Assessment of microcirculation in the diabetic foot with laser speckle contrast imaging

O. A. Mennes, J. J. Van Netten, J. G. Van Baal, W. Steenbergen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: A major challenge for treating diabetic foot ulcers is estimating the severity of ischemia, as the currently used non-invasive diagnostic techniques provide relatively poor prognostic values. Laser speckle contrast imaging (LSCI) is a promising non-invasive technique to assess microcirculation. Our aim was to investigate the stability and reproducibility of LSCI for the assessment of microcirculation in the diabetic foot, the relation of LSCI results to currently used non-invasive blood pressure measurements, and the ability of LSCI to discriminate between the degrees of ischemia. Approach: Thirty-three participants with diabetic foot ulcers were included in this prospective, single centre, observational cohort study that was conducted in the Netherlands. They were classified as non-ischemic, ischemic or critical-ischemic based on criteria formulated in the international guidelines. Two clinicians performed LSCI scans of the foot, consisting of baseline measurements, followed by two stress tests (post-occlusion peak and elevation test). With three measurement conditions and five regions of interest of the foot per patient, a total of 15 measurements were available for analyses. Main results: The intra-observer agreement of LSCI was high (interclass correlation coefficient (ICC) = 0.711-0.950; p  < 0.001) for all 15 measurements. The inter-observer agreement was high (ICC = 0.728-0.861; p  0.001) for 10 measurements and moderate (ICC = 0.476-0.570; p  0.005) for the remaining five measurements. The inter-assessor agreement was high and significant (ICC = 0.857-0.996; p  0.001) for all measurements. Correlation between LSCI and non-invasive blood pressure measurements was low (ICC = -0.272-0.582). During both stress tests, microcirculation was significantly lower in critical-ischemic feet compared to non-ischemic feet (67.5 perfusion units (PU) versus 96.3 PU and 41.0 PU versus 63.9 PU; p  < 0.05). Significance: LSCI is a stable and reproducible technique for assessment of microcirculation in people with diabetic foot ulcers and shows significant differences between non-ischemic, ischemic and critical-ischemic patient populations.

Original languageEnglish
Article number065002
JournalPhysiological measurement
Volume40
Issue number6
DOIs
Publication statusPublished - 28 Jun 2019

Fingerprint

Microcirculation
Diabetic Foot
Speckle
Lasers
Imaging techniques
Foot
Perfusion
Blood pressure
Pressure measurement
Exercise Test
Ischemia
Blood Pressure
Netherlands
Observational Studies
Cohort Studies
Guidelines

Keywords

  • diabetes complications
  • diabetes mellitus
  • foot ulcer
  • laser speckle contrast imaging
  • microcirculation
  • peripheral artery disease

Cite this

@article{2be4f5a63e834171a1728fdf294e487b,
title = "Assessment of microcirculation in the diabetic foot with laser speckle contrast imaging",
abstract = "Objective: A major challenge for treating diabetic foot ulcers is estimating the severity of ischemia, as the currently used non-invasive diagnostic techniques provide relatively poor prognostic values. Laser speckle contrast imaging (LSCI) is a promising non-invasive technique to assess microcirculation. Our aim was to investigate the stability and reproducibility of LSCI for the assessment of microcirculation in the diabetic foot, the relation of LSCI results to currently used non-invasive blood pressure measurements, and the ability of LSCI to discriminate between the degrees of ischemia. Approach: Thirty-three participants with diabetic foot ulcers were included in this prospective, single centre, observational cohort study that was conducted in the Netherlands. They were classified as non-ischemic, ischemic or critical-ischemic based on criteria formulated in the international guidelines. Two clinicians performed LSCI scans of the foot, consisting of baseline measurements, followed by two stress tests (post-occlusion peak and elevation test). With three measurement conditions and five regions of interest of the foot per patient, a total of 15 measurements were available for analyses. Main results: The intra-observer agreement of LSCI was high (interclass correlation coefficient (ICC) = 0.711-0.950; p  < 0.001) for all 15 measurements. The inter-observer agreement was high (ICC = 0.728-0.861; p  0.001) for 10 measurements and moderate (ICC = 0.476-0.570; p  0.005) for the remaining five measurements. The inter-assessor agreement was high and significant (ICC = 0.857-0.996; p  0.001) for all measurements. Correlation between LSCI and non-invasive blood pressure measurements was low (ICC = -0.272-0.582). During both stress tests, microcirculation was significantly lower in critical-ischemic feet compared to non-ischemic feet (67.5 perfusion units (PU) versus 96.3 PU and 41.0 PU versus 63.9 PU; p  < 0.05). Significance: LSCI is a stable and reproducible technique for assessment of microcirculation in people with diabetic foot ulcers and shows significant differences between non-ischemic, ischemic and critical-ischemic patient populations.",
keywords = "diabetes complications, diabetes mellitus, foot ulcer, laser speckle contrast imaging, microcirculation, peripheral artery disease",
author = "Mennes, {O. A.} and {Van Netten}, {J. J.} and {Van Baal}, {J. G.} and W. Steenbergen",
year = "2019",
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Assessment of microcirculation in the diabetic foot with laser speckle contrast imaging. / Mennes, O. A.; Van Netten, J. J.; Van Baal, J. G.; Steenbergen, W.

