Optical imaging of blood perfusion to predict treatment failure

描述（由申请人提供）：激光治疗血管异常，如portwine染色病变（PWS），针对具有热损伤的异常大的PWS血管，在PWS中产生凝块形成，引起伤口愈合反应，去除PWS。这种治疗在PWS容易治疗并提供终生正常外观的儿童中尤其合理。然而，经常有治疗失败的区域需要反复治疗。我们的工作假设是，治疗失败的发生是因为治疗未能诱导凝块或治疗诱导的血凝块松动，局部血流重新建立，从而从伤口愈合反应中拯救PWS。我们提出了一种光谱相机系统，该系统可以在激光治疗前、治疗后立即、30分钟和6周随访检查时对PWS的血液含量和混合动静脉氧饱和度进行成像，并指示血液灌注重新建立的区域。急性期的测量可以预测治疗失败的区域，而随访期的测量可以量化治疗的效果。不会改变标准护理。该研究的意义在于，一旦再灌注与治疗失败之间的相关性得到证实，就有理由立即对预测失败的区域进行再治疗，或采取其他策略来改善PWS中形成的血凝块的稳定性。本课题的目标是：(1)构建原型光谱相机用于临床中试研究；(2)开发能够有效分析这些图像的分析软件；(3)进行临床中试研究，建立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.