Development of a digital imaging analysis system to evaluate the treatment response in superficial infantile hemangiomas

PLOS ONE RESEARCH ARTICLE Development of a digital imaging analysis system to evaluate the treatment response in superficial infantile hemangiomas Mingfeng Xie1,2,3☯, Jianping Liu1☯, Pingsheng Zhou2,3, Xianyun Xu2,4, Haijin Liu1, Linshan Zeng1, Feng Chen1, Yong Zeng1, Haijin Huang1, Wei Peng1, Hui Xiao2,3, Qian Liu ID2,3* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Jiangxi Provincial Clinical Research Center for Vascular Anomalies, The First Affiliated Hospital of GanNan Medical University, Ganzhou, Jiangxi, China, 2 Chinese & Western Integrative Medicine Discipline, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China, 3 Jiangxi Key Laboratory of TCM for Prevention and Treatment on Hemangioma, Nanchang, Jiangxi, China, 4 Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China ☯ These authors contributed equally to this work. * Abstract OPEN ACCESS Citation: Xie M, Liu J, Zhou P, Xu X, Liu H, Zeng L, et al. (2023) Development of a digital imaging analysis system to evaluate the treatment response in superficial infantile hemangiomas. PLoS ONE 18(3): e0282274. https://doi.org/10.1371/journal. pone.0282274 Editor: Fahmi Hussein Kakamad, University of Sulaimani, IRAQ Received: November 6, 2022 Accepted: February 10, 2023 Published: March 20, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0282274 Copyright: © 2023 Xie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Superficial infantile hemangiomas (IH) are benign vascular tumors common in children characterized by bright red "strawberry" lesions on the skin. In order to optimize the treatment for this disease, there is a need to develop objective tools to assess treatment response. Since a color change in the lesion is a good indicator of treatment response, we have developed a digital imaging system to quantify the values of red, green, and blue (RGB) difference and RGB ratio between the tumor and normal tissue to take into account the variations in color between different skin types. The efficacy of the proposed system in assessing treatment response in superficial IH was evaluated in relation to established visual and biochemical tools used to grade hemangiomas. As the treatment progressed, the RGB ratio was almost 1, while the RGB difference was close to 0, which indicates a good response to treatment. There was a strong correlation between the RGB score and the other visual grading systems. However, the correlation between the RGB scoring system and the biochemical method was weak. These findings suggest that the system can be used clinically to objectively and accurately evaluate disease progression and treatment response in patients diagnosed with superficial IH. Introduction Hemangiomas are caused by abnormalities in the development of embryonic vascular tissue and regulation of blood vessel formation [1]. Infantile hemangioma (IH) is the most common benign tumor in infants and children [2]. The incidence is even higher in infants who weigh less than 1000g [3, 4]. Infantile hemangioma (IH) can affect any part of the body but occur more frequently on the face and limbs. The appearance of skin hemangioma lesions may range from small red macules to large dome-topped or polypoid papules [5]. Although these PLOS ONE | https://doi.org/10.1371/journal.pone.0282274 March 20, 2023 1 / 16 PLOS ONE Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Digital imaging analysis system evaluating treatment response in superficial infantile hemangiomas haemangiomas are not life-threatening, they can significantly alter the patient’s physical appearance and negatively impact the child’s quality of life and self-esteem [6]. The hemangiomas in the proliferation stage are divided into three types; superficial, deep type, and mixed [6], according to their degree of invasion. The superficial IH is often called "strawberry hemangioma" due to its typical shape, bright red color, and irregular protrusions on the skin surface [1]. These lesions are usually treated with oral propranolol treatment. Following treatment, the diameter of the tumor, the degree of protrusion, and the blood cavity generally start to decrease gradually. Furthermore, the local skin temperature and tumor color also change [4, 7]. Several visual grading systems have been proposed to assess the treatment efficacy for IH, including the Achauer method, the visual analog scoring (VAS) method, and the infant hemangioma activity scoring method (HAS) [8–11]. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can also be used to assess the extent of the disease [12–14]. Furthermore, quantitative methods that measure the skin temperature [14, 15] or the body fluid biochemical index have also been used [15, 16]. A change in the color of the tumor is also an important indicator of treatment response in IH [8]. However, there is currently no accurate, effective, and objective method to assess changes in color. As a result, the clinicians have to rely on a visual evaluation [17]. In order to overcome this problem, we aimed to develop a digital imaging system to objectively measure and analyze changes in the color of IH following treatment. The efficacy of the system in grading the severity of IH was compared with established visual and quantitative grading tools. Materials and methods Design of the digital imaging system The digital imaging system developed in this study consisted of three parts; a light source system (light source box, hood), an imaging system (CDC camera), and a software processing system (computer) [18–20]. The system was assembled as shown in Fig 1. A standard D65 light source was used to acquire the images on the CDC camera [21]. After comprehensive consideration, we adopt Olympus, model D33235 digital camera for the imaging system, with a total pixel of 10 million and an effective pixel of 9.3 million. We use M.Ziuiko professional lens, and the sensor is a 17.4mm� 13.0mm CCD. For the light source system, we chose P120 light source Fig 1. Digital imaging analysis system. https://doi.org/10.1371/journal.pone.0282274.g001 PLOS ONE | https://doi.org/10.1371/journal.pone.0282274 March 20, 2023 2 / 16 PLOS ONE Digital imaging analysis system evaluating treatment response in superficial infantile hemangiomas box jointly (...truncated)