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Qureshi MM, Allam N, Im J, Kwon HS, Chung E, Vitkin IA. Advances in laser speckle imaging: From qualitative to quantitative hemodynamic assessment. JOURNAL OF BIOPHOTONICS 2024; 17:e202300126. [PMID: 37545037 DOI: 10.1002/jbio.202300126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/03/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
Laser speckle imaging (LSI) techniques have emerged as a promising method for visualizing functional blood vessels and tissue perfusion by analyzing the speckle patterns generated by coherent light interacting with living biological tissue. These patterns carry important biophysical tissue information including blood flow dynamics. The noninvasive, label-free, and wide-field attributes along with relatively simple instrumental schematics make it an appealing imaging modality in preclinical and clinical applications. The review outlines the fundamentals of speckle physics and the three categories of LSI techniques based on their degree of quantification: qualitative, semi-quantitative and quantitative. Qualitative LSI produces microvascular maps by capturing speckle contrast variations between blood vessels containing moving red blood cells and the surrounding static tissue. Semi-quantitative techniques provide a more accurate analysis of blood flow dynamics by accounting for the effect of static scattering on spatiotemporal parameters. Quantitative LSI such as optical speckle image velocimetry provides quantitative flow velocity measurements, which is inspired by the particle image velocimetry in fluid mechanics. Additionally, discussions regarding the prospects of future innovations in LSI techniques for optimizing the vascular flow quantification with associated clinical outlook are presented.
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Affiliation(s)
- Muhammad Mohsin Qureshi
- Division of Biophysics and Bioimaging, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Nader Allam
- Division of Biophysics and Bioimaging, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Jeongmyo Im
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Hyuk-Sang Kwon
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Euiheon Chung
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
- AI Graduate School, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - I Alex Vitkin
- Division of Biophysics and Bioimaging, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
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Liu YZ, Mehrotra S, Nwaiwu CA, Buharin VE, Oberlin J, Stolyarov R, Schwaitzberg SD, Kim PCW. Real-time quantification of intestinal perfusion and arterial versus venous occlusion using laser speckle contrast imaging in porcine model. Langenbecks Arch Surg 2023; 408:114. [PMID: 36859714 DOI: 10.1007/s00423-023-02845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Real-time intraoperative perfusion assessment may reduce anastomotic leaks. Laser speckle contrast imaging (LSCI) provides dye-free visualization of perfusion by capturing coherent laser light scatter from red blood cells and displays perfusion as a colormap. Herein, we report a novel method to precisely quantify intestinal perfusion using LSCI. METHODS ActivSight™ is an FDA-cleared multi-modal visualization system that can detect and display perfusion via both indocyanine green imaging (ICG) and LSCI in minimally invasive surgery. An experimental prototype LSCI perfusion quantification algorithm was evaluated in porcine models. Porcine small bowel was selectively devascularized to create regions of perfused/watershed/ischemic bowel, and progressive aortic inflow/portal vein outflow clamping was performed to study arterial vs. venous ischemia. Continuous arterial pressure was monitored via femoral line. RESULTS LSCI perfusion colormaps and quantification distinguished between perfused, watershed, and ischemic bowel in all vascular control settings: no vascular occlusion (p < 0.001), aortic occlusion (p < 0.001), and portal venous occlusion (p < 0.001). LSCI quantification demonstrated similar levels of ischemia induced both by states of arterial inflow and venous outflow occlusion. LSCI-quantified perfusion values correlated positively with higher mean arterial pressure and with increasing distance from ischemic bowel. CONCLUSION LSCI relative perfusion quantification may provide more objective real-time assessment of intestinal perfusion compared to conventional naked eye assessment by quantifying currently subjective gradients of bowel ischemia and identifying both arterial/venous etiologies of ischemia.
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Affiliation(s)
- Yao Z Liu
- Department of Surgery, Brown University, Providence, RI, USA
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA
| | - Saloni Mehrotra
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA
- Department of Surgery, University of Buffalo, Buffalo, NY, USA
| | - Chibueze A Nwaiwu
- Department of Surgery, Brown University, Providence, RI, USA
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA
| | | | - John Oberlin
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA
| | - Roman Stolyarov
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA
| | | | - Peter C W Kim
- Department of Surgery, Brown University, Providence, RI, USA.
