Use of Indocyanine Green and Fluorescence Angiography in Parathyroid Surgery: A Feasibility Study

2020 ◽  
pp. 155335062095643
Author(s):  
Christina Maser ◽  
Amanda H. Kohlbrenner ◽  
Rachel Dirks
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Parathyroid Tissue ◽  
Surrounding Tissue ◽  
Fluorescence Angiography ◽  
Clinical Settings ◽  
Capillary Networks ◽  
Nir Fluorescence ◽  
Parathyroid Adenomas ◽  
Control Study

Background. Indocyanine green (ICG) with near-infrared (NIR) fluorescence is an established method for assessing vascularity in various clinical settings. We hypothesized that parathyroid adenomas, with increased capillary networks, may demonstrate a fluorescence which could aid intraoperative identification and confirmation of the abnormal parathyroid tissue. Methods. This prospective case–control study compared patients with primary hyperparathyroidism undergoing parathyroidectomy (cases) to normal parathyroid in thyroidectomy patients (controls). After exposing the parathyroid gland, ICG was injected and the fluorescence of parathyroid and thyroid was recorded and graded in comparison to the surrounding tissue and vasculature (0 = nonfluorescent and 5 = vasculature). Results. The intensity of parathyroid fluorescence was more in cases (4 ± 2) than controls (2 ± 1) when graded intraoperatively ( P = .001). Thyroid fluorescence did not differ (3 vs 3, P = .072); however, parathyroid fluorescence was more intense than thyroid in cases (parathyroid = 4 ± 2 and thyroid = 3 ± 1, P = .018). Conclusions. ICG fluorescence in diseased parathyroid was more intense than normal parathyroid and thyroid, suggesting the ICG/NIR technology may be a useful intraoperative tool for identification of abnormal parathyroid.

scholarly journals Shortwave Infrared Fluorescence Imaging with the Clinically Approved Near-Infrared Dye Indocyanine Green

2017 ◽  
Author(s):  
Jessica A. Carr ◽  
Daniel Franke ◽  
Justin R. Caram ◽  
Collin F. Perkinson ◽  
Vasileios Askoxylakis ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Real Time ◽  
Fluorescence Imaging ◽  
Near Infrared ◽  
Infrared Region ◽  
Fluorescence Angiography ◽  
Nir Fluorescence ◽  
Near Infrared Dye ◽  
Shortwave Infrared

AbstractFluorescence imaging is a method of real-time molecular tracking in vivo that has enabled many clinical technologies. Imaging in the shortwave infrared region (SWIR, 1-2 μm) promises higher contrast, sensitivity, and penetration depths compared to conventional visible and near-infrared (NIR) fluorescence imaging. However, adoption of SWIR imaging in clinical settings has been limited, due in part to the absence of FDA-approved fluorophores with peak emission in the SWIR. Here, we show that commercially available NIR dyes, including the FDA-approved contrast agent indocyanine green (ICG), exhibit optical properties suitable for in vivo SWIR fluorescence imaging. Despite the fact that their emission reaches a maximum in the NIR, these dyes can be imaged non-invasively in vivo in the SWIR spectral region, even beyond 1500 nm. We demonstrate real-time fluorescence angiography at wavelengths beyond 1300 nm using ICG at clinically relevant doses. Furthermore, we show tumortargeted SWIR imaging with trastuzumab labeled with IRDye 800CW, a NIR dye currently being tested in multiple phase II clinical trials. Our findings suggest that high-contrast SWIR fluorescence imaging can be implemented alongside existing imaging modalities by switching the detection of conventional NIR fluorescence systems from silicon-based NIR cameras to emerging indium gallium arsenide (InGaAs) SWIR cameras. Using ICG in particular opens the possibility of translating SWIR fluorescence imaging to human clinical applications.

Near-infrared fluorescence imaging with indocyanine green for quantification of changes in tissue perfusion following revascularization

Vascular ◽  
2021 ◽  
pp. 170853812110328
Author(s):  
Pim Van den Hoven ◽  
Floris S Weller ◽  
Merel Van De Bent ◽  
Lauren N Goncalves ◽  
Melissa Ruig ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Fluorescence Intensity ◽  
Near Infrared ◽  
Tissue Perfusion ◽  
Control Group ◽  
Maximum Slope ◽  
Nir Fluorescence ◽  
Significant Difference ◽  
Revascularization Procedures

