Comparison of laser speckle and laser Doppler perfusion imaging: measurement in human skin and rabbit articular tissue

Review of laser speckle-based analysis in medical imaging

Speckle pattern forms when a rough object is illuminated with coherent light (laser) and the backscattered radiation is imaged on a screen. The pattern changes over time due to movement in the object. Such time-integrate speckle pattern can be statistically analyzed to reveal the flow profile. For higher velocity the speckle contrast gets reduced. This theory can be utilized for tissue perfusion in capillaries of human skin tissue and cerebral blood flow mapping in rodents. Early, the technique was suffered from low resolution and computational intricacies for real-time monitoring purpose. However, modern engineering has made it feasible for real-time monitoring in microcirculation imaging with improved resolution. This review illustrates several modifications over classical technique done by many researchers. Recent advances in speckle contrast methods gain major interest, leading towards practical implementation of this technique. The review also brings out the scopes of laser speckle-based analysis in various medical applications.

Correcting the detrimental effects of nonuniform intensity distribution on fiber-transmitting laser speckle imaging of blood flow

Laser speckle spatial contrast analysis (LSSCA) is superior to laser speckle temporal contrast analysis (LSTCA) in monitoring the fast change in blood flow due to its advantage of high temporal resolution. However, the application of LSSCA which is based on spatial statistics may be limited when there is nonuniform intensity distribution such as fiber-transmitting laser speckle imaging. In this study, we present a normalized laser speckle spatial contrast analysis (nLSSCA) to correct the detrimental effects of nonuniform intensity distribution on the spatial statistics. Through numerical simulation and phantom experiments, it is found that just ten frames of dynamic laser speckle images are sufficient for nLSSCA to achieve effective correction. Furthermore, nLSSCA has higher temporal resolution than LSTCA to respond the change in velocity. LSSCA, LSTCA and nLSSCA are all applied in the fiber-transmitting laser speckle imaging system to analyze the change of cortical blood flow (CBF) during cortical spreading depression (CSD) in rat cortex respectively, and the results suggest that nLSSCA can examine the change of CBF more accurately. For these advantages, nLSSCA could be a potential tool for fiber-transmitting/endoscopic laser speckle imaging.

Consistent focal cerebral ischemia without posterior cerebral artery occlusion and its real-time monitoring in an intraluminal suture model in mice

OBJECT

In the intraluminal suture model of middle cerebral artery occlusion (MCAO) in the mouse, disturbance of blood flow from the internal carotid artery to the posterior cerebral artery (PCA) may affect the size of the infarction. In this study, PCA involvement in the model was investigated and modified for consistent MCAO without involving the PCA territory.

METHODS

Thirty-seven C57Bl/6 mice were randomly divided into 4 groups according to the length of coating over the tip of the suture (1, 2, 3, or 4 mm) and subjected to transient MCAO for 2 hours. Real-time topographical cerebral blood flow was monitored over both hemispheres by laser speckle flowmetry. After 24 hours of reperfusion, the infarct territories and volumes were evaluated.

RESULTS

The 1- and 2-mm coating groups showed all lesions in the MCA territory. In the 3- and 4-mm coating groups, 62.5% and 75% of mice, respectively, showed lesions in both the MCA and the PCA territories and other lesions in the MCA territory. Mice in the 1- and 2-mm coating groups had significantly smaller infarct volumes than the 3- and 4-mm groups. Laser speckle flowmetry was useful to distinguish whether the PCA territory would undergo infarction.

CONCLUSIONS

Small changes in the coating length of the intraluminal suture may be critical, and 1-2 mm of coating appeared to be optimal to produce consistent MCAO without involving the PCA territory. Laser speckle flowmetry could predict the territory of infarction and improve the consistency of the infarct size.

Cerebral blood flow during reperfusion predicts later brain damage in a mouse and a rat model of neonatal hypoxic-ischemic encephalopathy

Children with severe neonatal hypoxic-ischemic encephalopathy (HIE) die or develop life-long neurological impairments such as cerebral palsy and mental retardation. Decreased regional cerebral blood flow (CBF) is believed to be the predominant factor that determines the level of tissue injury in the immature brain. However, the spatio-temporal profiles of CBF after neonatal HIE are not well understood. CB17 mouse and Wistar rat pups were exposed to a unilateral hypoxic-ischemic (HI) insult at eight or seven days of age. Laser speckle imaging sequentially measured the cortical surface CBF before the hypoxic exposure and until 24h after the hypoxic exposure. Seven days after the HI insult, brain damage was morphologically assessed by measuring the hemispheric volumes and by semi-quantitative scoring for neuropathologic injury. The mean CBF on the ipsilateral hemisphere in mice decreased after carotid artery ligation. After the end of hypoxic insult (i.e., the reperfusion phase), the mean CBF level gradually rose and nearly attained its pre-surgery level by 9h of reperfusion. It then decreased. The degree of reduced CBF during reperfusion was well correlated with the degree of later morphological brain damage. The correlation was the strongest when the CBF was measured in the ischemic core region at 24h of reperfusion in mice (R²=0.89). A similar trend in results was found in rats. These results suggest that the CBF level during reperfusion may be a useful predictive factor for later brain damage in immature mice. This may enable optimizing brain damage for detail analyses.