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA.
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Harriott CB, Angeramo CA, Casas MA, Schlottmann F. Open vs. Hybrid vs. Totally Minimally Invasive Ivor Lewis Esophagectomy: Systematic Review and Meta-analysis. J Thorac Cardiovasc Surg 2022; 164:e233-e254. [DOI: 10.1016/j.jtcvs.2021.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/03/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023]
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Urbán D, Cserni T, Boros M, Juhász Á, Érces D, Varga G. Bladder augmentation from an insider's perspective: a review of the literature on microcirculatory studies. Int Urol Nephrol 2021; 53:2221-2230. [PMID: 34435307 DOI: 10.1007/s11255-021-02971-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/03/2021] [Indexed: 02/07/2023]
Abstract
Augmentation cystoplasty is an exemplary multiorgan intervention in urology which is particularly associated with microvascular damage. Our aim was to review the available intravital imaging techniques and data obtained from clinical and experimental microcirculatory studies involving the most important donor organs applied in bladder augmentation. Although numerous direct or indirect methods are available to assess the condition of microvessels the implementation of microcirculatory diagnostic methods in humans is still challenging and the assessment of organ microcirculation in the operating theatre has limitations. Nevertheless, preclinical studies generally report good internal validity and although prospective human protocols with reduced variability are needed, a possible positive impact of microcirculatory diagnostics on the clinical outcomes of urologic surgery can be anticipated.
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Affiliation(s)
- Dániel Urbán
- Institute of Surgical Research, University of Szeged, Pulz u. 1., Szeged, 6724, Hungary.,Department of General and Thoracic Surgery, Hetényi Géza County Hospital, Tószegi u. 21., Szolnok, 5000, Hungary
| | - Tamás Cserni
- Institute of Surgical Research, University of Szeged, Pulz u. 1., Szeged, 6724, Hungary.,Department of Paediatric Urology, The Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Mihály Boros
- Institute of Surgical Research, University of Szeged, Pulz u. 1., Szeged, 6724, Hungary
| | - Árpád Juhász
- Department of General and Thoracic Surgery, Hetényi Géza County Hospital, Tószegi u. 21., Szolnok, 5000, Hungary
| | - Dániel Érces
- Institute of Surgical Research, University of Szeged, Pulz u. 1., Szeged, 6724, Hungary
| | - Gabriella Varga
- Institute of Surgical Research, University of Szeged, Pulz u. 1., Szeged, 6724, Hungary.
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Yang Y, Liu L, Yang R, Ding X, Li Y, Liu H, Yan H. Blood perfusion in hypertrophic scars and keloids studied by laser speckle contrast imaging. Skin Res Technol 2021; 27:789-796. [PMID: 33651469 DOI: 10.1111/srt.13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study used laser speckle contrast imaging (LSCI) to evaluate the difference in blood perfusion between hypertrophic scars and keloids. MATERIALS AND METHODS A total of 30 keloids, 21 early hypertrophic scars, 20 proliferative hypertrophic scars, 20 regressive hypertrophic scars, and 20 mature hypertrophic scars were enrolled into this study. Vancouver Scar Scale (VSS) was assessed by a plastic surgeon. LSCI was used to evaluate perfusion of the whole (W), marginal (M), central (C) regions, and surrounding normal skin of the scars, and ratios (M/N, C/N) were calculated. RESULTS The perfusion of the marginal region in the keloid was significantly higher than that of the central region. Nevertheless, there was no significant difference in perfusion between the central and marginal regions in the early, proliferative, regressive, and mature hypertrophic scars. The degree of perfusion and perfusion ratio in the marginal region of keloid was similar to that of proliferative hypertrophic scars, and the degree of perfusion and perfusion ratio in central region of keloid group was similar to that of early and regressive hypertrophic scars. CONCLUSIONS The difference in perfusion distribution in keloids and hypertrophic scars may provide ideas for their identification. LSCI may be a useful method for differentiating between keloids and hypertrophic scars.
