Application of Digital Infrared Thermographic Imaging (DITI) in the Monitoring of Change of Skin Temperature about Vascular Supply of Lower Abdominal Axial Flap in the Rabbit / 고신대학교의과대학학술지

OBJECTIVES: Monitoring viability of flap is important. The flap survival depends on the vascularity of the flap, on which the skin temperature depends. The authors applied digital infrared thermographic imaging (DITI) for monitoring the vascular supply of the flap and for the prediction of the prognosis of the flap survival. METHODS: Eight male New Zealand white rabbits with average weight of 3kg were used. A 10 x 10 cm unipedicled fasciocutaneous island flap was elevated based on the left superficial inferior epigastric vessel. The surface temperatures on designed flap were checked with DITI for 24 hours after the operation. On 14th day after the operation, the surviving area was measured and compared with DITI image which was taken on 24 hours after the operation using digital analysis software ImageJ. Statistical analysis was evaluated by paired T-test. RESULTS: On DITI image 24 hours after the flap elevation, distal portion of the flap showed remarkable color change. The average percentage and the standard deviation of the survival area of the flap which is predicted by DITI and the average percentage and the standard deviation of the survival area of the flap which was actually measured 2 weeks after flap elevation were 55.3 (16.6), 56.2 (18.0), respectively. This shows no significant difference between the two. CONCLUSIONS: This study shows that DITI system could be used in evaluation of flap vascularity with ease, quickness and safety for patient and flap. Thus, it could be used clinically for the prediction of flap survival.

Is the use of Digital Infrared Thermal Imaging Useful in Whiplash Injury?

OBJECTIVE: The name of whiplash Injury derives from the etiopathogenic description of the sudden sharp whipping movement of the head and neck, symptoms are varied, manifesting as neck pain, occipital pain, dysesthesia, and weakness of arm, and so on. But there is no objective diagnostic tool for the evaluation of its symptoms. The purpose of the study is to visualize the symptomatic region before and after treatment and comparing the images obtained by infrared study. METHODS: From march 2006 to June 2008, 20 patients diagnosed as whiplash injuries were examined by digital infrared thermographic imaging system (DITI, DOREX, USA). The male-to-female ratio was 14:6 and their ages were ranging in age from 20 to 67 years, with mean age of 38.5 years. We evaluated thermal change (deltaT) in lesion area(neck and shoulder) and also compared thermal difference (deltaT (2wk-I)) after pre- & post- treatment. RESULTS: Initial DITI was 34.28 +/- 2.90 on anterior neck, 34.29 +/- 2.98 on posterior neck, 33.42 +/- 2.93 on right shoulder shoulder (Lt), and 33.59 +/- 2.81 on left shoulder. DITI after 2weeks treatment was 33.60 +/- 2.88 on anterior neck, 33.78 +/- 2.99 on posterior neck, 32.79 +/- 2.78 on right shoulder, and 33.05 +/- 2.74 on left shoulder. The thermal difference of lesional area on the initial treatment and after treatment (deltaT (2wk-I)) was 0.68 +/- 0.45 on anterior neck, 0.51 +/- 0.36 on posterior neck, 0.63 +/- 0.32 on right shoulder, and 0.54 +/- 0.64 on left shoulder, and these result were statistically significant (p < 0.05). Thermal difference (deltaT) was neck 0.34 and shoulder 0.33 on initial injury, and 0.39, 0.31 after 2 weeks respectively. This finding was symmetrical and below deltaT 0.5 based on pathologic body temperature. Initial VAS (Visual Analogue Scale) of Neck was 7.9 +/- 0.78 and after 2 weeks was 3.6 +/- 1.21 the initial VAS of shoulder was 7.4 +/- 0.52 and after 2 weeks was 3.2 +/- 0.97. There was statistically significant (p=0.001). CONCLUSION: Therefore DITI was perceived as a reliable tool in the objective assessment of treatment effect after sustaining whiplash injuries, in clinical practice.

