Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA.
Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37235, USA.
Sci Rep. 2017 Nov 1;7(1):14798. doi: 10.1038/s41598-017-14941-5.
Post-surgical hypoparathyroidism and hypocalcemia are known to occur after nearly 50% of all thyroid surgeries as a result of accidental disruption of blood supply to healthy parathyroid glands, which are responsible for regulating calcium. However, there are currently no clinical methods for accurately identifying compromised glands and the surgeon relies on visual assessment alone to determine if any gland(s) should be excised and auto-transplanted. Here, we present Laser Speckle Contrast Imaging (LSCI) for real-time assessment of parathyroid viability. Taking an experienced surgeon's visual assessment as the gold standard, LSCI can be used to distinguish between well vascularized (n = 32) and compromised (n = 27) parathyroid glands during thyroid surgery with an accuracy of 91.5%. Ability to detect vascular compromise with LSCI was validated in parathyroidectomies. Results showed that this technique is able to detect parathyroid gland devascularization before it is visually apparent to the surgeon. Measurements can be performed in real-time and without the need to turn off operating room lights. LSCI shows promise as a real-time, contrast-free, objective method for helping reduce hypoparathyroidism after thyroid surgery.
手术后甲状旁腺功能减退和低钙血症在近 50%的甲状腺手术后都会发生，这是由于健康甲状旁腺的血液供应意外中断所致，而甲状旁腺负责调节钙。然而，目前还没有临床方法可以准确识别受损的腺体，外科医生只能依靠视觉评估来确定是否需要切除任何腺体并进行自体移植。在这里，我们提出了激光散斑对比成像（LSCI）用于实时评估甲状旁腺的活力。以经验丰富的外科医生的视觉评估作为金标准，LSCI 可用于区分甲状腺手术中血管丰富的（n=32）和受损的（n=27）甲状旁腺，准确率为 91.5%。LSCI 检测血管损伤的能力在甲状旁腺切除术得到了验证。结果表明，该技术能够在外科医生肉眼可见之前检测到甲状旁腺的去血管化。测量可以实时进行，无需关闭手术室灯光。LSCI 有望成为一种实时、无对比、客观的方法，有助于减少甲状腺手术后甲状旁腺功能减退的发生。
