1
|
Triantafyllias K, Altamimi KK, Schederecker F, Schwarting A. Increased predictive value of optical spectral transmission in early rheumatoid arthritis through use of patient-adjusted cut-off scores. Arthritis Res Ther 2024; 26:165. [PMID: 39304933 DOI: 10.1186/s13075-024-03400-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 09/06/2024] [Indexed: 09/22/2024] Open
Abstract
OBJECTIVES The aims of this study were to suggest patient-adjusted optical spectral transmission (OST) cut-off values for the first time and to develop clinical models that predict the probability of an early rheumatoid arthritis (RA) diagnosis based on OST findings and the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria as a reference standard. METHODS OST examinations were performed in newly diagnosed RA patients and healthy controls by the HandScan device. Moreover, RA patients underwent a full clinical [tender/swollen joint counts (TJC/SJC), disease activity score-28 (DAS28)] and laboratory evaluation. OST confounding factors were examined via logistic multivariate regression analyses and patient-adjusted OST-cut-offs were subsequently determined. Furthermore, statistical models to calculate the probability of an RA diagnosis, based on the measured OST values and the presence of OST influencing factors, were developed. Finally, correlations of OST with RA activity parameters were assessed. RESULTS 1.584 joints of 72 early RA patients were examined via OST and compared to 2.200 joints of 100 healthy controls and 1.166 joints of 53 patients with non-inflammatory arthralgia (NIA), respectively. Overall OST diagnostic performance was excellent in the whole cohort between RA- and healthy control-group [Area-Under-the-Curve (AUC): 0.810 (95%CI: 0.746-0.873); p < 0.0001], and further improved in RA-patients with ≥ 1 swollen wrist/finger joint(s) [AUC: 0.841 (95%CI: 0.773-0.908); p < 0.0001]. Comparison between RA patients and patients with non-inflammatory arthralgia showed similar results by an AUC of 0.788 (95%-CI: 0.709-0.867; p < 0.0001), and further improved in RA patients with ≥ 1 swollen wrist/finger joint(s) [AUC: 0.822 (95%CI: 0.74-0.90); p < 0.0001]. For the assessment of an adjusted RA diagnosis probability, two gender-specific statistical models were developed, based on OST values and patient age. OST cut-off values of 11.2 and 18.21 were calculated for female and male patients with active disease (sensitivity 93% and 67%; specificity 71.2% and 90%), respectively. Among RA patients, OST was associated moderately/significantly with DAS28 (r = 0.42,p < 0.001) and swollen joint count (rho = 0.355,p = 0.002). CONCLUSION The development of patient-adjusted OST cut-off values and the suggested statistical models significantly enhance OST's diagnostic performance, supporting its utility in differentiating between RA and non-inflammatory conditions. Future research should include a broader spectrum of arthritis types to validate OST's comprehensive diagnostic utility also across various inflammatory arthritides. TRIAL REGISTRATION DRKS00016752 (German Registry of Clinical Trials).
Collapse
Affiliation(s)
- Konstantinos Triantafyllias
- Department of Rheumatology, Acute Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany.
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center, Mainz, Germany.
