types of fluid resuscitation for sepsis and septic shock. Biologically relevant animal model studies remain necessary to enhance understanding regarding the mechanisms by which fluid resuscitation affects the microcirculation and to facilitate the transfer of basic science discoveries to clinical applications.

Quantitative imaging of heterogeneous dynamics in drying and aging paints

Drying and aging paint dispersions display a wealth of complex phenomena that make their study fascinating yet challenging. To meet the growing demand for sustainable, high-quality paints, it is essential to unravel the microscopic mechanisms underlying these phenomena. Visualising the governing dynamics is, however, intrinsically difficult because the dynamics are typically heterogeneous and span a wide range of time scales. Moreover, the high turbidity of paints precludes conventional imaging techniques from reaching deep inside the paint. To address these challenges, we apply a scattering technique, Laser Speckle Imaging, as a versatile and quantitative tool to elucidate the internal dynamics, with microscopic resolution and spanning seven decades of time. We present a toolbox of data analysis and image processing methods that allows a tailored investigation of virtually any turbid dispersion, regardless of the geometry and substrate. Using these tools we watch a variety of paints dry and age with unprecedented detail.

Review of near-infrared methods for wound assessment

Wound management is a challenging and costly problem that is growing in importance as people are living longer. Instrumental methods are increasingly being relied upon to provide objective measures of wound assessment to help guide management. Technologies that employ near-infrared (NIR) light form a prominent contingent among the existing and emerging technologies. We review some of these technologies. Some are already established, such as indocyanine green fluorescence angiography, while we also speculate on others that have the potential to be clinically relevant to wound monitoring and assessment. These various NIR-based technologies address clinical wound management needs along the entire healing trajectory of a wound.

Optical coherence tomography angiography offers comprehensive evaluation of skin optical clearing in vivo by quantifying optical properties and blood flow imaging simultaneously

Tissue optical clearing (TOC) is helpful for reducing scattering and enhancing the penetration depth of light, and shows promising potential in optimizing optical imaging performances. A mixture of fructose with PEG-400 and thiazone (FPT) is used as an optical clearing agent in mouse dorsal skin and evaluated with OCT angiography (Angio-OCT) by quantifying optical properties and blood flow imaging simultaneously. It is observed that FPT leads to an improved imaging performance for the deeper tissues. The imaging performance improvement is most likely caused by the FPT-induced dehydration of skin, and the reduction of scattering coefficient (more than ∼ 40.5%) and refractive-index mismatching (more than ∼ 25.3%) in the superficial (epidermal, dermal, and hypodermal) layers. A high correlation (up to ∼ 90%) between the relative changes in refractive-index mismatching and Angio-OCT signal strength is measured. The optical clearing rate is ∼ 5.83 × 10(-5) cm/s. In addition, Angio-OCT demonstrates enhanced performance in imaging cutaneous hemodynamics with satisfactory spatiotemporal resolution and contrast when combined with TOC, which exhibits a powerful practical application in studying microcirculation.

Optical coherence tomography for longitudinal monitoring of vasculature in scars treated with laser fractionation

This study presents the first in vivo longitudinal assessment of scar vasculature in ablative fractional laser treatment using optical coherence tomography (OCT). A method based on OCT speckle decorrelation was developed to visualize and quantify the scar vasculature over the treatment period. Through reliable co-location of the imaging field of view across multiple imaging sessions, and compensation for motion artifact, the study was able to track the same scar tissue over a period of several months, and quantify changes in the vasculature area density. The results show incidences of occlusion of individual vessels 3 days after the first treatment. The subsequent responses ˜20 weeks after the initial treatment show differences between immature and mature scars. Image analysis showed a distinct decrease (25 ± 13%, mean ± standard deviation) and increase (19 ± 5%) of vasculature area density for the immature and mature scars, respectively. This study establishes the feasibility of OCT imaging for quantitative longitudinal monitoring of vasculature in scar treatment. En face optical coherence tomography vasculature images pre-treatment (top) and ˜20 weeks after the first laser treatment (bottom) of a mature burn scar. Arrows mark the same vessel pattern.

