Hyperspectral Imaging In Burn Evaluation From Bench To Bedside: A Case Report
Melissa J. McCarthy, MPH, Garrick Gu, BA, Jorge Lujan-Hernandez, MD, Danielle Stamer, BS, Janice Lalikos, MD.
University of Massachusetts Medical School, Worcester, MA, USA.
Background:Predicting burn depth is a major goal of imaging technology over the last 30 years.1 Hyperspectral imaging (HSI) is a FDA-approved non-invasive method of evaluating soft tissue oxygenation and perfusion using visible light3 previously, it demonstrated in mice to predict burn depth earlier than clinical assessment.2 We now describe the potential utility of HSI in evaluating burns in a patient.
Methods: A patient sustained thermal burns at various depths. He was evaluated in the ED 6hr post-burn. Based on initial clinical exam, burns were termed second (2Deg) or third degree (3Deg). 2Deg was subdivided into superficial (2DegS) and deep (2DegD). HSI images were taken on arrival and on post-burn days (PBD) 3, 4, and 5 with clinical evaluation, using unburned skin HSI results from PBD1 as control. HSI provided arbitrary units for oxygenated (OxyHb), deoxygenated (DeoxyHb), and total hemoglobin (THb), reflecting tissue perfusion. Burn areas that deepened between PBD1 to PBD5 were surgically excised. Clinical impressions from PBD1 to PBD5 (intra-operative) correlated with HSI findings.
Results: Findings at 6hr post-burn versus control: OxyHb: +124% (2DegS), +28% (2DegD) and -42% (3Deg). DeoxyHb: +8% (2DegS), -38% (2DegD), -64% (3Deg). THb: +60% (2DegS), -8% (2DegD) and -56% (3Deg). Findings at 40hr post-burn 2DegS versus 2DegD: +134% OxyHb, +97% DeoxyHb and +120% THb. These findings mirrored our animal model.2
Discussion: Our data suggests HSI readings correlate with burn depth, reflecting our animal model. Increased Thb and OxyHb in 2DegS, denoting hyperperfusion, could be from reactive erythema, which is blunted in 2DegD from deeper dermal plexus damage and destroyed in 3Deg, yielding negative values.2,5 HSI can detect trends in OxyHb and DeoxyHb, denoting tissue perfusion, that are consistent with deepening burns.4,5 This data can help determine 2nd degree burn depth; a vital surgical delineation . If further validated, this could represent an application of HSI for predicting burn depth earlier, potentially improving patient outcomes
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