Doctor Andrea Murray presentation for the Scleroderma Society and RSA joint annual conference 2015.

1. Andrea Murray
Shedding light on scleroderma

2. Aim and drive for developing
technologies
To develop better, more sensitive and robust imaging
techniques to measure disease severity, progression &
treatment response
Better targeting and monitoring of treatments
Improved disease management

3. Light based - techniques
• Advancement of nailfold capillaroscopy
• Laser Doppler imaging
• Multispectral imaging

4. Light based - techniques
• Advancement of nailfold capillaroscopy
• Laser Doppler imaging
• Multispectral imaging

5. Capillaroscopy equipment

6. Nailfold capillaroscopy in action

7. Nailfold capillary architecture

8. Nailfold capillaroscopy
• Developed
software for
automated
capillary
recognition
• Capable of
measuring
individual and
average capillary
width, density,
tortuosity…
Berks et al. Med Image Comput Comput Assist Interv. 2014;17(Pt 1):658-65.

9. Comparison of capillary measures
between subject groups

10. Blood flow in nailfold capillaroscopy
Tresadern et al. Conf Proc IEEE Eng Med Biol Soc. 2013;2013

11. Light based - techniques
• Advancement of nailfold capillaroscopy
• Laser Doppler imaging
• Multispectral imaging

12. Laser Doppler imaging

13. Measuring blood flow in digital ulcers
• LDI can image ischaemia/hyperaemia in ulceration
• 61 DU imaged; 60% ulcers were ischaemic
Murray A, et al. Arthritis and Rheumatism
2011; 63: s574

14. Measurement of healing in digital ulcers
LDI can measure healing of ulcers with respect to blood flow
– increase in ulcer blood flow and decrease in adjacent
blood flow
Baseline At healing (as clinically
assessed )
Murray A, et al. Arthritis and Rheumatism
2011; 63: s574

16. Pilot iontophoresis - perfusion increase with time
Good local method of delivery (no side
effects) – we need a longer lasting drug…

17. Light based - techniques
• Advancement of nailfold capillaroscopy
• Laser Doppler imaging
• Multispectral imaging

18. Hyperspectral or Multispectral imaging
Spectroscopy
spectrometer
White light

19. Hyperspectral or Multispectral imaging
Spectroscopy
spectrometer
White light

20. Hyperspectral or Multispectral imaging
Spectroscopy
spectrometer

21. Hyperspectral or Multispectral imaging
Spectroscopy
spectrometer

22. Hyperspectral or Multispectral imaging
Spectroscopy
spectrometer

23. • 10 HC, 10 LcSSc, 7 DcSSc
• Digital occlusion; 200 mmHg, 2 mins
• Imaged baseline, during, upon release and after 1 minute,
after 5 mins
• Oxygenation
Pilot study of multispectral imaging in patients with systemic
sclerosis and healthy controls
Poxon I et al. Rheumatology (2015) 54 : i161.

24. Pilot study of multispectral imaging in patients with systemic
sclerosis and healthy controls – oxygenation
• Oxygenation

25. Pilot study of multispectral imaging in patients with systemic
sclerosis and healthy controls – oxygenation
• Oxygenation
Possible to differentiate between controls and patients with SSc using changes in
oxygenation
Poxon I et al. Rheumatology (2015) 54 : i161.

26. Summary
• Light based imaging techniques help us to learn
more about Raynaud’s phenomenon and
scleroderma non-invasively
• Some techniques remain in the research arena,
others move towards clinical diagnostic status
• Aim is to validate techniques in order to measure
disease severity, progression & treatment
response
• Improve disease management

27. Ariane Herrick
Tonia Moore
Joanne Manning
Paul New
Sarah Leggett
Christopher Griffiths
Mark Dickinson
Chris Taylor
Danny Allen
Phil Tresadern
Mike Berks
Graham Dinsdale
Donna Arthur
Ian Poxon
Mike Hughes
Elizabeth Evans
I am grateful to:
All our volunteers – who make it possible!
Our funders