Beneficial effects of combination of valsartan and amlodipine on salt-induced brain injury in hypertensive rats

The optimum antihypertensive treatment for prevention of hypertensive stroke has yet to be elucidated. This study was undertaken to examine the benefit of a combination of valsartan, an angiotensin II type 1 (AT1) receptor blocker, and amlodipine, a calcium channel blocker, in prevention of high-salt-induced brain injury in hypertensive rats. High-salt-loaded stroke-prone spontaneously hypertensive rats (SHRSPs) were given 1) vehicle, 2) valsartan (2 mg/kg/day), 3) amlodipine (2 mg/kg/day), or 4) a combination of valsartan and amlodipine for 4 weeks. The effects on brain injury were compared between all groups. High-salt loading in SHRSPs caused the reduction of cerebral blood flow (CBF), cerebral hypoxia, white matter lesions, glial activation, AT1 receptor up-regulation, endothelial nitric-oxide synthase (eNOS) uncoupling, inducible nitric-oxide synthase induction, and nitroxidative stress. Valsartan, independently of blood pressure, enhanced the protective effects of amlodipine against brain injury, white matter lesions, and glial activation in salt-loaded SHRSPs. These beneficial effects of valsartan added to amlodipine were associated with an additive improvement in CBF and brain hypoxia because of an additive improvement in cerebral arteriolar remodeling and vascular endothelial dysfunction. Furthermore, valsartan added to amlodipine enhanced the attenuation of cerebral nitroxidative stress through an additive suppression of eNOS uncoupling. Valsartan, independently of blood pressure, augmented the protective effects of amlodipine against brain injury in salt-loaded hypertensive rats through an improvement in brain circulation attributed to nitroxidative stress. Our results suggest that the combination of valsartan and amlodipine may be a promising strategy for the prevention of salt-related brain injury in hypertensive patients.

A transmissive laser speckle imaging technique for measuring deep tissue blood flow: an example application in finger joints

BACKGROUND AND OBJECTIVE

Laser speckle perfusion imaging (LSPI) is a minimally invasive optical measure of relative changes in blood flow, providing real-time, high resolution, two-dimensional maps of vascular structure. Standard LSI imaging uses a light-reflective geometry that limits the measurement to a thin surface layer of 0.2-1 mm. The objective of this study was to test a new LSI instrument geometry with the laser source opposed to the image capture plane (light transmissive). Captured light then travels the entire tissue thickness (10-15 mm), sampling much deeper regions of interest than conventional optical imaging techniques.

STUDY DESIGN

Reflective-light (conventional) and transmissive-light LSI modes were used to measure finger joint blood flow during a timed tourniquet occlusion of the brachial artery in volunteer participants.

RESULTS

There was greatly increased visibility of vessels underlying the skin in the light-transmissive mode LSI mode. Established LSI algorithms were shown to still work in the light-transmissive mode, despite decorrelation due to finite laser coherence length and the light passing through a tissue thickness of 10-15 mm.

CONCLUSION

Transmissive LSI can be used to measure blood flow deep (10-15 mm) into tissues. This could be useful for non-invasive measurements of finger joint synovial blood flow in diagnosing and treating peripheral vascular disorders, such as rheumatoid arthritis.

Time domain algorithm for accelerated determination of the first order moment of photo current fluctuations in high speed laser Doppler perfusion imaging

Advances in optical array sensor technology allow for the real time acquisition of dynamic laser speckle patterns generated by tissue perfusion, which, in principle, allows for real time laser Doppler perfusion imaging (LDPI). Exploitation of these developments is enhanced with the introduction of faster algorithms to transform photo currents into perfusion estimates using the first moment of the power spectrum. A time domain (TD) algorithm is presented for determining the first-order spectral moment. Experiments are performed to compare this algorithm with the widely used Fast Fourier Transform (FFT). This study shows that the TD-algorithm is twice as fast as the FFT-algorithm without loss of accuracy. Compared to FFT, the TD-algorithm is efficient in terms of processor time, memory usage and data transport.

Free flap blood flow evaluated using two-dimensional laser speckle flowgraphy

Objective. We investigated the efficiency of laser speckle flowgraphy for evaluating blood flow in free flaps used for plastic surgery. Methods. We measured blood flow using a visual laser meter capable of providing two-dimensional color graphic representations of flow distribution for a given area using a dynamic laser speckle effect. Using laser speckle flowgraphy, we examined the blood flow of 20 free flaps applied following the excision of head and neck tumors. Results. After anastomosis of the feeding and draining blood vessels and sewing the flap, musculocutaneous (MC) flaps showed significantly lower blood flow than jejunal or omental flaps (P < .05). The ratio of blood flow decrease from the edge to the center was significantly greater in MC flaps than in jejunal or omental flaps (P < .001). Conclusion. Laser speckle flowgraphy is useful for the perioperative measurement of blood flow in free flaps used in plastic surgery. This method is a highly useful, practical, and reliable tool for assessing cutaneous blood flow and is expected to be applicable to several clinical fields.

