García Héctor A, Junak Mary I, Donahue Bailey, Liu Aiping, Uselmann Adam, Pogue Brian W, Gibson Angela L F
University of Wisconsin-Madison, Department of Medical Physics, Madison, Wisconsin, United States.
CIFICEN (UNCPBA - CICPBA - CONICET), Tandil, Argentina.
J Biomed Opt. 2025 Jun;30(6):065002. doi: 10.1117/1.JBO.30.6.065002. Epub 2025 Jun 23.
Determining the depth of injury in burn wounds is critical to inform surgical decision-making and enhance outcomes. Clinical assessment yields poor accuracy in the early post-burn period, and histologic analysis of biopsies (the gold standard) is time-consuming and clinically unfeasible. Indocyanine green angiography (ICGA) has provided very promising results; however, the evidence is still limited, and the details on instrumentation, measurement setup, and data processing/analysis (when reported) are considerably heterogeneous.
A processing and analysis pipeline was developed to interpret ICGA data from experimental burn studies in a way that provides objective, generalizable, and reproducible interpretation.
Different burns were created on the dorsal aspect of adult pigs, and ICGA was performed. ICGA measurements were then compared with different processing steps. Features were extracted from the indocyanine green angiography (ICG) kinetics curves at specific regions of interests and ran individual and group analyses to decide on the wound severity. To this end, the features were analyzed both separately and groupwise.
The repeatability of the study was enhanced by processing steps where ICG curves were normalized by their area under the curve (AUC). Peak value ( ), residual AUC (rAUC), mean transit time (MTT), full width at half maximum (FWHM), and ingress ( ) and egress ( ) slopes presented the strongest correlation with burn severity. MTT and FWHM were almost independent of the processing steps included in the pipeline, providing high reliability between imaging sessions and inter-subject comparisons. Superficial burns presented significantly higher , rAUC, , and , as well as lower FWHM, when compared with the ICG kinetics from normal tissue, whereas the contrary happens for deep burns.
We highlight the utility of a pre-processing step and judicious choice of parameters to use when interpreting ICGA data from indeterminate depth burn wounds to maximize the accuracy in severity estimation.
确定烧伤创面的损伤深度对于指导手术决策和改善治疗结果至关重要。临床评估在烧伤后早期准确性较差，而活检的组织学分析（金标准）耗时且在临床上不可行。吲哚菁绿血管造影（ICGA）已取得非常有前景的结果；然而，证据仍然有限，并且关于仪器、测量设置以及数据处理/分析（当有报道时）的细节差异很大。
开发一种处理和分析流程，以一种能够提供客观、可推广且可重复解释的方式来解读来自实验性烧伤研究的ICGA数据。
在成年猪的背部制造不同程度的烧伤，并进行ICGA检查。然后将ICGA测量结果与不同的处理步骤进行比较。从感兴趣的特定区域的吲哚菁绿血管造影（ICG）动力学曲线中提取特征，并进行个体和组分析以确定伤口严重程度。为此，对特征进行了单独分析和分组分析。
通过将ICG曲线按其曲线下面积（AUC）进行归一化的处理步骤，提高了研究的可重复性。峰值（ ）、残余AUC（rAUC）、平均通过时间（MTT）、半高宽（FWHM）以及流入（ ）和流出（ ）斜率与烧伤严重程度呈现出最强的相关性。MTT和FWHM几乎不受流程中所包含处理步骤的影响，在成像会话之间以及受试者间比较中提供了高可靠性。与正常组织的ICG动力学相比，浅度烧伤的 、rAUC、 和 显著更高，而FWHM更低，而深度烧伤则相反。
我们强调了预处理步骤的实用性以及在解释不确定深度烧伤创面的ICGA数据时明智选择参数的重要性，以最大限度地提高严重程度估计的准确性。