Multi-access for the Diagnosis of Missed Upper Lumbar Disc Herniation

Herein, a case of missed upper lumbar disc herniation, diagnosed by thorough neurological examination, digital infrared thermographic imaging(DITI), and repeated magnetic resonance(MR) image study, is reported. A 36-year-old female presented with intractable leg pain on left anterior thigh. Although she underwent lumbar MR image at other hospital, she was misdiagnosed as acute sprain. Neurological examination suggested the possibility of upper lumbar disc herniation, which was confirmed by DITI, MRI, and selective root block. After operation, her leg pain was significantly improved. It should be considered that upper lumbar disc herniation might be misdiagnosed as an acute sprain, as in our case. A high index of suspicion based on thorough neurological examination is most important in such cases. Then, multi-access such as DITI, MR image, and selective block, base on thorough neurological examination, are warranted.

Relationship between digital infrared thermographic imaging findings and status of the joint on magnetic resonance imaging in temporomandibular disorders

Assessment of inferior alveolar nerve damage using digital infrared thermographic imaging

Oral and Maxillofacial surgery can lead to complications that result in abnormal sensation or movement. Inferior alveolar nerve(IAN) injury can result in dysesthesia, paresthsia of the lower lip and chin, so patients presenting with IAN damage suffer from sensory loss. But diagnosis of the nerve injury is largely limited to the subjective statements made by the patient. Distribution of sympathetic nerves parallels the distribution of the somatosensory nerves. Loss of sensory tone causes a concomitant loss of sympathetic activity, resulting in vasodilation of the cutaneous blood vessels that demonstrates greater heat loss. Digital infrared thermographic imaging(DITI) detects infra-red radiation given off by body. DITI can detect minute difference in temperature from different parts of the body and translates the amount of heat into quantitative data. The area of different temperature correlated with pain or disease can be visualized by corresponding color. The objective of this study was to determine the efficacy of DITI in objectively assessing IAN injury. The 19 normal subjects and the 14 patients underwent DITI scan. The normal subjects received unilateral IAN block anesthesia with 2 ml of 2% lidocaine (IAN bolck group) to evaluate temporary alteration in nerve function. Patient group were patients with unilateral IAN damage (dysesthesia or paresthesia) after surgical treatment(Mn. 3rd molar Extraction, etc.). The surgical procedure performed within 6 months of test. The results were as follows. 1. No significant differences in temperature were found between left and right sides of the lower lip and chin in the control group. 2. Significant temperature differences were found between the anesthetized and non-anesthetized sides of the lower lip and chin in the IAN block group. 3. Significant temperature differences were found between the involved and uninvolved sides of the lower lip and chin areas of the experimental group. The results of the study show that DITI can be an useful and effective means of objectively assessing and visualizing IAN damage.

Application of Digital Infrared Thermographic Imaging(DITI) to the Evaluation of Blood Supply of Lower Abdominal Flap in Rabbit

The monitoring method of the flap for detecting the compromise of vascular circulation has been developed in order to prevent flap loss in the microsurgery. The ideal flap monitor for the flaps would show the vascularity and circulation state of the flap, any time, any place easily. The concept that the skin temperature is up to the vascularity under the skin, rendered to apply IR(infrared) thermometer as quantitative analysis and IRIS-2000 (digital infrared thermographic imaging: DITI) as geographic analysis to the several kinds of flap in 15 New Zealand white rabbits. The IR thermometer showed that the nearer to the pedicle, the higher temperature quantitatively. The DITI scan showed to us like below. The nearer to the pedicle, the higher temperature color in DITI scan image. The DITI scan image of myocutaneous flap had higher temperature color than that of fasciocutaneous flap. In case of cut down of one side vascular pedicle, the DITI scan image of the pedicle-cut-down side showed lower temperature color than the opposite side. So, the better blood supply in the area of the flap, the higher temperature as color image in DITI scan. We supposed that the DITI would help to estimate the circulation of the flap as its color image, based on skin temperature.

