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Krivetskaya AA, Kustov DM, Levkin VV, Osminin SV, Kharnas SS, Eventeva EV, Vetshev FP, Komarov RN, Linkov KG, Savelieva TA, Loschenov VB. Evaluation of tissue blood supply during esophagectomy using fluorescent diagnostics and diffuse scattering spectroscopy in visible region. Photodiagnosis Photodyn Ther 2024; 45:103937. [PMID: 38103583 DOI: 10.1016/j.pdpdt.2023.103937] [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: 10/31/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The success of the surgical treatment of a tumor or obstruction of the esophagus with subsequent anastomosis application depends on the level of blood supply to the stitched tissues. Intraoperative assessment of blood flow is widely used in medicine and can be used as a diagnostic method that affects the outcome of surgery and reduces the frequency of postoperative complications for the patient. METHODS In this work, the assessment of blood supply during esophageal resection operations was carried out using two techniques sequentially: fluorescent diagnostics with indocyanine green and measurement of hemoglobin oxygen saturation by diffuse scattering spectroscopy in the visible wavelength range. The first method was used to assess the integrity of the vascular network structure in the area of anastomosis and blood flow through the sutured tissues, the second one - for local assessment of hemoglobin oxygen saturation in the investigated area. RESULTS Conducted clinical study involved the participation of nine patients with malignant neoplasms (six cases) or esophageal obstruction (three cases). The presence of postoperative complications was compared with the measurement results. Anastomosis failure was observed in only one patient. According to the results of the study, with the use of the investigated method of assessing blood supply, there is a tendency towards a decrease in the frequency of anastomosis leaks (11.1 % compared with 21.4 %). CONCLUSIONS Therefore, fluorescent diagnostics with indocyanine green and measurement of hemoglobin oxygen saturation using diffuse scattering spectroscopy were affirmed as methods that allow increasing the safety of surgical procedures by assessing the risk of postoperative complications, including anastomosis failures.
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Affiliation(s)
- Anna A Krivetskaya
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991, Moscow, Russia; Institute of Engineering Physics for Biomedicine, National Research Nuclear University MEPhI, 115409, Moscow, Russia.
| | - Daniil M Kustov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991, Moscow, Russia
| | - Vladimir V Levkin
- Department of Faculty Surgery No. 1, I.M. Sechenov First Moscow State Medical University, 119992, Moscow, Russia
| | - Sergey V Osminin
- Department of Faculty Surgery No. 1, I.M. Sechenov First Moscow State Medical University, 119992, Moscow, Russia
| | - Sergey S Kharnas
- Department of Faculty Surgery No. 1, I.M. Sechenov First Moscow State Medical University, 119992, Moscow, Russia
| | - Evgenia V Eventeva
- Department of Faculty Surgery No. 1, I.M. Sechenov First Moscow State Medical University, 119992, Moscow, Russia
| | - Fedor P Vetshev
- Department of Faculty Surgery No. 1, I.M. Sechenov First Moscow State Medical University, 119992, Moscow, Russia
| | - Roman N Komarov
- Department of Faculty Surgery No. 1, I.M. Sechenov First Moscow State Medical University, 119992, Moscow, Russia
| | - Kirill G Linkov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991, Moscow, Russia
| | - Tatiana A Savelieva
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991, Moscow, Russia; Institute of Engineering Physics for Biomedicine, National Research Nuclear University MEPhI, 115409, Moscow, Russia
| | - Victor B Loschenov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991, Moscow, Russia; Institute of Engineering Physics for Biomedicine, National Research Nuclear University MEPhI, 115409, Moscow, Russia
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Merdasa A, Berggren J, Tenland K, Stridh M, Hernandez-Palacios J, Gustafsson N, Sheikh R, Malmsjö M. Oxygen saturation mapping during reconstructive surgery of human forehead flaps with hyperspectral imaging and spectral unmixing. Microvasc Res 2023; 150:104573. [PMID: 37390964 DOI: 10.1016/j.mvr.2023.104573] [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: 02/13/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Optical spectroscopy is commonly used clinically to monitor oxygen saturation in tissue. The most commonly employed technique is pulse oximetry, which provides a point measurement of the arterial oxygen saturation and is commonly used for monitoring systemic hemodynamics, e.g. during anesthesia. Hyperspectral imaging (HSI) is an emerging