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Research Article  |  Published 27 November 2018

Oral Cavity Examination with Real-Time Optical Vascular Imaging - A Validation Study of a New Method for Microvascular Analysis

P. Bastos* and R.J.Cook

Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, Guy’s Hospital, London, SE1 9RT, UK
Department of Oral Medicine, GSTFT & KCL, Guy’s Hospital, London, SE1 9RT, UK


Introduction: Microvascular changes, particularly in the oral cavity have been reported in relation to inflammatory and mitotic diseases; therefore, in-vivo microvascular imaging and capillary micro-circulation characterisation is clinically important. Microvascular imaging has the potential to highlight areas of pathology at an early stage, to avoid, minimize and best guide invasive procedures, such as biopsy.

To overcome the limitations of the current microvascular imaging techniques, the Centre for Oral, Clinical and Translational Sciences at Guy’s Hospital, developed an intra-oral real time optical vascular imaging instrument.

The analysis of resulting microvascular images remains challenging and despite the development of several classification systems, none has yet been validated for clinical use.

Aims & objectives: To determine whether a group of trained observers could derive comparable assessments when examining the same microvascular imaging information over time, examining intra and inter-observer variability, all having received identical baseline training in utilising the same image scoring system.

Materials & Methods: Six independent blinded observers were identically trained to use a simple image classification system before being asked to examine 10 microvascular images and 10 microvascular movies of 20 seconds, each from a different anatomical site within the oral cavity. The movies were randomly selected from a database of 132 microvascular movies obtained with Real Time Optical Vascular Imaging of 7 healthy volunteers. The images were recorded with in-house software. All patients were consented for imaging with RTOVI according to the ethics in place, approved by KCL Research Ethics Committee (REC) BDM/14/15-14.

Discussion & conclusion: This study demonstrated that except for capillary orientation, all other characteristics were unreliable for the assessment of microvascular image patterns. A subjective assessment method of the oral cavity microvascular anatomy is insufficient to characterise each anatomical site.

In order for Real Time Optical Vascular Imaging be clinically relevant it is important to develop an automated mathematical analysis method for microvascular images. Only then, it will be possible to assess the feasibility of microvascular imaging as a diagnostic method.

Real-time, in vivo, diagnosis, microvascular anatomy, microvascular patterns, imaging, oral cavity, descriptive assessment, classification system.


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