Herrick Ariane L, Dinsdale Graham, Murray Andrea
Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
Eur J Rheumatol. 2020 Oct;7(Suppl 3):S212-S221. doi: 10.5152/eurjrheum.2020.19124. Epub 2020 Jul 6.
The last 10-20 years have seen huge strides in imaging science. The aim of this review article is to share with the reader the key recent advances in non-invasive imaging of the digital (finger) vasculature in patients with Raynaud's phenomenon (RP), including in systemic sclerosis (SSc)-related digital vasculopathy. For the rheumatologist, seeing a patient with RP is an opportunity for early diagnosis of an underlying SSc-spectrum disorder or (conversely) for reassuring the patient with primary (idiopathic) RP. Non-invasive imaging techniques can help to provide diagnostic certainty. In addition, they can provide new insights into pathophysiology and have the potential to facilitate the development of much needed effective treatments by providing primary and secondary endpoints for randomized controlled trials: validation studies are ongoing. This review article focuses on nailfold capillaroscopy, thermography, and laser Doppler methods but also discusses (briefly) other technologies, including optical coherence tomography, multispectral imaging, and photoacoustic imaging. Key recent advances are the increasing use/availability of nailfold capillaroscopy (and better understanding of the role of low-cost hand-held devices), increased accessibility of thermography (including mobile phone thermography), and increased application of laser Doppler methods to the study of RP/digital vasculopathy (in particular of laser Doppler imaging and laser speckle contrast imaging, both of which measure blood flow over an area rather than at a single site). In an era of precision medicine, non-invasive imaging techniques can help stratify risk of (a) SSc in the patient with RP and (b) digital vascular disease progression in the patient with an SSc-spectrum disorder.
在过去的10至20年里，成像科学取得了巨大进展。这篇综述文章的目的是与读者分享近期在雷诺现象（RP）患者，包括系统性硬化症（SSc）相关数字血管病变患者的数字（手指）血管系统无创成像方面的关键进展。对于风湿病学家来说，见到RP患者是早期诊断潜在的SSc谱系疾病的机会，或者（相反）是让原发性（特发性）RP患者安心的机会。无创成像技术有助于提供诊断确定性。此外，它们可以为病理生理学提供新的见解，并有可能通过为随机对照试验提供主要和次要终点来促进急需的有效治疗方法的开发：验证研究正在进行中。这篇综述文章重点介绍甲襞毛细血管镜检查、热成像和激光多普勒方法，但也简要讨论了其他技术，包括光学相干断层扫描、多光谱成像和光声成像。近期的关键进展包括甲襞毛细血管镜检查的使用/可用性增加（以及对低成本手持设备作用的更好理解）、热成像的可及性提高（包括手机热成像），以及激光多普勒方法在RP/数字血管病变研究中的应用增加（特别是激光多普勒成像和激光散斑对比成像，这两种方法都测量一个区域而不是单个部位的血流）。在精准医学时代，无创成像技术有助于对（a）RP患者的SSc风险和（b）SSc谱系疾病患者的数字血管疾病进展风险进行分层。