Portable laser speckle perfusion imaging system based on digital signal processor

The ability to monitor blood flow in vivo is of major importance in clinical diagnosis and in basic researches of life science. As a noninvasive full-field technique without the need of scanning, laser speckle contrast imaging (LSCI) is widely used to study blood flow with high spatial and temporal resolution. Current LSCI systems are based on personal computers for image processing with large size, which potentially limit the widespread clinical utility. The need for portable laser speckle contrast imaging system that does not compromise processing efficiency is crucial in clinical diagnosis. However, the processing of laser speckle contrast images is time-consuming due to the heavy calculation for enormous high-resolution image data. To address this problem, a portable laser speckle perfusion imaging system based on digital signal processor (DSP) and the algorithm which is suitable for DSP is described. With highly integrated DSP and the algorithm, we have markedly reduced the size and weight of the system as well as its energy consumption while preserving the high processing speed. In vivo experiments demonstrate that our portable laser speckle perfusion imaging system can obtain blood flow images at 25 frames per second with the resolution of 640 × 480 pixels. The portable and lightweight features make it capable of being adapted to a wide variety of application areas such as research laboratory, operating room, ambulance, and even disaster site.

Nephron blood flow dynamics measured by laser speckle contrast imaging

Tubuloglomerular feedback (TGF) has an important role in autoregulation of renal blood flow and glomerular filtration rate (GFR). Because of the characteristics of signal transmission in the feedback loop, the TGF undergoes self-sustained oscillations in single-nephron blood flow, GFR, and tubular pressure and flow. Nephrons interact by exchanging electrical signals conducted electrotonically through cells of the vascular wall, leading to synchronization of the TGF-mediated oscillations. Experimental studies of these interactions have been limited to observations on two or at most three nephrons simultaneously. The interacting nephron fields are likely to be more extensive. We have turned to laser speckle contrast imaging to measure the blood flow dynamics of 50-100 nephrons simultaneously on the renal surface of anesthetized rats. We report the application of this method and describe analytic techniques for extracting the desired data and for examining them for evidence of nephron synchronization. Synchronized TGF oscillations were detected in pairs or triplets of nephrons. The amplitude and the frequency of the oscillations changed with time, as did the patterns of synchronization. Synchronization may take place among nephrons not immediately adjacent on the surface of the kidney.

Comparison of intensity-modulated continuous-wave lasers with a chirped modulation frequency to pulsed lasers for photoacoustic imaging applications

Using a Green's function solution to the photoacoustic wave equation, we compare intensity-modulated continuous-wave (CW) lasers with a chirped modulation frequency to pulsed lasers for photoacoustic imaging applications. Assuming the same transducer is used in both cases, we show that the axial resolution is identical and is determined by the transducer and material properties of the object. We derive a simple formula relating the signal-to-noise ratios (SNRs) of the two imaging systems that only depends on the fluence of each pulse and the time-bandwidth product of the chirp pulse. We also compare the SNR of the two systems assuming the fluence is limited by the American National Standards Institute (ANSI) laser safety guidelines for skin. We find that the SNR is about 20 dB to 30 dB larger for pulsed laser systems for reasonable values of the parameters. However, CW diode lasers have the advantage of being compact and relatively inexpensive, which may outweigh the lower SNR in many applications.

Hemodynamic and metabolic diffuse optical monitoring in a mouse model of hindlimb ischemia

Murine hindlimb ischemia is a useful model for investigation of the mechanisms of peripheral arterial disease and for understanding the role of endothelial cells and generic factors affecting vascular regeneration or angiogenesis. To date, important research with these models has explored tissue reperfusion following ischemia with Laser Doppler methods, methods which provide information about superficial (~mm) vascular regeneration. In this work, we employ diffuse correlation spectroscopy (DCS) and diffuse optical spectroscopy (DOS) in mice after hindlimb ischemia. We hypothesize that vascular re-growth is not uniform in tissue, and therefore, since diffuse optical methods are capable of probing deep tissues, that the diffuse optics approach will provide a more complete picture of the angiogenesis process throughout the whole depth profile of the limb. Besides increased depth penetration, the combined measurements of DCS and DOS enable all-optical, noninvasive, longitudinal monitoring of tissue perfusion and oxygenation that reveals the interplay between these hemodynamic parameters during angiogenesis. Control mice were found to reestablish 90% of perfusion and oxygen consumption during this period, but oxygen saturation in the limb only partially recovered to about 30% of its initial value. The vascular recovery of mice with endothelial cell-specific deletion of HIF-2α was found to be significantly impaired relative to control mice, indicating that HIF-2α is important for endothelial cell functions in angiogenesis. Comparison of DOS/DCS measurements to parallel measurements in the murine models using Laser Doppler Flowmetry reveal differences in the reperfusion achieved by superficial versus deep tissue during neoangiogenesis; findings from histological analysis of blood vessel development were further correlated with these differences. In general, the combination of DCS and DOS enables experimenters to obtain useful information about oxygenation, metabolism, and perfusion throughout the limb. The results establish diffuse optics as a practical noninvasive method to evaluate the role of transcription factors, such as the endothelial cell-specific HIF-2α, in genetic ally modified mice.

