THERMOGRAPHY AS AN ADJUNCT WITH OTHER IMAGING MODALITIES TO EVALUATE THE PERFUSION OF FREEZING COLD INJURIES

THERMOGRAPHY AS AN ADJUNCT WITH OTHER IMAGING MODALITIES TO EVALUATE THE PERFUSION OF FREEZING COLD INJURIES

J.B. Mercer1, 2, J.E. Løkebø3 and L. de Weerd3

1Cardiovascular Research Group, Department of Medical Biology,

Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.

2 Department of Radiology and

3Department of Plastic Surgery and Hand Surgery, University Hospital

of North Norway, Tromsø, Norway.

There is little international consensus on the management of freezing cold injuries (FCI) and treatment procedures vary from being aggressive (rapid amputation) to conservative (wait and see). The different approaches to treating such injuries can partly be explained by the complexity surrounding the injury. For example, with frostbite tissue freezing occurs which may involve only superficial tissues or may extend to the bone. The onset and severity of frostbite may be affected by a multitude of factors such as air temperature, wind speed, duration of exposure, amount of exposed area, and predisposing conditions such as poor or inadequate insulation from the cold or wind, immersion, altitude, impaired circulation from tight clothing or shoes, fatigue, injuries, circulatory disease, poor nutrition, dehydration, hypothermia, alcohol or drug use, and use of tobacco products. Damage to the frostbitten tissues is caused by crystallization of water within the tissues, typically between the cells, and by resulting changes in electrolyte concentration within the cells. Damage occurs during the freezing process. Further damage occurs during reperfusion of frostbitten tissue.Whatever the situation one of the key factors in recovery is adequate tissue blood perfusion. So whether one is interested in mapping the extent of such an injury in the acute phase or monitoring the effect of a treatment regime or assessing the final outcome, some form of blood perfusion measurement is desirable. An example of a multimodal imaging approach using CT angiography, MR, scintigraphy and thermography for investigating blood perfusion in a severe case of frost bite of the feet will be presented. It will be shown that thermography as a non-invasive method without the use of ionizing radiationwas helpful in confirming the diagnosis, assessing the severity of the injury, and finally monitoring the outcome of FCI.