■坏死性软组织感染(NSTIs)是威胁生命的感染,累计病死率为21%。NSTI的初始呈现是非特定的,经常导致误诊和延误护理。当前的策略没有产生准确的,NSTI的实时诊断。
■一类观察,临床试点研究检验了以下假设:在静脉给药和基于灌注的吲哚菁绿(ICG)荧光成像后,NSTI感染组织中出现可测量的荧光信号空洞.该假设基于NSTI与局部微血管血栓形成相关的既定知识。
■向三级护理医疗中心急诊科就诊的NSTI高危成人患者进行前瞻性登记,并用商用荧光成像仪进行成像。单帧荧光快照和首通灌注动力学参数-入口斜率(IS),峰值时间(TTP)强度,和最大荧光强度(IMAX)-使用动态对比增强荧光成像技术进行定量。临床变量(合并症,血液实验室值),荧光参数,和荧光信号背景比(SBR)与最终感染诊断进行了比较。
■14例患者被纳入并成像(6例NSTI,六个蜂窝织炎,一个与糖尿病相关的坏疽,和一个骨髓炎)。临床变量在NSTI和非NSTI患者组之间没有统计学上的显着差异(p值≥0.22)。所有NSTI病例在受影响的组织中表现出明显的荧光信号空洞,包括肉眼不可见的组织特征。所有蜂窝织炎病例均表现出充血反应,荧光增加,没有明显的信号空隙。基于快照的中位病变到背景组织SBR,IS,TTP,和IMAX参数图的范围分别为3.2至9.1、2.2至33.8、1.0至7.5和1.5至12.7,对于NSTI患者组。除TTP外,所有荧光参数均显示NSTI和蜂窝织炎患者组之间的统计学差异(p值<0.05)。
■实时,通过基于灌注的ICG荧光成像,与非坏死性感染相比,可以准确区分NSTIs.
UNASSIGNED: Necrotizing soft-tissue infections (NSTIs) are life-threatening infections with a cumulative case fatality rate of 21%. The initial presentation of an NSTI is non-specific, frequently leading to misdiagnosis and delays in care. No current strategies yield an accurate, real-time diagnosis of an NSTI.
UNASSIGNED: A first-in-kind, observational, clinical pilot study tested the hypothesis that measurable fluorescence signal voids occur in NSTI-affected tissues following intravenous administration and imaging of perfusion-based indocyanine green (ICG) fluorescence. This hypothesis is based on the established knowledge that NSTI is associated with local microvascular thrombosis.
UNASSIGNED: Adult patients presenting to the Emergency Department of a tertiary care medical center at high risk for NSTI were prospectively enrolled and imaged with a commercial fluorescence imager. Single-frame fluorescence snapshot and first-pass perfusion kinetic parameters-ingress slope (IS), time-to-peak (TTP) intensity, and maximum fluorescence intensity (IMAX)-were quantified using a dynamic contrast-enhanced fluorescence imaging technique. Clinical variables (comorbidities, blood laboratory values), fluorescence parameters, and fluorescence signal-to-background ratios (SBRs) were compared to final infection diagnosis.
UNASSIGNED: Fourteen patients were enrolled and imaged (six NSTI, six cellulitis, one diabetes mellitus-associated gangrene, and one osteomyelitis). Clinical variables demonstrated no statistically significant differences between NSTI and non-NSTI patient groups (p-value≥0.22). All NSTI cases exhibited prominent fluorescence signal voids in affected tissues, including tissue features not visible to the naked eye. All cellulitis cases exhibited a hyperemic response with increased fluorescence and no distinct signal voids. Median lesion-to-background tissue SBRs based on snapshot, IS, TTP, and IMAX parameter maps ranged from 3.2 to 9.1, 2.2 to 33.8, 1.0 to 7.5, and 1.5 to 12.7, respectively, for the NSTI patient group. All fluorescence parameters except TTP demonstrated statistically significant differences between NSTI and cellulitis patient groups (p-value<0.05).
UNASSIGNED: Real-time, accurate discrimination of NSTIs compared with non-necrotizing infections may be possible with perfusion-based ICG fluorescence imaging.