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Kiseleva E, Ryabkov M, Baleev M, et al. Prospects of Intraoperative Multimodal OCT Application in Patients with Acute Mesenteric Ischemia. Diagnostics (Basel). 2021;11(4)doi: 10.3390/diagnostics11040705.
Kiseleva, E., Ryabkov, M., Baleev, M., Bederina, E., Shilyagin, P., Moiseev, A., Beschastnov, V., Romanov, I., Gelikonov, G., & Gladkova, N. (2021). Prospects of Intraoperative Multimodal OCT Application in Patients with Acute Mesenteric Ischemia. Diagnostics (Basel, Switzerland), 11(4), . https://doi.org/10.3390/diagnostics11040705
Kiseleva, Elena, et al. "Prospects of Intraoperative Multimodal OCT Application in Patients with Acute Mesenteric Ischemia." Diagnostics (Basel, Switzerland) vol. 11,4 (2021). doi: https://doi.org/10.3390/diagnostics11040705
Kiseleva E, Ryabkov M, Baleev M, Bederina E, Shilyagin P, Moiseev A, Beschastnov V, Romanov I, Gelikonov G, Gladkova N. Prospects of Intraoperative Multimodal OCT Application in Patients with Acute Mesenteric Ischemia. Diagnostics (Basel). 2021 Apr 15;11(4). doi: 10.3390/diagnostics11040705. PMID: 33920827; PMCID: PMC8071199.
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Diagnostics (Basel). 2021 Apr 15;11(4). doi: 10.3390/diagnostics11040705.

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

Diagnostics (Basel, Switzerland)

Elena Kiseleva, Maxim Ryabkov, Mikhail Baleev, Evgeniya Bederina, Pavel Shilyagin, Alexander Moiseev, Vladimir Beschastnov, Ivan Romanov, Grigory Gelikonov, Natalia Gladkova

Affiliations

  1. Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia.
  2. Thermal Injury Group, University Clinic, Privolzhsky Research Medical University, 18/1 Verkhnevolzhskaya Naberezhnaja, 603155 Nizhny Novgorod, Russia.
  3. City Clinical Hospital No.30, 85A Berezovskaya St., 605157 Nizhny Novgorod, Russia.
  4. The Department of Pathology, University Clinic, Privolzhsky Research Medical University, 18/1 Verkhnevolzhskaya Naberezhnaja, 603155 Nizhny Novgorod, Russia.
  5. Institute of Applied Physics of the RAS, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia.

PMID: 33920827 PMCID: PMC8071199 DOI: 10.3390/diagnostics11040705

Abstract

INTRODUCTION: Despite the introduction of increasingly multifaceted diagnostic techniques and the general advances in emergency abdominal and vascular surgery, the outcome of treatment of patients with acute impaired intestinal circulation remains unsatisfactory. The non-invasive and high-resolution technique of optical coherence tomography (OCT) can be used intraoperatively to assess intestine viability and associated conditions that frequently emerge under conditions of impaired blood circulation. This study aims to demonstrate the effectiveness of multimodal (MM) OCT for intraoperative diagnostics of both the microstructure (cross-polarization OCT mode) and microcirculation (OCT angiography mode) of the small intestine wall in patients with acute mesenteric ischemia (AMI).

METHODS AND PARTICIPANTS: A total of 18 patients were enrolled in the study. Nine of them suffered from AMI in segments II-III of the superior mesenteric artery (AMI group), whereby the ischemic segments of the intestine were examined. Nine others were operated on for adenocarcinoma of the colon (control group), thus allowing areas of their normal small intestine to be examined for comparison. Data on the microstructure and microcirculation in the walls of the small intestine were obtained intraoperatively from the side of the serous membrane using the MM OCT system (IAP RAS, Russia) before bowel resection. The MM OCT data were compared with the results of histological examination.

RESULTS: The study finds that MM OCT visualized the damage to serosa, muscularis externa, and blood vessels localized in these layers in 100% of AMI cases. It also visualized the submucosa in 33.3% of AMI cases. The MM OCT images of non-ischemic (control group), viable ischemic, and necrotic small intestines (AMI group) differed significantly across stratification of the distinguishable layers, the severity of intermuscular fluid accumulations, and the type and density of the vasculature.

CONCLUSION: The MM OCT diagnostic procedure optimally meets the requirements of emergency surgery. Data on the microstructure and microcirculation of the intestinal wall can be obtained simultaneously in real time without requiring contrast agent injections. The depth of visualization of the intestinal wall from the side of the serous membrane is sufficient to assess the volume of the affected tissues. However, the methodology for obtaining MM OCT data needs to be improved to minimize the motion artefacts generated in actual clinical conditions.

Keywords: acute mesenteric ischemia (AMI); gut vitality; image assessment; intraoperative diagnostics; optical coherence tomography (OCT); optical coherence tomography angiography (OCTA)

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