The objective of this paper is to present two methods to extend the response range of laser speckle imaging (LSI). We report on the use of two methods (image exposure time control and magnetomotive actuation of exogenous contrast agents) to enhance characterization of high- and low-flow vasculature, respectively. With an exposure time of 10 and 0.01 ms, the linear response range extended to 10 and 280 mm/s, respectively. With application of an AC magnetic field to a solution of stagnant SPIO particles, an apparent increase of approximately 3x in speckle flow index was induced.

Background and objectives

During laser therapy of port wine stain (PWS) birthmarks, regions of persistent perfusion may exist. Immediate retreatment of such regions may improve PWS laser therapeutic outcome. To address this need, we propose use of laser speckle imaging (LSI) to provide real-time, quantitative feedback during laser surgery. Herein, we present in vitro and in vivo data collected with a clinic-based LSI instrument.

Study design/materials and methods

Prior to clinical implementation, we first investigated three aspects of LSI deemed important for clinical imaging: (1) instrument depth of field (DOF); (2) effects of laser irradiance on speckle flow index (SFI) values; and (3) measurement repeatability. Clinical measurements were acquired from the lesions of PWS patients immediately prior to and after laser therapy at the Beckman Laser Institute.

Results

Our preclinical data suggest the following: (1) instrument DOF was approximately 1 cm; (2) quantitative flow characterization with LSI was practically unaffected at normalized irradiance values between 0.06 and 0.5; and (3) our LSI instrument was capable of highly reproducible SFI values. From our clinical measurements, we found that the relative difference between blood perfusion in PWS lesions and adjacent normal skin was highly variable. Based on SFI images, the perfusion of PWS skin is sometimes indistinguishable from that of adjacent normal skin. With laser therapy, we measured a global decrease in blood perfusion, and we frequently observed distinct regions of persistent perfusion.

Conclusions

Our results demonstrate the potential role of image-guided laser therapy of PWS birthmarks. LSI is a promising tool for noninvasive blood flow characterization during laser therapy due to its relative simplicity and low cost.