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Updated: Dec 21, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Hyperspectral Imaging (HSI) in Acute Mesenteric Ischemia to Detect Intestinal Perfusion Deficits
Matthias Mehdorn1, Hannes Köhler2, Sebastian Murad Rabe1
1Department of Visceral-, Transplantation-, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.
Background:
Acute mesenteric ischemia is a life-threatening acute condition, which requires an interdisciplinary approach, including vascular recanalization and surgical treatment. Visual evaluation of intestinal perfusion might be misleading, and therefore, additional tools are necessary to reliably be able to resect the ischemic intestine. Hyperspectral imaging (HSI) has been shown to be feasible and safe for real-time assessment of tissue perfusion in visceral surgery but has never been used in cases of acute mesenteric ischemia. Therefore, we applied HSI in acute mesenteric ischemia to evaluate it for potential aid in the objectively discriminating ischemic and well-perfused intestine during explorative laparotomy.
Methods:
We recorded HSI measurements in 11 cases of acute mesenteric ischemia during explorative laparotomy. We evaluated the recorded images for macroscopic visual perfusion quality and divided it into three groups. Of those three groups, we calculated and compared the HSI indexes of tissue saturation, near-infrared perfusion index, organ hemoglobin index, and tissue water index, as well as the reflectance spectra.
Results:
We found significant differences in tissue saturation (0.7% versus 0.45%; P = 0.002) and near-infrared perfusion index (0.58 versus 0.23; P < 0.001) in poorly perfused intestinal segments compared with the viable intestine. Furthermore, we could detect an increasing peak at 630 nm of the reflectance spectra in less viable tissues, indicating a maximum in necrotic tissues. We attributed this peak to an increase in met-hemoglobin content in necrotic tissues, which is supported by the increase in the HSI organ hemoglobin index.
Conclusions:
HSI is able to discriminate tissue perfusion in acute mesenteric ischemia reliably and therefore might be helpful for resection. In addition, HSI gives information on tissue viability via reflectance spectra.
Insights
Hyperspectral imaging (HSI) reliably distinguishes between ischemic and healthy intestine in acute mesenteric ischemia. This technology aids surgeons in determining tissue viability and guiding resection decisions during surgery.
Area of Science:
- Surgical Innovation
- Medical Imaging Technology
- Gastrointestinal Surgery
Background:
- Acute mesenteric ischemia is a critical surgical emergency requiring accurate assessment of intestinal perfusion.
- Traditional visual evaluation of intestinal perfusion can be unreliable, necessitating advanced diagnostic tools.
- Hyperspectral imaging (HSI) has shown promise in real-time tissue perfusion assessment but its utility in acute mesenteric ischemia was unexplored.
Purpose of the Study:
- To investigate the application of hyperspectral imaging (HSI) in cases of acute mesenteric ischemia.
- To evaluate HSI's capability in objectively differentiating between ischemic and well-perfused intestinal tissue during surgery.
- To assess HSI's potential as an aid for guiding intestinal resection in acute mesenteric ischemia.
Main Methods:
- HSI measurements were acquired during explorative laparotomy in 11 patients diagnosed with acute mesenteric ischemia.
- Recorded HSI images were evaluated for macroscopic perfusion quality and categorized into three groups.
- Key HSI parameters including tissue saturation, near-infrared perfusion index, organ hemoglobin index, tissue water index, and reflectance spectra were analyzed and compared.
Main Results:
- Significant differences were observed in tissue saturation and near-infrared perfusion index between poorly perfused and viable intestinal segments (P < 0.001).
- A distinct peak at 630 nm in reflectance spectra was identified in less viable tissues, correlating with increased met-hemoglobin content.
- The HSI organ hemoglobin index supported the findings related to met-hemoglobin in necrotic tissues.
Conclusions:
- Hyperspectral imaging (HSI) demonstrates reliability in discriminating tissue perfusion in acute mesenteric ischemia.
- HSI can provide valuable objective data to assist surgeons in determining the extent of resection needed for ischemic bowel.
- Reflectance spectra analysis using HSI offers additional insights into tissue viability, potentially indicating necrosis.
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