| | - Khalid K Altamimi
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | | | - Andreas Schwarting
- Department of Rheumatology, Acute Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center, Mainz, Germany
| |
Collapse
|
2
|
Blanken AB, Korteweg M, van Boheemen L, van Vollenhoven RF, Nurmohamed MT, van der Laken CJ. Clinical evaluation of optical spectral transmission imaging for detection of disease activity in rheumatoid arthritis. Scand J Rheumatol 2024; 53:85-93. [PMID: 36974977 DOI: 10.1080/03009742.2023.2177382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/03/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To investigate the performance and factors of influence of optical spectral transmission (OST) imaging as a new technique for measuring joint inflammation in rheumatoid arthritis (RA). METHOD OST was performed in 24 RA patients and 37 controls. Mann-Whitney U-test was used to assess differences in OST score between RA patients and controls. Receiver operating characteristics (ROC), linear regression and generalized estimating equations analysis were used to assess the discriminative capability of OST and the association of OST score with clinical disease parameters, ultrasound, radiographic features and cardiovascular risk parameters. RESULTS Median OST score was higher in RA patients than in controls [16.9 (interquartile range 12.77-19.7) vs 12.11 (10.32-14.93)]. At patient level, OST score was moderately associated with ultrasound [beta 0.38 (95% CI 0.16-0.60), p = 0.001] and clinical disease activity [28-joint Disease Activity Score-C-reactive protein beta 0.30 (95% CI 0.04- 0.57), p = 0.024] in RA patients. In controls, male sex, high body mass index, and hypertension were associated with higher OST scores, while these associations were absent in RA. At joint level, the area under the ROC curve for OST score, with ultrasound or clinical swelling as reference, ranged from 0.63 to 0.70. Joint-space narrowing and malalignment were associated with higher OST joint scores, and subchondral sclerosis with lower scores. CONCLUSION OST provides an objective measure of synovitis and correlates moderately with other examined disease activity assessment tools. Clinical patient characteristics must be considered when interpreting the results.
Collapse
Affiliation(s)
- A B Blanken
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, The Netherlands
| | - M Korteweg
- Department of Radiology, Reade, Amsterdam, The Netherlands
| | - L van Boheemen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - R F van Vollenhoven
- Department of Radiology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, The Netherlands
| | - M T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, The Netherlands
| | - C J van der Laken
- Department of Radiology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, The Netherlands
| |
Collapse
|
3
|
van Boheemen L, Blanken A, Kuin A, van Schaardenburg D. No added value of optimal spectral transmission imaging in persons at risk of rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:4436-4438. [PMID: 33983434 DOI: 10.1093/rheumatology/keab435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/19/2021] [Accepted: 05/11/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Annelies Blanken
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center (ARC)
| | - Aja Kuin
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center (ARC)
| | - Dirkjan van Schaardenburg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center (ARC)
- Department of Rheumatology, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Kim Y, Marone A, Tang W, Gartshteyn Y, Kim HK, Askanase AD, Kymissis I, Hielscher AH. Flexible optical imaging band system for the assessment of arthritis in patients with systemic lupus erythematosus. BIOMEDICAL OPTICS EXPRESS 2021; 12:1651-1665. [PMID: 33796379 PMCID: PMC7984785 DOI: 10.1364/boe.415575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
We have developed a flexible optical imaging system (FOIS) to assess systemic lupus erythematosus (SLE) arthritis in the finger joints. While any part of the body can be affected, arthritis in the finger joints is one of the most common SLE manifestations. There is an unmet need for accurate, low-cost assessment of lupus arthritis that can be easily performed at every clinic visit. Current imaging methods are imprecise, expensive, and time consuming to allow for frequent monitoring. Our FOIS can be wrapped around joints, and multiple light sources and detectors gather reflected and transmitted light intensities. Using data from two SLE patients and two healthy volunteers, we demonstrate the potential of this FOIS for assessment of arthritis in SLE patients.