Objectives Current diagnostic modalities for patients with peripheral artery disease (PAD) mainly focus on the macrovascular level. For assessment of tissue perfusion, near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) seems promising. In this prospective cohort study, ICG NIR fluorescence imaging was performed pre- and post-revascularization to assess changes in foot perfusion. Methods ICG NIR fluorescence imaging was performed in 36 patients with PAD pre- and post-intervention. After intravenous bolus injection of 0.1 mg/kg ICG, the camera registered the NIR fluorescence intensity over time on the dorsum of the feet for 15 min using the Quest Spectrum Platform®. Time-intensity curves were plotted for three regions of interest (ROI): (1) the dorsum of the foot, (2) the forefoot, and (3) the hallux. Time-intensity curves were normalized for maximum fluorescence intensity. Extracted parameters were the maximum slope, area under the curve (AUC) for the ingress, and the AUC for the egress. The non-treated contralateral leg was used as a control group. Results Successful revascularization was performed in 32 patients. There was a significant increase for the maximum slope and AUC egress in all three ROIs. The most significant difference was seen for the maximum slope in ROI 3 (3.7%/s to 6.6%/s, p < 0.001). In the control group, no significant differences were seen for the maximum slope and AUC egress in all ROIs. Conclusions This study shows the potential of ICG NIR fluorescence imaging in assessing the effect of revascularization procedures on foot perfusion. Future studies should focus on the use of this technique in predicting favorable outcome of revascularization procedures.

scholarly journals Evaluation of Intranasal Flap Perfusion by Intraoperative Indocyanine Green Fluorescence Angiography

2018 ◽  
Vol 15 (6) ◽  
pp. 672-676 ◽  
Author(s):  
Mathew Geltzeiler ◽  
Ana Carolina Igami Nakassa ◽  
Meghan Turner ◽  
Pradeep Setty ◽  
George Zenonos ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Skull Base ◽  
Near Infrared ◽  
The Body ◽  
Fluorescence Angiography ◽  
Flap Necrosis ◽  
Endonasal Surgery ◽  
Mri Contrast ◽  
Postoperative Mri ◽  
Flap Perfusion

Abstract BACKGROUND Vascularized intranasal flaps are the primary reconstructive option for endoscopic skull base defects. Flap vascularity may be compromised by injury to the pedicle or prior endonasal surgery. There is currently no validated technique for intraoperative evaluation of intranasal flap viability. OBJECTIVE To evaluate the efficacy of indocyanine green (ICG) near-infrared angiography in predicting the viability of pedicled intranasal flaps during endoscopic skull base surgery through a pilot study. METHODS ICG near-infrared fluorescence endoscopy was performed during endoscopic endonasal surgery for skull base tumors. Intraoperative and postoperative data were collected regarding enhancement of the flap body and pedicle. Fluorescence was rated qualitatively. Postoperatively, flap perfusion was evaluated via MRI-contrast enhancement in addition to clinical outcomes (cerebrospinal fluid leak and endoscopic flap appearance). RESULTS Thirty-eight patients underwent ICG fluorescence angiography. Both the body and pedicle enhanced in 20 patients (53%), while the pedicle only enhanced for 12 patients (32%), the body only for 3 (8%), and neither for 3 (8%). When both the pedicle and body enhanced with ICG, the rate of postoperative MRI contrast enhancement was 100% and the rate of flap necrosis was 0%. The sensitivity and specificity of flap pedicle ICG enhancement for predicting postoperative flap MRI enhancement were 97% and 67%, respectively. Two of 3 patients without enhancement developed flap necrosis. CONCLUSION ICG fluorescence angiography of intraoperative flap perfusion is feasible and correlates well with outcomes of postoperative MRI flap enhancement and flap necrosis. Additional study is needed to further refine the imaging technique and optimally characterize the clinical utility.

scholarly journals Indocyanine Green-Enhanced Colorectal Surgery—between Being Superfluous and Being a Game-Changer

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 742
Author(s):  
Catalin Alius ◽  
Corneliu Tudor ◽  
Cristinel Dumitru Badiu ◽  
Ana Maria Dascalu ◽  
Catalin Gabriel Smarandache ◽  
...  
Keyword(s):  
Lymph Node ◽  
Colorectal Surgery ◽  
Indocyanine Green ◽  
Statistical Power ◽  
Near Infrared ◽  
Colorectal Anastomosis ◽  
Future Research ◽  
Anatomical Landmarks ◽  
Nir Fluorescence ◽  
Game Changer

Nowadays, surgical innovations incorporate new technological conquests and must be validated by evidence-based medicine. The use of augmented reality-assisted indocyanine green (ICG) fluorescence has generated a myriad of intraoperative applications such as demonstration of key anatomical landmarks, sentinel lymph nodes, and real-time assessment of local blood flow. This paper presents a systematic review of the clinical evidence regarding the applications of ICG near-infrared (NIR) fluorescence in colorectal surgery. After we removed duplicate publications and screened for eligibility, a total of 36 articles were evaluated: 23 on perfusion assessment, 10 on lymph node mapping, and 3 on intraoperative identification of ureters. Lack of homogenous studies, low statistical power, and confounding evidence were found to be common amongst publications supporting the use of ICG in colorectal surgery, raising concerns over this seductive technique′s cost efficiency and redundancy. The compiled data showed that ICG NIR fluorescence may be a game-changer in particular situations, as proven for low colorectal anastomosis or lateral pelvic lymph node dissection, but it remains controversial for routine use and sentinel lymph node assessment. Further randomized studies are needed to confirm these conclusions. Future research directions include tumor-targeted fluorescence imaging and digital software for quantitative evaluation of fluorescence.

