Intraoperative Optical and Fluorescence Imaging of Blood Flow Distributions in Mastectomy Skin Flaps for Identifying Ischemic Tissues
Year: 2022
Type: article
Study design: Observational Study
Abstract: SUMMARY: Insufficient blood flow causes mastectomy skin flap necrosis in 5 to 30 percent of cases. Fluorescence angiography with the injection of indocyanine green dye has shown high sensitivities (90 to 100 percent) but moderate specificities (72 to 50 percent) in predicting mastectomy skin flap necrosis. However, a number of challenging issues limit its wide acceptance in clinical settings, including allergic reaction, short time-window for observation, and high cost for equipment and supplies. An emerging inexpensive speckle contrast diffuse correlation tomography technology enables noninvasive, noncontact, and continuous three-dimensional imaging of blood flow distributions in deep tissues. This preliminary study tested the hypothesis that speckle contrast diffuse correlation tomography and indocyanine green-fluorescence angiography measurements of blood flow distributions in mastectomy skin flaps are consistent. Eleven female patients undergoing skin-sparing or nipple-sparing mastectomies were imaged sequentially by the dye-free speckle contrast diffuse correlation tomography and dye-based commercial fluorescence angiography (SPY-PHI). Resulting images from these two imaging modalities were co-registered based on the ischemic areas with the lowest blood flow values. Because the ischemic areas have irregular shapes, a novel contour-based algorithm was used to compare three-dimensional images of blood flow distribution and two-dimensional maps of indocyanine green perfusion. Significant correlations were observed between the two measurements in all contours from a selected area of 10 × 10 mm 2 with the lowest blood flow ( r ≥ 0.78; p < 0.004), suggesting that speckle contrast diffuse correlation tomography provides the information for identifying ischemic tissues in mastectomy skin flaps. With further optimization and validation in large populations, speckle contrast diffuse correlation tomography may ultimately be used as a noninvasive and inexpensive imaging tool for intraoperative assessment of skin flap viability to predict mastectomy skin flap necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.
Source: Plastic & Reconstructive Surgery
Authors: Siavash Mazdeyasna, Chong Huang, Alisha B. Paranzino, Mehrana Mohtasebi, Qiang Cheng, Lesley Wong, Guoqiang Yu
Institution: University of Kentucky
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: National Institute of Mental Health, National Cancer Institute, National Institute of Neurological Disorders and Stroke, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Biomedical Imaging and Bioengineering, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Non-contact Diffuse Optical Assessment of Pressure Ulcer and Therapy, Continuous and Longitudinal Monitoring of Cerebral Blood Flow and Metabolism in Freely Moving Rodents, Development of a Wearable Fluorescence Imaging Device for Intraoperative Identification of Brain Tumors, Perioperative Diffuse Optical Imaging of Tissue Blood Flow and Oxygenation for Optimization of Mastectomy Skin Flap Viability, High-density optical tomography of cerebral blood flow and metabolism in small animals, Noninvasive Noncontact High-Density Optical Imaging of Neonatal Intraventricular Hemorrhage, A Low-cost Compact Diffuse Speckle Contrast Flow-oximeter for Neonatal Brain Monitoring, Time-resolved laser speckle contrast imaging of resting-state functional connectivity in neonatal brain, Development of a Wearable Fluorescence Imaging Device for IntraoperativeIdentification of Brain Tumors
OpenAlex ID: W4282023473