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Background and Objective: The radial artery has become a routinely used conduit for coronary artery bypass graft surgery (CABG). Prior to surgery the Allen test is performed to test the patency of the ulnar artery. A positive Allen test, reperfusion >5 seconds, suggests an insufficient perfusion of the hand by the ulnar artery. In this study we investigated if laser speckle contrast analysis (LASCA) provides an objective determination of the reperfusion time., Materials and Methods: When the hand is illuminated with coherent laser light, the backscattered light will result in an interference pattern consisting of bright and dark areas called speckles. This speckle pattern will change due to movement of red blood cells. LASCA uses these changes to visualize the perfusion during the Allen test. Reperfusion is measured on the palmar side of the hand. The reperfusion time is defined as the time from onset of reperfusion to maximum perfusion calculated by a polynomial curve fit. The reperfusion time of the hand of patients undergoing CABG (n = 30) is measured using LASCA and is compared to the conventional Allen test performed by the nurse practitioner., Results: LASCA measurements showed a negative Allen test of both hands of 16 patients. Fourteen had a borderline reperfusion time of 5-6 seconds and/or a positive Allen test of one or both hands. No statistical significant difference was observed for the LASCA Allen test compared to the conventional Allen test, P = 0.549 for the left hand and P = 0.223 for the right hand., Conclusion: LASCA is able to visualize perfusion of the hand and measure a quick, moderate, slow reperfusion response or no reperfusion. It is technically feasible to determine the reperfusion time of the hand. LASCA can be a useful and objective tool to assess ulnar collateral blood supply to the hand prior to harvesting of the radial artery as a bypass graft., (© 2013 Wiley Periodicals, Inc.)

Background and Objective: Excision and histological assessment of the first draining node (sentinel lymph node) is a frequently used method to assess metastatic lymph node involvement related to cutaneous melanoma. Due to the time required for accurate histological assessment, nodal status is not immediately available to the surgeon. Hence, in case histological examination shows metastases, the patient has to be recalled to perform additional lymphadenectomy. To overcome these drawbacks we studied the applicability of photoacoustic tomographic imaging as an intra-operative modality for examining the status of resected lymph nodes., Materials and Methods: In melanoma patients undergoing lymphadectomy for metastatic disease, six suspect lymph nodes were photoacoustically (PA) imaged using multiple wavelengths. Histopathologal examination showed three nodes without tumor cells (benign nodes) and three nodes with melanoma cells (malignant nodes). PA images were compared with histology and anatomical features were analyzed. In addition, PA spectral analysis was performed on areas of increased signal intensity., Results: After correlation with histopathology, multiple areas containing melanoma cells could be identified in the PA images due to their increased response. Malignant nodes showed a higher PA response and responded differently to an increase in excitation wavelength than benign nodes. In addition, differences in anatomical features between the two groups were detected., Conclusions: Photoacoustic detection of melanoma metastases based on their melanin content proves to be possible in resected human lymph nodes. The amount of PA signal and several specific anatomical features seem to provide additional characteristics for nodal analysis. However, it is as yet preliminary to designate a highly accurate parameter to distinguish between malignant and benign nodes. We expect to improve the specificity of the technique with a future implementation of an adjusted illumination scheme and depth correction for photon fluence., (Copyright © 2012 Wiley Periodicals, Inc.)