scholarly journals Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas

Molecules ◽  
2020 ◽  
Vol 25 (7) ◽  
pp. 1724 ◽  
Author(s):  
Jacek Baj ◽  
Robert Sitarz ◽  
Marek Łokaj ◽  
Alicja Forma ◽  
Marcin Czeczelewski ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Carbon Nanoparticles ◽  
Near Infrared ◽  
Shear Wave Elastography ◽  
Laser Speckle ◽  
Parathyroid Glands ◽  
Contrast Imaging ◽  
Parathyroid Adenomas ◽  
Severe Hemorrhage

Accurate pre-operative determination of parathyroid glands localization is critical in the selection of minimally invasive parathyroidectomy as a surgical treatment approach in patients with primary hyperparathyroidism (PHPT). Its importance cannot be overemphasized as it helps to minimize the harmful side effects associated with damage to the parathyroid glands such as in hypocalcemia, severe hemorrhage or recurrent laryngeal nerve dysfunction. Preoperative and intraoperative methods decrease the incidence of mistakenly injuring the parathyroid glands and allow for the timely diagnosis of various abnormalities, including parathyroid adenomas. This article reviews 139 studies conducted between 1970 and 2020 (49 years). Studies that were reviewed focused on several techniques including application of carbon nanoparticles, carbon nanoparticles with technetium sestamibi (99m Tc-MIBI), Raman spectroscopy, near-infrared autofluorescence, dynamic optical contrast imaging, laser speckle contrast imaging, shear wave elastography, and indocyanine green to test their potential in providing proper parathyroid glands’ localization. Apart from reviewing the aforementioned techniques, this study focused on the applications that helped in the detection of parathyroid adenomas. Results suggest that applying all the reviewed techniques significantly improves the possibility of providing proper localization of parathyroid glands, and the application of indocyanine green has proven to be the ‘ideal’ approach for the diagnosis of parathyroid adenomas.

Fluorescence-guided surgery using indocyanine green in dogs with superficial solid tumours

2020 ◽  
Vol 187 (7) ◽  
pp. 273-273
Author(s):  
Sophie Favril ◽  
Eline Abma ◽  
Emmelie Stock ◽  
Nausikaa Devriendt ◽  
Bart Van Goethem ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Ex Vivo ◽  
False Positive Rate ◽  
Tumour Tissue ◽  
Surrounding Tissue ◽  
Tumour Resection ◽  
Nirf Imaging ◽  
Tumour Delineation

BackgroundNear-infrared fluorescence (NIRF) imaging is a relatively novel technique that can aid surgeons during intraoperative tumour identification.MethodsNine canine oncology patients (five mammary gland tumours, three mast cell tumours and one melanoma) received intravenous indocyanine green (ICG). After 24 hours, tumours were resected and fluorescence intensities of tumours and surroundings were evaluated. Additional wound bed tissue was resected if residual fluorescence was present after tumour resection. Ex vivo, fluorescence-guided dissection was performed to separate tumour from surrounding tissue.ResultsIntraoperative NIRF-guided tumour delineation was feasible in four out of nine dogs. Wound bed imaging after tumour removal identified nine additional fluorescent lesions, of which four contained tumour tissue. One of these four true positive in vivo lesions was missed by standard-of-care inspection. Ex vivo fluorescence-guided tumour dissection showed a sensitivity of 72 per cent and a specificity of 80 per cent in discriminating between tumour and surrounding tissue.ConclusionThe value of ICG for intraoperative tumour delineation seems more limited than originally thought. Although NIRF imaging using ICG did identify remaining tumour tissue in the wound bed, a high false positive rate was also observed.

Indocyanine Green Fluorescence Angiography of the Transverse Cervical Arterial Supply to Clavicle Flaps: An Anatomical Study

2021 ◽  
pp. 019459982110004
Author(s):  
Pichtat Muangsiri ◽  
Rungkit Tanjapatkul ◽  
Papat Sriswadpong ◽  
Pojanan Jomkoh ◽  
Supasid Jirawatnotai
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Fluorescence Angiography ◽  
Head And Neck Reconstruction ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Cervical Artery ◽  
Indocyanine Green Fluorescence Angiography ◽  
Vascularized Bone ◽  
Transverse Cervical Artery

