Abstract
A current therapeutic challenge of vascular lesions is that they do not always respond effectively to laser treatment. Information on targeted vessels could potentially be used to guide laser treatments. Optical coherence tomography (OCT) is a useful tool for the non-invasive imaging of tissues, including skin hemangiomas and port wine birthmarks. Dynamic OCT is able to rapidly characterize cutaneous blood vessels. The primary goal of this study was to demonstrate the ability of bedside OCT to image (i) overall vessel pattern; (ii) individual vessel morphology, diameter and depth; and (iii) total vessel density as a function of depth in infantile hemangiomas and port wine birthmarks (PWB). This IRB approved, observational clinical trial was performed among healthy volunteers ages 3 months-73 years old. All patients presented for laser treatment of either infantile hemangiomas or PWB with skin types ranging from Fitzpatrick I-V. OCT imaging of 49 hemangioma and PWB scans were performed pre- and post-treatment. The diameter and depth of the blood vessels making up the vascular lesions were measured. In addition, normal skin was scanned for comparison. Five datasets for infantile hemangiomas and five for PWB that were without motion artifacts were analyzed. Scanned lesions exhibited variable and highly heterogeneous blood vessel patterns with vessel diameters ranging from 20 to 160 μm, suggesting that the laser treatment with single pulse durations may not be optimal. The largest blood vessel diameter observed (160 μm) may not be adequately treated by commonly used pulsed dye laser pulse durations. OCT allowed rapid, non-invasive characterization of the diameter and depth of blood vessels in individual vascular lesions. Imaged lesions consisted of a heterogeneous population of vessel sizes, morphologies, and depth. Future studies could utilize this information to assist development of individualized treatment protocols in an effort to improve vascular birthmark removal. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
Highlights
Treating cutaneous vascular lesions was the first indication for the medical use of lasers
The research coordinator reviewed laser schedules and indiscriminately assigned the physician to scan a portion of our new infantile hemangioma and port wine birthmarks (PWB) patients to receive Optical coherence tomography (OCT) and subsequent laser treatment over a six-month period
The OCT images revealed that the blood vessel patterns in vascular lesions appeared dramatically different from that seen in normal skin (Fig. 1A)
Summary
Treating cutaneous vascular lesions was the first indication for the medical use of lasers. Therapeutic use sought to remove vascular birthmarks, especially port wine birthmarks (PWB), on the skin of children [1]. PWB are congenital cutaneous capillary malformations composed of ecstatic vessels. PWB’s have often previously been called Port Wine Stains. A relatively recent survey of patients [2] indicated that they preferred the terminology PWB, so this term will be used in this manuscript. PWBs may be resistant to laser therapy. Despite many studies showing efficacy of lasers for the treatment of PWB, less than 25% of lesions have complete clearing after multiple laser sessions [3]. Methods to improve the treatment effect need to be sought
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