Real-time assessment of renal cortical microvascular perfusion heterogeneities using near-infrared laser speckle imaging

Laser speckle imaging (LSI) is able to provide full-field perfusion maps of the renal cortex and allows quantification of the average LSI perfusion within an arbitrarily set region of interest and the recovery of LSI perfusion histograms within this region. The aim of the present study was to evaluate the use of LSI for mapping renal cortical microvascular perfusion and to demonstrate the capability of LSI to assess renal perfusion heterogeneities. The main findings were that: 1) full-field LSI measurements of renal microvascular perfusion were highly correlated to single-point LDV measurements; 2) LSI is able to detect differences in reperfusion dynamics following different durations of ischemia; and 3) renal microvascular perfusion heterogeneities can be quantitatively assessed by recovering LSI perfusion histograms.

Partial hexokinase II knockout results in acute ischemia-reperfusion damage in skeletal muscle of male, but not female, mice

Cellular studies have demonstrated a protective role of mitochondrial hexokinase against oxidative insults. It is unknown whether HK protective effects translate to the in vivo condition. In the present study, we hypothesize that HK affects acute ischemia–reperfusion injury in skeletal muscle of the intact animal. Male and female heterozygote knockout HKII (HK^+/-), heterozygote overexpressed HKII (HK^tg), and their wild-type (WT) C57Bl/6 littermates mice were examined. In anesthetized animals, the left gastrocnemius medialis (GM) muscle was connected to a force transducer and continuously stimulated (1-Hz twitches) during 60 min ischemia and 90 min reperfusion. Cell survival (%LDH) was defined by the amount of cytosolic lactate dehydrogenase (LDH) activity still present in the reperfused GM relative to the contralateral (non-ischemic) GM. Mitochondrial HK activity was 72.6 ± 7.5, 15.7 ± 1.7, and 8.8 ± 0.9 mU/mg protein in male mice, and 72.7 ± 3.7, 11.2 ± 1.4, and 5.9 ± 1.1 mU/mg in female mice for HK^tg, WT, and HK^+/-, respectively. Tetanic force recovery amounted to 33 ± 7% for male and 17 ± 4% for female mice and was similar for HK^tg, WT, and HK^+/-. However, cell survival was decreased (p = 0.014) in male HK^+/- (82 ± 4%LDH) as compared with WT (98 ± 5%LDH) and HK^tg (97 ± 4%LDH). No effects of HKII on cell survival was observed in female mice (92 ± 2% LDH). In conclusion, in this mild model of acute in vivo ischemia–reperfusion injury, a partial knockout of HKII was associated with increased cell death in male mice. The data suggest for the first time that HKII mediates skeletal muscle ischemia–reperfusion injury in the intact male animal.

Fenofibrate improves cerebral blood flow after middle cerebral artery occlusion in mice

Fibrates, one group of peroxisome proliferator-activated receptor (PPAR) activators, are lipid lowering drugs. Fibrates have been shown to attenuate brain tissue injury after focal cerebral ischemia. In this study, we investigated the impact of fenofibrate on cerebral blood flow (CBF) in male wild type and PPARalpha-null mice. Animals were treated for 7 days with fenofibrate and subjected to 2 h of filamentous middle cerebral artery occlusion and reperfusion under isoflurane anesthesia. Cortical surface CBF was measured by laser speckle imaging. Regional CBF (rCBF) in nonischemic animals was measured by (14)C-iodoantipyrine autoradiography. Fenofibrate did not affect rCBF and mean arterial blood pressure in nonischemic animals. In ischemic animals, laser speckle imaging showed delayed expansions of ischemic area, which was attenuated by fenofibrate. Fenofibrate also enhanced CBF recovery after reperfusion. However, such effects of fenofibrate on CBF in the ischemic brain were not observed in PPARalpha-null mice. These findings show that fenofibrate improves CBF in the ischemic hemisphere. Moreover, fenofibrate requires PPARalpha expression for the cerebrovascular protective effects in the ischemic brain.