technology that enables spatially resolved mapping of oxygen saturation in tissue (sO2), but needs to be further developed before implemented in clinical practice. The aim of this study is to demonstrate the applicability of HSI for mapping the sO2 in reconstructive surgery and demonstrate how spectral analysis can be used to obtain clinically relevant sO2 values. METHODS Spatial scanning HSI was performed on cutaneous forehead flaps, raised as part of a direct brow lift, in eight patients. Pixel-by-pixel spectral analysis, accounting for the absorption from multiple chromophores, was performed and compared to previous analysis techniques to assess sO2. RESULTS Spectral unmixing using a broad spectral range, and accounting for the absorption of melanin, fat, collagen, and water, provided a more clinically relevant estimate of sO2 than conventional techniques, where typically only spectral features associated with absorption of oxygenated (HbO2) and deoxygenated (HbR) hemoglobin are considered. We demonstrate its clinical applicability by generating sO2 maps of partially excised forehead flaps showed a gradual decrease in sO2 along the length of the flap from 95 % at the flap base to 85 % at the flap tip. After being fully excised, sO2 in the entire flap decreased to 50 % within a few minutes. CONCLUSIONS The results demonstrate the capability of sO2 mapping in reconstructive surgery in patients using HSI. Spectral unmixing, accounting for multiple chromophores, provides sO2 values that are in accordance with physiological expectations in patients with normal functioning microvascularization. Our results suggest that HSI methods that yield reliable spectra are to be preferred, so that the analysis can produce results that are of clinical relevance.
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Affiliation(s)
- Aboma Merdasa
- Department of Ophthalmology, Clinical Sciences Lund, Lund University, Sweden.
| | - Johanna Berggren
- Department of Ophthalmology, Clinical Sciences Lund, Lund University, Sweden; Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology Lund, Sweden
| | - Kajsa Tenland
- Department of Ophthalmology, Clinical Sciences Lund, Lund University, Sweden; Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology Lund, Sweden
| | - Magne Stridh
- Department of Ophthalmology, Clinical Sciences Lund, Lund University, Sweden; Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology Lund, Sweden
| | | | - Nils Gustafsson
- Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology Lund, Sweden
| | - Rafi Sheikh
- Department of Ophthalmology, Clinical Sciences Lund, Lund University, Sweden; Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology Lund, Sweden
| | - Malin Malmsjö
- Department of Ophthalmology, Clinical Sciences Lund, Lund University, Sweden; Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology Lund, Sweden
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Kim Y, Choi WJ, Oh J, Lee K, Kim JK. Smartphone-Based Rigid Endoscopy Device with Hemodynamic Response Imaging and Laser Speckle Contrast Imaging. BIOSENSORS 2023; 13:816. [PMID: 37622902 PMCID: PMC10452712 DOI: 10.3390/bios13080816] [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: 07/11/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
Modern smartphones have been employed as key elements in point-of-care (POC) devices due to remarkable advances in their form factor, computing, and display performances. Recently, we reported a combination of the smartphone with a handheld endoscope using laser speckle contrast imaging (LSCI), suggesting potential for functional POC endoscopy. Here, we extended our work to develop a smartphone-combined multifunctional handheld endoscope using dual-wavelength LSCI. Dual-wavelength LSCI is used to monitor the changes in dynamic blood flow as well as changes in the concentration of oxygenated (HbO2), deoxygenated (Hbr), and total hemoglobin (HbT). The smartphone in the device performs fast acquisition and computation of the raw LSCI data to map the blood perfusion parameters. The flow imaging performance of the proposed device was tested with a tissue-like flow phantom, exhibiting a speckle flow index map representing the blood perfusion. Furthermore, the device was employed to assess the blood perfusion status from an exteriorized intestine model of rat in vivo during and after local ischemia, showing that blood flow and HbO2 gradually decreased in the ischemic region whereas hyperemia and excess increases in HbO2 were observed in the same region right after reperfusion. The results indicate that the combination of LSCI with smartphone endoscopy delivers a valuable platform for better understanding of the functional hemodynamic changes in the vasculatures of the internal organs, which may benefit POC testing for diagnosis and treatment of vascular diseases.
