Evaluation of Diabetic Foot Ulcer Healing With Hyperspectral Imaging of Oxyhemoglobin and Deoxyhemoglobin

  1. Aksone Nouvong, DPM1,
  2. Byron Hoogwerf, MD2,
  3. Emile Mohler, MD3,
  4. Brian Davis, PHD2,
  5. Azita Tajaddini, PHD2 and
  6. Elizabeth Medenilla, MD3
  1. 1Olive View–University of California Los Angeles Medical Center, Sylmar, California, and Western University of Health Sciences, Pomona, California;
  2. 2Cleveland Clinic, Cleveland, Ohio;
  3. 3University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
  1. Corresponding author: Aksone Nouvong, anouvong{at}ucla.edu.


OBJECTIVE Foot ulceration remains a major health problem for diabetic patients and has a major impact on the cost of diabetes treatment. We tested a hyperspectral imaging technology that quantifies cutaneous tissue hemoglobin oxygenation and generated anatomically relevant tissue oxygenation maps to assess the healing potential of diabetic foot ulcers (DFUs).

RESEARCH DESIGN AND METHODS A prospective single-arm blinded study was completed in which 66 patients with type 1 and type 2 diabetes were enrolled and followed over a 24-week period. Clinical, medical, and diabetes histories were collected. Transcutaneous oxygen tension was measured at the ankles. Superficial tissue oxyhemoglobin (oxy) and deoxyhemoglobin (deoxy) were measured with hyperspectral imaging from intact tissue bordering the ulcer. A healing index derived from oxy and deoxy values was used to assess the potential for healing.

RESULTS Fifty-four patients with 73 ulcers completed the study; at 24 weeks, 54 ulcers healed while 19 ulcers did not heal. When using the healing index to predict healing, the sensitivity was 80% (43 of 54), the specificity was 74% (14 of 19), and the positive predictive value was 90% (43 of 48). The sensitivity, specificity, and positive predictive values increased to 86, 88, and 96%, respectively, when removing three false-positive osteomyelitis cases and four false-negative cases due to measurements on a callus. The results indicate that cutaneous tissue oxygenation correlates with wound healing in diabetic patients.

CONCLUSIONS Hyperspectral imaging of tissue oxy and deoxy may predict the healing of DFUs with high sensitivity and specificity based on information obtained from a single visit.


  • B.H. is currently affiliated with Lilly USA, LLC, Indianapolis, Indiana.

  • Clinical trial reg. no. NCT00617916, clinicaltrials.gov.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received December 18, 2008.
    • Accepted July 12, 2009.
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  1. Diabetes Care vol. 32 no. 11 2056-2061
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