KEYWORDS: Optical coherence tomography, Skin, Angiography, Tissues, Control systems, Vascular diseases, Capillaries, Analog to digital converters, 3D image processing, Tunable filters
Systemic sclerosis (SSc) is a complex autoimmune disease characterized by skin and internal organ fibrosis, with vascular dysfunction playing a critical role in its pathogenesis. This study utilizes optical coherence tomography angiography (OCTA) to explore vascular abnormalities in SSc patients. We imaged 26 SSc patients and 17 age- and sex-matched healthy volunteers. High-resolution OCTA images of the forearm, hand, finger, and nailbed skin vasculature were obtained using a swept-source OCT system, with a central wavelength of 1300 nm, a scan range of 108 nm, a scan rate of 100 kHz. Post-processing was achieved using Matlab and QuPath, where a Hessian filter-based approach was utilized to enhance blood vessel contrast and connectivity in 2D projections. These tools were also employed for vessel lumen width (VLW) calculation, with group comparisons made using Mann-Whitney U-test. The results showed a significant decrease in VLW in SSc patients compared to healthy controls across all imaged regions (p<0.001 for all locations: finger, hand, forearm, and nailbed). These findings suggest that OCTA is a valuable tool for detecting and quantifying vascular abnormalities in SSc skin, potentially offering new insights for disease management.
Systemic sclerosis (SSc) is a rare, chronic autoimmune disease characterized by fibrosis and vascular abnormalities in multiple organs, including skin, lungs, and gastrointestinal tract. Early and accurate diagnosis of SSc is essential for timely intervention and improved patient outcomes. More than 90% of patients with SSc have fibrosis in the skin that manifests as mechanical changes in the skin. The modified Rodnan Skin Score (mRSS) is the gold standard for assessing skin involvement in SSc but has high inter-observer variability. The other widely used method is ultrasound imaging. Ultrasound elastography is emerging as a useful technique for assessing SSc, but its accuracy is still under investigation. Even though the results from these studies provide a quantitative assessment of SSc, ultrasound elastography has many limits, such as the lack of high-resolution performance to detect SSc-affected skin structural and elastic characteristics simultaneously. Optical coherence elastography (OCE) is an established technique to assess the mechanical properties of tissues noninvasively and quantitatively with high resolution. We measured the mechanical properties of skin in 45 patients (36 SSc and 9 matched controls) using a home-built swept source OCE setup that uses air-coupled acoustic radiation force for tissue excitation. The measurements were performed at three locations on each arm: the proximal phalanx of the third finger, the second intermetacarpal space, and the dorsal forearm midline. The OCE results were compared to mRSS and clinical ultrasound elastography, which a trained physician performed. Our results show that OCE outperformed ultrasound elastography with a higher correlation with mRSS.
Systemic sclerosis (SSc) is an autoimmune disorder with high mortality due to excessive accumulation of collagen in the skin and internal organs. An accurate and early diagnosis is crucial to ensure effective treatment. Currently, the modified Rodnan skin score (mRSS) is the gold standard for evaluating dermal thickening during SSc onset and progression. However, obtaining the mRSS can be time consuming, and the score has noticeable inter- and intraobserver variabilities. Optical coherence elastography (OCE) is an emerging technique for measuring soft tissue biomechanical properties completely noninvasively. In this work, we demonstrate the first use of OCE combined with analysis of the OCT signal slope (OCTSS) for sclerosis detection in the dorsal forearm of 12 patients. A comparison to clinical diagnoses including dermal thickness assessed by histology, mRSS, and site specific mRSS (SMRSS). Results of both optical assessments demonstrated high correlation (OCE: 0.78 and OCTSS: 0.65) with SMRSS as performed by an experienced physician. Importantly, the correlation of both proposed parameters with the dermal thickness (OCTSS: r=0.78 and OCE: r=0.74) outperformed the SMRSS assessment (r=0.57), demonstrating the effectiveness of using OCT/OCE for monitoring the disease severity of SSc.
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