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Affiliation(s)
- Youngkyu Kim
- Biomedical Engineering Research Center, Asan Medical Center, Seoul 05505, Republic of Korea;
| | - Woo June Choi
- School of Electrical and Electronics Engineering, Chung-Ang University, Seoul 06974, Republic of Korea;
| | - Jeongmin Oh
- Department of Biomedical Engineering, College of Medicine, University of Ulsan, Seoul 05505, Republic of Korea; (J.O.); (K.L.)
| | - Kwanhee Lee
- Department of Biomedical Engineering, College of Medicine, University of Ulsan, Seoul 05505, Republic of Korea; (J.O.); (K.L.)
| | - Jun Ki Kim
- Biomedical Engineering Research Center, Asan Medical Center, Seoul 05505, Republic of Korea;
- Department of Biomedical Engineering, College of Medicine, University of Ulsan, Seoul 05505, Republic of Korea; (J.O.); (K.L.)
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Nickel F, Studier-Fischer A, Özdemir B, Odenthal J, Müller LR, Knoedler S, Kowalewski KF, Camplisson I, Allers MM, Dietrich M, Schmidt K, Salg GA, Kenngott HG, Billeter AT, Gockel I, Sagiv C, Hadar OE, Gildenblat J, Ayala L, Seidlitz S, Maier-Hein L, Müller-Stich BP. Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging and machine learning in an experimental model for minimally invasive esophagectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023:S0748-7983(23)00444-4. [PMID: 37105869 DOI: 10.1016/j.ejso.2023.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/26/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Esophagectomy is the mainstay of esophageal cancer treatment, but anastomotic insufficiency related morbidity and mortality remain challenging for patient outcome. Therefore, the objective of this work was to optimize anastomotic technique and gastric conduit perfusion with hyperspectral imaging (HSI) for total minimally invasive esophagectomy (MIE) with linear stapled anastomosis. MATERIAL AND METHODS A live porcine model (n = 58) for MIE was used with gastric conduit formation and simulation of linear stapled side-to-side esophagogastrostomy. Four main experimental groups differed in stapling length (3 vs. 6 cm) and simulation of anastomotic position on the conduit (cranial vs. caudal). Tissue oxygenation around the anastomotic simulation site was evaluated using HSI and was validated with histopathology. RESULTS The tissue oxygenation (ΔStO2) after the anastomotic simulation remained constant only for the short stapler in caudal position (-0.4 ± 4.4%, n.s.) while it was impaired markedly in the other groups (short-cranial: -15.6 ± 11.5%, p = 0.0002; long-cranial: -20.4 ± 7.6%, p = 0.0126; long-caudal: -16.1 ± 9.4%, p < 0.0001). Tissue samples from avascular stomach as measured by HSI showed correspondent eosinophilic pre-necrotic changes in 35.7 ± 9.7% of the surface area. CONCLUSION Tissue oxygenation at the site of anastomotic simulation of the gastric conduit during MIE is influenced by stapling technique. Optimal oxygenation was achieved with a short stapler (3 cm) and sufficient distance of the simulated anastomosis to the cranial end of the gastric conduit. HSI tissue deoxygenation corresponded to histopathologic necrotic tissue changes. The experimental model with HSI and ML allow for systematic optimization of gastric conduit perfusion and anastomotic technique while clinical translation will have to be proven.
