Background and objective

Objective methods to assess port wine stain (PWS) response to laser treatment have been the subject of various research efforts for several years. Herein, we present a pilot study using a newly developed, light emitting diode (LED) based spatial frequency domain imaging (SFDI) device to record quantitatively biochemical compositional changes in PWS after laser therapy.

Study design/patients and methods

A SFDI system was used to image before, and after, five PWS treatment sessions [n = 4 subjects (one subject was imaged before and after two consecutive laser treatments)]. SFDI derived wide-field optical properties (absorption and scattering) and tissue chromophore concentrations including oxy-hemoglobin (ctO(2) Hb), deoxy-hemoglobin (ctHHb), total hemoglobin (ctTHb), and tissue oxygen saturation (stO(2) ) are presented for skin imaged prior to and immediately after laser treatment. The SFDI derived images were analyzed by comparing the above measurements in PWS to those of normal skin and tracking changes immediately after laser exposure.

Results

Elevated oxy-hemoglobin (>20%) and tissue oxygen saturation (>5%) were measured in all PWS lesions and compared to values for normal skin prior to treatment. Laser treatment resulted in an increase in deoxy-hemoglobin (>100%), decrease in tissue oxygen saturation (>10%), and reduced scattering (>15%) in all PWS lesions. One subject was followed before and after two consecutive laser treatments and the overall improvement in PWS lesion blanching was quantitatively assessed by measuring a 45% decrease in dermal blood volume.

Conclusion

SFDI is a rapid non-contact wide-field optical technique that shows potential as an imaging device that can be used to quantify biochemical compositional changes in PWS after laser therapy. Future work will investigate the potential of SFDI to provide intra-operative guidance for laser therapy of PWS lesions on an individual patient basis.

Significance

Spatial frequency domain imaging (SFDI) is a wide-field diffuse optical imaging technique for separately quantifying tissue reduced scattering (μs  '  ) and absorption (μa) coefficients at multiple wavelengths, providing wide potential utility for clinical applications such as burn wound characterization and cancer detection. However, measured μs  '   and μa can be confounded by absorption from melanin in patients with highly pigmented skin. This issue arises because epidermal melanin is highly absorbing for visible wavelengths and standard homogeneous light-tissue interaction models do not properly account for this complexity. Tristimulus colorimetry (which quantifies pigmentation using the L  *   "lightness" parameter) can provide a point of comparison between μa, μs  '  , and skin pigmentation.

Aim

We systematically compare SFDI and colorimetry parameters to quantify confounding effects of pigmentation on measured skin μs  '   and μa. We assess the correlation between SFDI and colorimetry parameters as a function of wavelength.

Approach

μs  '   and μa from the palm and ventral forearm were measured for 15 healthy subjects with a wide range of skin pigmentation levels (Fitzpatrick types I to VI) using a Reflect RS® (Modulim, Inc., Irvine, California) SFDI instrument (eight wavelengths, 471 to 851 nm). L  *   was measured using a Chroma Meter CR-400 (Konica Minolta Sensing, Inc., Tokyo). Linear correlation coefficients were calculated between L  *   and μs  '   and between L  *   and μa at all wavelengths.

Results

For the ventral forearm, strong linear correlations between measured L  *   and μs  '   values were observed at shorter wavelengths (R  >  0.92 at ≤659  nm), where absorption from melanin confounded the measured μs  '  . These correlations were weaker for the palm (R  <  0.59 at ≤659  nm), which has less melanin than the forearm. Similar relationships were observed between L  *   and μa.

Conclusions

We quantified the effects of epidermal melanin on skin μs  '   and μa measured with SFDI. This information may help characterize and correct pigmentation-related inaccuracies in SFDI skin measurements.

Spatial Frequency Domain Imaging (SFDI) is a non-contact imaging method that uses multiple frequency spatial illumination to generate two dimensional maps of tissue optical properties (absorption and reduced scattering) and chromophore concentrations. We present phantom validation and pilot clinical data of a deployed light-emitting diode (LED) based system. The system employs four LED wavelengths (658 nm, 730 nm, 850 nm, 970 nm) to quantitatively assess tissue health by measurement of common tissue constituents. Phantom validation results and maps of oxyhemoglobin, deoxy-hemoglobin, water content, reduced scattering, and surface topography will be presented for pilot studies assessing burn severity and efficacy of port wine stain treatment. © 2012 SPIE.

Significance

Spatial frequency domain imaging (SFDI), a noncontact wide-field imaging technique using patterned illumination with multiple wavelengths, has been used to quantitatively measure structural and functional parameters of in vivo tissue. Using SFDI in a porcine model, we previously found that scattering changes in skin could potentially be used to noninvasively assess burn severity and monitor wound healing. Translating these findings to human subjects necessitates a better understanding of the variation in "baseline" human skin scattering properties across skin types and anatomical locations.

Aim

Using SFDI, we aim to characterize the variation in the reduced scattering coefficient (μs') for skin across a range of pigmentation and anatomic sites (including common burn locations) for normal human subjects. These measurements are expected to characterize baseline human skin properties to inform our use of SFDI for clinical burn severity and wound healing assessments.

Approach

SFDI was used to measure μs' in the visible- and near-infrared regime (471 to 851 nm) in 15 subjects at 10 anatomical locations. Subjects varied in age, gender, and Fitzpatrick skin type.

Results

For all anatomical locations, the coefficient of variation in measured μs' decreased with increasing wavelength. High intersubject variation in μs' at visible wavelengths coincided with large values of the melanin extinction coefficient at those wavelengths. At 851 nm, where intersubject variation in μs' was smallest for all anatomical locations and absorption from melanin is minimal, significant intrasubject differences in μs' were observed at the different anatomical locations.

Conclusions

Our study is the first report of wide-field mapping of human skin scattering properties across multiple skin types and anatomical locations using SFDI. Measured μs' values varied notably between skin types at wavelengths where absorption from melanin was prominent. Additionally, μs' varied considerably across different anatomical locations at 851 nm, where the confounding effects from melanin absorption are minimized.