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The Use Of Thermal Imaging To Assess Peripheral Artery Disease
Khanjan Nagarsheth, MD, Eleanor Dunlap, DNP, Georges Jreij, MD.
University of Maryland School of Medicine, Baltimore, MD, USA.
Background:Peripheral arterial disease(PAD) affects over 5 million people in the United States over the age of 40 annually. Initial diagnostics involve medical history, physical exam, and ankle-brachial index (ABI). While ABI is the main diagnostic tool, overlapping comorbidities can limit its effectiveness. Cutaneous thermography, or thermal imaging of target tissue, has emerged in recent years as a hypothetical alternative imaging technique to diagnose and surveil PAD as small angiosomal temperature changes may correlate with disease severity. We hypothesized that 1)there is a correlation between surface temperature and lower extremity pressure indices and 2)thermography could be a valuable screening tool for patients with suspected PAD.
Methods:We conducted a prospective observational clinical trial involving patients with known PAD. The study enrolled 53 post-intervention subjects and 50 control subjects, all undergoing ABI examinations. Temperature measurements of the toe, medial-aspect of the foot, and lateral-aspect of the foot were obtained using Flir-ONE, an FDA-approved high-resolution thermal imaging camera(Figure-1A). The thermal ankle thumb index(TATI), calculated as the ratio of medial-foot temperature to thumb temperature, was used due to the observed correlation between medial-foot temperature and ABI. The predictive ability of TATI for mild, moderate, and severe PAD was evaluated using the area under the receiver operating characteristic curves(AUC).
Results:Fifty-three patients who underwent a lower extremity procedure had a baseline mean TATI of 0.92±0.06 °C. Correlation analysis revealed a positive relationship between ABI and TATI (r = 0.43, p=0.01) (Figure-1B). ROC curve analysis for severe arterial disease(ABI<0.5) demonstrated a strong discriminatory ability with an AUC of 0.76(Figure-1C). For moderate arterial disease(ABI 0.5-0.8), the ROC curve showed a moderate discriminatory ability with an AUC of 0.69. Similarly, the ROC curve for some arterial disease(ABI 0.8-0.9) revealed a moderate discriminatory ability with an AUC of 0.67.
Conclusions:The use of thermography for detecting vascularization, though still in its early stages, holds significant promise for future applications. A strong correlation between surface temperature and lower extremity pressure indices suggests that thermography could be developed into a valuable diagnostic tool. These findings pave the way for creating a thermography scale correlated with ABI to enhance the diagnosis of patients with PAD.
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