Collapse
Affiliation(s)
- Youngwan Kim
- Columbia University, Department of Electrical Engineering, 500 W. 120th Street, New York, NY 10027, USA
- New York University, Department of Biomedical Engineering, Brooklyn, NY 11201, USA
| | - Alessandro Marone
- New York University, Department of Biomedical Engineering, Brooklyn, NY 11201, USA
| | - Wei Tang
- Columbia University Irving Medical Center, Department of Medicine-Rheumatology, 650 W. 168th Street, New York, NY 10032, USA
| | - Yevgeniya Gartshteyn
- Columbia University Irving Medical Center, Department of Medicine-Rheumatology, 650 W. 168th Street, New York, NY 10032, USA
| | - Hyun K. Kim
- New York University, Department of Biomedical Engineering, Brooklyn, NY 11201, USA
- Columbia University Irving Medical Center, Department of Radiology, 650 W. 168th Street, New York, NY 10032, USA
| | - Anca D. Askanase
- Columbia University Irving Medical Center, Department of Medicine-Rheumatology, 650 W. 168th Street, New York, NY 10032, USA
| | - Ioannis Kymissis
- Columbia University, Department of Electrical Engineering, 500 W. 120th Street, New York, NY 10027, USA
| | - Andreas H. Hielscher
- New York University, Department of Biomedical Engineering, Brooklyn, NY 11201, USA
- Columbia University, Department of Biomedical Engineering, 500 W. 120th Street, New York, NY 10027, USA
| |
Collapse
|
5
|
Ioussoufovitch S, Morrison LB, Desjardins L, Hadway JA, Lawrence KS, Lee TY, Beier F, Diop M. Quantification of joint blood flow by dynamic contrast-enhanced near-infrared spectroscopy: application to monitoring disease activity in a rat model of rheumatoid arthritis. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-10. [PMID: 31939225 PMCID: PMC6983648 DOI: 10.1117/1.jbo.25.1.015003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/06/2019] [Indexed: 05/11/2023]
Abstract
Significance Current guidelines for rheumatoid arthritis (RA) management recommend early treatment with disease modifying antirheumatic drugs (DMARDs). However, DMARD treatment fails in 30% of patients and current monitoring methods can only detect failure after 3 to 6 months of therapy. Aim We investigated whether joint blood flow (BF), quantified using dynamic contrast-enhanced time-resolved near-infrared spectroscopy, can monitor disease activity and treatment response in a rat model of RA. Approach Ankle joint BF was measured every 5 days in eight rats with adjuvant-induced arthritis (AIA) and four healthy controls. Arthritis was allowed to progress for 20 days before rats with AIA were treated with a DMARD once every 5 days until day 40. Results Time and group had separate significant main effects on joint BF; however, there was no significant interaction between time and group despite a notable difference in average joint BF on day 5. Comparison of individual blood flow measures between rats with AIA and control group animals did not reveal a clear response to treatment. Conclusions Joint BF time courses could not distinguish between rats with AIA and study controls. Heterogeneous disease response and low temporal frequency of BF measurements may have been important study limitations.
Collapse
Affiliation(s)
- Seva Ioussoufovitch
- Western University, Bone and Joint Institute, School of Biomedical Engineering, Faculty of Engineering, London, Ontario, Canada
| | - Laura B. Morrison
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
| | - Lise Desjardins
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
| | - Jennifer A. Hadway
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
| | - Keith St. Lawrence
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
| | - Ting-Yim Lee
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
- Robarts Research Institute, Imaging Program, London, Ontario, Canada
| | - Frank Beier
- Western University, Schulich School of Medicine and Dentistry, Department of Physiology and Pharmacology, London, Ontario, Canada
| | - Mamadou Diop
- Western University, Bone and Joint Institute, School of Biomedical Engineering, Faculty of Engineering, London, Ontario, Canada
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
| |
Collapse
|
6
|
Jo J, Xu G, Cao M, Marquardt A, Francis S, Gandikota G, Wang X. A Functional Study of Human Inflammatory Arthritis Using Photoacoustic Imaging. Sci Rep 2017; 7:15026. [PMID: 29101339 PMCID: PMC5670248 DOI: 10.1038/s41598-017-15147-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/18/2017] [Indexed: 12/02/2022] Open
Abstract
By using our dual-modality system enabling simultaneous real-time ultrasound (US) and photoacoustic (PA) imaging of human peripheral joints, we explored the potential contribution of PA imaging modality to rheumatology clinic. By performing PA imaging at a single laser wavelength, the spatially distributed hemoglobin content reflecting the hyperemia in synovial tissue in metacarpophalangeal (MCP) joints of 16 patients were imaged, and compared to the results from 16 healthy controls. In addition, by performing PA imaging at two laser wavelengths, the spatially distributed hemoglobin oxygenation reflecting the hypoxia in inflammatory joints of 10 patients were imaged, and compared to the results from 10 healthy controls. The statistical analyses of the PA imaging results demonstrated significant differences (p < 0.001) in quantified hemoglobin content and oxygenation between the unequivocally arthritic joints and the normal joints. Increased hyperemia and increased hypoxia, two important physiological biomarkers of synovitis reflecting the increased metabolic demand and the relatively inadequate oxygen delivery in affected synovium, can both be objectively and non-invasively evaluated by PA imaging. The proposed dual-modality system has the potential of providing additional diagnostic information over the traditional US imaging approaches and introducing novel imaging biomarkers for diagnosis and treatment evaluation of inflammatory arthritis.
