Infrared thermography: Experience from a decade of pediatric imaging.
Saxena AK, Willital GH. Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, Graz, A-8036, Austria
The aim of this study was to evaluate the feasibility of clinical application of infrared thermography (IRT) in the pediatric population and to identify pathological states that can be diagnosed as well as followed up using this non-invasive technique. In real time computer-assisted IRT, 483 examinations were performed over a period of 10 years from 1990-2000 on 285 patients in the pediatric age group (range 1 week-16 years) presenting with a wide range of pathologies. The temperature was measured in centigrade (degrees C), and color images obtained were computer analyzed and stored on floppy discs. IRT was found to be an excellent noninvasive tool in the follow-up of hemangiomas, vascular
malformations and digit amputations related to re implantation, burns as well as skin and vascular
growth after bio-material implants in newborns with gastroschisis and giant omphaloceles. In the
emergency room, it was a valuable tool for rapid diagnosis of extremity thrombosis, varicoceles,
inflammation, abscesses, gangrene and wound infections. In conclusion, IRT can be performed in
the pediatric age group, is non-invasive, without any biological side effects, requires no sedation or
anesthesia and can be repeated as desired for follow-ups, with objective results that can demonstrated as colored images. Periodic thermographic studies to follow progression of lesions seem to be a
useful and reproducible method.
Showing posts with label INFLAMMATION. Show all posts
Showing posts with label INFLAMMATION. Show all posts
Wednesday, June 8, 2016
Tuesday, June 7, 2016
Thermal signature analysis as a novel method for evaluating inflammatory arthritis activity.
Thermal signature analysis as a novel method for evaluating inflammatory arthritis activity.
Brenner M, Braun C, Oster M, Gulko PS. North Shore-LIJ Research Institute, United States.
OBJECTIVES: To determine the potential usefulness of a novel thermal imaging technology to evaluate and monitor inflammatory arthritis activity in small joints using rat models, and to determine whether thermal changes can be used to detect pre-clinical stages of synovitis.
METHODS: Three different rat strains were studied in a mono-articular model of inflammatory arthritis of the ankle induced with an intraarticular (IA) injection of complete Freund's adjuvant (CFA), and compared with the contra-lateral ankle injected with normal saline. Arthritis activity and severity scores, ankle diameters, pain related posture scores, and thermal images were obtained at ten different time-points between 0h (before induction) and day 7. The pristane-induced arthritis (PIA) model was used to study pre-clinical synovitis.
RESULTS: Rats developed similar ankle arthritis detected 6h after the IA injection of CFA, which persisted for seven days. All ankle clinical parameters, including arthritis activity and severity scores, significantly correlated with ankle thermal imaging changes in the mono-arthritis model (P<0.003). No thermal imaging changes were detected in pre-clinical stages of PIA. However, PIA onset coincided with increased ankle thermal signature.
CONCLUSION:Thermal measurements significantly correlated with arthritis activity and severity parameters. This technology was highly sensitive and could directly measure two cardinal signs of inflammation (warmth and edema - based on ankle diameter) in an area (ankle) that is less than half the size of a human interphalangeal joint, suggesting a potential use to monitor drug responses of rheumatoid arthritis in drug trials or clinical practice.
Brenner M, Braun C, Oster M, Gulko PS. North Shore-LIJ Research Institute, United States.
OBJECTIVES: To determine the potential usefulness of a novel thermal imaging technology to evaluate and monitor inflammatory arthritis activity in small joints using rat models, and to determine whether thermal changes can be used to detect pre-clinical stages of synovitis.
METHODS: Three different rat strains were studied in a mono-articular model of inflammatory arthritis of the ankle induced with an intraarticular (IA) injection of complete Freund's adjuvant (CFA), and compared with the contra-lateral ankle injected with normal saline. Arthritis activity and severity scores, ankle diameters, pain related posture scores, and thermal images were obtained at ten different time-points between 0h (before induction) and day 7. The pristane-induced arthritis (PIA) model was used to study pre-clinical synovitis.