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Affiliation(s)
- F Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany; HIDSS4Health - Helmholtz Information and Data Science School for Health, Heidelberg and Karlsruhe, Germany
| | - A Studier-Fischer
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany; School of Medicine, Heidelberg University, Heidelberg, Germany
| | - B Özdemir
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - J Odenthal
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - L R Müller
- HIDSS4Health - Helmholtz Information and Data Science School for Health, Heidelberg and Karlsruhe, Germany; Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
| | - S Knoedler
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K F Kowalewski
- Department of Urology, Medical Faculty of Mannheim at the University of Heidelberg, Mannheim, Germany
| | - I Camplisson
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, USA
| | - M M Allers
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Dietrich
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - K Schmidt
- Department of Anaesthesiology and Intensive Care Medicine, Essen University Hospital, Essen, Germany
| | - G A Salg
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - H G Kenngott
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - A T Billeter
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - I Gockel
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany
| | - C Sagiv
- DeePathology Ltd., Ra'anana, Israel
| | | | | | - L Ayala
- HIDSS4Health - Helmholtz Information and Data Science School for Health, Heidelberg and Karlsruhe, Germany; Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - S Seidlitz
- HIDSS4Health - Helmholtz Information and Data Science School for Health, Heidelberg and Karlsruhe, Germany; Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - L Maier-Hein
- HIDSS4Health - Helmholtz Information and Data Science School for Health, Heidelberg and Karlsruhe, Germany; Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany; Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany; HIDSS4Health - Helmholtz Information and Data Science School for Health, Heidelberg and Karlsruhe, Germany.
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J Waterhouse D, Stoyanov D. Optimized spectral filter design enables more accurate estimation of oxygen saturation in spectral imaging. BIOMEDICAL OPTICS EXPRESS 2022; 13:2156-2173. [PMID: 35519287 PMCID: PMC9045927 DOI: 10.1364/boe.446975] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
Oxygen saturation (SO2) in tissue is a crucially important physiological parameter with ubiquitous clinical utility in diagnosis, treatment, and monitoring, as well as widespread use as an invaluable preclinical research tool. Multispectral imaging can be used to visualize SO2 non-invasively, non-destructively and without contact in real-time using narrow spectral filter sets, but typically, these spectral filter sets are poorly suited to a specific clinical task, application, or tissue type. In this work, we demonstrate the merit of optimizing spectral filter sets for more accurate estimation of SO2. Using tissue modelling and simulated multispectral imaging, we demonstrate filter optimization reduces the root-mean-square-error (RMSE) in estimating SO2 by up to 37% compared with evenly spaced filters. Moreover, we demonstrate up to a 79% decrease in RMSE for optimized filter sets compared with filter sets chosen to minimize mutual information. Wider adoption of this approach will result in more effective multispectral imaging systems that can address specific clinical needs and consequently, more widespread adoption of multispectral imaging technologies in disease diagnosis and treatment.
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Affiliation(s)
- Dale J Waterhouse
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Department of Medical Physics and Biomedical Engineering, University College London, UK
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López-Moral M, García-Álvarez Y, Molines-Barroso RJ, Tardáguila-García A, García-Madrid M, Lázaro-Martínez JL. A comparison of hyperspectral imaging with routine vascular noninvasive techniques to assess the healing prognosis in patients with diabetic foot ulcers. J Vasc Surg 2021; 75:255-261. [PMID: 34314832 DOI: 10.1016/j.jvs.2021.07.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the potential healing prognosis of the different routine noninvasive techniques implemented in the International Working Group Diabetic Foot Guidelines with the novel use of hyperspectral imaging (HSI) in patients with diabetic foot ulcers (DFUs). METHODS Twenty-one patients with active DFUs participated in this 1-year prospective study in a specialized diabetic foot unit between December 2018 and January 2020. HSI was performed at baseline to quantify tissue oxygenation and should be presented on an anatomical map by analyzing the following parameters: (1) oxygen saturation of the hemoglobin, (2) tissue hemoglobin index, (3) the near-infrared perfusion index, and (4) tissue water index. In addition, transcutaneous oxygen pressure (TcpO2), systolic toe and ankle pressures, ankle-brachial index, and toe-brachial index values were calculated for the ulcerated limb. The primary outcome measure was wound healing, defined as complete epithelization without any drainage confirmed for at least 10 days after closure was first documented at 24 weeks. RESULTS During the follow-up period 14 patients (66.66 %) healed and 7 patients did not heal (33.3%) by 24 weeks. The TcpO2 optimal cut-off point as determined by a balance of sensitivity and specificity of 28.5 mm Hg that yielded a sensitivity of 91% and a specificity of 100%, and area under the curve of 0.989 (P = .005; 95% confidence interval [CI], 0.945-1.000). Followed by the oxygen saturation of the hemoglobin optimal cut-off point as determined by a balance of sensitivity and specificity of 48.5 mm Hg that yielded a sensitivity of 93% and a specificity of 0.71%, and area under the curve of 0.932 (P = .013; 95% CI, 0.787-1.000). The logistic regression analyses showed that TcpO2 was the only variable associated with wound healing at 24 weeks (P < .001; 95% CI, 0.046-0.642). CONCLUSIONS The HSI was shown to be effective in the prognosis of DFU healing compared with other noninvasive test; only TcpO2 values resulted in better diagnosis potential in wound healing.
