Analysis of microvascular pattern in diabetes mellitus condition using the nailfold capillaroscopy images

Abstract

Diabetes is often considered a vascular disease due to its impact on blood vessels, it is a complex condition with various metabolic and autoimmune factors involved. One of the long term comorbidities of diabetes includes microvascular complications. The microvascular complications can be analyzed using the Nailfold capillaroscopy, a non-invasive technique that allows for the visualization and analysis of capillaries in the proximal nailfold area. Using advanced video capillaroscopy with high magnification, capillary images can be captured from and processed to analyze their morphology. The capillary images of normal group and diabetic group are acquired from 118 participants using nailfold capillaroscopy and the obtained images are preprocessed using image processing filters. The identification and segmentation of the capillaries are the challenges to be addressed in the processing of the images. Hence segmentation of capillaries is done using morphological operations, thresholding and convolutional neural networks. The performance of the filters and segmentation methods are evaluated using Mean Square Error (MSE), Peak signal to Noise Ratio (PSNR), Structural Similarity Index Measure (SSIM), Jaccard Index and Sorensen coefficient. By analyzing the morphological features namely the capillary diameter, density, distribution, presence of hemorrhage and the shape of the capillaries from both the groups, the capillary changes associated with diabetic condition were studied. It was found that the non diabetic participants considered in this study has capillary diameter in the range of 8–14 µm and the capillary density in the range of 10–30 capillaries per mm2 whereas the diabetic participants has capillary diameter greater than 30 µm and the capillary density is less than 10 capillaries per mm2. In addition to capillary density and diameter, the presence of hemorrhage, the orientation and distribution of the capillaries are also considered to differentiate the diabetic group from the non diabetic group. The classification of the participants are validated with the clinical history of the participants.

The Impact of Disease Duration on Microcirculatory Dysfunction in Young Patients with Uncomplicated Type 1 Diabetes

“…There are a number of non-invasive techniques available to assess the microcirculation [1]. Capillaroscopy [2][3][4][5][6][7][8] and videocapillaroscopy [9][10][11], laser Doppler flowmetry [12][13][14], thermography [15,16], and transcutaneous oxygen measurements [17][18][19][20][21][22][23] are of recognized clinical value. Therefore, any emerging methods for detecting early signs of microcirculatory changes should be evaluated, and if plausible, the standard for use should be established.…”

“…In fact, the earliest symptoms of cardiovascular diseases appear in microcirculation, especially those related to inflammation [9,28]. Microvascular abnormalities are found in conditions like diabetes [3,29], renal disorders [30], cardiovascular disorders [31][32][33] like hypertension [34][35][36] or systemic connective tissue disorders [2], septic shock [37], and hypoxia [38]. They primarily lead to flow abnormalities, which are associated with impaired tissue oxygenation and organ damage and hurt prognosis [33,36].…”