Case example:

University of Genova – Italy, University of Ghent – Belgium

Maurizio Cutolo (University of Genova – Italy), Barbara Ruaro (University of Genova – Italy), Vanessa Smith (University of Ghent – Belgium)

 

nLASCA analyses the peripheral blood perfusion and gives a value of its intensity. Our recent study performed using LASCA showed significantly lower blood perfusion in SSc patients than in healthy subjects at the level of the fingertips, periungual areas, and palms of the hands, but not at face level3Ruaro B, Sulli A, Smith V, Pizzorni C, Gallo M, Cutolo M. speckle contrast analysis: a new method to evaluate peripheral blood perfusion in systemic sclerosis patients. Ann Rheum Dis. 2014; 73: 1181-5. ,4Ruaro B, Sulli A, Pizzorni C, Paolino S, Smith V, Cutolo M. Correlations between skin blood perfusion values and nailfold capillaroscopy scores in systemic sclerosis patients. Microvasc Res. 2016;105:119-24.

In addition, a statistically significant negative correlation between the extent of nailfold microangiopathy and degree of blood perfusion was detected at the level of those skin areas mentioned above5Ruaro B, Sulli A, Smith V, Pizzorni C, Gallo M, Cutolo M. speckle contrast analysis: a new method to evaluate peripheral blood perfusion in systemic sclerosis patients. Ann Rheum Dis. 2014; 73: 1181-5. ,6Ruaro B, Sulli A, Pizzorni C, Paolino S, Smith V, Cutolo M. Correlations between skin blood perfusion values and nailfold capillaroscopy scores in systemic sclerosis patients. Microvasc Res. 2016;105:119-24.(see figure 1, 2). Furthermore, we have demonstrated in SSc patients that LASCA is a safe technique that monitors the perfusion of digital ulcers, treated by local medical dressing during the healing process.

We have used LASCA to evaluate the change in blood perfusion during long term treatment with various drugs such as Bosentan, Iloprost and Aminapthone7Trombetta AC, Pizzorni C, Ruaro B, Paolino S, Sulli A, Smith V, Cutolo M. Effects of Longterm Treatment with Bosentan and Iloprost on Nailfold Absolute Capillary Number, Fingertip Blood Perfusion, and Clinical Status in Systemic Sclerosis. J Rheumatol. 2016;43:2033-2041.,8Ruaro B, Paolino S, Pizzorni C, Cutolo M, Sulli A. Assessment of treatment effects on digital ulcer and blood perfusion by laser speckle contrast analysis in a patient affected by systemic sclerosis. Reumatismo. 2017;69:134-136..
In conclusion LASCA represents an essential safe, non-invasive, and non-contact tool for a reliable quantification of blood perfusion in SSc skin and ulcer areas. Along with NVC it may be useful to monitor disease progression, response to treatment, and ulcer outcome.

Figure 1. LASCA compared with NVC in SSc patients. Image modified from: Ruaro B., .. , Cutolo M. Laser speckle contrast analysis: a new method to evaluate peripheral blood perfusion in systemic sclerosis patients. Ann Rheum Dis. 2014;73:1181-5.

Figure 2. LASCA evaluation in a SSc patient

Expert opinion

Perimed’s PeriCam PSI laser speckle contrast imager (LASCA) is an excellent tool to study the function of microcirculation, in particular the peripheral blood perfusion and Raynaud’s phenomenon in Systemic Sclerosis at any time of the disease 9Ruaro B, Sulli A, Smith V, Pizzorni C, Gallo M, Cutolo M. speckle contrast analysis: a new method to evaluate peripheral blood perfusion in systemic sclerosis patients. Ann Rheum Dis. 2014; 73: 1181-5. . The effects of therapies on microcirculation in SSc patients represent also an important application of LASCA. The LASCA analysis of the microcirculation (image below) is a SSc patient before and after 6 days of iv vasodilation with prostacyclin.

A SSc patient before…

…and after 6 days of iv vasodilation with prostacyclin. Maurizio Cutolo (University of Genova – Italy) Barbara Ruaro (University of Genova – Italy) Vanessa Smith (University of Ghent – Belgium)

References:

  1. Ruaro B, Sulli A, Smith V, Pizzorni C, Gallo M, Cutolo M. speckle contrast analysis: a new method to evaluate peripheral blood perfusion in systemic sclerosis patients. Ann Rheum Dis. 2014; 73: 1181-5.
  2. Ruaro B, Sulli A, Pizzorni C, Paolino S, Smith V, Cutolo M. Correlations between skin blood perfusion values and nailfold capillaroscopy scores in systemic sclerosis patients. Microvasc Res. 2016;105:119-24.
  3. Ruaro B, Sulli A, Smith V, Pizzorni C, Gallo M, Cutolo M. speckle contrast analysis: a new method to evaluate peripheral blood perfusion in systemic sclerosis patients. Ann Rheum Dis. 2014; 73: 1181-5.
  4. Ruaro B, Sulli A, Pizzorni C, Paolino S, Smith V, Cutolo M. Correlations between skin blood perfusion values and nailfold capillaroscopy scores in systemic sclerosis patients. Microvasc Res. 2016;105:119-24.
  5. Trombetta AC, Pizzorni C, Ruaro B, Paolino S, Sulli A, Smith V, Cutolo M. Effects of Longterm Treatment with Bosentan and Iloprost on Nailfold Absolute Capillary Number, Fingertip Blood Perfusion, and Clinical Status in Systemic Sclerosis. J Rheumatol. 2016;43:2033-2041.
  6. Ruaro B, Paolino S, Pizzorni C, Cutolo M, Sulli A. Assessment of treatment effects on digital ulcer and blood perfusion by laser speckle contrast analysis in a patient affected by systemic sclerosis. Reumatismo. 2017;69:134-136.
  7. Ruaro B, Sulli A, Smith V, Pizzorni C, Gallo M, Cutolo M. speckle contrast analysis: a new method to evaluate peripheral blood perfusion in systemic sclerosis patients. Ann Rheum Dis. 2014; 73: 1181-5.

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