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Objectives: Systemic sclerosis (SSc) causes functional and structural microcirculatory dysfunction, affecting also distal extremities. Optical Near-InfraRed Spectroscopy (NIRS) of blood HbO 2 saturation (stO 2 ) is able to evaluate O 2 delivery/consumption balance in the explored tissue. The NIRS-sensitive camera non-invasively detects stO 2 values in superficial tissues, automatically generating 2D-imaging maps in real time. We aimed at testing whether NIRS hand imaging may evaluate peripheral microcirculatory dysfunction and its spatial heterogeneity in SSc patients compared to controls., Methods: Forty SSc patients (aged 55.1 ± 15.6 years) and twenty-one healthy controls (aged 54.3 ± 14.5years, p = 0.89) were studied by palmar hand NIRS-2D imaging. A blood pressure cuff was applied to the forearm and 3 min ischemia was induced. Images were acquired at basal conditions and every 10 seconds during 3 minutes of ischemia and 5 minutes of reperfusion. Five regions of interest were positioned on each fingertip, from the second to the fifth finger and one on the thenar eminence., Results: A significant difference was found between controls and SSc patients in basal stO 2 (84.3 ± 7.5 vs. 75.4 ± 10.9%, p < 0.001), minimum stO 2 (65.2 ± 8.0 vs. 53.4 ± 10.1%, p < 0.001) and time to maximum stO 2 during hyperemia (63 ± 38 vs. 85 ± 49 s, p < 0.05). Among clinical characteristics, anti-Scl70 antibody positivity, digital ulcers history and smoke exposure affected NIRS parameters, as well as sildenafil and statins therapy. Conversely, no significant differences were found in NIRS-2D values between different nailfold-videocapillaroscopy patterns., Conclusion: NIRS-2D imaging is a simple, automated tool to non-invasively detect regional microcirculatory impairment in SSc, which seems to add significant functional information to the morphological picture of nailfold-videocapillaroscopy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background and Objective: Patients affected by systemic sclerosis (SSc) develop functional and structural microcirculatory dysfunction, which progressively evolves towards systemic tissue fibrosis (sclerosis). Disease initially affects distal extremities, which become preferential sites of diagnostic scrutiny. This pilot investigation tested the hypothesis that peripheral microcirculatory dysfunction in SSc could be non-invasively assessed by 2D Near Infrared Spectroscopic (NIRS) imaging of the hand associated with Vascular Occlusion Testing (VOT). NIRS allows measurement of hemoglobin oxygen saturation (StO 2 ) in the blood perfusing the volume tissue under scrutiny., Methods: In five normal volunteers and five SSc patients we applied a multispectral oximetry imaging device (Kent camera, Kent Imaging, Calgary, Canada) to acquire StO 2 2D maps of the whole hand palm during baseline, ischemia and reperfusion phase., Results: We found significant differences between controls and SSc patients in basal StO 2 (82.80 ± 2.51 vs 65.44 ± 7.96%, p = 0.0016), minimum StO 2 (59.35 ± 4.29 vs 40.73 ± 6.47%, p = 0.0007), final StO 2 (83.83 ± 4.09 vs 68.84 ± 11.41%, p = 0.02) and time to maximum StO 2 (40 ± 12.25 vs 62 ± 4.47 s, p = 0.005)., Conclusions: This is, to our knowledge, the first application of 2D NIRS imaging of the whole hand to the investigation of microvascular dysfunction in systemic sclerosis. The image processing presented here considered the StO 2 in the entire hand allowing a comprehensive view of the spatial heterogeneity of microvascular dysfunction., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: A high percentage of patients with systemic sclerosis (SSc) develop interstitial lung disease (ILD) during the course of the disease. Promising data have recently shown that lung ultrasound (LUS) is able to detect ILD by the evaluation of B-lines (previously called ultrasound lung comets), the sonographic marker of pulmonary interstitial syndrome., Objective: To evaluate whether LUS is reliable in the screening of ILD in patients with SSc., Methods: Fifty-eight consecutive patients with SSc (54 women, mean age 51±14 years) who underwent a high resolution CT (HRCT) scan of the chest were also evaluated by LUS for detection of B-lines. Of these, 32 patients (29 women, mean age 51±15 years) fulfilled the criteria for a diagnosis of very early SSc., Results: At HRCT, ILD was detected in 88% of the SSc population and in 41% of the very early SSc population. A significant difference in the number of B-lines was found in patients with and without ILD on HRCT (57±53 vs 9±9; p<0.0001), with a concordance rate of 83%. All discordant cases were false positive at LUS, providing a sensitivity and negative predictive value of 100% in both SSc and very early SSc., Conclusions: ILD may be detected in patients with very early SSc. The presence of B-lines at LUS examination correlates with ILD at HRCT. LUS is very sensitive for detecting ILD even in patients with a diagnosis of very early SSc. The use of LUS as a screening tool for ILD may be feasible to guide further investigation with HRCT.