Diagnostic Efficacy of Digital Infrared Thermographic Imaging in Carpal Tunnel Syndrome

OBJECTIVE: Electromyography(EMG) has been very helpful in establishing the diagnosis of carpal tunnel syndrome(CTS). But invasive procedure of EMG makes patients discomfort, who are suffering from consistent numbness. The authors investigate the diagnostic efficacy of Digital Infrared Thermographic Imaging(DITI) in CTS by comparing thermal changes between normal control group and patients group. METHODS: Among 31 patients who had operated due to CTS from march 1984 to February 2002 at the Spine Center, both EMG & DITI were used for diagnostic method in 24 patients. Authors have measured thermal differences(deltaT, degrees C) of symptomatic site between forearm and palm in 20 patients, and 30 normal controls. Authors have analyzed thermal differences(deltaT, degrees C) statistically using T-test. RESULTS: Average thermal difference(deltaT, degrees C) in symptomatic site was statistically higher than that of normal control group. Average thermal difference(deltaT, degrees C) is+0.984+/-0.342 degrees C in symptomatic site, +0.323+/-0.296 degrees C in normal control group, respectively. Significant thermal difference(deltaT, degrees C) was seen between two groups(p<0.005). Average thermal difference(deltaT, degrees C) in CT S was statistically higher than normal group, significantly. Average thermal difference(deltaT, degrees C) greater than 1 degrees C can be suspicious of CTS. CONCLUSION: Diagnostic usefulness of DITI in CTS is very high especially for the screening purpose.

Low Back Pain Assessment Using Surface Electromyography and Digital Infrared Thermographic Imaging / 대한산업의학회지

OBJECTIVES: We studied the efficacy of surface electromyography(SEMG) and digital infrared thermographic imaging(DITI) in the assessment of low back pain both(LBP) quantitatively and qualitatively. METHODS: We compared electromygraphic signals from electrodes placed in the lumbar area and the digital thermographic images in 16 LBP patients and 16 control subjects. The LBP patients and the control subjects were matched for age, gender, and body mass index(BMI) to adjust for any confounding effects RESULTS: In the static analyses of SEMG, median value was 198.1 microV for the LBP patients and 161.3 microV for the controls on the right side, and they were 194.2 microV and 180.5 microV on left side respectively. There was a statistically significant difference between the two groups on the right side(p<0.01), but not on the left side. In the dynamic analyses of the SEMG, the median values of the extension per flexion ratio of right side were 1.12 for LBP patients and 1.39 for controls. and those on the left side were 1.08 and 1.21 respectively. There were statistically significant differences in both sides(p<0.05). The sensitivity and specificity were 100% and 81.3% in DITI, 78.6% and 72.2% in SEMG . CONCLUSIONS: These results indicate that SEMG and DITI are useful methods for indirect assessments of LBP, and that DITI is more sensitive and specific than SEMG.

Retrospective Outcome Evaluation of Cervical Chemonucleolysis with Digital Infrared Thermographic Imaging

The diagnostic efficacy and comparability of digital infrared thermographic imaging(DITI), computerized tomographic(CT) scan and magnetic resonance imaging(MRI) in the assessment of outcome of chemonucleolysis for herniated soft cervical disc patients with ce rvicobrachial neuralgia were evaluated. Forty seven patients of herniated cervical discs who were treated with nucleolysis using chymopapain for last 2 years were assessed by each studying modality and clinical examinations. All the cases received DITI, CT scan and/ or MRI, and the thermal difference of each patient between symptomatic and asymptomatic limb was analyzed pre- and post-operatively. The diagnostic efficacy of each technology was similar, and inter-rater comparability did not differ significantly. DITI showed significantly good correlation with clinical outcome although there existed a considerable inaccuracy in assessing individual subjects. Digital infrared thermographic imaging was shown to be very useful method in the outcome evaluation of cervical chemonucleolysis.