Objective To describe the anatomy of the transverse cervical artery and to prove its perfusion to the clavicle using indocyanine green fluorescence angiography as an alternative vascularized bone for head and neck reconstruction. Study Design Cadaveric dissection. Setting Anatomy lab. Methods Twenty-two necks and shoulders from 11 fresh-frozen cadavers were dissected. The transverse cervical artery diameter, length, emerging point, and the length of clavicle segment harvested were described. Photographic and near-infrared video recordings of the bone’s medial and longitudinal cut surfaces were taken prior to, during, and after indocyanine green injection. Results The transverse cervical artery originated from the thyrocervical trunk and emerged at the level of the medial one-third of the clavicle in 22 of 22 (100%) specimens. The average length of the pedicle was 3.6 cm (range, 2.2-4.4 cm), and the mean diameter was 2.5 mm (range, 1.8-3.4 mm). The harvested bone had a mean length of 5.1 cm (range, 4.3-5.8 cm). After injecting the indocyanine green, 22 of 22 (100%) specimens showed enhancement in the periosteum, bony cortex, and medulla. Conclusion The middle third of the clavicle can be reliably harvested as a vascularized bone with its perfusion solely from the transverse cervical artery pedicle, as shown by the near-infrared fluorescence imaging. The pedicle was sizable and constant in origin.

scholarly journals Intraoperative Near-infrared Fluorescence Imaging with Novel Indocyanine Green-Loaded Nanocarrier for Spinal Metastasis: A Preliminary Animal Study

2012 ◽  
Vol 6 (1) ◽  
pp. 80-84 ◽  
Author(s):  
Toru Funayama ◽  
Masataka Sakane ◽  
Tetsuya Abe ◽  
Isao Hara ◽  
Eiichi Ozeki ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Rat Model ◽  
Near Infrared ◽  
Imaging Modality ◽  
Intraoperative Imaging ◽  
Spinal Metastasis ◽  
Vena Cava ◽  
Nir Fluorescence

Marginal resection during resection of a spinal metastasis is frequently difficult because of the presence of important tissues such as the aorta, vena cava, and dura mater, including the spinal cord adjacent to the vertebral body. Thus, there is an urgent need for novel intraoperative imaging modalities with the ability to clearly identify bone metastasis. We have proposed a novel nanocarrier loaded with indocyanine green (ICG) (ICG-lactosome) with tumor selectivity attributable to its enhanced permeation and retention (EPR) effect. We studied its feasibility in intraoperative near-infrared (NIR) fluorescence diagnosis with ICG-lactosome for imaging spinal metastasis. A rat model of subcutaneous mammary tumor and a rat model of spinal metastasis of breast cancer were used. Fluorescence emitted by the subcutaneous tumors and the spinal metastasis were clearly detected for at least 24 h. Moreover, imaging of the dissected spine revealed clear fluorescence emitted by the metastatic lesion in the L6 vertebra while the normal bone lacked fluorescence. This study was the first report on NIR fluorescence imaging of spinal metastasis in vivo. NIR fluorescence imaging with ICG-lactosome could be an effective intraoperative imaging modality for detecting spinal metastasis.

scholarly journals Perfusion Patterns in Patients with Chronic Limb-Threatening Ischemia versus Control Patients Using Near-Infrared Fluorescence Imaging with Indocyanine Green

Biomedicines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1417
Author(s):  
Pim Van Den Hoven ◽  
Lauren N. Goncalves ◽  
Paulus H. A. Quax ◽  
Catharina S. P. Van Rijswijk ◽  
Jan Van Schaik ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Near Infrared ◽  
Tissue Perfusion ◽  
Arterial Disease ◽  
Diagnostic Techniques ◽  
Control Group ◽  
Maximum Slope ◽  
Perfusion Studies ◽  
Nir Fluorescence

In assessing the severity of lower extremity arterial disease (LEAD), physicians rely on clinical judgements supported by conventional measurements of macrovascular blood flow. However, current diagnostic techniques provide no information about regional tissue perfusion and are of limited value in patients with chronic limb-threatening ischemia (CLTI). Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has been used extensively in perfusion studies and is a possible modality for tissue perfusion measurement in patients with CLTI. In this prospective cohort study, ICG NIR fluorescence imaging was performed in patients with CLTI and control patients using the Quest Spectrum Platform® (Middenmeer, The Netherlands). The time–intensity curves were analyzed using the Quest Research Framework. Fourteen parameters were extracted. Successful ICG NIR fluorescence imaging was performed in 19 patients with CLTI and in 16 control patients. The time to maximum intensity (seconds) was lower for CLTI patients (90.5 vs. 143.3, p = 0.002). For the inflow parameters, the maximum slope, the normalized maximum slope and the ingress rate were all significantly higher in the CLTI group. The inflow parameters observed in patients with CLTI were superior to the control group. Possible explanations for the increased inflow include damage to the regulatory mechanisms of the microcirculation, arterial stiffness, and transcapillary leakage.

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