RESULTS: Rats developed similar ankle arthritis detected 6h after the IA injection of CFA, which persisted for seven days. All ankle clinical parameters, including arthritis activity and severity scores, significantly correlated with ankle thermal imaging changes in the mono-arthritis model (P<0.003). No thermal imaging changes were detected in pre-clinical stages of PIA. However, PIA onset coincided with increased ankle thermal signature.
CONCLUSION:Thermal measurements significantly correlated with arthritis activity and severity parameters. This technology was highly sensitive and could directly measure two cardinal signs of inflammation (warmth and edema - based on ankle diameter) in an area (ankle) that is less than half the size of a human interphalangeal joint, suggesting a potential use to monitor drug responses of rheumatoid arthritis in drug trials or clinical practice.
Wednesday, June 1, 2016
Dynamic infrared imaging of cutaneous melanoma and normal skin in patients treated with BNCT.
Dynamic infrared imaging of cutaneous melanoma and normal skin in patients treated with BNCT.
Santa Cruz GA, Bertotti J, Marín J, González SJ, Gossio S, Alvarez D, Roth BM, Menéndez P, Pereira MD, Albero M, Cubau L, Orellano P, Liberman SJ.
Source
Dpto. de Instrumentación y Control, Comisión Nacional de Energía Atómica, Av. del Libertador 8250 (1429), Buenos Aires, Argentina. santacr@cnea.gov.ar
Abstract
We recently initiated a program aimed to investigate the suitability of dynamic infrared imaging for following-up nodular melanoma patients treated with BNCT. The reason that makes infrared imaging attractive is the fact that it constitutes a functional and non-invasive imaging method, providing information on the normal and abnormal physiologic response of the nervous and vascular systems, as well as the local metabolic rate and inflammatory processes that ultimately appear as differences in the skin temperature. An infrared camera, with a focal plane array of 320 x 240 uncooled ferroelectric detectors is employed, which provides a video stream of the infrared emission in the 7-14 micron wavelength band. A double black-body is used as reference for absolute temperature calibration. After following a protocol for patient preparation and acclimatization, a basal study is performed. Subsequently, the anatomic region of interest is subjected to a provocation test (a cold stimulus), which induces an autonomic vasoconstriction reflex in normal structures, thus enhancing the thermal contrast due to the differences in the vasculature of the different skin regions. Radiation erythema reactions and melanoma nodules possess typically a faster temperature recovery than healthy, non-irradiated skin. However, some other non-pathological structures are also detectable by infrared imaging, (e.g. scars, vessels, arteriovenous anastomoses and injuries), thus requiring a multi-study comparison in order to discriminate the tumor signal. Besides the superficial nodules, which are readily noticeable by infrared imaging, we have detected thermal signals that are coincident with the location of non-palpable nodules, which are observable by CT and ultrasound. Diffuse regions of fast temperature recovery after a cold stimulus were observed between the third and sixth weeks post-BNCT, concurrent with the clinical manifestation of radiation erythema. The location of the erythematous visible and infrared regions is consistent with the 3D dosimetry calculations.
Santa Cruz GA, Bertotti J, Marín J, González SJ, Gossio S, Alvarez D, Roth BM, Menéndez P, Pereira MD, Albero M, Cubau L, Orellano P, Liberman SJ.
