Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia

Acute limb ischemia is a common cause of morbidity and mortality following trauma both in civilian centers and in combat related injuries. Rapid determination of tissue viability and surgical restoration of blood flow are desirable, but not always possible. We sought to characterize the response to...

Descripción completa

Detalles Bibliográficos
Autores principales: Radowsky, Jason S., Caruso, Joseph D., Luthra, Rajiv, Bradley, Matthew J., Elster, Eric A., Forsberg, Jonathan A., Crane, Nicole J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569513/
https://www.ncbi.nlm.nih.gov/pubmed/26368024
http://dx.doi.org/10.1371/journal.pone.0137430
_version_ 1782390055838416896
author Radowsky, Jason S.
Caruso, Joseph D.
Luthra, Rajiv
Bradley, Matthew J.
Elster, Eric A.
Forsberg, Jonathan A.
Crane, Nicole J.
author_facet Radowsky, Jason S.
Caruso, Joseph D.
Luthra, Rajiv
Bradley, Matthew J.
Elster, Eric A.
Forsberg, Jonathan A.
Crane, Nicole J.
author_sort Radowsky, Jason S.
collection PubMed
description Acute limb ischemia is a common cause of morbidity and mortality following trauma both in civilian centers and in combat related injuries. Rapid determination of tissue viability and surgical restoration of blood flow are desirable, but not always possible. We sought to characterize the response to increasing periods of hind limb ischemia in a porcine model such that we could define a period of critical ischemia (the point after which irreversible neuromuscular injury occurs), evaluate non-invasive methods for characterizing that ischemia, and establish a model by which we could predict whether or not the animal’s locomotion would return to baselines levels post-operatively. Ischemia was induced by either application of a pneumatic tourniquet or vessel occlusion (performed by clamping the proximal iliac artery and vein at the level of the inguinal ligament). The limb was monitored for the duration of the procedure with both 3-charge coupled device (3CCD) and infrared (IR) imaging for tissue oxygenation and perfusion, respectively. The experimental arms of this model are effective at inducing histologically evident muscle injury with some evidence of expected secondary organ damage, particularly in animals with longer ischemia times. Noninvasive imaging data shows excellent correlation with post-operative functional outcomes, validating its use as a non-invasive means of viability assessment, and directly monitors post-occlusive reactive hyperemia. A classification model, based on partial-least squares discriminant analysis (PLSDA) of imaging variables only, successfully classified animals as “returned to normal locomotion” or “did not return to normal locomotion” with 87.5% sensitivity and 66.7% specificity after cross-validation. PLSDA models generated from non-imaging data were not as accurate (AUC of 0.53) compared the PLSDA model generated from only imaging data (AUC of 0.76). With some modification, this limb ischemia model could also serve as a means on which to test therapies designed to prolong the time before critical ischemia.
format Online
Article
Text
id pubmed-4569513
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-45695132015-09-18 Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia Radowsky, Jason S. Caruso, Joseph D. Luthra, Rajiv Bradley, Matthew J. Elster, Eric A. Forsberg, Jonathan A. Crane, Nicole J. PLoS One Research Article Acute limb ischemia is a common cause of morbidity and mortality following trauma both in civilian centers and in combat related injuries. Rapid determination of tissue viability and surgical restoration of blood flow are desirable, but not always possible. We sought to characterize the response to increasing periods of hind limb ischemia in a porcine model such that we could define a period of critical ischemia (the point after which irreversible neuromuscular injury occurs), evaluate non-invasive methods for characterizing that ischemia, and establish a model by which we could predict whether or not the animal’s locomotion would return to baselines levels post-operatively. Ischemia was induced by either application of a pneumatic tourniquet or vessel occlusion (performed by clamping the proximal iliac artery and vein at the level of the inguinal ligament). The limb was monitored for the duration of the procedure with both 3-charge coupled device (3CCD) and infrared (IR) imaging for tissue oxygenation and perfusion, respectively. The experimental arms of this model are effective at inducing histologically evident muscle injury with some evidence of expected secondary organ damage, particularly in animals with longer ischemia times. Noninvasive imaging data shows excellent correlation with post-operative functional outcomes, validating its use as a non-invasive means of viability assessment, and directly monitors post-occlusive reactive hyperemia. A classification model, based on partial-least squares discriminant analysis (PLSDA) of imaging variables only, successfully classified animals as “returned to normal locomotion” or “did not return to normal locomotion” with 87.5% sensitivity and 66.7% specificity after cross-validation. PLSDA models generated from non-imaging data were not as accurate (AUC of 0.53) compared the PLSDA model generated from only imaging data (AUC of 0.76). With some modification, this limb ischemia model could also serve as a means on which to test therapies designed to prolong the time before critical ischemia. Public Library of Science 2015-09-14 /pmc/articles/PMC4569513/ /pubmed/26368024 http://dx.doi.org/10.1371/journal.pone.0137430 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
spellingShingle Research Article
Radowsky, Jason S.
Caruso, Joseph D.
Luthra, Rajiv
Bradley, Matthew J.
Elster, Eric A.
Forsberg, Jonathan A.
Crane, Nicole J.
Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia
title Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia
title_full Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia
title_fullStr Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia
title_full_unstemmed Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia
title_short Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia
title_sort noninvasive multimodal imaging to predict recovery of locomotion after extended limb ischemia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569513/
https://www.ncbi.nlm.nih.gov/pubmed/26368024
http://dx.doi.org/10.1371/journal.pone.0137430
work_keys_str_mv AT radowskyjasons noninvasivemultimodalimagingtopredictrecoveryoflocomotionafterextendedlimbischemia
AT carusojosephd noninvasivemultimodalimagingtopredictrecoveryoflocomotionafterextendedlimbischemia
AT luthrarajiv noninvasivemultimodalimagingtopredictrecoveryoflocomotionafterextendedlimbischemia
AT bradleymatthewj noninvasivemultimodalimagingtopredictrecoveryoflocomotionafterextendedlimbischemia
AT elstererica noninvasivemultimodalimagingtopredictrecoveryoflocomotionafterextendedlimbischemia
AT forsbergjonathana noninvasivemultimodalimagingtopredictrecoveryoflocomotionafterextendedlimbischemia
AT cranenicolej noninvasivemultimodalimagingtopredictrecoveryoflocomotionafterextendedlimbischemia