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Affiliation(s)
- Mateo López-Moral
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Yolanda García-Álvarez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain.
| | - Raúl J Molines-Barroso
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Aroa Tardáguila-García
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Marta García-Madrid
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
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Dietrich M, Marx S, von der Forst M, Bruckner T, Schmitt FCF, Fiedler MO, Nickel F, Studier-Fischer A, Müller-Stich BP, Hackert T, Brenner T, Weigand MA, Uhle F, Schmidt K. Bedside hyperspectral imaging indicates a microcirculatory sepsis pattern - an observational study. Microvasc Res 2021; 136:104164. [PMID: 33831406 DOI: 10.1016/j.mvr.2021.104164] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Microcirculatory alterations are key mechanisms in sepsis pathophysiology leading to tissue hypoxia, edema formation, and organ dysfunction. Hyperspectral imaging (HSI) is an emerging imaging technology that uses tissue-light interactions to evaluate biochemical tissue characteristics including tissue oxygenation, hemoglobin content and water content. Currently, clinical data for HSI technologies in critical ill patients are still limited. METHODS AND ANALYSIS TIVITA® Tissue System was used to measure Tissue oxygenation (StO2), Tissue Hemoglobin Index (THI), Near Infrared Perfusion Index (NPI) and Tissue Water Index (TWI) in 25 healthy volunteers and 25 septic patients. HSI measurement sites were the palm, the fingertip, and a suprapatellar knee area. Septic patients were evaluated on admission to the ICU (E), 6 h afterwards (E+6) and three times a day (t3-t9) within a total observation period of 72 h. Primary outcome was the correlation of HSI results with daily SOFA-scores. RESULTS Serial HSI at the three measurement sites in healthy volunteers showed a low mean variance expressing high retest reliability. HSI at E demonstrated significantly lower StO2 and NPI as well as higher TWI at the palm and fingertip in septic patients compared to healthy volunteers. StO2 and TWI showed corresponding results at the suprapatellar knee area. In septic patients, palm and fingertip THI identified survivors (E-t4) and revealed predictivity for 28-day mortality (E). Fingertip StO2 and THI correlated to SOFA-score on day 2. TWI was consistently increased in relation to the TWI range of healthy controls during the observation time. Palm TWI correlated positively with SOFA scores on day 3. DISCUSSION HSI results in septic patients point to a distinctive microcirculatory pattern indicative of reduced skin oxygenation and perfusion quality combined with increased blood pooling and tissue water content. THI might possess risk-stratification properties and TWI could allow tissue edema evaluation in critically ill patients. CONCLUSION HSI technologies could open new perspectives in microcirculatory monitoring by visualizing oxygenation and perfusion quality combined with tissue water content in critically ill patients - a prerequisite for future tissue perfusion guided therapy concepts in intensive care medicine.