Source
Dpto. de Instrumentación y Control, Comisión Nacional de Energía Atómica, Av. del Libertador 8250 (1429), Buenos Aires, Argentina. santacr@cnea.gov.ar
Abstract
We recently initiated a program aimed to investigate the suitability of dynamic infrared imaging for following-up nodular melanoma patients treated with BNCT. The reason that makes infrared imaging attractive is the fact that it constitutes a functional and non-invasive imaging method, providing information on the normal and abnormal physiologic response of the nervous and vascular systems, as well as the local metabolic rate and inflammatory processes that ultimately appear as differences in the skin temperature. An infrared camera, with a focal plane array of 320 x 240 uncooled ferroelectric detectors is employed, which provides a video stream of the infrared emission in the 7-14 micron wavelength band. A double black-body is used as reference for absolute temperature calibration. After following a protocol for patient preparation and acclimatization, a basal study is performed. Subsequently, the anatomic region of interest is subjected to a provocation test (a cold stimulus), which induces an autonomic vasoconstriction reflex in normal structures, thus enhancing the thermal contrast due to the differences in the vasculature of the different skin regions. Radiation erythema reactions and melanoma nodules possess typically a faster temperature recovery than healthy, non-irradiated skin. However, some other non-pathological structures are also detectable by infrared imaging, (e.g. scars, vessels, arteriovenous anastomoses and injuries), thus requiring a multi-study comparison in order to discriminate the tumor signal. Besides the superficial nodules, which are readily noticeable by infrared imaging, we have detected thermal signals that are coincident with the location of non-palpable nodules, which are observable by CT and ultrasound. Diffuse regions of fast temperature recovery after a cold stimulus were observed between the third and sixth weeks post-BNCT, concurrent with the clinical manifestation of radiation erythema. The location of the erythematous visible and infrared regions is consistent with the 3D dosimetry calculations.
Wednesday, April 20, 2016
About Complex Region Pain Syndrome
About Complex Region Pain Syndrome
“The more names the medical profession has for a condition, the less they understand it”
--Charlie April M.D. ISIS Meeting October 2006
Previously called Reflex Sympathetic Dystrophy (RSD), CRPS (called crips) is a subset of neuropathic pain that generalizes from an injury site to affect an entire extremity. It will occasionally ‘spread’ without additional injury to other parts of the body. Statistically it is a rare condition. There are considered to be about 15,000 new cases diagnosed in the United States each year, one new case for every 100,000-300,000 people. Unfortunately, CRPS is like being struck by lightning or bitten by a shark, it doesn’t matter how rare it is if it happens to you.
The condition has never been well understood by clinicians. However, a model is slowly emerging and treatment options are available for the condition.
First, it is important to understand Neuropathic Pain. While all CRPS is neuropathic, not all neuropathic pain is CRPS. Neuropathic pain occurs when nerves are injured, deteriorate, or are compressed. Some common examples are carpal tunnel syndrome, radiculopathy, or diabetic neuropathy. Common features of nerve pain are a reduction in normal ability to feel replaced with burning and shooting pain in the distribution of the affected nerve. These conditions are treated with a variety of medical tools ranging from epidural steroid injections, to physical therapy, to acupuncture and chiropractic, to pharmacologic agents, to decompressive surgeries. The hallmark of neuropathic pain is its clinical pattern of distribution along the zone of the damaged nerve or nerves.
It is also important to be aware of the difference between the inflammation of infection, tissue injury, and arthritis. Each of these conditions is similar but slightly different. The body has a way of using similar mechanisms to solve different problems. Inflammation to combat infection results in the activation of white cells, other components of the immune system and the vascular system. Inflammation to treat injury is a mechanism to clean up a damaged component of the body. In autoimmune inflammation such as rheumatoid arthritis the body actually attacks itself as if it were a foreign object. One of the components of CRPS is an inflammation that is activated by the nervous system that seems to incorporate both normal and pathologic elements of the inflammatory process.
In some fashion the sympathetic nervous system becomes involved (the old name Reflex Sympathetic Dystrophy). The primary role of the sympathetic nervous system is the regulation of blood flow into the extremities and tissues to control heat regulation, excretion of metabolites, and nutrition. In normal tissues it has no role in pain. This seems to change in CRPS with confusing series of changes in the tissues, warm and red, blue and sweaty, and rapid changes back and forth.
Compared to neuropathic pain and injury, which is very common, Complex Regional Pain is very highly unusual. For CRPS to develop linkage to the central nervous system including the brain and the spinal cord relay centers occurs. Peripheral links to the immune system and the endocrine system can occur. Changes in the involved limb take on characteristics seen when the nerve is
severely injured. Burning pain rapidly moves beyond the area of the original injury. Unpredictable changes in limb color, temperature, and sweating occur. ‘Trophic changes’, meaning unexpected swelling, atrophy, and nail bed changes occur.