Reflex Sympathetic Dystrophy in Cervical Cord Injured Patients

OBJECTIVE: Reflex sympathetic dystrophy (RSD) is a syndrome of post-traumatic neuropathic pain in association with dystrophic changes and signs of sympathetic overactivity. Pain following spinal cord injury occurs frequently, but RSD is not usually considered as one of the common sources of pain. There have only been a few reports of RSD in spinal cord injured patients, although this condition is well-known in the painful upper extremity of hemiplegia due to stroke. The purpose of this study was to investigate the rate of occurrence, characteristic clinical features and more objective evaluation tools for the diagnosis of RSD in cervical cord injured patients. METHOD: Thirty-two cervical cord injured patients were evaluated for hand pain, swelling, vasomotor changes and dystrophic skin or nail changes. The patients were evaluated with studies such as three phase bone scintigrathy, digital infrared thermographic imaging (DITI) and plain roentgenograms of the hands. RESULTS: Eighteen patients (56.3%) were diagnosed as RSD based on the clinical symptoms and findings of three phase bone scintigraphy. Characteristic symptoms were hand pain, edema and dystrophic skin or nail changes, in the order of frequency. In patients with spasticity of the upper extremity, the incidence of RSD was higher than in patients without spasticity. CONCLUSION: We should consider RSD as a cause of upper extremity pain in cervical cord injured patients. This will lead to early diagnosis and treatment of the condition and it will be helpful in preventing various complications.

Clinical Application of Digital Infrared Thermographic Imaging for the Prediction of Foot Ulcer Development in Diabetic Patients

OBJECTIVE: To investigate the regional differences of skin blood flow and to evaluate the effects of foot temperature on the severity of neuropathic pain and to predict the development of plantar foot ulceration by measuring of the temperature variations on the plantar surface of feet in the diabetic patients. METHOD: We measured the temperature variations on plantar surface of the feet in controls (n=18) and diabetic patients with(n=20) or without(n=23) polyneuropathy. The surface temperature from the 3rd metatarsal head(MTH), greater toe(GT), heel, medial and lateral longitudinal arch(LA) was measured by Digital Infrared Thermographic Imaging(DITI). RESULTS: The mean foot temperature of diabetic patients with polyneuropathy was significantly increased compared to controls or diabetic patients without polyneuropathy(p<0.001). The surface temperature readings of the GT, medial LA and the 3rd MTH tended to be increased in controls and patients with polyneuropathy. The mean plantar surface temperature was significantly increased according to the duration of diabetes mellitus(DM)(p<0.05). CONCLUSION: The results suggest that DITI provides a diagnostic modality in the prediction of neuropathic foot and increased risks of foot ulcer development in the diabetic patients.

Clinical Efficacy of Digital Infrared Thermographic Imaging in Multiple Lumbar Disc Herniations

Localization of the specific symptomatic level in multiple lumbar disc herniations is very important in the decision of surgical levels and operative method and is also one of the rate limiting factor for the successful postoperative results. Until now pain provocation test with discography is known as the unique functional and physiological method to localize the symptomatic level of disc herniation. But it is an invasive study and there is still an ongoing argument about discography for their diagnostic accuracy and specificity. Digital infrared thermographic imaging technique is a non-invasive technique to detect the discogenic pain with high accuracy. Authors evaluated the diagnostic efficacy of digital infrared thermographic imaging in 202 cases of multiple lumbar disc herniations by analysis of symptom correlation and the accuracy with operative findings. And also the correlation of digital infrared thermographic imaging technique with discography was analyzed. The digital infrared thermographic imaging technique showed high sensitivity(86.4%) to the clinical symptom and good correlation with the operative findings. It also revealed high correlation rate(81.4%) with discography. As a conclusion, digital infrared thermographic imaging technique is a highly effective diagnostic tool in the localization of the symptomatic level in multiple disc herniations.

