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Abstract Number: 850

A Multicentre Reliability Study of Laser Speckle Contrast Imaging and Thermography in Patients with Raynaud’s Phenomenon Secondary to Systemic Sclerosis

Andrea Murray1, Joanne Manning2, Tonia Moore3,4, Jack Wilkinson5, Elizabeth J. Marjanovic6, Sarah Leggett7, Chris Roberts8, John Allen9, Jason Britton10, Maya H. Buch11, Francesco Del Galdo12, Christopher Denton13, Tracey Drayton14, Anita Furlong14, Bridget Griffiths15, Frances Hall16, Darren Hart17, Kevin Howell18, Audrey MacDonald19, Neil J. McHugh20, John D. Pauling21, Jacqueline Shipley22 and Ariane L. Herrick23, 1University of Manchester, Salford Royal Hospital, Salford, United Kingdom, 2Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, United Kingdom, 3Salford Royal Hospital NHS Foundation Trust, Salford, United Kingdom, 4Centre for Musculoskeletal Research, University of Manchester, MAHSC, Salford Royal Hospital, Salford, United Kingdom, 5Research and Development, Salford Royal NHS Foundation Trust, Salford, United Kingdom, 6Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom, 7Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, United Kingdom, 8Centre for Biostatistics, The University of Manchester, Manchester, United Kingdom, 9Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom, 10Medical Physics Department, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom, 11NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds, United Kingdom, 12Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom, 13Division of Medicine, Centre for Rheumatology and Connective Tissue Disease, University College London, London, United Kingdom, 14Addenbrookes Hospital, Cambridge, United Kingdom, 15Rheumatology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom, 16School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom, 17Clinical Measurement Department, Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom, 18Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, United Kingdom, 19The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom, 20Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom, 21Upper Borough Walls, Royal National Hospital for Rheumatic Disease, Bath, United Kingdom, 22Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom, 23Centre for Musculoskeletal Research, University of Manchester, MAHSC, Salford Royal Hospital, Manchester, United Kingdom

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Imaging techniques and systemic sclerosis

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Session Information

Date: Sunday, November 13, 2016

Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud's – Clinical Aspects and Therapeutics - Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Effective treatments for systemic sclerosis (SSc) related Raynaud’s phenomenon (RP) are badly needed but clinical trials have been hampered by the lack of objective outcome measures. Laser speckle contrast imaging (LSCI) and thermography are two non-invasive measures of blood flow that show excellent potential but require further investigation to prove their suitability as outcome measures in multi-centre clinical trials. The main aim of this multi-centre study was to determine the validity and reliability of LSCI and thermography. This abstract reports the first step in a more comprehensive analysis; the repeatability of the techniques as assessed by a local assessor at each site.

Methods: 158 patients with RP secondary to SSc were recruited from 6 specialist SSc centres in the UK. Patients attended their local centre on 2 consecutive days. They underwent a cold challenge; 15oC water submersion of gloved hands for 1 minute, then un-gloved reperfusion and rewarming at 23oC room temperature. Baseline and changes in blood flow and temperature over 15 minutes post challenge were imaged simultaneously using LSCI (relative perfusion) and thermography (skin temperature, an indirect measure of perfusion), respectively. Parameters for both perfusion and temperature were calculated locally and data analysis was performed centrally. The distal dorsal differences (DDD) of each hand were calculated from baseline images. The area under curve (AUC), maximum value (MAX), and gradient (GRAD) in first two minutes were calculated from the post challenge data of the fingers. Data were averaged across 8 digits for each patient to obtain a single measurement for each parameter for each technique at both visits. Test-retest reliability was assessed using intra-class correlation coefficients (ICC) using linear mixed models (R version 3.2.3) where an ICC of 0.60 is regarded as substantial reliability (Landis and Koch 1977).

Results: Median age was 63.3 years (IQR 53.8–69.8), 84% were female, median SSc symptom duration was 9.6 years (IQR 4.5 – 17.4), and 77% had limited cutaneous SSc. Both techniques had substantial reliability for AUC.  Thermography reliability across all parameters varied from moderate to strong (GRAD 0.56 to MAX 0.72) and LSCI varied from moderate to substantial (GRAD 0.46 to AUC 0.67) (table 1). Reliability of the two techniques has higher overall ICCs for thermography, suggesting marginally greater reliability of thermography in this sample.

Conclusion: This is the first multi-centre study examining reliability of LSCI and thermography in patients with RP secondary to SSc, and these are the preliminary findings from local analysis. The results and analysis are encouraging, overall, LSCI and thermography demonstrated moderate to strong reliability (and therefore good potential as outcome measures of digital vasculopathy), although thermography appears to be marginally superior to LSCI. Table 1. ICCs (Logged for non-normality where necessary) for summary measures of response to cold challenge under LSCI and thermography.

ICCs LSCI

Thermography                                         

Difference (LSCI-     Thermography)

AUC

0.67 (0.54 to 0.76)

0.68 (0.58 to 0.80)

-0.01 (-0.17 to 0.11)

DDD

0.67(0.56 to 0.76)

0.66 (0.56 to 0.76)

0.01 (-0.12 to 0.11)

MAX

0.64 (0.52 to 0.75)

0.72 (0.64 to 0.81)

-0.09 (-0.21 to 0.03)

GRAD

0.46 (0.40 to 0.69)

0.56 (0.40 to 0.74)

-0.09 (-0.24 to 0.18)


Disclosure: A. Murray, None; J. Manning, None; T. Moore, None; J. Wilkinson, None; E. J. Marjanovic, None; S. Leggett, None; C. Roberts, None; J. Allen, None; J. Britton, None; M. H. Buch, None; F. Del Galdo, None; C. Denton, GSK, Celgene, Actelion, Bayer, Sanofi, Roche-Genentech, Inventiva, 5,CSL Behring, GSK, Actelion, Roche-Genentech, Inventiva, 2; T. Drayton, None; A. Furlong, None; B. Griffiths, None; F. Hall, None; D. Hart, None; K. Howell, None; A. MacDonald, None; N. J. McHugh, None; J. D. Pauling, None; J. Shipley, None; A. L. Herrick, None.

To cite this abstract in AMA style:

Murray A, Manning J, Moore T, Wilkinson J, Marjanovic EJ, Leggett S, Roberts C, Allen J, Britton J, Buch MH, Del Galdo F, Denton C, Drayton T, Furlong A, Griffiths B, Hall F, Hart D, Howell K, MacDonald A, McHugh NJ, Pauling JD, Shipley J, Herrick AL. A Multicentre Reliability Study of Laser Speckle Contrast Imaging and Thermography in Patients with Raynaud’s Phenomenon Secondary to Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/a-multicentre-reliability-study-of-laser-speckle-contrast-imaging-and-thermography-in-patients-with-raynauds-phenomenon-secondary-to-systemic-sclerosis/. Accessed .
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