Determination of the Optimum Harvest Window for Apples Using the Non-Destructive Biospeckle Method

Determination of the optimum harvest window plays a key role in the agro-food chain as the quality of fruit depends on the right harvesting time and appropriate storage conditions during the postharvest period. Usually, indices based on destructive measurements are used for this purpose, like the De Jager Index (PFW-1), FARS index and the most popular Streif Index. In this study, we proposed a biospeckle method for the evaluation of the optimum harvest window (OHW) of the "Ligol" and "Szampion" apple cultivars. The experiment involved eight different maturity stages, of which four were followed by long cold storage and shelf life to assist the determination of the optimum harvest window. The biospeckle activity was studied in relation to standard quality attributes (firmness, acidity, starch, soluble solids content, Streif Index) and physiological parameters (respiration and ethylene emission) of both apple cultivars. Changes of biospeckle activity (BA) over time showed moderate relationships with biochemical changes during apple maturation and ripening. The harvest date suggested by the Streif Index and postharvest quality indicators matched with characteristic decrease in BA. The ability of biospeckle method to characterize the biological state of apples was confirmed by significant correlations of BA with firmness, starch index, total soluble solids and Streif Index, as well as good match with changes in carbon dioxide and ethylene emission. However, it should be noted that correlations between variables changing over time are not as meaningful as independent observations. Also, it is a well-known property of the Pearson's correlation that its value is highly susceptible to outlier data. Due to its non-selective nature the BA reflected only the current biological state of the fruit and could be affected by many other factors. The investigations showed that the optimum harvest window for apples was indicated by the characteristic drop of BA during pre-harvest development. Despite this, at the current state of development the BA method cannot be used as an indicator alone. Due to rather poor results for prediction in OHW the BA measurements should be supported by other destructive methods to compensate its low selectivity.

Quantitative blood flow velocity imaging using laser speckle flowmetry

Laser speckle flowmetry suffers from a debated quantification of the inverse relation between decorrelation time (τ_c) and blood flow velocity (V), i.e. 1/τ_c = αV. Using a modified microcirculation imager (integrated sidestream dark field - laser speckle contrast imaging [SDF-LSCI]), we experimentally investigate on the influence of the optical properties of scatterers on α in vitro and in vivo. We found a good agreement to theoretical predictions within certain limits for scatterer size and multiple scattering. We present a practical model-based scaling factor to correct for multiple scattering in microcirculatory vessels. Our results show that SDF-LSCI offers a quantitative measure of flow velocity in addition to vessel morphology, enabling the quantification of the clinically relevant blood flow, velocity and tissue perfusion.

Bridging macroscopic and microscopic methods for the measurements of cerebral blood flow: Toward finding the determinants in maintaining the CBF homeostasis

Methods exist to evaluate the cerebral blood flow (CBF) at both the macroscopic and microscopic spatial scales. These methods provide complementary information for understanding the mechanism in maintaining an adequate blood supply in response to neural demand. The macroscopic CBF assesses perfusion flow, which is usually measured using radioactive tracers, such as diffusible, nondiffusible, or microsphere. Each of them determines CBF based on indicator dilution principle or particle fraction principle under the assumption that CBF is steady state during the measurement. Macroscopic CBF therefore represents averaged CBF over a certain space and time domains. On the other hand, the microscopic CBF assesses bulk flow, usually measures using real-time microscopy. The method assesses hemodynamics of microvessels, ie, vascular dimensions and flow velocities of fluorescently labeled or nonlabeled RBC and plasma markers. The microscopic CBF continuously fluctuates in time and space. Smoothing out this heterogeneity may lead to underestimation in the macroscopic CBF. To link the two measurements, it is needed to introduce a common parameter which is measurable for the both methods, such as mean transit time. Additionally, applying the defined physiological and/or pharmacological perturbation may provide a good exercise to determine how the specific perturbations interfere the quantitative relationships between the macroscopic and microscopic CBF. Finally, bridging these two-scale methods potentially gives a further indication how the absolute CBF is regulated with respect to a specific type of the cerebrovascular tones or capillary flow velocities in the brain.

Pen needle design influences ease of insertion, pain, and skin trauma in subjects with type 2 diabetes

OBJECTIVE

Pen needles used for subcutaneous injections have gradually become shorter, thinner and more thin walled, and thereby less robust to patient reuse. Thus, different needle sizes, alternative tip designs and needles resembling reuse were tested to explore how needle design influences ease of insertion, pain and skin trauma.

RESEARCH DESIGN AND METHODS

30 subjects with injection-treated type 2 diabetes and body mass index 25-35 kg/m² were included in the single-blinded study. Each subject received abdominal insertions with 18 different types of needles. All needles were tested twice per subject and in random order. Penetration force (PF) through the skin, pain perception on 100 mm visual analog scale, and change in skin blood perfusion (SBP) were quantified after the insertions.