In: Physiological measurement, Vol. 40, No. 6, 065002, 28.06.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Assessment of microcirculation in the diabetic foot with laser speckle contrast imaging

AU - Mennes, O. A.

AU - Van Netten, J. J.

AU - Van Baal, J. G.

AU - Steenbergen, W.

PY - 2019/6/28

Y1 - 2019/6/28

N2 - Objective: A major challenge for treating diabetic foot ulcers is estimating the severity of ischemia, as the currently used non-invasive diagnostic techniques provide relatively poor prognostic values. Laser speckle contrast imaging (LSCI) is a promising non-invasive technique to assess microcirculation. Our aim was to investigate the stability and reproducibility of LSCI for the assessment of microcirculation in the diabetic foot, the relation of LSCI results to currently used non-invasive blood pressure measurements, and the ability of LSCI to discriminate between the degrees of ischemia. Approach: Thirty-three participants with diabetic foot ulcers were included in this prospective, single centre, observational cohort study that was conducted in the Netherlands. They were classified as non-ischemic, ischemic or critical-ischemic based on criteria formulated in the international guidelines. Two clinicians performed LSCI scans of the foot, consisting of baseline measurements, followed by two stress tests (post-occlusion peak and elevation test). With three measurement conditions and five regions of interest of the foot per patient, a total of 15 measurements were available for analyses. Main results: The intra-observer agreement of LSCI was high (interclass correlation coefficient (ICC) = 0.711-0.950; p  < 0.001) for all 15 measurements. The inter-observer agreement was high (ICC = 0.728-0.861; p  0.001) for 10 measurements and moderate (ICC = 0.476-0.570; p  0.005) for the remaining five measurements. The inter-assessor agreement was high and significant (ICC = 0.857-0.996; p  0.001) for all measurements. Correlation between LSCI and non-invasive blood pressure measurements was low (ICC = -0.272-0.582). During both stress tests, microcirculation was significantly lower in critical-ischemic feet compared to non-ischemic feet (67.5 perfusion units (PU) versus 96.3 PU and 41.0 PU versus 63.9 PU; p  < 0.05). Significance: LSCI is a stable and reproducible technique for assessment of microcirculation in people with diabetic foot ulcers and shows significant differences between non-ischemic, ischemic and critical-ischemic patient populations.

AB - Objective: A major challenge for treating diabetic foot ulcers is estimating the severity of ischemia, as the currently used non-invasive diagnostic techniques provide relatively poor prognostic values. Laser speckle contrast imaging (LSCI) is a promising non-invasive technique to assess microcirculation. Our aim was to investigate the stability and reproducibility of LSCI for the assessment of microcirculation in the diabetic foot, the relation of LSCI results to currently used non-invasive blood pressure measurements, and the ability of LSCI to discriminate between the degrees of ischemia. Approach: Thirty-three participants with diabetic foot ulcers were included in this prospective, single centre, observational cohort study that was conducted in the Netherlands. They were classified as non-ischemic, ischemic or critical-ischemic based on criteria formulated in the international guidelines. Two clinicians performed LSCI scans of the foot, consisting of baseline measurements, followed by two stress tests (post-occlusion peak and elevation test). With three measurement conditions and five regions of interest of the foot per patient, a total of 15 measurements were available for analyses. Main results: The intra-observer agreement of LSCI was high (interclass correlation coefficient (ICC) = 0.711-0.950; p  < 0.001) for all 15 measurements. The inter-observer agreement was high (ICC = 0.728-0.861; p  0.001) for 10 measurements and moderate (ICC = 0.476-0.570; p  0.005) for the remaining five measurements. The inter-assessor agreement was high and significant (ICC = 0.857-0.996; p  0.001) for all measurements. Correlation between LSCI and non-invasive blood pressure measurements was low (ICC = -0.272-0.582). During both stress tests, microcirculation was significantly lower in critical-ischemic feet compared to non-ischemic feet (67.5 perfusion units (PU) versus 96.3 PU and 41.0 PU versus 63.9 PU; p  < 0.05). Significance: LSCI is a stable and reproducible technique for assessment of microcirculation in people with diabetic foot ulcers and shows significant differences between non-ischemic, ischemic and critical-ischemic patient populations.

KW - diabetes complications

KW - diabetes mellitus

KW - foot ulcer

KW - laser speckle contrast imaging

KW - microcirculation

KW - peripheral artery disease

U2 - 10.1088/1361-6579/ab2058

DO - 10.1088/1361-6579/ab2058

M3 - Article

VL - 40

JO - Physiological measurement

JF - Physiological measurement

SN - 0967-3334

IS - 6

M1 - 065002

ER -