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Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, ChinaInstitute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai, China
It uses the intrinsically strong optical absorption by hemoglobin in the visible and near-infrared spectral region to quantify the blood perfusion under the skin.
We adapted a commercial, portable, light emitting diode–based PAI system for the clinical assessment of PWSs. A new imaging parameter, the “PWS level,” indicating the severity of PWS lesions, can quantitatively assess the severity and treatment response in PWS lesions.
Thirty-five patients with a facial PWS were included for the PWS level validation. Because of financial reasons, only 4 of these patients were enrolled in a 6-checkpoint prospective study over a 2-month treatment cycle of hematoporphyrin monomethyl ether photodynamic therapy. To observe PWS level changes, they were imaged immediately after treatment and at 1, 2, 4, and 8 weeks posttreatment. With 1 additional patient imaged at 2 time points (before treatment and at 8 weeks posttreatment), 5 patients were also enrolled in the longitudinal 2-checkpoint efficacy assessment study. Details regarding the PWS level, PAI schematic, protocol, patient demography, clearance score standards, and results of the PWS level validation and longitudinal 2-checkpoint treatment efficacy evaluation of 5 patients can be found in the Supplemental Material available via Mendeley at https://data.mendeley.com/datasets/rzsjvj9m2r/1.
The trend in the PWS levels was similar in all 4 patients enrolled in the 6-checkpoint study (Fig 1). Immediately posttreatment, a quick decrease in the PWS level occurred because of a swelling effect. Local blood perfusion is reduced because of vascular endothelial destruction after PDT. At 1 week posttreatment, the levels rose because of short-term inflammation. However, at 2, 4, and 8 weeks, they dropped again and were lower than the pretreatment measurements, reflecting the long-term outcomes. Significant differences were achieved in unpaired t tests comparing the posttreatment (immediately and at 8 weeks) and pretreatment levels per patient. Corresponding clinical pictures are shown in Fig 2.
The treatment response was also evaluated in the 2-checkpoint longitudinal study (Supplemental Fig 1). The mean PWS levels before treatment and at 8 weeks posttreatment were 2.45 ± 0.23 and 1.73 ± 0.14, respectively (P < .01). The PWS level reduction at 8 weeks posttreatment per patient was computed and compared with the clearance scores allocated by 5 dermatologists. The standard deviation of each PWS level reduction was smaller than that of the corresponding clearance score, suggesting a better repeatability in assessing response to treatment. In addition, the average PWS level reduction of this cohort was 49.30% ± 9.50%, demonstrating a satisfactory treatment effect.
The findings indicate a new quantitative assessment method for PWS severity and treatment response, which shows better repeatability compared with semiquantitative visual assessment.
In conclusion, we propose a new alternative to evaluate PWS, which is now being developed into a practical option in the clinic for monitoring purposes.
Conflicts of interest
Noninvasive clinical assessment of port-wine stain birthmarks using current and future optical imaging technology: a review: noninvasive clinical assessment of port-wine stain birthmarks.
Drs H. Zhang and G. Zhang contributed equally to this article.
Funding sources: Supported by the National Key Research and Development Program of China ( 2017YFC0111400 ), the Shanghai Science and Technology Committee (STCSM) ( 17411952500 ), and the National Natural Science Foundation of China ( 11674249 ).
IRB approval status: Reviewed and approved by Ethics Committee of Shanghai Skin Disease Hospital (approval 2019-06).
We thank Cyberdyne Inc for its support in providing the light emitting diode–based photoacoustic imaging system used in this study. We also thank Editage (www.editage.cn) for English language editing.