Interpretable photoacoustic phenotyping of distal microcirculation for peripheral artery disease diagnosis with exploratory perioperative assessment
- 1Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, Tsinghua University
Abstract
Peripheral artery disease (PAD) spans a continuum from large-vessel obstruction to distal microvascular dysfunction, yet routine non-invasive tests, including the ankle-brachial index (ABI), do not provide structurally resolved assessment of the foot microvascular bed and may be unreliable in the setting of medial arterial calcification or perioperative follow-up. Here we developed a clinic-oriented multispectral compound-scanning photoacoustic tomography system (MCPATS) for compression-free distal toe imaging, and an interpretable photoacoustic tomography distal microcirculation score, termed PACT-DMS, for phenotyping PAD-related distal vascular abnormalities. PACT-DMS was derived from anatomically standardized distal toe sections and integrated seven prespecified vascular features spanning trunk-vessel morphology, microvascular distribution and pulsation-related dynamics through a traceable linear support vector machine. In a prospective single-centre cohort of 45 participants, the bilateral fusion PACT-DMS model distinguished patients with PAD from healthy controls with an area under the receiver operating characteristic curve of 0.964 (95% CI, 0.907-1.000) and an accuracy of 91.1% (95% CI, 82.2%-97.8%) under subject-level leave-one-out cross-validation, supported by complementary robustness analyses. Exploratory analyses further showed that PACT-DMS identified abnormal distal vascular phenotypes in 6 of 9 clinically diagnosed PAD limbs with non-abnormal ABI and visualized distal vascular-bed changes before and after revascularization. These findings support MCPATS-enabled interpretable photoacoustic vascular phenotyping as a candidate adjunctive approach for distal microcirculatory assessment in PAD; larger multicentre studies with external validation and prespecified analysis protocols will be required to define its clinical role.
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BibTeX
@misc{deng2026interpretable,
title = {{Interpretable photoacoustic phenotyping of distal microcirculation for peripheral artery disease diagnosis with exploratory perioperative assessment}},
author = {H. Deng and T. Yuwen and Z. Li and J. Xiang and Y. Bai and N. Zhang and W. Fu and X. Wang and J. Guo and W. Wu and C. Ma and M.-Y. Liu},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.02.26361270},
url = {https://www.medrxiv.org/content/10.64898/2026.09.02.26361270v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Interpretable photoacoustic phenotyping of distal microcirculation for peripheral artery disease diagnosis with exploratory perioperative assessment
AU - H. Deng
AU - T. Yuwen
AU - Z. Li
AU - J. Xiang
AU - Y. Bai
AU - N. Zhang
AU - W. Fu
AU - X. Wang
AU - J. Guo
AU - W. Wu
AU - C. Ma
AU - M.-Y. Liu
PY - 2026
DA - 2026/09/02
PB - medRxiv
DO - 10.64898/2026.09.02.26361270
UR - https://www.medrxiv.org/content/10.64898/2026.09.02.26361270v1
AB - Peripheral artery disease (PAD) spans a continuum from large-vessel obstruction to distal microvascular dysfunction, yet routine non-invasive tests, including the ankle-brachial index (ABI), do not provide structurally resolved assessment of the foot microvascular bed and may be unreliable in the setting of medial arterial calcification or perioperative follow-up. Here we developed a clinic-oriented multispectral compound-scanning photoacoustic tomography system (MCPATS) for compression-free distal toe imaging, and an interpretable photoacoustic tomography distal microcirculation score, termed PACT-DMS, for phenotyping PAD-related distal vascular abnormalities. PACT-DMS was derived from anatomically standardized distal toe sections and integrated seven prespecified vascular features spanning trunk-vessel morphology, microvascular distribution and pulsation-related dynamics through a traceable linear support vector machine. In a prospective single-centre cohort of 45 participants, the bilateral fusion PACT-DMS model distinguished patients with PAD from healthy controls with an area under the receiver operating characteristic curve of 0.964 (95% CI, 0.907-1.000) and an accuracy of 91.1% (95% CI, 82.2%-97.8%) under subject-level leave-one-out cross-validation, supported by complementary robustness analyses. Exploratory analyses further showed that PACT-DMS identified abnormal distal vascular phenotypes in 6 of 9 clinically diagnosed PAD limbs with non-abnormal ABI and visualized distal vascular-bed changes before and after revascularization. These findings support MCPATS-enabled interpretable photoacoustic vascular phenotyping as a candidate adjunctive approach for distal microcirculatory assessment in PAD; larger multicentre studies with external validation and prespecified analysis protocols will be required to define its clinical role.
ER -