Detection of Peripheral Arterial Disease Within the Foot Using Vascular Optical Tomographic Imaging: A Clinical Pilot Study.

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.

Modeling of the hemodynamics in the feet of patients with peripheral artery disease.

To simulate the hemodynamic effects in the feet in response to a thigh cuff occlusion, we have developed a multi-compartmental model in which the circulatory system for the leg is represented by its electrical equivalents. Dynamic vascular optical tomographic imaging data previously obtained from 20 patients with peripheral artery disease (PAD) and 20 healthy subjects is used to test the model. Analyzing the clinical data with the support of the model yields diagnostic specificity and sensitivity in the 90-95% range, significantly higher than previously reported.

Non-contact dynamic diffuse optical tomography imaging system for evaluating lower extremity vasculature.

A novel multi-view non-contact dynamic diffuse optical tomographic imaging system for the clinical evaluation of vasculature in the lower extremities is presented. The system design and implementation are described in detail, including methods for simultaneously obtaining and reconstructing diffusely reflected and transmitted light using a system of mirrors and a single CCD camera. The system and its performance using numeric simulations and optical phantoms. Measurements of a healthy foot in vivo demonstrates the potential of the system in assessing perfusion within the foot.