Collapse
Affiliation(s)
- Janggun Jo
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Guan Xu
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, 48109, USA
| | - Meng Cao
- Department of Electronic Science and Engineering, Nanjing University, Nanjing, 210093, China
| | - April Marquardt
- Division of Rheumatology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, 48109, USA
| | - Sheeja Francis
- Division of Rheumatology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, 48109, USA
| | - Girish Gandikota
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, 48109, USA.
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109, USA. .,Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, 48109, USA.
| |
Collapse
|
7
|
Wu HY, Filer A, Styles I, Dehghani H. Development of a multi-wavelength diffuse optical tomography system for early diagnosis of rheumatoid arthritis: simulation, phantoms and healthy human studies. BIOMEDICAL OPTICS EXPRESS 2016; 7:4769-4786. [PMID: 27896015 PMCID: PMC5119615 DOI: 10.1364/boe.7.004769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/30/2016] [Accepted: 07/22/2016] [Indexed: 05/21/2023]
Abstract
A multi-wavelength diffuse optical tomography (DOT) system has been developed to directly extract physiological information, such as total haemoglobin concentration, from tissue in human hand joints. Novel methods for 3D surface imaging and spectrally constrained image reconstruction are introduced and their potential application to imaging of rheumatoid arthritis is discussed. Results are presented from simulation studies as well as experiments using phantoms and data from imaging of three healthy volunteers. The image features are recovered partially for phantom data using transmission measurements only. Images that reveal joint regions and surrounding features within the hand are shown to co-register with co-acquired ultrasound images which are shown to be related to total haemoglobin concentration.
Collapse
Affiliation(s)
- Hao Yang Wu
- The Centre for Physical Sciences of Imaging in Biomedical Sciences (PSIBS), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Andrew Filer
- The Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Iain Styles
- The Centre for Physical Sciences of Imaging in Biomedical Sciences (PSIBS), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- School of Computer Science, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Hamid Dehghani
- The Centre for Physical Sciences of Imaging in Biomedical Sciences (PSIBS), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- School of Computer Science, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| |
Collapse
|
8
|
Rajaram A, Ioussoufovitch S, Morrison LB, St Lawrence K, Lee TY, Bureau Y, Diop M. Joint blood flow is more sensitive to inflammatory arthritis than oxyhemoglobin, deoxyhemoglobin, and oxygen saturation. BIOMEDICAL OPTICS EXPRESS 2016; 7:3843-3854. [PMID: 27867697 PMCID: PMC5102556 DOI: 10.1364/boe.7.003843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/23/2016] [Accepted: 08/28/2016] [Indexed: 05/11/2023]
Abstract
Joint hypoxia plays a central role in the progression and perpetuation of rheumatoid arthritis (RA). Thus, optical techniques that can measure surrogate markers of hypoxia such as blood flow, oxyhemoglobin, deoxyhemoglobin, and oxygen saturation are being developed to monitor RA. The purpose of the current study was to compare the sensitivity of these physiological parameters to arthritis. Experiments were conducted in a rabbit model of RA and the results revealed that joint blood flow was the most sensitive to arthritis and could detect a statistically significant difference (p<0.05, power = 0.8) between inflamed and healthy joints with a sample size of only four subjects. Considering that this a quantitative technique, the high sensitivity to arthritis suggests that joint perfusion has the potential to become a potent tool for monitoring disease progression and treatment response in RA.
