Optical Coherence Tomography Angiography and Attenuation Imaging for Label-Free Observation of Functional Changes in the Intestine after Sympathectomy: A Pilot Study

Abstract

We present in this study optical coherence tomography angiography (OCTA) and OCT attenuation imaging (OCTAI) for in vivo non-destructive visualization of intramural blood and lymphatic vessels of the intestine wall. Rabbit small intestine in the norm and after thoracolumbar sympathectomy served as the object of the intraoperative study. Compared to OCTA real-time imaging, OCTAI takes several minutes and can be termed as “nearly real time”. OCTAI signal processing was modified to take into account the signal-to-noise ratio and the final thickness of the intestine wall. The results showed that, after sympathectomy, changes in functioning of intramural blood and lymphatic vessels were observed with a high statistical significance. The occurrence of trauma-induced constriction of the blood and lymphatic vessels led to an especially pronounced decrease in the length of small-caliber (<30 µm) blood vessels (p < 10−5), as well as in the volumetric density of lymphatic vessels (on average by ~50%) compared to their initial state. Remarkably, OCTA/OCTAI modalities provide the unique ability for “nearly-instant detection” of changes in functional status of the tissues, long before they become visible on histology. The proposed approach can be used in further experiments to clarify the mechanisms of changes in intestinal blood and lymph flows in response to trauma of the nervous system. Furthermore, potentially it can be used intraoperatively in patients requiring express diagnosis of the state of intramural blood and lymph circulation.

Optical Coherence Tomography Angiography of the Intestine: How to Prevent Motion Artifacts in Open and Laparoscopic Surgery?

“…Prospects for the clinical use of OCTA in bowel surgery are associated with diagnostic and therapeutic tasks. Diagnostic direction is one of the most important: OCTA can become the leading method for diagnosing intramural blood and lymphatic vessels, lymphoid tissue [ 43 ]; in addition, using OCT elastography [ 44 ], it is possible to assess inflammatory changes in the intestine [ 45 ]. Another promising direction for clinical OCTA implementation is the provision of microsurgical interventions under OCTA navigation: the removal of tumors, polyps, a biopsy, and the imposition of micro-surgical anastomoses.…”