Evaluation of diabetic foot ulcer healing with hyperspectral imaging of oxyhemoglobin and deoxyhemoglobin.
OBJECTIVE
Foot ulceration remains a major health problem for diabetic patients and has a major impact on the cost of diabetes treatment. We tested a hyperspectral imaging technology that quantifies cutaneous tissue hemoglobin oxygenation and generated anatomically relevant tissue oxygenation maps to assess the healing potential of diabetic foot ulcers (DFUs).


METHODS
A prospective single-arm blinded study was completed in which 66 patients with type 1 and type 2 diabetes were enrolled and followed over a 24-week period. Clinical, medical, and diabetes histories were collected. Transcutaneous oxygen tension was measured at the ankles. Superficial tissue oxyhemoglobin (oxy) and deoxyhemoglobin (deoxy) were measured with hyperspectral imaging from intact tissue bordering the ulcer. A healing index derived from oxy and deoxy values was used to assess the potential for healing.


RESULTS
Fifty-four patients with 73 ulcers completed the study; at 24 weeks, 54 ulcers healed while 19 ulcers did not heal. When using the healing index to predict healing, the sensitivity was 80% (43 of 54), the specificity was 74% (14 of 19), and the positive predictive value was 90% (43 of 48). The sensitivity, specificity, and positive predictive values increased to 86, 88, and 96%, respectively, when removing three false-positive osteomyelitis cases and four false-negative cases due to measurements on a callus. The results indicate that cutaneous tissue oxygenation correlates with wound healing in diabetic patients.


CONCLUSIONS
Hyperspectral imaging of tissue oxy and deoxy may predict the healing of DFUs with high sensitivity and specificity based on information obtained from a single visit.
Nouvong
Aksone
A
Olive View-University of California Los Angeles Medical Center, Sylmar, California, USA. anouvong@ucla.edu
Hoogwerf
Byron
B
Mohler
Emile
E
Davis
Brian
B
Tajaddini
Azita
A
Medenilla
Elizabeth
E
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000473:pathology; D017719:Diabetic Foot / Q000097:blood* / Q000473:pathology; D005260:Female; D016523:Foot Ulcer / Q000097:blood* / Q000473:pathology; D006442:Glycated Hemoglobin / Q000032:analysis; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010108:Oxyhemoglobins / Q000032:analysis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016037:Single-Blind Method; D014945:Wound Healing
D015415:Biomarkers; D006442:Glycated Hemoglobin; D006454:Hemoglobins; D010108:Oxyhemoglobins; C100003:deoxyhemoglobin