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Affiliation(s)
- Yuting Yang
- Department of Plastic and Burn Surgery, National Key Clinical Construction Specialty, Wound Repair and Regeneration Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lan Liu
- Department of Plastic and Burn Surgery, National Key Clinical Construction Specialty, Wound Repair and Regeneration Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ruxi Yang
- Department of Plastic and Burn Surgery, National Key Clinical Construction Specialty, Wound Repair and Regeneration Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaobing Ding
- Department of Plastic and Burn Surgery, National Key Clinical Construction Specialty, Wound Repair and Regeneration Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ying Li
- Department of Plastic and Burn Surgery, National Key Clinical Construction Specialty, Wound Repair and Regeneration Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongjun Liu
- Department of Plastic and Burn Surgery, National Key Clinical Construction Specialty, Wound Repair and Regeneration Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hong Yan
- Department of Plastic and Burn Surgery, National Key Clinical Construction Specialty, Wound Repair and Regeneration Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Intraoperative Perfusion Assessment in Enhanced Reality Using Quantitative Optical Imaging: An Experimental Study in a Pancreatic Partial Ischemia Model. Diagnostics (Basel) 2021; 11:diagnostics11010093. [PMID: 33430038 PMCID: PMC7826658 DOI: 10.3390/diagnostics11010093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 02/06/2023] Open
Abstract
To reduce the risk of pancreatic fistula after pancreatectomy, a satisfactory blood flow at the pancreatic stump is considered crucial. Our group has developed and validated a real-time computational imaging analysis of tissue perfusion, using fluorescence imaging, the fluorescence-based enhanced reality (FLER). Hyperspectral imaging (HSI) is another emerging technology, which provides tissue-specific spectral signatures, allowing for perfusion quantification. Both imaging modalities were employed to estimate perfusion in a porcine model of partial pancreatic ischemia. Perfusion quantification was assessed using the metrics of both imaging modalities (slope of the time to reach maximum fluorescence intensity and tissue oxygen saturation (StO2), for FLER and HSI, respectively). We found that the HSI-StO2 and the FLER slope were statistically correlated using the Spearman analysis (R = 0.697; p = 0.013). Local capillary lactate values were statistically correlated to the HSI-StO2 and to the FLER slope (R = −0.88; p < 0.001 and R = −0.608; p = 0.0074). HSI-based and FLER-based lactate prediction models had statistically similar predictive abilities (p = 0.112). Both modalities are promising to assess real-time pancreatic perfusion. Clinical translation in human pancreatic surgery is currently underway.
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Tagkalos E, Lindner A, Gruber G, Lang H, Heimann A, Grimminger PP, Muensterer OJ, Oetzmann von Sochaczewski C. Using simple interrupted suture anastomoses may impair translatability of experimental rodent oesophageal surgery. Acta Chir Belg 2020; 120:310-314. [PMID: 31012385 DOI: 10.1080/00015458.2019.1610263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background/purpose: Irreproducibility and missing translatability are major drawbacks in experimental animal studies. Hand-sewn anastomoses in oesophageal surgery are usually continuous, whereas those in experimental oesophageal surgery are widely performed using the simple interrupted technique. It has been implicated to be inferior in tolerating anastomotic tension, which we aimed to test in rats due to their importance as an animal model in oesophageal surgery.Methods: We determined linear breaking strengths for the native oesophagus (n = 10), the simple interrupted suture anastomosis (n = 11), and the simple stitch (n = 9) in 8-week old Sprague-Dawley rats. Experiments were powered to a margin of error of 10% around the results of exploratory investigations. The comparison of anastomotic resilience between native organ and simple interrupted suture anastomosis was a priori powered to 99%.Results: Native oesophagi sustained traction forces of 4.25 N (95% CI: 4.03-4.58 N), but the simple interrupted suture anastomosis had only 38.6% (Δ= -2.78 N, 95% CI: -2.46 to -3.11 N, p < .0001) of the resilience of native oesophagi.Conclusions: Oesophageal division and re-anastomosis markedly decreases resilience to traction forces compared to the native organ. This effect is even more pronounced in rats compared to other species and might impair transferability of results.