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Affiliation(s)
- M Dietrich
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Marx
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M von der Forst
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - F C F Schmitt
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M O Fiedler
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - A Studier-Fischer
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Brenner
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - M A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - F Uhle
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - K Schmidt
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020; 17:1840-1856. [PMID: 32830443 PMCID: PMC7949456 DOI: 10.1111/iwj.13474] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of MedicineUniversity of Southern California, Los AngelesCaliforniaCaliforniaCanada
| | - Keith Harding
- School of MedicineCardiff UniversityWalesUK
- A*STARSingapore
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9
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Algorithm for Mapping Kidney Tissue Water Content during Normothermic Machine Perfusion Using Hyperspectral Imaging. ALGORITHMS 2020. [DOI: 10.3390/a13110289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The preservation of kidneys using normothermic machine perfusion (NMP) prior to transplantation has the potential for predictive evaluation of organ quality. Investigations concerning the quantitative assessment of physiological tissue parameters and their dependence on organ function lack in this context. In this study, hyperspectral imaging (HSI) in the wavelength range of 500–995 nm was conducted for the determination of tissue water content (TWC) in kidneys. The quantitative relationship between spectral data and the reference TWC values was established by partial least squares regression (PLSR). Different preprocessing methods were applied to investigate their influence on predicting the TWC of kidneys. In the full wavelength range, the best models for absorbance and reflectance spectra provided Rp2 values of 0.968 and 0.963, as well as root-mean-square error of prediction (RMSEP) values of 2.016 and 2.155, respectively. Considering an optimal wavelength range (800–980 nm), the best model based on reflectance spectra (Rp2 value of 0.941, RMSEP value of 3.202). Finally, the visualization of TWC distribution in all pixels of kidneys’ HSI image was implemented. The results show the feasibility of HSI for a non-invasively and accurate TWC prediction in kidneys, which could be used in the future to assess the quality of kidneys during the preservation period.
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Mehdorn M, Köhler H, Rabe SM, Niebisch S, Lyros O, Chalopin C, Gockel I, Jansen-Winkeln B. Hyperspectral Imaging (HSI) in Acute Mesenteric Ischemia to Detect Intestinal Perfusion Deficits. J Surg Res 2020; 254:7-15. [DOI: 10.1016/j.jss.2020.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/19/2020] [Accepted: 04/07/2020] [Indexed: 02/07/2023]
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11
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020. [PMID: 32830443 DOI: 10.1111/iwj.13474.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California, California, Canada
| | - Keith Harding
- School of Medicine, Cardiff University, Wales, UK.,A*STAR, Singapore
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Lemmens S, Van Eijgen J, Van Keer K, Jacob J, Moylett S, De Groef L, Vancraenendonck T, De Boever P, Stalmans I. Hyperspectral Imaging and the Retina: Worth the Wave? Transl Vis Sci Technol 2020; 9:9. [PMID: 32879765 PMCID: PMC7442879 DOI: 10.1167/tvst.9.9.9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose Hyperspectral imaging is gaining attention in the biomedical field because it generates additional spectral information to study physiological and clinical processes. Several technologies have been described; however an independent, systematic literature overview is lacking, especially in the field of ophthalmology. This investigation is the first to systematically overview scientific literature specifically regarding retinal hyperspectral imaging. Methods A systematic literature review was conducted, in accordance with PRISMA Statement 2009 criteria, in four bibliographic databases: Medline, Embase, Cochrane Database of Systematic Reviews, and Web of Science. Results Fifty-six articles were found that meet the review criteria. A range of techniques was reported: Fourier analysis, liquid crystal tunable filters, tunable laser sources, dual-slit monochromators, dispersive prisms and gratings, computed tomography, fiber optics, and Fabry-Perrot cavity filter covered complementary metal oxide semiconductor. We present a narrative synthesis and summary tables of findings of the included articles, because methodologic heterogeneity and diverse research topics prevented a meta-analysis being conducted. Conclusions Application in ophthalmology is still in its infancy. Most previous experiments have been performed in the field of retinal oximetry, providing valuable information in the diagnosis and monitoring of various ocular diseases. To date, none of these applications have graduated to clinical practice owing to the lack of sufficiently large validation studies. Translational Relevance Given the promising results that smaller studies show for hyperspectral imaging (e.g., in Alzheimer's disease), advanced research in larger validation studies is warranted to determine its true clinical potential.
