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Photodiagnosis Photodyn Ther. 2019 Jan 6. pii: S1572-1000(18)30236-9. doi: 10.1016/j.pdpdt.2019.01.008. [Epub ahead of print]

Comparison of different non-invasive diagnostic techniques used for HMME-PDT in the treatment of port wine stains.

Author information

1
Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.
2
Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
3
Department of Skin and Cosmetic Research, Shanghai Skin Disease Hospital, Shanghai, China.
4
Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China. Electronic address: wangxiuli20150315@163.com.

Abstract

BACKGROUND:

Hemoporfin-mediated photodynamic therapy (HMME-PDT) is an effective method for treating port wine stains (PWS). While, it still lacks methods to evaluate the treatment of HMME-PDT for PWS effectively and objectively.

OBJECTIVE:

This study aimed to compare the value of different non-invasive diagnostic techniques used for HMME-PDT treatment evaluation in PWS.

METHODS:

Thirty-one lesions of 22 patients with PWS were treated with HMME-PDT. Four non-invasive diagnostic techniques including VISIA-CRTM system, dermoscopy, high-frequency ultrasound (HFUS) and laser speckle imager (LSCI) were used to obtain standard radiographic data containing skin color, skin thickness, blood vessel morphology, blood vessel distribution and blood perfusion from lesions and normal skin surrounded before and after HMME-PDT.

RESULTS:

The standard image pattern of VISIA-CRTM system showed color change of the lesions of PWS after HMME-PDT. RBX-red image of VISIA-CRTM system showed that erythema was highly aggregated even on invisible lesions at baseline but decreased after HMME-PDT. The erythema index reduced value d was related to the efficacy rating (γ = 0.631, P<0.05). Dermoscopy showed that the number of spot-like and irregular linear vessels increased correlated with increase of clinical classification. After HMME-PDT, vascular rupture was observed by dermoscopy. The response rate of lesions with vascular rupture was 100.00% (20/20). And the response rate of lesions without vascular rupture was 63.64% (7/11). Vascular rupture sign was correlated with better efficacy (P<0.05). High-frequency ultrasound showed that dermis of PWS thickened and arranged loosely with scattered linear hypoechoic signal. After HMME-PDT, the dermal layer of the lesions became thinner with the linear hypoechoic signal decreased. The response rate of lesions with linear hypoechoic signal was 76.92% (10/13), and that without linear hypoechoic signal was 94.44% (17/18). The lesions without linear hypoechoic signal in dermis showed better efficacy (P<0.05). In some lesions, Laser speckle contrast showed high blood perfusion signal in PWS lesions and a blood perfusion reduction after HMME-PDT.

CONCLUSION:

VISIA-CRTM system can be used to observe not only visible but also invisible lesions of PWS. Moreover, lesions fading after HMME-PDT treatment can be described objectively by VISIA-CRTM system. Dermoscopy played an important role in the clinical classification of PWS, including assessing vascular injury after HMME-PDT, guiding the adjustment of therapeutic dose, and selecting the end point of treatment. HFUS and LSCI can be both used to assist the treatment response evaluation of HMME-PDT.

KEYWORDS:

VISIA-CR(TM) system; dermoscopy; hemoporfin-mediated photodynamic therapy; high-frequency ultrasound; laser speckle contrast imaging; port-wine stains

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