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Affiliation(s)
- Evangelos Tagkalos
- Department of General, Visceral and Transplant Surgery Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Andreas Lindner
- Department of Paediatric Surgery, Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Gudrun Gruber
- Translational Animal Research Centre Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Axel Heimann
- Institute of Neurosurgical Pathophysiology Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Peter P. Grimminger
- Department of General, Visceral and Transplant Surgery Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Oliver J. Muensterer
- Department of Paediatric Surgery, Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
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Zhao Y, Wang K, Li W, Zhang H, Qian Z, Liu Y. Laser speckle contrast imaging system using nanosecond pulse laser source. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-10. [PMID: 32452171 PMCID: PMC7247735 DOI: 10.1117/1.jbo.25.5.056005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
SIGNIFICANCE Nanosecond-pulsed laser has proven to be used to obtain the velocity of blood using the speckle contrast method. Without the scanning time, it has potential for achieving fast two-dimensional blood flow images in a photoacoustic imaging system with the same pulsed laser. AIM Our study aimed to evaluate the qualities of regional cerebral blood flow (rCBF) obtained in a laser speckle contrast imaging (LSCI) system using continuous wave (cw) and nanosecond pulse laser sources. APPROACH First, a LSCI system consisting of a cw laser with a wavelength of 632.8 nm and a cw laser/nanosecond pulse laser with a wavelength of 532 nm was developed. This system was used to obtain rCBF images of mouse in vivo with two different laser sources. RESULTS Continuous wave lasers (532 and 632.8 nm) show different imaging characteristics for rCBF imaging. The rCBF images obtained using 532-nm nanosecond pulse laser showed higher resolution than those using 532-nm cw laser. There was no significant difference in the results using nanosecond pulse laser among various pulse widths or repetition rates. CONCLUSIONS It is proved that a nanosecond pulse laser could be used for LSCI.
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Affiliation(s)
- Yuemei Zhao
- Nanjing University of Aeronautics and Astronautics, Department of Biomedical Engineering, Nanjing, China
| | - Kang Wang
- Nanjing University of Aeronautics and Astronautics, Department of Biomedical Engineering, Nanjing, China
| | - Weitao Li
- Nanjing University of Aeronautics and Astronautics, Department of Biomedical Engineering, Nanjing, China
| | - Huan Zhang
- Nanjing University of Aeronautics and Astronautics, Department of Biomedical Engineering, Nanjing, China
| | - Zhiyu Qian
- Nanjing University of Aeronautics and Astronautics, Department of Biomedical Engineering, Nanjing, China
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Feasibility and usability of real-time intraoperative quantitative fluorescent-guided perfusion assessment during resection of gastroesophageal junction cancer. Langenbecks Arch Surg 2020; 405:215-222. [PMID: 32281020 DOI: 10.1007/s00423-020-01876-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Anastomotic leakage after resection of gastroesophageal junction cancer is a dangerous complication, and leakage rates have remained stable for decades. Perfusion is crucial for anastomotic healing, but traditional perfusion assessment is limited in a minimally invasive environment. New methods as indocyanine green fluorescence angiography (ICG-FA) have proven promising, but quantitative analysis has been challenging. This study aimed to demonstrate the feasibility and usability of real-time intraoperative quantitative fluorescence angiography (q-ICG) with a touchscreen tablet. METHODS A software for q-ICG was previously developed and validated. Ten patients underwent perfusion assessment in white light (WL), with ICG-FA, and with q-ICG during Ivor-Lewis esophageal resection. The usability of the tablet-based software was tested with the System Usability Scale (SUS®). Furthermore, we investigated the differences in perfusion assessment as the distance from the conduit margin to a surgeon selected point of sufficient perfusion for anastomosis using the different modalities. RESULTS Q-ICG was successful in all patients, with an excellent median SUS® of 82.5 (77.5-93.8). Significant differences in distances from the conduit margin to points of sufficient perfusion selected by the surgeons were found: ICG: WL = 14.1 mm (p = 0.048), q-ICG: WL = 32.08 mm (p < 0.001), and q-ICG: ICG = 17.95 mm (p = 0.002). Furthermore, significant differences of perfusion were found between the points, when q-ICG was performed retrospectively in the surgeon selected areas (p = 0.008-0.013). CONCLUSION Real-time intraoperative touchscreen-based q-ICG was feasible with excellent usability, and differences in sufficient perfusion points selected by the surgeons between modalities were found. Further studies should focus on clinical relevance and determine cutoff values associated with anastomotic leakage.