RESULTS

Needle diameter was positively related to PF and SBP (p<0.05) and with a positive pain trend relation. Lack of needle lubrication and small 'needle hooks' increased PF and SBP (p<0.05) but did not affect pain. Short-tip, obtuse needle grinds affected PF and SBP, but pain was only significantly affected in extreme cases. PF in skin and in polyurethane rubber were linearly related, and pain outcome was dependent of SBP increase.

CONCLUSIONS

The shape and design of a needle and the needle tip affect ease of insertion, pain and skin trauma. Relations are seen across different data acquisition methods and across species, enabling needle performance testing outside of clinical trials.

TRIAL REGISTRATION NUMBER

NCT02531776; results.

Relationship between the blood perfusion values determined by laser speckle imaging and laser Doppler imaging in normal skin and port wine stains

OBJECTIVE

Laser Doppler imaging (LDI) and laser speckle imaging (LSI) are two major optical techniques aiming at non-invasively imaging the skin blood perfusion. However, the relationship between perfusion values determined by LDI and LSI has not been fully explored.

METHODS

8 healthy volunteers and 13 PWS patients were recruited. The perfusions in normal skin on the forearm of 8 healthy volunteers were simultaneously measured by both LDI and LSI during post-occlusive reactive hyperemia (PORH). Furthermore, the perfusions of port wine stains (PWS) lesions and contralateral normal skin of 10 PWS patients were also determined. In addition, the perfusions for PWS lesions from 3 PWS patients were successively monitored at 0, 10 and 20min during vascular-targeted photodynamic therapy (V-PDT). The average perfusion values determined by LSI were compared with those of LDI for each subject.

RESULTS

In the normal skin during PORH, power function provided better fits of perfusion values than linear function: powers for individual subjects go from 1.312 to 1.942 (R(2)=0.8967-0.9951). There was a linear relationship between perfusion values determined by LDI and LSI in PWS and contralateral normal skin (R(2)=0.7308-0.9623), and in PWS during V-PDT (R(2)=0.8037-0.9968).

CONCLUSION

The perfusion values determined by LDI and LSI correlate closely in normal skin and PWS over a broad range of skin perfusion. However, it still suggests that perfusion range and characteristics of the measured skin should be carefully considered if LDI and LSI measures are compared.

Multi-exposure laser speckle contrast imaging using a high frame rate CMOS sensor with a field programmable gate array

A system has been developed in which multi-exposure laser speckle contrast imaging (LSCI) is implemented using a high frame rate CMOS imaging sensor chip. Processing is performed using a field programmable gate array (FPGA). The system allows different exposure times to be simulated by accumulating a number of short exposures. This has the advantage that the image acquisition time is limited by the maximum exposure time and that regulation of the illuminating light level is not required. This high frame rate camera has also been deployed to implement laser Doppler blood flow processing, enabling a direct comparison of multi-exposure laser speckle imaging and laser Doppler imaging (LDI) to be carried out using the same experimental data. Results from a rotating diffuser indicate that both multi-exposure LSCI and LDI provide a linear response to changes in velocity. This cannot be obtained using single-exposure LSCI, unless an appropriate model is used for correcting the response.

Epidermal devices for noninvasive, precise, and continuous mapping of macrovascular and microvascular blood flow

Continuous monitoring of variations in blood flow is vital in assessing the status of microvascular and macrovascular beds for a wide range of clinical and research scenarios. Although a variety of techniques exist, most require complete immobilization of the subject, thereby limiting their utility to hospital or clinical settings. Those that can be rendered in wearable formats suffer from limited accuracy, motion artifacts, and other shortcomings that follow from an inability to achieve intimate, noninvasive mechanical linkage of sensors with the surface of the skin. We introduce an ultrathin, soft, skin-conforming sensor technology that offers advanced capabilities in continuous and precise blood flow mapping. Systematic work establishes a set of experimental procedures and theoretical models for quantitative measurements and guidelines in design and operation. Experimental studies on human subjects, including validation with measurements performed using state-of-the-art clinical techniques, demonstrate sensitive and accurate assessment of both macrovascular and microvascular flow under a range of physiological conditions. Refined operational modes eliminate long-term drifts and reduce power consumption, thereby providing steps toward the use of this technology for continuous monitoring during daily activities.