The New Diagnostic Method for Hyperhidrosis: Digital Infrared Thermographic Imaging

Essential palmar hyperhidrosis is a disease characterized by excessive sweating on palms and hands due to hyperaction of sympathetic nervous discharge. It develops severe hypothermia on both hands because of loss of surface heat by evaporation of the sweating. Numerous tests including starch-iodine test were used to detect sweating status. But they were complicated and unpleasant to patients. Digital infrared Thermographic Imaging(DITI) can show a thermal difference very clearly. We have used DITI not only for the diagnosis, but for planning of the operation and operative follow up of the disease since 1990. 343 cases of bilateral upper thoracic(T2 & T3) sympathetic ganglionectomy were performed from Mar. 1989 to Dec. 1996 in our spine center. Among them, open surgery with posterior midline approach were initially carried out in 54 cases and recently percutaneous endoscopic sympathectomy were carried out in 289 additional cases. Digital Infrared Thermographic Imaging has been taken pre and postoperatively in 339 cases. Preoperatively, severe hypothermia is noted in 96.2% in both hands and feet. Immediately after operation, the sweating ceased in all cases and marked hyperthermia was noted in both hands compared to preoperative status due to sympathetic denervation. DITI is more accurate and easier than any other method for diagnosis and evaluation of treatment effect in hyperhidrosis. DITI is simple, accurate, comfortable and objective diagnostic tool for hyperhidrosis patient.

Thermatomes of the Lumbosacral Nerve Roots

Thermography shows the skin temperature changes in various conditions of the body. The skin temperature varies according to subcutaneous blood flow under the control of autonomic nervous system. Lumbar radiculopathy due to disc hernation makes difference in the temperature of lower extremities caused by the changes in general functions and autonomic functions of the nerve root. Digital infrared thermographic imaging(DITI) system has been used to diagnose radiculopathy without any hazards or discomforts and shows the pain due to LDH by objective change of temperature. This study has used DITIs of 55 control cases and 217 cases of LDH patients and analysed it statistically. In the room the temperature stable at 20 degrees C, the temperature distribution of the lower extremities of the control cases ranged from 24.9 degrees C to 29.9 degrees C. The significant minimal temperature difference between right and left lower extremities range from 0.1 degrees C to 0.4 degrees C. The more distal, the greater the temperature difference was. The thermatome of L4, L5 and S1 was drawn in radiating type and spot type. The thermatome showed larger area than the sensory dermatome and sympathetic dermatome. There was significant increase or decrease of temperature in thermatome in LDH patients. In conclusion, preoperative DITI of the LDH patient can be helpful for diagnosing the level of LDH and the areas of pain.

Comparison of sympathetic skin response and digital infrared thermographic imaging in peripheral neuropathy

It is well known that the SSR (sympathetic skin response) is to evaluate the function of sudomotor activity and Digital infrared thermal imaging (DITI) is to evaluate the function of vasomotor activity of the sympathetic nerve. To assess the sympathetic nerve impairment in the patients with peripheral neuropathy, the SSRs and DITIs were tested in 35 cases. Twenty-four (68.6%) patients were abnormal on SSR test and twenty-nine (82.9%) patients were abnormal on DITI test. In the relationship between DITI and SSR, 19 (54.3%) cases were abnormal and 1 case was normal finding in both of these two tests. And the remaining 25 (42.9%) patients were abnormal on only either one of both tests. Frequency of abnormal SSR and DITI findings were correlated with severity of axonal involvement in peripheral nerve lesion. The results of this study revealed DITI to be more sensitive test in assessing sympathetic dysfunction in peripheral neuropathy than the SSR. However DITI has very limited values in the patients with symmetrically involved peripheral neuropathy because thermal asymmetry is considered as abnormal on DITI. Therefore, in assessing the function of sympathetic nerve in peripheral neuropathy, combined tests of SSR and DITI are useful.

Postoperative Evaluation of Lumbar Disc Herniation Using Digital Infrared Thermographic Imaging

Digital infrared thermographic imaging system is noninvasive, easy to reading, objective and physiologic instrument by measuring and imaging infrared energy emitted from skin surface. The authors present the result of digital infrared thermographic images of 83 patients of operated lumbar disc herniation from October, 1990 to March, 1991. 46 patients have received discectomy and the other 37 patients have received chemonucleolysis. We have done digital infrared thermographic imaging preoperatively and postoperatively. In preoperative digital infrared thermographic imaging, diagnostic sensitivity is about 76%, In postoperative digital infrared thermographic imaging, clinical results were well correlated in discectomy group. But in chemonucleolysis group, clinical results were not correlated with digital infrared thermographic images.