Diagnosis can be relatively simple when the limb changes are obvious and far more difficult when the changes are more subtle. One of the more common mistakes is for a practioner to classify neuropathic injury as CRPS. Unfortunately there is no gold standard test for the condition. Commonly use studies in Colorado are the three phase bone scan, quantitative Sudomotor reflex testing (QSART), and infrared thermography. Sympathetic blocks are still commonly used for treatment but are not very helpful for the diagnosis. Each of the tests documents a different element of how the nervous system changes. However, the changes seen in each case can occur in other conditions. The International Association for the Study of Pain (the people who named it CRPS) has a set of clinical criteria that form the basis of clinical diagnosis and research protocols.
These include the following:
1. The presence of an initiating noxious event, or a cause of immobilization.
2. Continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event.
3. Evidence at some time of edema, changes in skin blood flow, or abnormal Sudomotor activity in the region of the pain.
4. This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.
5. Criteria 2-4 must be satisfied.
Treatment of the condition has evolved rapidly of the last few years. In reality the treatment is not much different that that used for neuropathic pain. A pyramid of medications including the tricylic antidressants, older and newer anticonvulsants such as carbamazipine and pregabalin, as well as several medications directed toward the NMDA (n-methyl D aspartate) receptor are used. Pain control includes cervical or lumbar blocks, antiinflamatories, opioids, physical therapy, electrical stimulation, topical lidocaine (EMLA or Lidoderm), custom made local anesthetic creams, and even spinal cord stimulation or implantable pumps.
With recent advances in medications many cases of CRPS can be helped. STAR makes every attempt to return patients to work and to living the most normal life possible. Just as in the case of other chronic conditions such as stroke, spinal cord injury, or heart disease much of the treatment is about solving and treating the conditions that can be treated, managing the others and helping a patient come to terms with the condition.
1. CRPS: Current Diagnosis and Therapy / Eds Peter R. Wilson, Michael-Hicks, R. Normal Harden. ISBN 0-931092-55-8, IASP Press, 2005
2. Mechanisms and Mediators of Neuropathic Pain, Malberg & Chaplin, eds., Berkhauser Verlag, Sweden 2002. ISBN 3-7643-6237-5
3. Emerging Strategies for the Treatment of Neuropathic Pain, Campbell, et al eds, IASP Press Seattle 2006 ISBN 0-931092-61-2
4. Hyperalgesia: Molecular Mechanisms and Clinical Implications Brune & Handwerker, eds IASP Press Seattle 2004 ISBN 0-931092-50-7
“The more names the medical profession has for a condition, the less they understand it”
--Charlie April M.D. ISIS Meeting October 2006
Previously called Reflex Sympathetic Dystrophy (RSD), CRPS (called crips) is a subset of neuropathic pain that generalizes from an injury site to affect an entire extremity. It will occasionally ‘spread’ without additional injury to other parts of the body. Statistically it is a rare condition. There are considered to be about 15,000 new cases diagnosed in the United States each year, one new case for every 100,000-300,000 people. Unfortunately, CRPS is like being struck by lightning or bitten by a shark, it doesn’t matter how rare it is if it happens to you.
The condition has never been well understood by clinicians. However, a model is slowly emerging and treatment options are available for the condition.
First, it is important to understand Neuropathic Pain. While all CRPS is neuropathic, not all neuropathic pain is CRPS. Neuropathic pain occurs when nerves are injured, deteriorate, or are compressed. Some common examples are carpal tunnel syndrome, radiculopathy, or diabetic neuropathy. Common features of nerve pain are a reduction in normal ability to feel replaced with burning and shooting pain in the distribution of the affected nerve. These conditions are treated with a variety of medical tools ranging from epidural steroid injections, to physical therapy, to acupuncture and chiropractic, to pharmacologic agents, to decompressive surgeries. The hallmark of neuropathic pain is its clinical pattern of distribution along the zone of the damaged nerve or nerves.
