Real-time visualization of renal microperfusion using laser speckle contrast imaging

Heeman, Wido; Maassen, Hanno; Calon, Joost; Goor, Harry van; Leuvenink, Henri G. D.; Dam, Gooitzen M. van; Boerma, E. Christiaan

doi:10.1117/1.jbo.26.5.056004

Cited by 11 publications

(17 citation statements)

References 32 publications

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“… 23 It has also been reported to be capable of imaging renal cortical microperfusion in porcine kidney transplantation. 24 Despite the accumulated research and clinical evidence, it has not translated to clinical use in kidney or kidney-pancreas transplantation so far.…”

Section: Discussionmentioning

confidence: 99%

Using Laser Speckle Contrast Imaging to Quantify Perfusion Quality in Kidney and Pancreas Grafts on Vascular Reperfusion: A Proof-of-Principle Study

Gopal

Vaz

Varley

et al. 2023

Transplantation Direct

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Introduction. The accuracy of intraoperative graft perfusion assessment still remains subjective, with doppler examination being the only objective adjunct. Laser speckle contrast imaging (LSCI) has been used to assess intraoperative blood flow in neurosurgery and in various surgical specialties. Despite its ability to accurately quantify perfusion at the microvascular level, it has not been clinically evaluated in kidney/kidney-pancreas transplantation for perfusion characterization. We aimed to evaluate the utility of LSCI and identify objective parameters that can be quantified at reperfusion. Methods. This study was registered in ClinicalTrials.gov (NCT04202237). The Moor FLPI-2 blood flow imager was used in 4 patients (1 Simultaneous Pancreas and Kidney, 2 deceased, and 1 living donor kidney transplants) during reperfusion to capture reperfusion data. The following parameters were measured: flux (average speed × concentration of moving red blood cells in the sample volume), doppler centroid, total and valid pixels, valid rate, and total and valid area. Flux data were analyzed with Moor FLPI analysis software. Results. The perfusion characteristics and flux images correlated with initial graft function. Conclusions. LSCI is a safe, noncontact imaging modality that provides real-time, accurate, high-resolution, full field blood flow images and a wide range of flux data to objectively quantify organ reperfusion intraoperatively in kidney/kidney-pancreas transplantation. This modality could be used to develop a robust numerical quantification system for the evaluation and reporting of intraoperative organ perfusion, and aid intraoperative decision-making. Perfusion data could be combined with biomarkers and immunological parameters to more accurately predict graft outcomes.

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Section: Discussionmentioning

confidence: 99%

Using Laser Speckle Contrast Imaging to Quantify Perfusion Quality in Kidney and Pancreas Grafts on Vascular Reperfusion: A Proof-of-Principle Study

Gopal

Vaz

Varley

et al. 2023

Transplantation Direct

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“…However, the correlation of renal blood flow with stream dark-field imaging was superior to that with LSCI in 1 study. [24]…”

Section: Discussionmentioning

confidence: 99%

“…However, the correlation of renal blood flow with stream dark-field imaging was superior to that with LSCI in 1 study. [24] Because LSCI is a dyeless visualization technology, it can be used in its different modes multiple times during the same procedure without any interference to its field of view. It also provides an objective relative quantification of flow and perfusion.…”

Section: Discussionmentioning

confidence: 99%

Laser speckle contrast imaging compared with indocyanine green in renal perfusion of a porcine model

Noël¹,

Mascarenhas²,

Nwaiwu³

et al. 2022

Curr Urol

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BackgroundWhen viewed under near-infrared light, indocyanine green (ICG) signal for kidney perfusion can be utilized in partial nephrectomy. Laser speckle contrast imaging (LSCI) uses coherent light to detect perfusion during real-time laparoscopic surgery.Materials and methodsLaser speckle contrast imaging or ActivSight, an imaging sensor adapter, was used during laparoscopy of an anesthetized porcine kidney model. ActivSight's “perfusion mode” and “quantification mode” displayed the blood flow as a heatmap and numerical signal intensity, respectively.ResultsAfter the upper segmental renal artery was clamped, ICG was seen in the lower pole, and LSCI showed low unit (dark color) quantification and perfusion in the upper pole. Indocyanine green was retained in the lower pole after the upper segmental artery was unclamped, and LSCI perfusion was demonstrated in the entire kidney.ConclusionsLaser speckle contrast imaging is a dye-free, repeatable, real-time adjunct for renal parenchymal perfusion assessment applicable to minimally invasive renal surgery to complement the technology of ICG near-infrared fluorescence and advance digital surgery.