Effects of gemfibrozil on outcome after permanent middle cerebral artery occlusion in mice

Fibrates are lipid lowering drugs and found as ligands for peroxisome proliferator-activated receptors (PPARs). A clinical study has shown that one type of fibrate gemfibrozil reduces stroke incidence in men. However, it remains unknown whether gemfibrozil improves outcome after stroke. We hypothesized that prophylactic administration of gemfibrozil improves outcome after ischemic stroke. In this study, we measured the impact of gemfibrozil in two permanent middle cerebral artery occlusion (MCAO) models in young adult male mice on normal diet. First, we tested gemfibrozil in a filamentous MCAO model. Pretreatment with gemfibrozil (30 mg/kg) for 7 days moderately but significantly reduced infarct size at 24 h after MCAO. A higher dose (120 mg/kg) did not attenuate infarct size. Rather, it tended to increase brain swelling. Second, we tested in a distal MCAO model. Gemfibrozil (30 mg/kg) for 7 days before and after stroke significantly attenuated cortical lesion size at 7 days after MCAO. Cortical blood flow measured by laser speckle imaging was improved by gemfibrozil in the ischemic hemisphere. In non-stroke animals gemfibrozil also altered gene expression levels of PPARs in both the aorta and brain in organ specific manners; however, endothelial nitric oxide synthase (eNOS) was not significantly affected. These findings suggested the possibility that the observed infarct reductions and cortical blood flow improvements in ischemic brains were not through eNOS-mediated mechanisms. Further investigations may be meritorious to examine whether prophylactic usage of gemfibrozil against stroke is beneficial.

Comparison of instruments for investigation of microcirculatory blood flow and red blood cell concentration

The use of laser Doppler perfusion imaging (LDPI) and laser speckle perfusion imaging (LSPI) is well known in the noninvasive investigation of microcirculatory blood flow. This work compares the two techniques with the recently developed tissue viability (TiVi) imaging system, which is proposed as a useful tool to quantify red blood cell concentration in microcirculation. Three systems are evaluated with common skin tests such as the use of vasodilating and vasoconstricting drugs (methlynicotinate and clobetasol, respectively) and a reactive hyperaemia maneuver (using a sphygmomanometer). The devices investigated are the laser Doppler line scanner (LDLS), the laser speckle perfusion imager (FLPI)-both from Moor Instruments (Axminster, United Kingdom)-and the TiVi imaging system (WheelsBridge AB, Linkoping, Sweden). Both imaging and point scanning by the devices are used to quantify the provoked reactions. Perfusion images of vasodilatation and vasoconstriction are acquired with both LDLS and FLPI, while TiVi images are acquired with the TiVi imager. Time acquisitions of an averaged region of interest are acquired for temporal studies such as the reactive hyperaemia. In contrast to the change in perfusion over time with pressure, the TiVi imager shows a different response due its measurement of blood concentration rather than perfusion. The responses can be explained by physiological understanding. Although the three devices sample different compartments of tissue, and output essentially different variables, comparisons can be seen between the three systems. The LDLS system proves to be suited to measurement of perfusion in deeper vessels, while FLPI and TiVi showed sensitivity to more superficial nutritional supply. LDLS and FLPI are insensitive to the action of the vasoconstrictor, while TiVi shows the clear boundaries of the reaction. Assessment of the resolution, penetration depth, and acquisition rate of each instrument show complimentary features that should be taken into account when choosing a system for a particular clinical measurement.

Remote plethysmographic imaging using ambient light

Plethysmographic signals were measured remotely (> 1m) using ambient light and a simple consumer level digital camera in movie mode. Heart and respiration rates could be quantified up to several harmonics. Although the green channel featuring the strongest plethysmographic signal, corresponding to an absorption peak by (oxy-) hemoglobin, the red and blue channels also contained plethysmographic information. The results show that ambient light photo-plethysmography may be useful for medical purposes such as characterization of vascular skin lesions (e.g., port wine stains) and remote sensing of vital signs (e.g., heart and respiration rates) for triage or sports purposes.

Review of laser speckle contrast techniques for visualizing tissue perfusion

When a diffuse object is illuminated with coherent laser light, the backscattered light will form an interference pattern on the detector. This pattern of bright and dark areas is called a speckle pattern. When there is movement in the object, the speckle pattern will change over time. Laser speckle contrast techniques use this change in speckle pattern to visualize tissue perfusion. We present and review the contribution of laser speckle contrast techniques to the field of perfusion visualization and discuss the development of the techniques.

Efficient processing of laser speckle contrast images

Though laser speckle contrast imaging enables the measurement of scattering particle dynamics with high temporal resolution, the subsequent processing has previously been much slower. In prior studies, generating a laser speckle contrast image required about 1 s to process a raw image potentially collected in 10 ms or less. In this paper, novel algorithms are described which are demonstrated to convert 291 raw images per second to laser speckle contrast images and as many as 410 laser speckle contrast images per second to relative correlation time images. As long as image processing occurs during image acquisition, these algorithms render processing time irrelevant in most circumstances and enable real-time imaging of blood flow dynamics.

In vivo dynamic light scattering imaging of blood coagulation

Physiological blood coagulation/clotting is an essential biological process that is initiated by vessel injury and includes a cascade of enzymatic reactions finalized by fibrin polymerization and clot formation. We utilize dynamic light scattering (DLS) imaging to monitor in vivo red cell mobility as an indicator of blood coagulation. In the course of the experiments, blood flow is arrested using mechanical occlusion, and then laser injury is applied. We demonstrate that the combination of laser injury with DLS imaging on occluded blood vessels (i.e., under static conditions) is suitable to detect even subtle changes of plasma viscosity in the circulatory system, which reflects the process of clot development. This approach is noninvasive and has a relatively simple and easy-to-use technical design. Thus, the proposed methodology provides a promising tool for investigating blood clotting within the vasculature.