Collapse
Affiliation(s)
- Ajay Rajaram
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Seva Ioussoufovitch
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Laura B. Morrison
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Keith St Lawrence
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Ting-Yim Lee
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
- Imaging Program, Robarts Research Institute, 100 Perth Drive, London, Ontario N6A 5K8, Canada
| | - Yves Bureau
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
| | - Mamadou Diop
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| |
Collapse
|
9
|
van Onna M, Ten Cate DF, Tsoi KL, Meier AJL, Jacobs JWG, Westgeest AAA, Meijer PBL, van Beek MC, Rensen WHJ, Bijlsma JWJ. Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique. Ann Rheum Dis 2015; 75:511-8. [PMID: 26452538 PMCID: PMC4789697 DOI: 10.1136/annrheumdis-2015-207315] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 09/20/2015] [Indexed: 01/30/2023]
Abstract
Objectives In rheumatoid arthritis (RA), treat-to-target strategies require instruments for valid detection of joint inflammation. Therefore, imaging modalities are increasingly used in clinical practice. Optical spectral transmission (OST) measurements are non-invasive and fast and may therefore have benefits over existing imaging modalities. We tested whether OST could measure disease activity validly in patients with RA. Methods In 59 patients with RA and 10 patients with arthralgia, OST, joint counts, Disease Activity Score (DAS) 28 and ultrasonography (US) were performed. Additionally, MRI was performed in patients with DAS28<2.6. We developed and validated within the same cohort an algorithm for detection of joint inflammation by OST with US as reference. Results At the joint level, OST and US performed similarly inproximal interphalangeal-joints (area under the receiver-operating curve (AUC) of 0.79, p<0.0001) andmetacarpophalangeal joints (AUC 0.78, p<0.0001). Performance was less similar in wrists (AUC 0.62, p=0.006). On the patient level, OST correlated moderately with clinical examination (DAS28 r=0.42, p=0.001), and US scores (r=0.64, p<0.0001). Furthermore, in patients with subclinical and low disease activity, there was a correlation between OST and MRI synovitis score (RAMRIS (Rheumatoid Arthritis MRI Scoring) synovitis), r=0.52, p=0.005. Conclusions In this pilot study, OST performed moderately in the detection of joint inflammation in patients with RA. Further studies are needed to determine the diagnostic performance in a new cohort of patients with RA.
Collapse
Affiliation(s)
- M van Onna
- Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
| | - D F Ten Cate
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K L Tsoi
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A J L Meier
- Department of Rheumatology, Regional Rheumatology Center, Eindhoven, The Netherlands
| | - J W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A A A Westgeest
- Department of Rheumatology, Regional Rheumatology Center, Eindhoven, The Netherlands
| | | | | | | | - J W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
10
|
Khalil MA, Kim HK, Hoi JW, Kim I, Dayal R, Shrikhande G, Hielscher AH. Detection of Peripheral Arterial Disease Within the Foot Using Vascular Optical Tomographic Imaging: A Clinical Pilot Study. Eur J Vasc Endovasc Surg 2015; 49:83-9. [PMID: 25457299 PMCID: PMC4439381 DOI: 10.1016/j.ejvs.2014.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Vascular optical tomographic imaging (VOTI) is a novel imaging modality that is capable of detecting hemoglobin concentrations in tissue. VOTI is non-invasive, non-ionizing and does not require contrast injection. This technology was applied to the diagnosis of peripheral arterial disease (PAD) within lower extremities of diabetic patients with calcified arteries. This could be of substantial benefit as these patients suffer from comorbidities such as arterial incompressibility, which complicates diagnosis and monitoring. METHODS Forty individuals (10 non-diabetic patients with PAD, 10 diabetic patients with PAD, and 20 healthy volunteers) were enrolled in a diagnostic pilot study using the VOTI system. The patients were imaged during at high pressure cuff occlusion. RESULTS The VOTI system was capable of quantifying the blood volume changes within the foot during the thigh cuff occlusion and outputting diagnostic parameters, such as change in hemoglobin concentration, enabling the assessment of foot perfusion. This study resulted in a statistically significant difference between the healthy cohort and both the non-diabetic and the diabetic PAD cohorts (p = .006, p = .006). Receiver operating characteristic (ROC) curve analysis showed that PAD diagnosis could be made with over 80% sensitivity or specificity depending on the characteristic cutoff point. In addition, VOTI was capable of providing the locations of under-perfused regions within the foot and evaluating the severity of arterial disease, even within diabetic patients with calcified arteries, who are traditionally difficult to diagnose. CONCLUSION VOTI can effectively diagnose PAD independently of arterial compressibility, making it very useful for assessing vascular disease in diabetic patients.