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Moukarzel LA, Feinberg J, Levy EJ, Leitao MM. Current and novel mapping substances in gynecologic cancer care. Int J Gynecol Cancer 2020; 30:387-393. [PMID: 31953349 PMCID: PMC7375198 DOI: 10.1136/ijgc-2019-001078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 01/01/2023] Open
Abstract
Many tracers have been introduced into current medical practice with the purpose of improving lymphatic mapping techniques, anatomic visualization, and organ/tissue perfusion assessment. Among them, three tracers have dominated the field: indocyanine green, technetium-99m radiocolloid (Tc99m), and blue dye. Tc99m and blue dye are used individually or in combination; however, given particular challenges with these tracers, such as the need for a preoperative procedure by nuclear medicine and cost, other options have been sought. Indocyanine green has proven to be a promising alternative for certain procedures, as it is easy to use and has quick uptake. Its use in the management of gynecologic cancers was first described for sentinel lymph node mapping in cervical cancer, and later for endometrial and vulvar cancers. This review provides an in-depth look at these mapping substances, their uses, and the potential for new discoveries.
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Affiliation(s)
- Lea A Moukarzel
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jacqueline Feinberg
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evan J Levy
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, United States
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Heeman W, Steenbergen W, van Dam GM, Boerma EC. Clinical applications of laser speckle contrast imaging: a review. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-11. [PMID: 31385481 PMCID: PMC6983474 DOI: 10.1117/1.jbo.24.8.080901] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/02/2019] [Indexed: 05/02/2023]
Abstract
When a biological tissue is illuminated with coherent light, an interference pattern will be formed at the detector, the so-called speckle pattern. Laser speckle contrast imaging (LSCI) is a technique based on the dynamic change in this backscattered light as a result of interaction with red blood cells. It can be used to visualize perfusion in various tissues and, even though this technique has been extensively described in the literature, the actual clinical implementation lags behind. We provide an overview of LSCI as a tool to image tissue perfusion. We present a brief introduction to the theory, review clinical studies from various medical fields, and discuss current limitations impeding clinical acceptance.
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Affiliation(s)
- Wido Heeman
- University of Groningen, Faculty Campus Fryslân, Leeuwarden, The Netherlands
- University Medical Centre Groningen, Department of Surgery, Optical Molecular Imaging Groningen, Groningen, The Netherlands
- LIMIS Development BV, Leeuwarden, The Netherlands
| | - Wiendelt Steenbergen
- University of Twente, Techmed Center, Faculty of Science and Technology, Biomedical Photonic Imaging Group, Enschede, The Netherlands
| | - Gooitzen M. van Dam
- University Medical Centre Groningen, Department of Surgery, Optical Molecular Imaging Groningen, Groningen, The Netherlands
| | - E. Christiaan Boerma
- Medical Centre Leeuwarden, Department of Intensive Care, Leeuwarden, The Netherlands
- Address all correspondence to E. Christiaan Boerma, E-mail:
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Cheng W, Zhu X, Chen X, Li M, Lu J, Li P. Manhattan Distance-Based Adaptive 3D Transform-Domain Collaborative Filtering for Laser Speckle Imaging of Blood Flow. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:1726-1735. [PMID: 30714912 DOI: 10.1109/tmi.2019.2896007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Laser speckle contrast imaging (LSCI) is a full-field, noncontact imaging technology for mapping blood flow with high spatio-temporal resolution, in which the speckle contrast can be estimated either in spatial domain or temporal domain. Temporal LSCI (tLSCI) provides higher spatial resolution than spatial domain does. However, when the number of sampling frames is limited, it is difficult to obtain accurate blood flow velocity owing to the significant statistical noise. The widely used spatially averaged tLSCI (savg-tLSCI) usually requires a large number of sampling frames to obtain acceptable denoising performance. Here, based on the nonlocal filtering strategy of block-matching and three-dimensional transform-domain collaborative filtering (BM3D), Manhattan distance-based adaptive BM3D (MD-ABM3D) is proposed to effectively manage the complicated inhomogeneous noise in tLSCI image and improve the signal-to-noise ratio. Manhattan distance improves the accuracy of the block matching in strong noise, and the adaptive algorithm adapts to the inhomogeneous noise and estimates suitable parameters for improved denoising. MD-ABM3D improves 4.91 dB in peak signal-to-noise ratio relative to savg-tLSCI. It achieves stability for denoising tLSCI image with different temporal windows. The image-quality evaluation of MD-ABM3D for tLSCI (t = 20 frames) equals that of savg-tLSCI (t = 60 frames). It achieves high signal-to-noise ratio with a reduced number of sampling frames. A reduced number of sampling frames are more practical for biomedical applications. It also offers higher temporal resolution and less disturbance from the motion of the moving object.
