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3D Imaging Of Vascular Anomalies Using Raster-Scanning Optoacoustic Mesoscopy
Emily L. Geisler, BS1,2, Mark P. Pressler, BS1,2, Jeyna K. Perez, MS1,2, James R. Seaward, MD1,2, Rami R. Hallac, PhD1,2, Alex A. Kane, MD1,2.
1University of Texas Southwestern Medical Center, Dallas, TX, USA, 2Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA.

PURPOSE: Vascular anomalies such as capillary malformations and hemangiomas are common pediatric disorders. Therapeutic laser treatments depend on subjective evaluation of the skin in order to assign appropriate laser treatment settings, and effects can be unpredictable. To-date, there are no reliable, affordable 3D imaging systems to assess and visualize the microvasculature to assist in treatment planning and outcomes. Raster-Scanning Optoacoustic Mesoscopy (RSOM) is a novel, non-invasive imaging technology based on pulsed-light generation to specifically excite hemoglobin which in turn produces ultrasound waves which are reconstructed to provide high-resolution ultrastructural information regarding affected microvasculature on a mesoscopic scale. In this study we explored the use of RSOM imaging to evaluate vascular malformations before and immediately after laser treatment.
METHODS: RSOM scans were obtained immediately pre- and post-operatively on six patients with either infantile hemangioma (n=3) or capillary malformations (n=3). The field of view (FOV) for the RSOM scans were 5x3x3mm. Laser treatments were performed using 532/1064 nm Nd:YAG. 3D images were reconstructed to evaluate vascular structure and quantify blood vessel volume.
RESULTS: For capillary malformations, average pre- and post-op blood vessel volumes were 2.89x108 Ám3 and 3.60x108 Ám3, respectively. Average relative volume (volume of the vessels relative to the total scanned volume) increased 0.36% from 1.45% pre-op to 1.81% post-op, equating to an approximate 25% increase in vessel volume. For hemangiomas, average pre- and post-op blood vessel volumes were 3.56x108 Ám3 and 3.09x108 Ám3, respectively. Average relative vessel volume decreased 0.18% from 1.97% pre-op to 1.79% post-op, equating to an approximate 9% decrease in vessel volume. The data was found to be normally distributed, and the pre- and post- treatment volumes were not significantly different. 3D reconstructed images of post-op scans showed evidence of less signal (i.e. blood vessels) in the deep vascular plexus, with higher signal intensity in the superficial vascular plexus and skin layers.
CONCLUSION: This is the first use of RSOM to evaluate changes in the skin microvasculature in response to treatment laser for capillary malformations and hemangiomas. The RSOM may have a role in disease monitoring and prediction of pathological behavior or response to laser therapy for difficult-to-treat vascular lesions. In the future, this may contribute to developing a targeted treatment algorithm for individual patients to avoid morbidity associated with treatment lasers such as burns, scars, and ineffective treatment.


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