Background and Objectives: In laser Doppler measurements, perfusion values averaged over different and basically unknown path lengths are recorded. To facilitate quantitative path length resolved perfusion measurements, we developed a phase modulated Mach-Zehnder interferometer with spatially separated fibers for illumination and detection. The goal of this study is to measure in vivo optical path lengths and path length resolved Doppler shifts and to compare these with conventional laser Doppler perfusion measurements., Study Design/materials and Methods: With a phase modulated Mach-Zehnder interferometer, we performed path length resolved perfusion measurements on human skin and its variations to external stimuli and compared these with conventional laser Doppler perfusion measurements. The method was evaluated in three human subjects on the dorsal side of the forearm to establish inter-individual within-site variations. Measurements were performed at three different locations of one individual for observing intra-individual inter-site variations resulting from the heterogeneity of the tissue, both in the static matrix and in the microvascular architecture of the skin. In all measurements, perfusion was simultaneously measured with a conventional laser Doppler perfusion monitor., Results: In this study, we show the first results of path length resolved perfusion measurements in skin and its variations to occlusion and Capsicum cream provocation. From our data, we deduced the Doppler shifted fraction of photons, which is related to the blood volume, and the path length dependent average Doppler shift, which is related to the mean velocities of red blood cells. The Doppler shifted fraction of photons is decreased from 28% to 18% during occlusion and increases to 41% when capsicum cream was applied to the skin. Inter- and intra-individual inter-site measurements demonstrated variations in optical path length distributions and path length resolved Doppler shifts. The Doppler shifted fraction of photons measured on the fingertip is about 38% and that measured on the dorsal and palmar sides of the forearm are 32% and 17%, respectively. The path length distributions depend on the skin site that is being probed and the intra-individual inter-site variability is higher than the inter-individual within-site variability measured on comparable sites between different individuals., Conclusions: In this study, we demonstrated, for the first time to our knowledge, that in vivo path length resolved perfusion measurements are feasible. Optical path length distributions of multiply scattered light, spanning a range of 0-6 mm, and their response to external stimuli such as occlusion and capsicum cream provocation have been measured. This method will enable better interpretation of inter- and intra-individual inter-site variations in the LDF readings that are introduced by the variance in tissue optical properties. The inter- and intra-individual inter-site variations measured with our setup results indicate that that these variations should be taken into account while comparing the perfusion readings from comparable sites between individuals and from different sites of the same individual. Furthermore, the observed inter- and intra-individual inter-site variations in path length resolved Doppler measurements indicate the inherent limitation of conventional LDPM that restrict its clinical usefulness, due to its dependence on the unknown photon path length. Consequently, this method will enable to correctly interpret or counter-act the inter- and intra-individual inter-site variations in the LDF readings introduced by the variance in tissue optical properties. This approach also enables to discriminate between the Doppler-shifted photons resulting from interaction with the moving red blood cells and the non-shifted light scattered only by the surrounding static tissue matrices., (© 2010 Wiley-Liss, Inc.)

Background and Objective: To optimize laser therapy of port-wine stains (PWSs), information about the vasculature as well as lesion depth is valuable. In this study we investigated the use of photoacoustic imaging (PAI) to obtain this information., Study Design/materials and Methods: PAI uses pulsed light to generate ultrasound upon absorption of short light pulses by blood. In this study we used PAI to image vasculature in PWSs in three human volunteers. Two-dimensional imaging (scan direction vs. depth) was carried out by scanning a double-ring photoacoustic sensor over the tissue surface., Results: In the photoacoustic images we observed an increased photoacoustic signal intensity at the locations of the PWS that is associated with increased vascularization. From the obtained images we measured the thickness of the vascular layer and estimated lesion depth. In some cases single vessels could be observed at the position of the PWS whereas in other cases the PWS appeared as a region with large photoacoustic signal intensity., Conclusions: PAI has the potential to reveal information about the lesion depth as well as thickness of the vascular layer., ((c) 2008 Wiley-Liss, Inc.)

Background and Objectives: In intravenous access to veins there is a risk of puncturing venous valves or blocking of the catheter by the valves. Therefore, we have investigated whether and how photoacoustic imaging (PAI), which visualizes the lumen of blood vessels, can be used to detect these valves., Study Design/materials and Methods: Venous valves in superficial veins on the dorsal side of the hand of human volunteers were located by palpation and visual inspection. Next, this location was imaged using PAI., Results: In 16 of 21 human volunteers venous valves that were found by palpation could be observed by PAI as local discontinuities in the imaged vessel. From these images, four characteristic features by which venous valves can be recognized in photoacoustic images were identified., Conclusions: PAI has the potential to be applied in the detection of venous valves., ((c) 2006 Wiley-Liss, Inc.)

Background and Objectives: The ability to correctly visualize the architectural arrangement of microvasculature is valuable to many diverse fields in medicine. In this study, we applied photoacoustics (PA) to obtain high-resolution images of submillimeter blood vessels., Study Design/materials and Methods: Short laser pulses are used to generate ultrasound from superficial blood vessels in several animal models. From these ultrasound waves the interior of blood vessels can be reconstructed., Results: We present results from a novel approach based on the PA principle that allows specific in vivo visualization of dermal blood vessels without the use of contrast agents or ionizing radiation., Conclusions: We show PA images of externalized blood vessels and demonstrate in vivo PA imaging of vasculature through layers of skin varying in thickness., ((c) 2004 Wiley-Liss, Inc.)