Abstract
BackgroundDiabetes mellitus (DM) is one of the most common diseases worldwide. Uncontrolled and prolonged hyperglycemia can cause diabetic complications, which reduce the quality of life of patients. Diabetic complications are common in DM patients. Because it is impossible to completely recover from diabetic complications, it is important for early detection. In this study, we suggest a novel method of determining blood flow characteristics based on fluorescence image analysis with indocyanine green and report that diabetic complications have unique blood flow characteristics.MethodsWe analyzed time-series fluorescence images obtained from controls, DM patients, and DM patients with complications. The images were segmented into the digits and the dorsum of the feet and hands, and each part has been considered as arterial and capillary flow. We compared the blood flow parameters in each region among the three groups.ResultsThe DM patients with complications showed similar blood flow parameters to the controls, except the area under the curve and the maximum intensity, which indicate the blood flow volume. These parameters were significantly decreased in DM patients with complications. Although some blood flow parameters in the feet of DM patients with complications were close to normal blood flow, the vascular response of the macrovessels and microvessels to stimulation of the hands was significantly reduced, which indicates less reactivity in DM patients with complications.ConclusionsOur results suggest that DM patients, and DM patients with complications, have unique peripheral blood flow characteristics.
Highlights
Diabetes mellitus (DM) is one of the most common diseases worldwide
Indocyanine green (ICG) is a fluorescent dye that has been used in clinics for decades and it is activated by near-infrared (NIR) light, which can penetrate to a depth of several centimeters
We considered diabetic retinopathy or neuropathy as a marker that shows severity of diabetes, and due to the increased disease severity, we considered that diabetic patients with these complications could have more severe microvascular dysfunctions than the diabetes only patients
Summary
Diabetes mellitus (DM) is one of the most common diseases worldwide. Uncontrolled and prolonged hyperglycemia can cause diabetic complications, which reduce the quality of life of patients. In diabetes mellitus (DM) patients, limb perfusion monitoring is critical due to its vulnerability to peripheral macro- and micro-vascular complications [1, 2]. Using ICG imaging, blood perfusion in deep tissue can be monitored. ICG fluorescence imaging has been used to detect various diseases, such as synovitis [13, 14], rheumatoid arthritis [15,16,17], peripheral vascular disease (PVD) [18, 19], and diabetes [7, 20, 21]. Compared to other blood flow characterization systems, such as laser Doppler imaging (LDI), ICG fluorescence imaging has several advantages. Blood permeability can be measured by ICG imaging, [24] and ICG imaging has greater sensitivity for monitoring tissue perfusion [23]. Compared to LDI, ICG imaging had already been used for even whole body imaging [27, 28]
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