Rapid flare development evoked by current frequency-dependent stimulation analyzed by full-field laser perfusion imaging

We analyzed, with a new imaging technique, the rapid axon reflex flare responses in human skin upon transcutaneous delivery of electrical stimuli at 1, 5, 10 and 50 Hz in single bursts of five pulses each. Two-dimensional perfusion images covering an area of 8 x 8 cm(2) were captured at 25 Hz and their averages saved at 0.5 Hz. The stimulation caused an axon reflex flare (maximum 3 cm(2), 20 s after stimulation) that gradually resolved within 2 min. Maximum flare responses developed at 5 Hz, whereas pain ratings increased with stimulation frequency. The highest neuropeptide release at 5 Hz correlates to the discharge characteristics of mechanoinsensitive C-fibers, whereas the maximum pain intensity at 50 Hz may be attributed to the activation of A-delta fibers.

Laser Doppler perfusion monitoring and imaging: novel approaches

Laser Doppler flowmetry (LDF) is a non invasive method enabling the monitoring of microvascular blood flow, a very important marker of tissue health. This article gives an overview on the concept of LDF for microvascular perfusion monitoring and imaging. It first describes the theoretical background of the technique. Then, the benefits of LDF signal processing are shown through clinical examples: use of time-frequency representations and wavelets. Afterwards, the paper introduces novel approaches of velocity components. For that purpose, a work providing the determination of the velocities relative contribution in physiologically relevant units (mm/s) is presented. Imaging perfusion is also reviewed through methods based on laser speckle. The most prominent disadvantage of the latter devices being the time needed to produce a perfusion image, solutions are proposed in the last part of the paper.

Cortical blood flow assessment with frequency-domain laser Doppler microscopy

We report the assessment of cerebral blood flow (CBF) changes with a wide-field laser Doppler imager based on a CCD camera detection scheme, in vivo, in mice. The setup enables the acquisition of data in minimally invasive conditions. In contrast with conventional laser Doppler velocimeters and imagers, the Doppler signature of moving scatterers is measured in the frequency domain, by detuning a heterodyne optical detection. The quadratic mean of the measured frequency shift is used as an indicator of CBF. We observe a significant variability of this indicator in an experiment designed to induce blood flow changes.

Endothelial dysfunction and decreased vascular responsiveness in the anterior cruciate ligament-deficient model of osteoarthritis

Chronic inflammation associated with osteoarthritis (OA) may alter normal vascular responses and contribute to joint degradation. Vascular responses to vasoactive mediators were evaluated in the medial collateral ligament (MCL) of the anterior cruciate ligament (ACL)-deficient knee. Chronic joint instability and progressive OA were induced in rabbit knees by surgical transection of the ACL. Under halothane anesthesia, laser speckle perfusion imaging (LSPI) was used to measure MCL blood flow in unoperated control (n = 12) and 6-wk ACL-transected knees (n = 12). ACh, bradykinin, histamine, substance P (SP), and prostaglandin E(2) (PGE(2)) were applied to the MCL vasculature in topical boluses of 100 microl (dose range 10(-14) to 10(-8) mol). In normal joints, ACh, bradykinin, histamine, and PGE(2) evoked a dilatory response. Substance P caused a biphasic response that was dilatory from 10(-14) to 10(-11) mol and constricting at higher doses. In ACL-deficient knees, ACh, bradykinin, histamine, and SP decreased perfusion, whereas PGE(2) had a biphasic response that decreased perfusion at 10(-14) to 10(-11) mol and was dilatory at higher concentrations. Sodium nitroprusside increased perfusion in resting and phenylephrine-precontracted vessels with no significant differences between ACL-transected and control knees. Femoral artery occlusion and release increased perfusion by 74.3 +/- 11.1% in control knees but only by 25.8 +/- 4.4% in ACL-deficient knees. The altered responsiveness of the MCL vasculature to these inflammatory mediators may indicate endothelial dysfunction in the MCL, which may contribute to the progression and severity of OA and to the adaptation of the joint in an altered mechanical environment.

Kinetics of blood flow during healing of excisional full-thickness skin wounds in pigs as monitored by laser speckle perfusion imaging

BACKGROUND/PURPOSE

The laser speckle perfusion imaging (LSPI) system is a new, non-invasive technique for rapidly and reproducibly measuring tissue perfusion. The high resolution and frame rate of the LSPI overcome many of the limitations of traditional laser Doppler imaging techniques. Therefore, LSPI is a useful means for evaluating blood flow in a variety of situations. The present study investigates the ability of the LSPI system to detect temporal changes in blood flow during the healing of cutaneous wounds in a well-characterized animal model.

METHODS

Full-thickness excisional skin wounds (2 x 2 cm) were created on the backs of juvenile female red Duroc pigs. Every week post-injury, the wounds were measured and photographed, and normalized blood flow values were determined using the LSPI system.

