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The Use of Medical Hyperspectral Technology to Evaluate Microcirculatory Changes in Diabetic Foot Ulcers and Predict Clinical Outcomes. Diabetes Care. 2007 Feb 15;
Khaodhiar L, Dinh T, Schomacker KT, Panasyuk SV, Freeman JE, Lew R, Vo T, Panasyuk AA, Lima C, Giurini JM, Lyons TE, Veves A
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Background: Foot ulceration (DFU) is a serious complication of diabetes and new techniques that can predict wound healing may prove very helpful. We tested the ability of Medical Hyperspectral Technology (HT), a novel diagnostic scanning technique which can quantify tissue oxy- and deoxyhemoglobin, to predict DFU healing.
Methods: Ten T1DM patients with 21 foot ulcer sites, 13 T1DM without ulcers and 14 non-diabetic controls were seen up to four times over a 6-month period. HT measurements of oxyhemoglobin (HT-Oxy), deoxyhemoglobin (HT-Deoxy) were performed at or near the ulcer area, and on the upper extremity and the lower extremity distant from the ulcer. A HT-Healing Index for each site was calculated from the HT-Oxy and HT-Deoxy values.
Results: Hyperspectral tissue oxygenation measurements observed changes in tissue immediately surrounding the ulcer when comparing ulcers that heal and ulcers that do not heal (p <.001). The sensitivity, specificity, positive predictive and negative predictive value of the HT Index to predicting healing were 93%, 86%, 93% and 86% when evaluated on images taken at the first visit. Changes in HT-Oxy among the three risk group were noted for the metatarsal area of the foot (p <.05) and the palm (p <.01). Changes in HT-Deoxy and HT Healing Index were noted for the palm only (p <.05 and p <.01, respectively).
Conclusions: HT has the capability to identify microvascular abnormalities and tissue oxygenation in the diabetic foot and predict ulcer healing. HT can assist in the management of foot ulceration.
New Technology Predicts Healing Potential of Diabetic Ulcers
Press Release: New Technology Predicts Healing Potential of Diabetic Ulcers
Diabetic wound indicator could significantly reduce diabetic amputation rates
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New research technology, named Hyperspectral Transcutaneous Oxygen Montitoring (HTcOM), effectively measures real-time oxygen levels surrounding the foot ulcerations commonly seen in patients with type 1 and 2 diabetes. The measurements taken with HTcOM are calculated in approximately 15 seconds, and can then be used to determine the most successful treatment plan for that particular wound. Two poster abstracts summarizing results from the study will be presented at the American Podiatric Medical Association’s (APMA) 96th Annual Scientific Meeting in Honolulu from July 24-27.
"Hyperspectral imaging will quickly become one of the most important tools physicians can use to assist diabetic patients in wound care treatment," said Aksone Nouvong, DPM, a podiatric physician involved in the study and an assistant clinical professor at UCLA’s David Geffen School of Medicine. "One of the most important findings we have discovered while studying HTcOM is that if a patient already has an existing foot wound, this technology can tell right away whether or not the ulcer has the ability to heal on its own."
Study data on HTcOM was collected in a Phase 2 longitudinal study at the National Institutes of Health (NIH), and looked at 66 type 1 and 2 diabetic subjects with at least one foot ulcer. Over six months, HTcOM was used to monitor oxygen levels at the site of the various ulcerations and accurately predicted which ulcer would heal. Interim data of 28 subjects that had completed the study after six months showed that 29 of the 36 ulcers had displayed positive healing potential after being treated based on HTcOM measurements. The positive predictive value for healing was 100 percent with this interim data cut.
According to Dr. Nouvong, the technology may begin to make its way into physicians' offices across the country after the full set of research data on HTcOM is released in September.
"Many lower-limb amputations currently being performed have to be done at an unnecessarily high level – often because the physician has no way of knowing the exact spot at which to perform an effective amputation," Dr. Nouvong said. "A patient who might have had an entire foot amputated may be found to only need to have their big toe done after being assessed with HTcOM."
Re: Hyperspectral Technology and Changes in Diabetic Foot Ulcers
EVALUATION OF DIABETIC FOOT ULCER HEALING WITH HYPERSPECTRAL IMAGING OF OXYHEMOGLOBIN AND DEOXYHEMOGLOBIN.
Nouvong A, Hoogwerf B, Mohler E, Davis B, Tajaddini A, Medenilla E. Diabetes Care. 2009 Jul 29. [Epub ahead of print]
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Objective- Foot ulceration remains a major health problem for diabetic patients and has a major impact on cost of diabetes treatment. We tested a hyperspectral imaging technology that quantifies cutaneous tissue hemoglobin oxygenation and generated anatomically relevant tissue oxygenation maps to assess the healing potential of diabetic foot ulcers (DFU).
Research Design and Methods- Prospective single arm blinded study that enrolled 66 patients with type 1 and 2 diabetes mellitus (DM) and followed them over a 24-week period. Clinical, medical and diabetes histories were collected. Transcutaneous oxygen tension was measured at the ankles. Superficial tissue oxyhemoglobin and deoxyhemoglobin were measured with hyperspectral imaging from intact tissue bordering the ulcer. A healing index, derived from oxyhemoglobin and deoxyhemoglobin values was used to assess the potential for healing.
Results- Fifty-four patients with 73 ulcers completed the study; 54 ulcers healed while 19 ulcers did not heal at 24 weeks. When using the healing index to predict healing, the sensitivity was 80% (43/54), the specificity was 74% (14/19), and the positive predictive value was 90% (43/48). The sensitivity, specificity and positive predictive values increase to 86%, 88% and 96% respectively, when removing three false positive osteomyelitis cases and four false negative cases due to measurements on a callus. The results indicate that cutaneous tissue oxygenation correlate with wound healing in DM patients.
Conclusion- Hyperspectral imaging of tissue oxyhemoglobin and deoxyhemoglobin may predict healing of DFUs with high sensitivity and specificity based on information obtained from a single visit.
Hyperspectral Technology and Changes in Diabetic Foot Ulcers
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