It is also important to be aware of the difference between the inflammation of infection, tissue injury, and arthritis. Each of these conditions is similar but slightly different. The body has a way of using similar mechanisms to solve different problems. Inflammation to combat infection results in the activation of white cells, other components of the immune system and the vascular system. Inflammation to treat injury is a mechanism to clean up a damaged component of the body. In autoimmune inflammation such as rheumatoid arthritis the body actually attacks itself as if it were a foreign object. One of the components of CRPS is an inflammation that is activated by the nervous system that seems to incorporate both normal and pathologic elements of the inflammatory process.
In some fashion the sympathetic nervous system becomes involved (the old name Reflex Sympathetic Dystrophy). The primary role of the sympathetic nervous system is the regulation of blood flow into the extremities and tissues to control heat regulation, excretion of metabolites, and nutrition. In normal tissues it has no role in pain. This seems to change in CRPS with confusing series of changes in the tissues, warm and red, blue and sweaty, and rapid changes back and forth.
Compared to neuropathic pain and injury, which is very common, Complex Regional Pain is very highly unusual. For CRPS to develop linkage to the central nervous system including the brain and the spinal cord relay centers occurs. Peripheral links to the immune system and the endocrine system can occur. Changes in the involved limb take on characteristics seen when the nerve is
severely injured. Burning pain rapidly moves beyond the area of the original injury. Unpredictable changes in limb color, temperature, and sweating occur. ‘Trophic changes’, meaning unexpected swelling, atrophy, and nail bed changes occur.
Diagnosis can be relatively simple when the limb changes are obvious and far more difficult when the changes are more subtle. One of the more common mistakes is for a practioner to classify neuropathic injury as CRPS. Unfortunately there is no gold standard test for the condition. Commonly use studies in Colorado are the three phase bone scan, quantitative Sudomotor reflex testing (QSART), and infrared thermography. Sympathetic blocks are still commonly used for treatment but are not very helpful for the diagnosis. Each of the tests documents a different element of how the nervous system changes. However, the changes seen in each case can occur in other conditions. The International Association for the Study of Pain (the people who named it CRPS) has a set of clinical criteria that form the basis of clinical diagnosis and research protocols.
These include the following:
1. The presence of an initiating noxious event, or a cause of immobilization.
2. Continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event.
3. Evidence at some time of edema, changes in skin blood flow, or abnormal Sudomotor activity in the region of the pain.
4. This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.
5. Criteria 2-4 must be satisfied.
Treatment of the condition has evolved rapidly of the last few years. In reality the treatment is not much different that that used for neuropathic pain. A pyramid of medications including the tricylic antidressants, older and newer anticonvulsants such as carbamazipine and pregabalin, as well as several medications directed toward the NMDA (n-methyl D aspartate) receptor are used. Pain control includes cervical or lumbar blocks, antiinflamatories, opioids, physical therapy, electrical stimulation, topical lidocaine (EMLA or Lidoderm), custom made local anesthetic creams, and even spinal cord stimulation or implantable pumps.
With recent advances in medications many cases of CRPS can be helped. STAR makes every attempt to return patients to work and to living the most normal life possible. Just as in the case of other chronic conditions such as stroke, spinal cord injury, or heart disease much of the treatment is about solving and treating the conditions that can be treated, managing the others and helping a patient come to terms with the condition.
1. CRPS: Current Diagnosis and Therapy / Eds Peter R. Wilson, Michael-Hicks, R. Normal Harden. ISBN 0-931092-55-8, IASP Press, 2005
2. Mechanisms and Mediators of Neuropathic Pain, Malberg & Chaplin, eds., Berkhauser Verlag, Sweden 2002. ISBN 3-7643-6237-5
3. Emerging Strategies for the Treatment of Neuropathic Pain, Campbell, et al eds, IASP Press Seattle 2006 ISBN 0-931092-61-2
4. Hyperalgesia: Molecular Mechanisms and Clinical Implications Brune & Handwerker, eds IASP Press Seattle 2004 ISBN 0-931092-50-7
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