RESULTS

Tissue perfusion values were available after complete re-epithelialization and removal of the eschar, at day 21. At this point, wound blood flow was significantly elevated as compared with the surrounding, uninvolved skin. Wound blood flow declined steadily during healing, and approached normal values by day 35 post-injury.

CONCLUSION

The kinetics of blood flow during excisional wound healing in the red Duroc model are comparable with that previously observed in laser Doppler imaging of healing human skin wounds and hypertrophic scars. These results therefore confirm that the red Duroc is a good model of human wound healing, and further indicates that the LSPI is an excellent technique for evaluating angiogenesis and neovascularization during healing in this and other models.

Laser speckle imaging of dynamic changes in flow during photodynamic therapy

We present a study investigating the use of laser speckle imaging (LSI) for monitoring blood flow during photodynamic therapy (PDT) utilizing the therapeutic illumination radiation. The coherent nature of a laser source, often used in PDT, offers the possibility of obtaining information on the blood flow without interrupting treatment. We have found that in the rat skin-fold observation chamber, it is possible to monitor the vasculature response to PDT in individual arteries, veins and in tumour microvasculature with significantly higher spatial and temporal resolution than current methods. This illustrates the potential for LSI for monitoring PDT, in particular for vascular-localizing photosensitizers, where current non-invasive methods are difficult because of high absorption due to blood and the specific localization of photosensitizer within the vasculature. However, critical problems need to be further investigated and solved, like the influence of tissue sampling volume, changing of optical properties and movement artefacts from other vessels on the LSI signal. Until then, the real potential of LSI for monitoring blood flow remains of limited value.

A comparison of two laser-based methods for determination of burn scar perfusion: laser Doppler versus laser speckle imaging

Laser Doppler perfusion imaging (LDI) is an established technique for early assessment of burn depth to help determine a course of treatment. Laser speckle perfusion imaging (LSPI) is an alternative laser based, non-invasive perfusion monitoring technique that offers rapid and high resolution images of tissue. We have evaluated the ability of the LSPI instrument in determining and monitoring burn scar perfusion over time and compared it with the LDI instrument as a standard.

METHODS

Ten patients with hypertrophic burn scars (time since injury: 1-8 months) were recruited. Burn scars were scanned with both instruments (LSPI and LDI) monthly over a period of 11 months. Clinical grading of the burn scars was assessed on every scan date using the Vancouver burn scar scale.

RESULTS

Comparison of the perfusion values determined by each instrument shows a strong positive correlation, r2=0.86 (n=63). Each instrument's output also correlated significantly with the clinical grading of the scar, indicating the expected decrease in perfusion as the clinical condition of the scars improved with time.

SIGNIFICANCE

The new LSPI instrument compared favorably with the established LDI instrument, yielding similar results. The considerably faster scan time and higher resolution of the LSPI method provides a distinct clinical advantage, both in terms of patient comfort and for reliably matching perfusion characteristics to their associated anatomical features. The fast temporal response of the LSPI instrument could be used to monitor near real-time responses to mechanical or pharmacological interventions to study dynamic vascular changes to burn damaged tissues.

Endoscopic laser speckle imaging of tissue blood flow: applications in the human knee

This work represents the first clinical data acquired with the endoscopic laser speckle imaging (eLSPI) system, a new diagnostic tool developed for real-time imaging of tissue blood flow during endoscopic surgical procedures. eLSPI was used to image tissue perfusion in the medial compartment of the knee of five patients requiring arthroscopic knee surgery. The effectiveness of eLSPI as a diagnostic tool was tested by measuring changes in tissue perfusion resultant from tourniquet application, and intra-articular epinephrine. eLSPI produced real-time perfusion video images of tissue blood flow in the knee joint. Tourniquet applications produced consistent decreases in mean perfusion index measurements (29.3% +/- 5.1% in meniscus; 39.5% +/- 8.2% in synovium with an intra patient variability of 6%-9%). A dose-dependent vasoconstrictive response to the administration of intra-articular epinephrine was measured, with maximum dose producing a mean decrease in perfusion of 31.0%-9.3% in meniscus and 41.2%-10.9% in synovium. eLSPI consistently detects decreases in articular tissue blood flow resultant from tourniquet inflation or from the administration of increasing concentrations of epinephrine. These are the first in vivo results indicating physiologic changes in articular tissue as a function of two commonly applied practices in endoscopic joint surgery.

Effect of compression on blood flow in lower limb wounds

Blood flow is believed to be a key parameter in the formation and management of lower limb wounds. Patients with venous leg ulcers (VLUs) have high venous pressures, due to the partial or complete failure of calf muscle pump, which in turn disturbs the local blood flow within the lower limb. Compression has currently been the mainstay for treatment of VLUs and is thought to restore valvular competence and reduce or suppress superficial and deep venous reflux. Efficacy and assessment of compression therapy can be understood in a better way by measuring blood flow in lower limbs. Publications applicable to the effects of compression on lower limb blood flow parameters are summarised. However, they have shown varying results due to the different methodology and assessment techniques used. This article seeks to explore the methods of assessment of blood flow in the lower limb associated with wound management and compression in particular and provides suggestions for future explorations.