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Klevebro F, Boshier PR, Low DE. Application of standardized hemodynamic protocols within enhanced recovery after surgery programs to improve outcomes associated with anastomotic leak and conduit necrosis in patients undergoing esophagectomy. J Thorac Dis 2019; 11:S692-S701. [PMID: 31080646 PMCID: PMC6503292 DOI: 10.21037/jtd.2018.11.141] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 11/29/2018] [Indexed: 12/13/2022]
Abstract
Esophagectomy for cancer is associated with high risk for postoperative morbidity. The most serious regularly encountered complication is anastomotic leak and the most feared individual complication is conduit necrosis. Both of these complications affect the length of stay, mortality, quality of life, and survival for patients undergoing esophageal resection. The maintenance of conduit viability is of primary importance in the perioperative care of patients following esophageal resection. It has been shown that restrictive fluid management may be associated with improved postoperative outcomes in abdominal and other types of surgery, but many factors can affect the incidence of anastomotic leak and the viability of the gastric conduit. We have performed a comprehensive review with the aim to give an overview of the available evidence for the use of standardized hemodynamic protocols (SHPs) for esophagectomy and review the hemodynamic protocol, which has been applied within a standardized clinical pathway (SCP) at the Department of Thoracic surgery at the Virginia Mason Medical Center between 2004-2018 where the anastomotic leak rate over the period has been 5.2% and the incidence of conduit necrosis requiring surgical management is zero. The literature review demonstrates that there are few high quality studies that provide scientific evidence for the use of a SHP. The evidence indicates that the use of goal-directed hemodynamic monitoring might be associated with a reduced risk for postoperative complications, shortened length of stay, and decreased need for intensive care unit stay. We propose that the routine application of a SHP can provide a uniform infrastructure to optimize conduit perfusion and decrease the incidence of anastomotic leak.
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Affiliation(s)
- Fredrik Klevebro
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, USA
| | - Piers R Boshier
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, USA
| | - Donald E Low
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, USA
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Jansen SM, de Bruin DM, van Berge Henegouwen MI, Strackee SD, Veelo DP, van Leeuwen TG, Gisbertz SS. Optical techniques for perfusion monitoring of the gastric tube after esophagectomy: a review of technologies and thresholds. Dis Esophagus 2018; 31:4986868. [PMID: 29701760 DOI: 10.1093/dote/dox161] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anastomotic leakage is one of the most severe complications after esophageal resection with gastric tube reconstruction. Impaired perfusion of the gastric fundus is seen as the main contributing factor for this complication. Optical modalities show potential in recognizing compromised perfusion in real time, when ischemia is still reversible. This review provides an overview of optical techniques with the aim to evaluate the (1) quantitative measurement of change in perfusion in gastric tube reconstruction and (2) to test which parameters are the most predictive for anastomotic leakage.A Pubmed, MEDLINE, and Embase search was performed and articles on laser Doppler flowmetry (LDF), near-infrared spectroscopy (NIRS), laser speckle contrast imaging (LSCI), fluorescence imaging (FI), sidestream darkfield microscopy (SDF), and optical coherence tomography (OCT) regarding blood flow in gastric tube surgery were reviewed. Two independent reviewers critically appraised articles and extracted the data: Primary outcome was quantitative measure of perfusion change; secondary outcome was successful prediction of necrosis or anastomotic leakage by measured perfusion parameters.Thirty-three articles (including 973 patients and 73 animals) were selected for data