Collapse
Affiliation(s)
- M A. Khalil
- Department of Biomedical Engineering, Columbia University, NY 10027 USA, 351 Engineering Terrace, 1210 Amsterdam Avenue, Mail Code: 8904, New York, NY 10027. Phone: 1 203-508-2036, Fax: 1 212-854-8725
| | - H. K. Kim
- Department of Radiology, Columbia University, NY 10027 USA
| | - J. W. Hoi
- Department of Biomedical Engineering, Columbia University, NY 10027 USA
| | - I. Kim
- Department of Surgery, NY Presbyterian Hospital-Columbia University, NY 10032 USA
| | - Rajeev Dayal
- NY Presbyterian Hospital-Columbia University, NY 10032 USA. He is now with the Department of Surgery, NY Hospital Queens, NY 11355 USA
| | - Gautam Shrikhande
- Department of Surgery, NY Presbyterian Hospital-Columbia University, NY 10032 USA
| | - A. H. Hielscher
- Departments of Biomedical Engineering, Radiology, and Electrical Engineering, Columbia University, NY, 10027 USA
| |
Collapse
|
11
|
Khalil MA, Kim HK, Kim IK, Flexman M, Dayal R, Shrikhande G, Hielscher AH. Dynamic diffuse optical tomography imaging of peripheral arterial disease. BIOMEDICAL OPTICS EXPRESS 2012; 3:2288-98. [PMID: 23024920 PMCID: PMC3447568 DOI: 10.1364/boe.3.002288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 07/30/2012] [Accepted: 08/02/2012] [Indexed: 05/03/2023]
Abstract
Peripheral arterial disease (PAD) is the narrowing of arteries due to plaque accumulation in the vascular walls. This leads to insufficient blood supply to the extremities and can ultimately cause cell death. Currently available methods are ineffective in diagnosing PAD in patients with calcified arteries, such as those with diabetes. In this paper we investigate the potential of dynamic diffuse optical tomography (DDOT) as an alternative way to assess PAD in the lower extremities. DDOT is a non-invasive, non-ionizing imaging modality that uses near-infrared light to create spatio-temporal maps of oxy- and deoxy-hemoglobin in tissue. We present three case studies in which we used DDOT to visualize vascular perfusion of a healthy volunteer, a PAD patient and a diabetic PAD patient with calcified arteries. These preliminary results show significant differences in DDOT time-traces and images between all three cases, underscoring the potential of DDOT as a new diagnostic tool.
