Infrared Thermography to Assess Proliferation and Involution of Infantile Hemangiomas

Abstract

IMPORTANCEInfantile hemangiomas (IHs) are common benign tumors of infancy that have the potential to interfere with vital organ function and cause permanent disfigurement. Currently, few objective and validated measures exist to assess IHs.OBJECTIVE To determine the utility of infrared thermography in assessing and monitoring the growth of IHs. DESIGN, SETTING, AND PARTICIPANTSIn a prospective cohort study conducted at an outpatient dermatology clinic of a tertiary care hospital between February 2011 and December 2012, a convenience sample of 42 infants aged 0 to 6 months with an IH were enrolled. The mean age of the study group was 3.7 months, with the majority of IHs being mixed type (57%) affecting the head and neck (81%). Of the infants, 36 (86%) were receiving active treatment during the study period, and patients were followed for a minimum of 3 clinical visits, at least 1 month apart. MAIN OUTCOMES AND MEASURESAbility of infrared thermography to assess the proliferation and involution of IHs compared with a visual analog scale. Secondary outcomes were reliability, ease of use, and parental acceptance of the instrument. RESULTSThe mean temperature difference at baseline was 1.9°F (95% CI, 1.2°F to 2.7°F), which peaked at 3 months to 2.5°F (95% CI, 0.8°F to 4.2°F), and decreased progressively to 0.2°F (95% CI, −1.1°F to 1.4°F) at 18.5 months (P < .001). This change in temperature was inversely correlated with mean visual analog scale (r = −0.25). Mean temperature differences recorded at baseline and 30 minutes later were not significant (least squares mean baseline temperature, 87.9°F [95% CI, 87.4°F to 88.3°F], vs least squares mean temperature after 30 minutes, 88.1°F [95% CI, 87.7°F to 88.6°F] [P = .14]). Multivariate analysis demonstrated facial location (F 1,365 = 47.63, P < .001), IH type (F 2,365 = 3.26, P = .04), age (F 2,365 = 7.03, P = .001), and surface area at baseline (F 2,365 = 8.18, P < .001) as factors significantly affecting temperature difference over time. Only IH type (Wald χ 2 2 = 6.79, P = .03) and treatment (Wald χ 2 1 = 4.29, P = .04) significantly affected time to reach a zero-temperature difference. All caregivers (100%) reported IRT to be easy to implement, quick to perform, and comfortable for their child.CONCLUSIONS AND RELEVANCE Infrared thermography is a reliable and valid measure of IH growth that is noninvasive, convenient, and well tolerated by infants, making it well suited to daily clinical practice. It has the potential to provide real-time objective results that can be used for routine monitoring and evaluating treatment efficacy.JAMA Dermatol. 2014;150(9):964-969.

Infantile hemangioma status by dynamic infrared thermography: A preliminary study

“…24 Decreases in IR temperature (difference IH - control) occurred over 18 months, with highest values at 3 months and significant IH improvement (VAS). 25 Reported differences of 1.1, 1.4, 0.9 and 0.6°C at baseline, 3, 12 and 15 months were lower than our static values of 1.2, 1.9, and 1.7°C at months 2.2, 4.5 and 12.8, respectively, perhaps due to variations in the IR devices and/or IH characteristics, treatment, etc. We averaged temperatures over the total IH area in contrast to local temperatures at the tumor center.…”

“…25 Dynamic IR imaging may reveal changes when other modalities do not. The IH in Figure 3a showed a progressively slower recovery from stress over 10 months, as demonstrated by decreasing AUCrw, despite slight changes in height and size (Table 4).…”

“…16 It is a reliable technique to evaluate vascular function 18; 19 , vascular disease 17; 20 , tumors including breast cancer 21; 22 and melanoma 23 , and infantile hemangiomas. 24; 25 Tumor temperatures are higher than uninvolved skin 26 , due in part to differences in perfusion and metabolism. 15; 27 Surface temperature is influenced by lesion size, i.e., higher with increasing size, and depth, i.e., inversely with vasculature distance.…”

Long-Wave Medical Infrared Thermography: A Clinical Biomarker of Inflammation in Hidradenitis Suppurativa/Acne Inversa

“…These factors include structural abnormalities of vessels (dilation and incompetence), abnormalities of vascular control, local effects on vessels, changes in thermal conductivity of the tissues, and increased heat production of the tissues, e.g., in inflammatory processes. Technological advances have made MIT a reliable medical measurement tool [25-29] for detecting both changes of skin temperature [32, 36] and their magnitude in inflammatory skin diseases [33, 37-40]. Moreover, it can be employed to objectively detect the therapeutic success of anti-inflammatory treatment [39, 40].…”

“…Nevertheless, the inherently “hidden” dermal component of HS puts some limitations on the utility of ordinary photography as a biomarker. Long-wave medical infrared thermography (MIT) is a noninvasive and radiation-free imaging method that has been introduced in the measurement of skin temperature [23, 24], the detection of skin blood flow [25], the objective assessment of wound healing [26], and the detection of tissue abnormalities beneath the skin, e.g., of the joints [27, 28]. Correlations between joint inflammation and MIT parameters, including thermographic index, heat distribution index, and mean and maximum temperature, have been reported.…”