extraction, quality assessment, and risk of bias (QUADAS-2). LDF, NIRS, LSCI, and FI were investigated in gastric tube surgery; all had a medium level of evidence. IDEAL stage ranges from 1 to 3. Most articles were found on LDF (n = 12), which is able to measure perfusion in arbitrary perfusion units with a significant lower amount in tissue with necrosis development and on FI (n = 12). With FI blood flow routes could be observed and flow was qualitative evaluated in rapid, slow, or low flow. NIRS uses mucosal oxygen saturation and hemoglobin concentration as perfusion parameters. With LSCI, a decrease of perfusion units is observed toward the gastric fundus intraoperatively. The perfusion units (LDF, LSCI), although arbitrary and not absolute values, and low flow or length of demarcation to the anastomosis (FI) both seem predictive values for necrosis intraoperatively. SDF and OCT are able to measure microvascular flow, intraoperative prediction of necrosis is not yet described.Optical techniques aim to improve perfusion monitoring by real-time, high-resolution, and high-contrast measurements and could therefore be valuable in intraoperative perfusion mapping. LDF and LSCI use perfusion units, and are therefore subjective in interpretation. FI visualizes influx directly, but needs a quantitative parameter for interpretation during surgery.
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Affiliation(s)
- S M Jansen
- Departments of Biomedical Engineering & Physics, Amsterdam zo, the Netherlands.,Departments of Plastic, Reconstructive & Hand Surgery, Amsterdam zo, the Netherlands
| | - D M de Bruin
- Departments of Biomedical Engineering & Physics, Amsterdam zo, the Netherlands
| | | | - S D Strackee
- Departments of Plastic, Reconstructive & Hand Surgery, Amsterdam zo, the Netherlands
| | - D P Veelo
- Departments of Anaesthesiology, Amsterdam zo, the Netherlands
| | - T G van Leeuwen
- Departments of Biomedical Engineering & Physics, Amsterdam zo, the Netherlands
| | - S S Gisbertz
- Departments of Surgery, Amsterdam zo, the Netherlands
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15
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Wang Y, Lv W, Chen X, Lu J, Li P. Improving the sensitivity of velocity measurements in laser speckle contrast imaging using a noise correction method. OPTICS LETTERS 2017; 42:4655-4658. [PMID: 29140335 DOI: 10.1364/ol.42.004655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
We demonstrate that noise is an important factor contributing to the decline of sensitivity and linear response range of velocity measurements for laser speckle contrast imaging. We propose to use a noise correction method to improve the sensitivity of velocity measurements. For a kind of camera in which the mean values of the dark noise have been subtracted and negative counts have been set to zero, we propose a method to estimate the true dark noise based on the maximum likelihood estimation, which expands the application scope of the noise correction method.
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16
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Evaluation of Gastric Microcirculation by Laser Speckle Contrast Imaging During Esophagectomy. J Am Coll Surg 2017; 225:395-402. [DOI: 10.1016/j.jamcollsurg.2017.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/18/2017] [Accepted: 06/19/2017] [Indexed: 12/22/2022]
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17
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Knudsen KBK, Thorup J, Strandby RB, Ambrus R, Ring LL, Ifaoui I. Laser Speckle Contrast Imaging to Evaluate Bowel Lesions in Neonates with NEC. European J Pediatr Surg Rep 2017; 5:e43-e46. [PMID: 28868231 PMCID: PMC5578818 DOI: 10.1055/s-0037-1606196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/16/2017] [Indexed: 02/06/2023] Open
Abstract
Background
Necrotizing enterocolitis (NEC) is the most frequent surgical emergency in newborns. Intestinal ischemia is considered a factor that precedes the development of NEC lesions. Laser speckle contrast imaging (LSCI) can be used to assess tissue microcirculation. We evaluated if LSCI may help to detect intestinal regions with reduced microcirculation in NEC.