Collapse
Affiliation(s)
- Michael A. Khalil
- Department. of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Hyun K. Kim
- Department. of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - In-Kyong Kim
- Divison of Vascular Surgery, New York-Presbyterian Columbia University Medical Center, New York, NY 10032, USA
| | - Molly Flexman
- Department. of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Rajeev Dayal
- Divison of Vascular Surgery, New York-Presbyterian Columbia University Medical Center, New York, NY 10032, USA
| | - Gautam Shrikhande
- Divison of Vascular Surgery, New York-Presbyterian Columbia University Medical Center, New York, NY 10032, USA
| | - Andreas H. Hielscher
- Department. of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Department of Radiology, Columbia University, New York, NY 10027, USA
- Department. of Electrical Engineering, Columbia University, New York, NY 10027, USA
| |
Collapse
|
12
|
Meier AJL, Rensen WHJ, de Bokx PK, de Nijs RNJ. Potential of optical spectral transmission measurements for joint inflammation measurements in rheumatoid arthritis patients. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:081420. [PMID: 23224181 DOI: 10.1117/1.jbo.17.8.081420] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Frequent monitoring of rheumatoid arthritis (RA) patients enables timely treatment adjustments and improved outcomes. Currently this is not feasible due to a shortage of rheumatologists. An optical spectral transmission device is presented for objective assessment of joint inflammation in RA patients, while improving diagnostic accuracy and clinical workflow. A cross-sectional, nonrandomized observational study was performed with this device. In the study, 77 proximal interphalangeal (PIP) joints in 67 patients have been analyzed. Inflammation of these PIP joints was also assessed by a rheumatologist with a score varying from 1 (not inflamed) to 5 (severely inflamed). Out of 77 measurements, 27 were performed in moderate to strongly inflamed PIP joints. Comparison between the clinical assessment and an optical measurement showed a correlation coefficient r=0.63, p<0.001, 95% CI [0.47, 0.75], and a ROC curve (AUC=0.88) that shows a relative good specificity and sensitivity. Optical spectral transmission measurements in a single joint correlate with clinical assessment of joint inflammation, and therefore might be useful in monitoring joint inflammation in RA patients.
Collapse
Affiliation(s)
- A J Louise Meier
- Regional Rheumatic Centre (RRC), Department of Rheumatology, Ds. Th. Fliednerstraat 1, 5631 BM, Eindhoven, The Netherlands.
| | | | | | | |
Collapse
|
13
|
Klose CD, Klose AD, Netz UJ, Scheel AK, Beuthan J, Hielscher AH. Computer-aided interpretation approach for optical tomographic images. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:066020. [PMID: 21198194 PMCID: PMC3017575 DOI: 10.1117/1.3516705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A computer-aided interpretation approach is proposed to detect rheumatic arthritis (RA) in human finger joints using optical tomographic images. The image interpretation method employs a classification algorithm that makes use of a so-called self-organizing mapping scheme to classify fingers as either affected or unaffected by RA. Unlike in previous studies, this allows for combining multiple image features, such as minimum and maximum values of the absorption coefficient for identifying affected and not affected joints. Classification performances obtained by the proposed method were evaluated in terms of sensitivity, specificity, Youden index, and mutual information. Different methods (i.e., clinical diagnostics, ultrasound imaging, magnet resonance imaging, and inspection of optical tomographic images), were used to produce ground truth benchmarks to determine the performance of image interpretations. Using data from 100 finger joints, findings suggest that some parameter combinations lead to higher sensitivities, while others to higher specificities when compared to single parameter classifications employed in previous studies. Maximum performances are reached when combining the minimum/maximum ratio of the absorption coefficient and image variance. In this case, sensitivities and specificities over 0.9 can be achieved. These values are much higher than values obtained when only single parameter classifications were used, where sensitivities and specificities remained well below 0.8.
