The Application of Fluorescence Optical Imaging in Systemic Sclerosis.

Alexander Pfeil,Marcus Franz,Christian Jung,Diane M Renz,Peter Oelzner,Joachim Böttcher,Karl F Drummer,Gunter Wolf,Andreas Hansch

doi:10.1155/2015/658710

Abstract

Objective. The aim of this study was to visualize soft tissue inflammation using FOI on patients with Systemic Sclerosis (SSc) characterized by SSc-related Raynaud's phenomenon and to detect the therapeutic response to treatment with iloprost or alprostadil. Methods. Twenty-one patients with SSc and Raynaud's phenomenon and twenty-six healthy controls were prospectively included. The SSc patients were intravenously treated with iloprost or alprostadil over seven days. FOI was performed at baseline and after seven days using an intravenous application of indocyanine green (ICG). The hands were divided into nineteen segments per hand. All segments were quantitatively evaluated to determine changes in ICG. Results. The sensitivity and specificity of FOI in the detection of ICG enhancement in patients with SSc were 95% versus 96%. At baseline, 31.5% hand segments showed ICG enhancement. After seven days of either iloprost or alprostadil therapy a significant reduction in the ICG was observed which ranged from 40.9% to 24.7%. Conclusion. The study demonstrates that the FOI technique is able to visualize soft-tissue inflammation with both high sensitivity and specificity. The anti-inflammatory therapeutic effects of iloprost were slightly stronger than alprostadil. FOI offers promising benefits in the diagnosis and therapy of patients with SSc-associated Raynaud's phenomenon.

Highlights

Systemic Sclerosis (SSc) is a connective tissue disease affecting various organs including the peripheral vessels [1, 2]
The sensitivity and specificity of Fluorescence optical imaging (FOI) in the detection of SSc-associated indocyanine green (ICG) enhancement were 95% versus 96% with an accuracy of 97%
In vivo fluorescence optical imaging is a technique for the imaging of inflammation in patients suffering from SSc and related Raynaud’s phenomenon

Summary

Introduction

Systemic Sclerosis (SSc) is a connective tissue disease affecting various organs including the peripheral vessels [1, 2]. A characteristic clinical feature of the disease is peripheral vessel involvement associated with Raynaud’s phenomenon and digital ulceration [2]. Mononuclear cells and T-cells produce inflammatory cytokines and growth factors which are associated with the onset and progression of fibrosis and induce autoinflammatory microvascular damage [4]. Such microvascular damage is characteristically predominant in SSc [1] leading to Raynaud’s phenomenon, a vasospastic disorder of the fingers [5]. For treatment of Raynaud’s phenomenon the vasodilator prostaglandin I2 analogue iloprost [6] and the prostaglandin E1 analogue alprostadil are widely used [7]

Methods

Discussion

Conclusion