Case Report
A male patient (gestational age, 26 [3/7] weeks; birth weight, 600 g) showed clinical signs of NEC 28 days after birth. X-ray revealed pneumatosis intestinalis and portal gas. Laparotomy showed NEC lesions with signs of transmural ischemia in the terminal ileum and cecum. Surgical resection lines (RLs) were marked, followed by LSCI measurements and resection of the bowel between the two RLs. Post hoc LSCI analyses were conducted on both sides of the proximal and distal RL. Low-flux values, indicating reduced microcirculation, were found in the macroscopically assessed necrotic bowel at the proximal RL, whereas higher flux values, indicating sufficient microcirculation, were found in the macroscopically assessed normal bowel.
Discussion
This study is the first description of intra-abdominal use of LSCI to evaluate tissue microcirculation in relation to NEC lesions. LSCI could be a valuable tool to distinguish between ischemic and nonischemic bowel in neonates undergoing surgery for NEC.
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Affiliation(s)
- Kristine Bach Korsholm Knudsen
- Department of Surgical Gastroenterology and Pediatric Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Joergen Thorup
- Department of Surgical Gastroenterology and Pediatric Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Rune Broni Strandby
- Department of Surgical Gastroenterology and Pediatric Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Rikard Ambrus
- Department of Surgical Gastroenterology and Pediatric Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Linea Landgrebe Ring
- Department of Surgical Gastroenterology and Pediatric Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Inge Ifaoui
- Department of Surgical Gastroenterology and Pediatric Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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18
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Strandby RB, Ambrus R, Secher NH, Goetze JP, Achiam MP, Svendsen LB. Plasma pro-atrial natriuretic peptide to estimate fluid balance during open and robot-assisted esophagectomy: a prospective observational study. BMC Anesthesiol 2017; 17:20. [PMID: 28159014 PMCID: PMC5291941 DOI: 10.1186/s12871-017-0314-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background It remains debated how much fluid should be administered during surgery. The atrial natriuretic peptide precursor proANP is released by atrial distension and deviations in plasma proANP are reported associated with perioperative fluid balance. We hypothesized that plasma proANP would decrease when the central blood volume is compromised during the abdominal part of robot-assisted hybrid (RE) esophagectomy and that a positive fluid balance would be required to maintain plasma proANP. Methods Patients undergoing RE (n = 25) or open (OE; n = 25) esophagectomy for gastroesophageal cancer were included consecutively in this prospective observational study. Plasma proANP was determined repetitively during esophagectomy to allow for distinction between the abdominal and thoracic part of the procedure. The RE group was 15° head up tilted during the abdominal procedure. Results The blood loss was 250 (150–375) (RE) and 600 ml (390–855) (OE) (p = 0.01), but the two groups of patients were provided with a similar positive fluid balance: 1705 (1390–1983) vs. 1528 ml (1316–1834) (p = 0.4). However, plasma proANP decreased by 21% (p < 0.01) during the abdominal part of RE carried out during moderate head-up tilt, but only by 11% (p = 0.01) during OE where the patients were supine. Plasma proANP and fluid balance were correlated in the RE-group (r = 0.5 (0.073–0.840), p = 0.02) and tended to correlate in the OE group (r = 0.4 (−0.045–0.833), p = 0.08). Conclusion The results support that plasma proANP decreases when the central blood volume is compromised and suggest that an about 2200 ml surplus administration of crystalloid is required to maintain plasma proANP during esophagectomy. Trial registration Clinicaltrials.gov (NCT02077673). Registered retrospectively February 12th 2014.
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Affiliation(s)
- Rune Broni Strandby
- Department of Surgical Gastroenterology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen-Ø, Denmark.
| | - Rikard Ambrus
- Department of Surgical Gastroenterology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen-Ø, Denmark
| | - Niels H Secher
- Department of Anesthesiology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen-Ø, DK-2100, Denmark
| | - Jens Peter Goetze
- Department of Clinical Biochemistry, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen-Ø, DK-2100, Denmark
| | - Michael Patrick Achiam
- Department of Surgical Gastroenterology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen-Ø, Denmark
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen-Ø, Denmark
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