Collapse
Affiliation(s)
- Christian D Klose
- Columbia University, Department of Biomedical Engineering, New York, NY 10027, USA
| | | | | | | | | | | |
Collapse
|
14
|
Abstract
Conventional radiography, ultrasound, CT, MRI, and nuclear imaging are the current imaging modalities used for clinical evaluation of arthritis which is highly prevalent and a leading cause of disability. Some of these types of imaging are also used for monitoring disease progression and treatment response of arthritis. However, their disadvantages limit their utilities, such as ionizing radiation for radiography, CT, and nuclear imaging; suboptimal tissue contrast resolution for radiography, CT, ultrasound, and nuclear imaging; high cost for CT and MRI and nuclear imaging; and long data-acquisition time with ensuing patient discomfort for MRI. Recently, there have been considerable advances in nonionizing noninvasive optical imaging which has demonstrated promise for early diagnosis, monitoring therapeutic interventions and disease progression of arthritis. Optical based molecular imaging modalities such as fluorescence imaging have shown high sensitivity in detection of optical contrast agents and can aid early diagnosis and ongoing evaluation of chronic inflammatory arthritis. Optical transillumination imaging or diffuse optical tomography may differentiate normal joint clear synovial fluid from turbid and pink medium early in the inflammatory process. Fourier transform infrared spectroscopy has been used to evaluate fluid composition from joints affected by arthritis. Hemodynamic changes such as angiogenesis, hypervascularization, and hypoxia in arthritic articular tissue can potentially be observed by diffuse optical tomography and photoacoustic tomography. Optical measurements could also facilitate quantification of hemodynamic properties such as blood volume and oxygenation levels at early stages of inflammatory arthritis. Optical imaging provides methodologies which should contribute to detection of early changes and monitoring of progression in pathological characteristics of arthritis, with relatively simple instrumentation.
Collapse
Affiliation(s)
- David Chamberland
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, 48109, USA
| | | | | |
Collapse
|
15
|
Durduran T, Choe R, Baker WB, Yodh AG. Diffuse Optics for Tissue Monitoring and Tomography. REPORTS ON PROGRESS IN PHYSICS. PHYSICAL SOCIETY (GREAT BRITAIN) 2010; 73:076701. [PMID: 26120204 PMCID: PMC4482362 DOI: 10.1088/0034-4885/73/7/076701] [Citation(s) in RCA: 571] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This review describes the diffusion model for light transport in tissues and the medical applications of diffuse light. Diffuse optics is particularly useful for measurement of tissue hemodynamics, wherein quantitative assessment of oxy- and deoxy-hemoglobin concentrations and blood flow are desired. The theoretical basis for near-infrared or diffuse optical spectroscopy (NIRS or DOS, respectively) is developed, and the basic elements of diffuse optical tomography (DOT) are outlined. We also discuss diffuse correlation spectroscopy (DCS), a technique whereby temporal correlation functions of diffusing light are transported through tissue and are used to measure blood flow. Essential instrumentation is described, and representative brain and breast functional imaging and monitoring results illustrate the workings of these new tissue diagnostics.
Collapse
Affiliation(s)
- T Durduran
- ICFO- Institut de Ciències Fotòniques, Mediterranean Technology Park, 08860 Castelldefels (Barcelona), Spain
| | - R Choe
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - W B Baker
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - A G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
16
|
Yuan B. Sensitivity of fluorophore-quencher labeled microbubbles to externally applied static pressure. Med Phys 2009; 36:3455-69. [PMID: 19746779 DOI: 10.1118/1.3158734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A fluorophore-quencher (F-Q) labeled microbubble system is proposed as a sensor for measuring externally applied static pressure distribution in a tumor. To quantify the sensitivity of such an F-Q bubble system to the externally applied pressure, a model describing bubble response to the static pressure was derived. Additionally, a model connecting the fluorescence lifetime and bubble radius was developed for the basic F-Q bubble system. The sensitivity is quantified based on these models given typical parameters. Results show that it is possible to resolve as low as 1 mm Hg pressure variation when both the F-Q bubble system and the measurement system are optimized. Strategies for optimizing an F-Q bubble system are discussed.
Collapse
Affiliation(s)
- Baohong Yuan
- Department of Biomedical Engineering, Catholic University of America, Washington, DC 20064, USA.
| |
Collapse
|