Application of full field optical studies for pulsatile flow in a carotid artery phantom

A preliminary comparative measurement between particle imaging velocimetry (PIV) and laser speckle contrast analysis (LASCA) to study pulsatile flow using ventricular assist device in a patient-specific carotid artery phantom is reported. These full-field optical techniques have both been used to study flow and extract complementary parameters. We use the high spatial resolution of PIV to generate a full velocity map of the flow field and the high temporal resolution of LASCA to extract the detailed frequency spectrum of the fluid pulses. Using this combination of techniques a complete study of complex pulsatile flow in an intricate flow network can be studied.

Review of photoacoustic flow imaging: its current state and its promises

Flow imaging is an important method for quantification in many medical imaging modalities, with applications ranging from estimating wall shear rate to detecting angiogenesis. Modalities like ultrasound and optical coherence tomography both offer flow imaging capabilities, but suffer from low contrast to red blood cells and are sensitive to clutter artefacts. Photoacoustic imaging (PAI) is a relatively new field, with a recent interest in flow imaging. The recent enthusiasm for PA flow imaging is due to its intrinsic contrast to haemoglobin, which offers a new spin on existing methods of flow imaging, and some unique approaches in addition. This review article will delve into the research on photoacoustic flow imaging, explain the principles behind the many techniques and comment on their individual advantages and disadvantages.

Optimization of focusing through scattering media using the continuous sequential algorithm

The ability to control the propagation of light through scattering media is essential for atmospheric optics, astronomy, biomedical imaging and remote sensing. The optimization of focusing light through a scattering medium is of particular interest for the case of highly scattering materials. Optical wavefront beam-shaping plays a critical role in optimizing such a propagation; however, an enormous field of adjustable parameters makes the overall task complicated. Here, we propose and experimentally evaluate several variations on the standard continuous sequential algorithm that hold a promise of revealing new, faster and more efficient optimization algorithms for selecting an optical wavefront to focus light through a scattering medium. We demonstrate that the order in which pixels are chosen in the continuous sequential algorithm can lead to a 2-fold decrease in the number of iterations required to reach a given enhancement.

Accessing to arteriovenous blood flow dynamics response using combined laser speckle contrast imaging and skin optical clearing

Laser speckle contrast imaging (LSCI) shows a great potential for monitoring blood flow, but the spatial resolution suffers from the scattering of tissue. Here, we demonstrate the capability of a combination method of LSCI and skin optical clearing to describe in detail the dynamic response of cutaneous vasculature to vasoactive noradrenaline injection. Moreover, the superior resolution, contrast and sensitivity make it possible to rebuild arteries-veins separation and quantitatively assess the blood flow dynamical changes in terms of flow velocity and vascular diameter at single artery or vein level.

Microvascular blood flow monitoring with laser speckle contrast imaging using the generalized differences algorithm

Laser speckle contrast imaging (LSCI) is a full-field optical technique to monitor microvascular blood flow with high spatial and temporal resolutions. It is used in many medical fields such as dermatology, vascular medicine, or neurosciences. However, LSCI leads to a large amount of data: image sampling frequency is often of several Hz and recordings usually last several minutes. Therefore, clinicians often perform regions of interest in which a spatial averaging of blood flow is performed and the result is followed with time. Unfortunately, this leads to a poor spatial resolution for the analyzed data. At the same time, a higher spatial resolution for the perfusion maps is wanted. To get over this dilemma we propose a new post-acquisition visual representation for LSCI perfusion data using the so-called generalized differences (GD) algorithm. From a stack of perfusion images, the procedure leads to a new single image with the same spatial resolution as the original images and this new image reflects perfusion changes. The algorithm is herein applied on simulated stacks of images and on experimental LSCI perfusion data acquired in three different situations with a commercialized laser speckle contrast imager. The results show that the GD algorithm provides a new way of visualizing LSCI perfusion data.

Measurement of vital sign in chick embryo using multi-channel diffuse speckle contrast analysis

In poultry industry which is avian breeding program, the determination whether chick embryos survive in the artificial incubation periods or not is essential to reduce the financial resources. We developed the multi-channel diffuse speckle contrast analysis (DSCA) system composed of four optical fiber detectors enabling to achieve in-vivo measurements of deep tissue flow noninvasively. The system could confirm vital sign of the chick embryo in early incubation stage. Moreover, it demonstrates the change of relative blood flow index and depth information with simplicity, low cost, and flexibility.