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Affiliation(s)
- Sophie Lemmens
- University Hospitals UZ Leuven, Department of Ophthalmology, Leuven, Belgium.,KU Leuven, Biomedical Sciences Group, Department of Neurosciences, Research Group Ophthalmology, Leuven, Belgium.,VITO (Flemish Institute for Technological Research), Health Unit, Boeretang, Belgium
| | - Jan Van Eijgen
- University Hospitals UZ Leuven, Department of Ophthalmology, Leuven, Belgium.,KU Leuven, Biomedical Sciences Group, Department of Neurosciences, Research Group Ophthalmology, Leuven, Belgium.,VITO (Flemish Institute for Technological Research), Health Unit, Boeretang, Belgium
| | - Karel Van Keer
- University Hospitals UZ Leuven, Department of Ophthalmology, Leuven, Belgium.,KU Leuven, Biomedical Sciences Group, Department of Neurosciences, Research Group Ophthalmology, Leuven, Belgium
| | - Julie Jacob
- University Hospitals UZ Leuven, Department of Ophthalmology, Leuven, Belgium.,KU Leuven, Biomedical Sciences Group, Department of Neurosciences, Research Group Ophthalmology, Leuven, Belgium
| | - Sinéad Moylett
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Lies De Groef
- Neural Circuit Development and Regeneration Research Group, Department of Biology, KU Leuven, Leuven, Belgium
| | - Toon Vancraenendonck
- VITO (Flemish Institute for Technological Research), Health Unit, Boeretang, Belgium
| | - Patrick De Boever
- VITO (Flemish Institute for Technological Research), Health Unit, Boeretang, Belgium.,Hasselt University, Centre of Environmental Sciences, Agoralaan, Belgium
| | - Ingeborg Stalmans
- University Hospitals UZ Leuven, Department of Ophthalmology, Leuven, Belgium.,KU Leuven, Biomedical Sciences Group, Department of Neurosciences, Research Group Ophthalmology, Leuven, Belgium
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Nondestructive Determination and Visualization of Quality Attributes in Fresh and Dry Chrysanthemum morifolium Using Near-Infrared Hyperspectral Imaging. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9091959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rapid and nondestructive determination of quality attributes in fresh and dry Chrysanthemum morifolium is of great importance for quality sorting and monitoring during harvest and trade. Near-infrared hyperspectral imaging covering the spectral range of 874–1734 nm was used to detect chlorogenic acid, luteolin-7-O-glucoside, and 3,5-O-dicaffeoylquinic acid content in Chrysanthemum morifolium. Fresh and dry Chrysanthemum morifolium flowers were studied for harvest and trade. Pixelwise spectra were preprocessed by wavelet transform (WT) and area normalization, and calculated as average spectrum. Successive projections algorithm (SPA) was used to select optimal wavelengths. Partial least squares (PLS), extreme learning machine (ELM), and least-squares support vector machine (LS-SVM) were used to build calibration models based on full spectra and optimal wavelengths. Calibration models of fresh and dry flowers obtained good results. Calibration models for chlorogenic acid in fresh flowers obtained best performances, with coefficient of determination (R2) over 0.85 and residual predictive deviation (RPD) over 2.50. Visualization maps of chlorogenic acid, luteolin-7-O-glucoside, and 3,5-O-dicaffeoylquinic acid in single fresh and dry flowers were obtained. The overall results showed that hyperspectral imaging was feasible to determine chlorogenic acid, luteolin-7-O-glucoside, and 3,5-O-dicaffeoylquinic acid. Much more work should be done in the future to improve the prediction performance.
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Nahm W, Hornberger C, Morgenstern U, Sobottka SB. Optical imaging methods in medicine: how can we escape the plausibility trap? BIOMED ENG-BIOMED TE 2018; 63:507-510. [PMID: 30243014 DOI: 10.1515/bmt-2018-2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Werner Nahm
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Christoph Hornberger
- Faculty of Engineering, Wismar University of Applied Sciences, 23966 Wismar, Germany
| | - Ute Morgenstern
- Institute of Biomedical Engineering, Faculty of Electrical and Computer Engineering, Technische Universität Dresden, 01307 Dresden, Germany
| | - Stephan B Sobottka
- Department of Neurosurgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
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