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“…[7][8][9][10][11] Despite extensive research on LSCI, few studies have explored its potential as kidney quality assessment tool. The only study that has used LSCI to measure the kidney during NMP, conducted by Heeman et al 12 showed that onesided measurement can assess cortical microcirculation and detect perfusion deficits. However, it is unknown whether there is heterogeneity of microcirculation between the ventral and dorsal aspects.…”

Section: Introductionmentioning

confidence: 99%

Real‐time laser speckle contrast imaging measurement during normothermic machine perfusion in pretransplant kidney assessment

Fang,

van Ooijen,

Ambagtsheer

et al. 2023

Lasers Surg Med

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ObjectivesNormothermic machine perfusion (NMP) provides a platform for pre‐transplant kidney quality assessment that is essential for the use of marginal donor kidneys. Laser speckle contrast imaging (LSCI) presents distinct advantages as a real‐time and noncontact imaging technique for measuring microcirculation. In this study, we aimed to assess the value of LSCI in visualizing renal cortical perfusion and investigate the additional value of dual‐side LSCI measurements compared to single aspect measurement during NMP.MethodsPorcine kidneys were obtained from a slaughterhouse and then underwent NMP. LSCI was used to measure one‐sided cortical perfusion in the first 100 min of NMP. Thereafter, the inferior renal artery branch was occluded to induce partial ischemia and LSCI measurements on both ventral and dorsal sides were performed.ResultsLSCI fluxes correlated linearly with the renal blood flow (R2 = 0.90, p < 0.001). After renal artery branch occlusion, absence of renal cortical perfusion could be visualized and semiquantified by LSCI. The overall ischemic area percentage of the ventral and dorsal sides was comparable (median interquartile range [IQR], 38 [24−43]% vs. 29 [17−46]%, p = 0.43), but heterogenous patterns between the two aspects were observed. There was a significant difference in oxygen consumption (mean ± standard deviation [SD], 2.57 ± 0.63 vs. 1.83 ± 0.49 mLO2/min/100 g, p < 0.001), urine output (median [IQR], 1.3 [1.1−1.7] vs. 0.8 [0.6−1.3] mL/min, p < 0.05), lactate dehydrogenase (mean ± SD, 768 ± 370 vs. 905 ± 401 U/L, p < 0.05) and AST (mean ± SD, 352 ± 285 vs. 462 ± 383 U/L, p < 0.01) before and after renal artery occlusion, while no significant difference was found in creatinine clearance, fractional excretion of sodium, total sodium reabsorption and histological damage.ConclusionsLSCI fluxes correlated linearly with renal blood flow during NMP. Renal cortical microcirculation and absent perfusion can be visualized and semiquantified by LSCI. It provides a relative understanding of perfusion levels, allowing for a qualitative comparison between regions in the kidney. Dual‐side LSCI measurements are of added value compared to single aspect measurement and renal function markers.

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Real-time visualization of renal microperfusion using laser speckle contrast imaging

Cited by 11 publications

References 32 publications

Using Laser Speckle Contrast Imaging to Quantify Perfusion Quality in Kidney and Pancreas Grafts on Vascular Reperfusion: A Proof-of-Principle Study

Using Laser Speckle Contrast Imaging to Quantify Perfusion Quality in Kidney and Pancreas Grafts on Vascular Reperfusion: A Proof-of-Principle Study

Laser speckle contrast imaging compared with indocyanine green in renal perfusion of a porcine model

Real‐time laser speckle contrast imaging measurement during normothermic machine perfusion in pretransplant kidney assessment

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