Determination of optimal exposure time for imaging of blood flow changes with laser speckle contrast imaging

Laser speckle contrast imaging is becoming an established method for full-field imaging of cerebral blood flow dynamics in animal models. The sensitivity and noise in the measurement of blood flow changes depend on the camera exposure time. The relation among sensitivity, noise, and camera exposure time was investigated experimentally by imaging the speckle contrast changes in the brain after electrical forepaw stimulation in rats. The sensitivity to relative changes in speckle contrast was found to increase at longer exposure times and to reach a plateau for exposure times greater than approximately 2 ms. However, the speckle contrast noise also increases with exposure time and thus the contrast-to-noise ratio was found to peak at an exposure time of approximately 5 ms. Our results suggests that approximately 5 ms is an optimal exposure time for imaging of stimulus-induced changes in cerebral blood flow in rodents.

ACL deficiency impairs the vasoconstrictive efficacy of neuropeptide Y and phenylephrine in articular tissues: a laser speckle perfusion imaging study

Sympathetic-derived neuropeptide Y (NPY) helps regulate inflammatory responses in injury and disease, is a vasoconstrictor, and stimulates angiogenesis. Rupture of the anterior cruciate ligament (ACL) is a common clinical presentation that results in tissue inflammation, hyperemia, and angiogenesis in the intact medial collateral ligament (MCL). This study is the first to examine the vasoregulatory role of NPY in ACL-deficient knee joints by using the newly developed technique of laser speckle perfusion imaging (LSPI). MCL blood flow was measured in two groups of adult rabbits: unoperated control ( n = 6), and 6-wk ACL transected ( n = 5). Under anesthesia, the MCL was surgically exposed and tissue blood flow was imaged at high resolution using LSPI. NPY was applied to the MCL vasculature in topical boluses of 100 μl (dose range 10−14 to 10−9 mol), and the α-adrenoceptor agonist phenylephrine was applied in doses of 10−14, 10−10, and 10−7 mol. In control rabbits, topical administration of NPY or phenylephrine produced dose-dependent vasopressor responses (maximal effect at 10−9 mol NPY and 10−7 mol phenylephrine). In ACL-transected knees, there was little or no vasoconstrictive response to NPY at any dose. The response to phenylephrine was significantly reduced compared with control ligaments. Possible causes of the reduced vasoconstrictive response to NPY in the MCL after 6 wk of ACL deficiency include development of tolerance to the peptide due to a prolonged increase in sympathetic nerve activity or change in the distribution or functionality of the NPY Y1 receptors. Chronic ACL deficiency leads to profound and protracted hyperemia in associated articular tissues. Abrogation of a vasoconstrictor response to both NPY and phenylephrine in the MCL indicates that ACL deficiency induces major changes in the vascular physiological homeostasis.

A laser speckle imaging technique for measuring tissue perfusion

Laser Doppler imaging (LDI) has become a standard method for optical measurement of tissue perfusion, but is limited by low resolution and long measurement times. We have developed an analysis technique based on a laser speckle imaging method that generates rapid, high-resolution perfusion images. We have called it laser speckle perfusion imaging (LSPI). This paper investigates LSPI output and compares it to LDI using blood flow models designed to simulate human skin at various levels of pigmentation. Results show that LSPI parameters can be chosen such that the instrumentation exhibits a similar response to changes in red blood cell concentration (0.1%-5%, 200 microL/min) and velocity (0-800 microL/min, 1% concentration) and, given its higher resolution and quicker response time, could provide a significant advantage over LDI for some applications. Differences were observed in the LDI and LSPI response to tissue optical properties. LDI perfusion values increased with increasing tissue absorption, while LSPI perfusion values showed a slight decrease. This dependence is predictable, owing to the perfusion algorithms specific to each instrument, and, if properly compensated for, should not influence each instrument's ability to measure relative changes in tissue perfusion.

Endoscopic laser imaging of tissue perfusion: new instrumentation and technique

BACKGROUND AND OBJECTIVES

New instrumentation, based on a previously established laser speckle perfusion imaging (LSI) technique is evaluated for its ability to capture and generate blood flow images during endoscopic surgery.

STUDY DESIGN/MATERIALS AND METHODS

Investigations are detailed in an in-vitro blood flow model simulating physiological properties of vascularized tissue, and in-vivo in rabbit joint capsule tissue.

RESULTS

In-vitro measurements showed a linear response of the instrument to blood flow in the range of 0-800 microl/minute, where data points were significantly correlated with an r(2) value of 0.96. In-vivo measurements showed a 58.7% decrease to the medial collateral ligament during occlusion of the femoral artery.

CONCLUSIONS

Blood flow images demonstrate that the endoscopic LSI technique is capable of measuring relative tissue blood flow changes at high resolutions and rapid response times and incorporates well with endoscopic surgeries.