Optical imaging of blood perfusion to predict treatment failure

描述(申请人提供)：激光治疗血管异常，如Portwine染色病变(PWS)，目标是具有热损伤的异常大的PWS血管，在PWS中产生凝块，引起伤口愈合反应，移除PWS。这种治疗尤其适用于那些容易治疗并提供终身正常外表的儿童。然而，经常有一些治疗失败的区域需要重复治疗。我们的工作假设是，治疗失败是因为治疗未能诱导血栓，或者治疗诱导的血液凝块松动，局部血流重新建立，从而将PWS从伤口愈合反应中拯救出来。我们提出了一种光谱摄像系统，它可以在PWS前、即刻、30min、6周随访时、激光治疗后显示PWS的血液含量和混合动静脉血氧饱和度，并指示血液灌流已重建的区域。急性测量可以预测治疗失败的区域，随访时的测量可以量化治疗的效果。不会改变标准护理。这项研究的意义在于，一旦证明了再灌注与治疗失败之间的相关性，就有理由立即对预测失败的区域进行再次治疗，或采取其他策略来改善通过该程序在PWS中形成的血栓的稳定性。这项建议的目的是(1)构建一个用于临床试验的原型光谱相机，(2)开发能够有效分析这些图像的分析软件，以及(3)进行一项试验临床研究，以确定光学成像的预测价值。

DESCRIPTION (provided by applicant): Laser treatment of vascular abnormalities, such as portwine stain lesions (PWS), target the abnormally large PWS vessels with thermal damage, which yields clot formation in the PWS that elicits a wound healing response that removes the PWS. This treatment has been especially justified in children whose PWS are easily treated and provide a lifetime of normal appearance. However, there are often regions of treatment failure that require repeated treatments. Our working hypothesis is that treatment failure occurs because the treatment fails to induce a clot or the treatment-induced blood clot loosens and local blood flow is re-established thereby rescuing the PWS from the wound healing response. We propose a spectral camera system that can image the blood content and mixed arterio-venous oxygen saturation of the PWS before, immediately after, at 30 min, and at the 6-week follow-up exam, after laser treatment and indicate regions where blood perfusion has re-established. The acute measurements can predict regions of treatment failure and the measurements at follow-up can quantify the efficacy of treatments. No alteration of standard care will be done. The significance of the study is that once the correlation between reperfusion and treatment failure is demonstrated, justification would be established for immediate re-treatment of regions predicted to fail or other strategies for improving the stability of blood clots formed in the PWS by the procedure. The aims of this proposal are to (1) construct a prototype spectral camera for a pilot clinical study, (2) develop the analysis software that can efficiently analyze these images, and (3) conduct a pilot clinical study to establish the predictive value of the optical imaging.