Intraoperative Incident Dark Field Imaging of the Human Peritoneal Microcirculation

Abstract

Background/Aims: This study describes the peritoneal microcirculation, compares quantitative parameters and angioarchitecture to the standard of sublingual microcirculatory assessment, and determines the practical feasibility of this method. Methods: Incident dark field imaging was performed of the peritoneum and sublingually to determine angioarchitecture, total and perfused vessel density (TVD and PVD), the proportion of perfused vessels (PPV), the microvascular flow index (MFI) and image acquisition time. Results: Peritoneal angioarchitecture was characterized by a quadrangular network of longitudinally oriented capillaries, often flanked by fat cells. Differences between peritoneal and sublingual microcirculation were observed with regard to TVD (peritoneum 12 mm/mm² [95% CI 10–14] vs. sublingual 23 mm/mm² [95% CI 21–25]; p < 0.0001), PVD (peritoneum 11 mm/mm² [95% CI 9–13] vs. sublingual 23 mm/mm² [95% CI 21–25]; p < 0.0001), PPV (peritoneum 88% [95% CI 79–97] vs. sublingual 99% [95% CI 99–100]; p = 0.014), and MFI (peritoneum 3 [IQR 2.3–3.0] vs. sublingual 3 [IQR 3.0–3.0]; p = 0.012). There was no difference in image acquisition time (peritoneum 2: 34 min [95% CI 1: 49–3: 19] vs. sublingual 2: 38 [95% CI 1: 37–3: 32]; p = 0.916). Conclusion: The peritoneal microcirculation was characterized by a low capillary density and a distinctive angioarchitecture. The possibility of peri­toneal microcirculatory assessment offers promise for the study of peritoneal (patho-)physiology and (monitoring or detection of) associated diseases.

Poor perfusion of the microvasculature in peritoneal metastases of ovarian cancer

“…However, inter-participant differences of microvascular parameters did not occur and findings were consistent, irrespective of imaging during primary cytoreductive surgery or after neo-adjuvant chemotherapy. Also, the number of included participants was rather small, but because of the consistency of findings in the present study and our previous study [18], the differences are unlikely to be caused by coincidence.…”

“…Incident dark field (IDF) imaging enables real-time in vivo visualization of the human microvasculature, allowing quantification of perfusion [17]. We recently visualized the peritoneal microvasculature with IDF imaging and we showed that the peritoneal microvasculature consists of well-perfused vessels forming an organized network, often embedded in fat tissue [18].…”

Morphologic Mapping of the Sublingual Microcirculation in Healthy Volunteers

“…As recommended in the consensus report [6] and the Massey Microcirculation Image Quality Score [34], this field was determined to contain the least capillary loops among the sublingual area. This finding confirms the location that Uz et al [36] previously described as the triangle area.…”

Prospects of Intraoperative Multimodal OCT Application in Patients with Acute Mesenteric Ischemia

“…Other optical methods that demonstrate potential in the detection of perfusion changes in the gut includes sidestream dark field (SDF) microscopy [ 30 , 31 , 32 ], incident dark field (IDF) imaging [ 33 , 34 ], and hyperspectral imaging (HSI) [ 35 ]. SDF and IDF are non-invasive microscopies for quantitative perfusion imaging, but have not been used in AMI.…”

“…SDF demonstrates potential in the evaluation of perfusion of gastric tube [ 32 ] and colon [ 30 , 31 ] so that a reduction in anastomotic leakage could be accomplished. IDF with quantification related perfusion parameters was used in [ 33 ], only to determine angioarchitecture of the peritoneum, including capillaries. HSI is a novel technique for applications in intestinal ischemia.…”