ReviewIs laser speckle contrast analysis (LASCA) the new kid on the block in systemic sclerosis? A systematic literature review and pilot study to evaluate reliability of LASCA to measure peripheral blood perfusion in scleroderma patients
Introduction
The microcirculation is majorly involved in systemic sclerosis (SSc), making the assessment of microvascular alterations a key issue in SSc clinical research [[1], [2], [3], [4]]. Nailfold videocapillaroscopy (NVC) is a valuable tool to detect and classify morphological microvascular alterations [5, 6]. Since last century, NVC has been recognized as an important tool in the diagnosis of SSc and has therefore been incorporated in the 2013 American College of Rheumatology/European League Against Rheumatism (2013 ACR/EULAR) classification criteria [7]. A putative role as biomarker has also been postulated [[8], [9], [10], [11]]. Nowadays, eyes of the SSc community and EULAR Study Group on microcirculation in Rheumatic diseases are geared towards finding a tool which can dynamically evaluate the blood flow in the microcirculation. Such a tool would be handy in several ways. One example, it could be used in clinical trials to evaluate the flow under treatment with vasodilating treatment [12]. Laser speckle contrast analysis (LASCA), has been proposed as an objective non-invasive imaging technique to dynamically evaluate the peripheral blood perfusion (PBP) [[13], [14], [15], [16], [17]]. In comparison to other non-invasive tools used to dynamically evaluate the microcirculation in SSc, i.e. infrared thermography (IRT) and laser doppler techniques (laser doppler imaging [LDI] and laser doppler flowmetry [LDF]), LASCA is a more practicable laser tool as it allows the assessment and quantification of the PBP with a higher spatial and temporal resolution (over a given area in real time).
The first objective of this study was to systematically identify and review the available literature on the reliability of LASCA in SSc. The second objective was to additionally perform a pilot study to first investigate intra-rater and inter-rater reliability in an unselected SSc cohort and to externally validate the results.
Section snippets
Data source and search strategy
A systematic search according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was performed in Pubmed, EMBASE and Web of Science to identify relevant full-text manuscripts that document the use of LASCA in SSc patients [18]. The search of articles was performed using following keywords: ‘systemic sclerosis’, ‘laser speckle contrast’, ‘laser speckle contrast analysis’, ‘laser speckle contrast imaging’, ‘LSCI’ and ‘LASCA’ without limitation of date of
Selection of studies
Fig. 1 depicts the flowchart of the systematic review process. The systematic search rendered 16 references in PubMed, 60 in EMBASE and 43 in Web of Science. After removal of duplicates (n = 45), 74 unique records were screened on title and abstract level. Thirteen full-text articles were reviewed to finally identify only 1 manuscript that documented the reliability of LASCA in SSc patients as a primary outcome. From the additional record yielded through manual search (n = 1), none could be
Discussion
A reliable tool to evaluate flow is paramount in systemic sclerosis. This is the first systematic literature review investigating evidence for the reliability of LASCA in the dynamic evaluation of the microcirculation in SSc patients. Only 1 reliability study, which reported good to excellent inter-rater agreement, could be identified through a systematic literature search performed in 3 electronic databases and an additional manual search of reference lists. To date, no extensive intra-rater
Conclusions
In conclusion, LASCA may be the new kid on the block in SSc as current literature suggests reliable measurements of blood flow in SSc.
Statement of author contribution
Maurizio Cutolo:
Substantial contributions to the design of the study, interpretation and analysis of data, critical revision of the article's intellectual content, final approval of the version to be published.
Amber Vanhaecke:
Substantial contributions to the design of the study, acquisition of data, interpretation and analysis of data, drafting of the article, critical revision of the article's intellectual content, final approval of the version to be published.
Barbara Ruaro:
Interpretation of
Statement of conflict of interest
Maurizio Cutolo: no conflicts of interest to declare
Amber Vanhaecke: no conflicts of interest to declare
Barbara Ruaro: no conflicts of interest to declare
Ellen Deschepper: no conflicts of interest to declare
Claudia Ickinger: no conflicts of interest to declare
Karin Melsens: no conflicts of interest to declare
Yves Piette: no conflicts of interest to declare
Amelia Chiara Trombetta: no conflicts of interest to declare
Filip De Keyser: no conflicts of interest to declare
Vanessa Smith: V. Smith is
Acknowledgements
We are grateful to all the participants and the EULAR Study Group on Microcirculation in Rheumatic Diseases for making this study possible.
A special thanks goes to Melissa De Decker for her dedication in coordinating daily the logistics of the multidisciplinary care in our Ghent University Scleroderma Unit (GUSU) and to Liselotte Deroo for her help in collection of data.
Funding statement
This work was supported by a research grant of the Research Foundation - Flanders (Belgium) (Fond Wetenschappelijk Onderzoek [FWO]) [1.5.217.13 N] to V. Smith, who is a Senior Clinical Investigator of the Research Foundation - Flanders (Belgium) (FWO) [1.8.029.15 N]. The FWO had no involvement in study design, collection, analysis and interpretation of data, writing of the report, nor in the decision to submit the article for publication.
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2020, Annals of Vascular SurgeryCitation Excerpt :Applying it on the surface of the affected area can therefore provide an evaluation of the microcirculation with high temporal and spatial resolution.13 Currently, this technique has found a broad consensus as a useful tool for evaluating tissue perfusion in many diverse clinical settings,14–16 motivating our use in the analysis of TCOT-induced modifications in ulcer perfusion, comparing them with the subjects’ healthy skin. Patients were enrolled between November 2016 and October 2017.
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Maurizio Cutolo and Amber Vanhaecke equally contributed to this study.