Intraoperative Optical and Fluorescence Imaging of Blood Flow Distributions in Mastectomy Skin Flaps for Identifying Ischemic Tissues.
Intraoperative Optical and Fluorescence Imaging of Blood Flow Distributions in Mastectomy Skin Flaps for Identifying Ischemic Tissues.
复制标题
乳房切除术皮瓣中血流分布的术中光学和荧光成像，以鉴定缺血组织。
DOI：
10.1097/prs.0000000000009333
复制
发表时间：
2022-08-01
影响因子：
3.6
通讯作者：
中科院分区：
文献类型：
--
作者：
血流不足（BF）会导致5%-30%的乳腺切除术皮瓣坏死（MSFN）。荧光血管造影术（FA）注射吲哚菁绿色（ICG）染料显示出高灵敏度（90%-100%），但在预测MSFN中具有中等特异性（72%-50%）。然而，一些具有挑战性的问题限制了其在临床环境中的广泛接受，包括过敏反应、观察时间窗短以及设备和用品的高成本。一种新兴的廉价散斑对比度扩散相关断层扫描（scDCT）技术，使非侵入性，非接触，和连续的三维成像的BF分布在深部组织。该初步研究检验了乳房切除术皮瓣中BF分布的scDCT和ICG-FA测量值一致的假设。通过无染料scDCT和基于染料的市售FA（SPY-PHI，Novadaq/斯特赖克）对11名接受保留皮肤或保留乳头乳房切除术的女性患者进行连续成像。基于具有最低BF值的缺血区域，对这两种成像模式的结果图像进行共配准。由于缺血区域具有不规则的形状，因此使用一种新的基于轮廓的算法来比较BF分布的3D图像和ICG灌注的2D图。在10 × 10 mm 2的选定区域的所有轮廓中观察到两个测量值之间的显著相关性，BF最低（r ≥ 0.78，p < 0.004），表明scDCT为识别乳房切除术皮瓣中的缺血组织提供了信息。随着在大规模人群中的进一步优化和验证，scDCT最终可能用作术中评估皮瓣活力以预测MSFN的非侵入性和廉价的成像工具。
Insufficient blood flow (BF) causes mastectomy skin flap necrosis (MSFN) in 5%−30% of cases. Fluorescence angiography (FA) with the injection of indocyanine green (ICG) dye has shown high sensitivities (90%−100%) but moderate specificities (72%−50%) in predicting MSFN. 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 (scDCT) technology enables noninvasive, noncontact, and continuous 3D imaging of BF distributions in deep tissues. This preliminary study tested the hypothesis that scDCT and ICG-FA measurements of BF distributions in mastectomy skin flaps are consistent. Eleven female patients undergoing skin sparing or nipple sparing mastectomies were imaged sequentially by the dye-free scDCT and dye-based commercial FA (SPY-PHI, Novadaq/Stryker). Resulting images from these two imaging modalities were co-registered based on the ischemic areas with the lowest BF values. Because the ischemic areas have irregular shapes, a novel contour-based algorithm was used to compare 3D images of BF distribution and 2D maps of ICG perfusion. Significant correlations were observed between the two measurements in all contours from a selected area of 10 × 10 mm2 with the lowest BF (r ≥ 0.78, p < 0.004), suggesting that scDCT provides the information for identifying ischemic tissues in mastectomy skin flaps. With further optimization and validation in large populations, scDCT may ultimately be used as a noninvasive and inexpensive imaging tool for intraoperative assessment of skin flap viability to predict MSFN.