Use of Multispectral Optoacoustic Tomography to Diagnose Vascular Malformations
Use of Multispectral Optoacoustic Tomography to Diagnose Vascular Malformations
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DOI：
10.1001/jamadermatol.2018.3269
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发表时间：
2018-12-01
期刊：
影响因子：
10.9
通讯作者：
Wildgruber, Moritz
中科院分区：
文献类型：
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作者：
Masthoff, Max;Helfen, Anne;Wildgruber, Moritz
重要性先天性血管畸形的鉴别诊断具有挑战性，误诊是常见的。血管畸形被认为是最难治疗的血管疾病之一，一种新的成像方法，可视化的解剖特征和定量评估的分子生物标志物的无创性将有助于诊断和监测血管畸形的治疗反应。目的评估多光谱光声断层成像（MSOT）的分子生物标志物的诊断和治疗监测。设计，地点和参与者本初步研究检查了6例动静脉畸形（AVM）和6例静脉畸形（VM）患者，根据国际血管畸形研究学会的分类系统进行诊断。所有患者在治疗前后均在跨学科血管畸形诊所接受了临床混合MSOT/超声（US）成像，由经过培训的MSOT和US检查员进行。检查者对患者的病史和疾病阶段不知情。数据收集时间为2017年4月11日至25日，分析时间为5月1日至10月31日，2017.干预在血管内栓塞（AVM）或经皮硬化治疗（VM）之前或之后1周内进行临床混合MSOT/US成像。主要结果和指标病变和对侧健康组织的感兴趣区域分析显示氧合（HbO）定量值，2））和脱氧（HbR）血红蛋白。治疗前后计算健康组织和AVM及VM的HbO（2）：HbR比值。结果12例血管畸形患者（6例AVM和6例VM）（9例女性和3例男性;平均[SD]年龄，23 [18]岁;年龄范围，6-59岁）入选。与健康组织相比，MSOT组织中AVM的HbO（2）：HbR比值（平均值[SEM]，1.82 [0.08] vs 0.89 [0.03]; P < .001）和VM的HbO（2）：HbR比值（平均值[SEM]，1.12 [0.04] vs 0.89 [0.03]; P = .001）显著更高。与VM相比，AVM的HbO（2）：HbR比值显著更高（平均值[SEM]，1.82 [0.08] vs 1.12 [0.04]; P <0.001）。因此，MSOT提供了区分两种血管畸形的内在生物标志物模式。治疗后，HbO（2）：HbR的比率下降相关的治疗成功的磁共振成像或angiography.CONCLUSIONS和RELEVANCE验证这项研究表明，不同类型的血管畸形明确区分MSOT为基础的，非侵入性评估血红蛋白水平的血管畸形。本研究中发现的治疗效果可以即时可视化，这可能为血管畸形的无创诊断和监测提供新的工具。
IMPORTANCE Differential diagnosis of congenital vascular anomalies is challenging, and misdiagnosis is frequent. Vascular malformations are considered one of the most difficult vascular diseases to treat. A new imaging approach that visualizes anatomical features and quantitatively assesses molecular biomarkers noninvasively would aid diagnosis and monitoring of treatment response of vascular malformations.OBJECTIVE To evaluate multispectral optoacoustic tomography (MSOT) for noninvasive assessment of molecular biomarkers for diagnosis and therapeutic monitoring of vascular malformations.DESIGN, SETTING, AND PARTICIPANTS This pilot study examined 6 patients with arteriovenous malformation (AVM) and 6 patients with venous malformation (VM) diagnosed according to the classification system of the International Society for the Study of Vascular Anomalies. All patients underwent clinical hybrid MSOT/ultrasonographic (US) imaging before and after treatment at an interdisciplinary vascular malformations clinic by trained MSOT and US examiners. Examiners were blinded to the patient history and stage of disease. Data were collected from April 11 to 25, 2017, and analyzed from May 1 to October 31, 2017.INTERVENTIONS Clinical hybrid MSOT/US imaging was performed before or within 1 week after endovascular embolization (for AVM) or percutaneous sclerotherapy (for VM).MAIN OUTCOMES AND MEASURES Region-of-interest analysis of the lesion and contralateral healthy tissue revealed quantitative values for oxygenated (HbO(2)) and deoxygenated (HbR) hemoglobin by spectral unmixing of optoacoustic data acquired at multiple wavelengths. The HbO(2):HbR ratio was calculated for healthy tissue and for AVM and VM before and after treatment.RESULTS Twelve patients (9 female and 3 male; mean [SD] age, 23 [18] years; age range, 6-59 years) with vascular malformations (6 with AVMs and 6 with VMs) were included. Significantly higher HbO(2):HbR ratios for AVMs (mean [SEM], 1.82 [0.08] vs 0.89 [0.03]; P < .001) and for VMs (mean [SEM], 1.12 [0.04] vs 0.89 [0.03]; P = .001) were found on MSOT tissue compared with healthy tissue. Significantly higher HbO(2):HbR ratios for AVMs compared with VMs (mean [SEM], 1.82 [0.08] vs 1.12 [0.04]; P < .001) were also found. Therefore, MSOT provided intrinsic biomarker patterns to distinguish both vascular malformations. After therapy, the HbO(2):HbR ratio dropped in correlation to treatment success validated by magnetic resonance imaging or angiography.CONCLUSIONS AND RELEVANCE This study suggests that different types of vascular malformations are clearly distinguished by MSOT-based, noninvasive assessment of hemoglobin levels in vascular malformations. The therapy effects found in this study could be instantly visualized, and this may offer a new tool for noninvasive diagnosis and monitoring of vascular malformations.