Microfabrication of polydimethylsiloxane phantoms to simulate tumor hypoxia and vascular anomaly

We introduce a microfluidic approach to simulate tumor hypoxia and vascular anomaly. Polydimethylsiloxane (PDMS) phantoms with embedded microchannel networks were fabricated by a soft lithography process. A dialysis membrane was sandwiched between two PDMS slabs to simulate the controlled mass transport and oxygen metabolism. A tortuous microchannel network was fabricated to simulate tumor microvasculature. A dual-modal multispectral and laser speckle imaging system was used for oxygen and blood flow imaging in the tumor-simulating phantom. The imaging results were compared with those of the normal vasculature. Our experiments demonstrated the technical feasibility of simulating tumor hypoxia and vascular anomalies using the proposed PDMS phantom. Such a phantom fabrication technique may be potentially used to calibrate optical imaging devices, to study the mechanisms for tumor hypoxia and angiogenesis, and to optimize the drug delivery strategies.

In vivo pump-probe optical coherence tomography imaging in Xenopus laevis

Currently, optical coherence tomography (OCT), is not capable of obtaining molecular information often crucial for identification of disease. To enable molecular imaging with OCT, we have further developed a technique that harnesses transient changes in light absorption in the sample to garner molecular information. A Fourier-domain Pump-Probe OCT (PPOCT) system utilizing a 532 nm pump and 830 nm probe has been developed for imaging hemoglobin. Methylene blue, a biological dye with well-know photophysics, was used to characterize the system before investigating the origin of the hemoglobin PPOCT signal. The first in vivo PPOCT images were recorded of the vasculature in Xenopus laevis. The technique was shown to work equally well in flowing and nonflowing vessels. Furthermore, PPOCT was compared with other OCT extensions which require flow, such as Doppler OCT and phase-variance OCT. PPOCT was shown to better delineate tortuous vessels, where nodes often restrict Doppler and phase-variance reconstruction.

Methods for the morphological and functional evaluation of microvascular damage in systemic sclerosis

Systemic sclerosis is a connective tissue disease characterized by alterations in microvascular structure and function. In these patients, numerous studies have demonstrated a relationship between capillary morphology and peripheral blood perfusion. Nailfold videocapillaroscopy reveals the peripheral microvascular morphology and thus allows classification and scoring of capillary abnormalities with respect to different microangiopathy patterns (early, active, and late). Laser Doppler flowmetry and laser speckle contrast analysis can be used to estimate cutaneous blood flow through microvessels and to assess and quantify blood perfusion at peripheral sites. These two methods are also used to identify changes in digital blood perfusion after the infusion of vasodilators.

Reducing misfocus-related motion artefacts in laser speckle contrast imaging

Laser Speckle Contrast Imaging (LSCI) is a flexible, easy-to-implement technique for measuring blood flow speeds in-vivo. In order to obtain reliable quantitative data from LSCI the object must remain in the focal plane of the imaging system for the duration of the measurement session. However, since LSCI suffers from inherent frame-to-frame noise, it often requires a moving average filter to produce quantitative results. This frame-to-frame noise also makes the implementation of rapid autofocus system challenging. In this work, we demonstrate an autofocus method and system based on a novel measure of misfocus which serves as an accurate and noise-robust feedback mechanism. This measure of misfocus is shown to enable the localization of best focus with sub-depth-of-field sensitivity, yielding more accurate estimates of blood flow speeds and blood vessel diameters.

Probabilistic graphical modeling of speckle statistics in laser speckle contrast imaging for noninvasive and label-free retinal angiography

This paper introduces a noninvasive and label-free approach for retinal angiography using Laser speckle contrast imaging (LSCI). Retinal vessel structure is segmented using a Hidden Markov Random Field (HMRF) based model. Prior to that, k-means clustering is used to obtain initial parameter set and labels for HMRF. Final parameter set for HMRF is estimated using expectation-maximization (EM) algorithm and final labeling is achieved using maximum aposteriori (MAP) algorithm. Clique energy for HMRF is computed from eigenvalue analysis of structure tensor for each pixel. This helps to get connectivity in the direction of strongest tangents in its neighborhood, facilitating the tracking of fine vessels in retinal vascular network. Quantitative evaluation shows an average vessel segmentation accuracy of 96.41% in normal condition with substantial improvement in tracking capability of fine vessels. Changes in blood flow can be tracked and observed at segmented output; particularly applicable for the study of different pathological conditions.