Microscope-Integrated Quantitative Analysis of Intraoperative Indocyanine Green Fluorescence Angiography for Blood Flow Assessment: First Experience in 30 Patients

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons65-ons74 ◽  
Author(s):  
Marcel A. Kamp ◽  
Philipp Slotty ◽  
Bernd Turowski ◽  
Nima Etminan ◽  
Hans-Jakob Steiger ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Indocyanine Green ◽  
Transit Time ◽  
Rise Time ◽  
Fluorescence Angiography ◽  
Flow Index ◽  
Time To Peak ◽  
Transit Times ◽  
Blood Flow Index

Abstract BACKGROUND: Intraoperative measurements of cerebral blood flow are of interest during vascular neurosurgery. Near-infrared indocyanine green (ICG) fluorescence angiography was introduced for visualizing vessel patency intraoperatively. However, quantitative information has not been available. OBJECTIVE: To report our experience with a microscope with an integrated dynamic ICG fluorescence analysis system supplying semiquantitative information on blood flow. METHODS: We recorded ICG fluorescence curves of cortex and cerebral vessels using software integrated into the surgical microscope (Flow 800 software; Zeiss Pentero) in 30 patients undergoing surgery for different pathologies. The following hemodynamic parameters were assessed: maximum intensity, rise time, time to peak, time to half-maximal fluorescence, cerebral blood flow index, and transit times from arteries to cortex. RESULTS: For patients without obvious perfusion deficit, maximum fluorescence intensity was 177.7 arbitrary intensity units (AIs; 5-mg ICG bolus), mean rise time was 5.2 seconds (range, 2.9-8.2 seconds; SD, 1.3 seconds), mean time to peak was 9.4 seconds (range, 4.9-15.2 seconds; SD, 2.5 seconds), mean cerebral blood flow index was 38.6 AI/s (range, 13.5-180.6 AI/s; SD, 36.9 seconds), and mean transit time was 1.5 seconds (range, 360 milliseconds-3 seconds; SD, 0.73 seconds). For 3 patients with impaired cerebral perfusion, time to peak, rise time, and transit time between arteries and cortex were markedly prolonged (>20, >9 , and >5 seconds). In single patients, the degree of perfusion impairment could be quantified by the cerebral blood flow index ratios between normal and ischemic tissue. Transit times also reflected blood flow perturbations in arteriovenous fistulas. CONCLUSION: Quantification of ICG-based fluorescence angiography appears to be useful for intraoperative monitoring of arterial patency and regional cerebral blood flow.

scholarly journals Blood Flow Assessment of Arteriovenous Malformations Using Intraoperative Indocyanine Green Videoangiography

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Naoki Kato ◽  
Vincent Prinz ◽  
Julius Dengler ◽  
Peter Vajkoczy
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Indocyanine Green ◽  
Region Of Interest ◽  
Flow Dynamics ◽  
Flow Index ◽  
Indocyanine Green Videoangiography ◽  
Blood Flow Index ◽  
High Resolution Images ◽  
The Individual

Intraoperative indocyanine green (ICG) videoangiography is widely used in patients undergoing neurosurgery. FLOW800 is a recently developed analytical tool for ICG videoangiography to assess semi-quantitative flow dynamics; however, its efficacy is unknown. In this study, we evaluated its functionality in the assessment of flow dynamics of arteriovenous malformation (AVM) through ICG videoangiography under clinical settings. ICG videoangiography was performed in the exposed AVM in eight patients undergoing surgery. FLOW800 analysis was applied directly, and gray-scale and color-coded maps of the surgical field were obtained. After surgery, a region of interest was placed on the individual vessels to obtain time-intensity curves. Parameters of flow dynamics, including the maximum intensity, transit time, and cerebral blood flow index, were calculated using the curves. The color-coded maps provided high-resolution images; however, reconstruction of colored images was restricted by the depth, approach angle, and brain swelling. Semi-quantitative parameters were similar among the feeders, niduses, and drainers. However, a higher cerebral blood flow index was observed in the feeders of large AVM (>3 cm) than in those of small AVM (P < 0.05). Similarly, the cerebral blood flow index values were positively correlated with the nidus volume (P < 0.01). FLOW800 enabled visualization of the AVM structure and safer resection, except in case of deep-seated AVM. Moreover, semi-quantitative values in the individual vessels through using ICG intensity diagram showed different patterns according to size of the AVM. ICG videoangiography showed good performance in evaluating flow dynamics of the AVM in patients undergoing surgery.

scholarly journals Features of cerebral blood flow in patients with chronic obstructive pulmonary disease associated with hypertension

2021 ◽  
Vol 26 (6) ◽  
pp. 676-687
Author(s):  
N. B. Poletaeva ◽  
O. V. Teplyakova ◽  
I. F. Grishina ◽  
A. A. Klepikova
Keyword(s):  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Blood Flow Velocity ◽  
Flow Index ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Blood Flow Index

Objective. The aim of the work was to study the features of cerebral blood flow in patients with chronic obstructive pulmonary disease (COPD) associated with hypertension (HTN). Design and methods. A crosssectional study was conducted, which included 90 males 40–60 years old. Of these, 30 patients with chronic COPD associated with HTN (COPD + HTN) were included in the study group, 30 individuals with isolated COPD were in the comparison group, 30 healthy volunteers were included in the control group. All participants underwent physical examination, spirography, 24-hour blood pressure monitoring and ultrasound examination of cerebral vessels. Results. Patients with COPD + HTN in comparison with the control showed an increase in the diameter (p = 0,018) and complex of the intima-media of the common carotid artery (p = 0,003) while the velocities, resistance index (RI) and pulsation index (PI) did not change. In the basin of the internal carotid artery an increase in RI values was noted (p = 0,018). At the intracranial level there was a decrease in the end-diastolic velocity (p = 0,03) and the time-averaged average blood flow velocity (TAV) (p = 0,033) without due changes RI and PI. At the same time no changes in speed indicators and indices were noted in the vertebral artery basin. Among the indicators of cerebral perfusion in patients with COPD + HTN, hydrodynamic resistance (p = 0,0015), intracranial pressure (ICP) (p = 0,0048) significantly increased, and the cerebral blood flow index was comparable with the control. Assessment of venous cerebral blood flow showed an increase in the diameter of the internal jugular vein (p = 0,021) with unchanged TAV together with an increase in ICP indicating the formation of venous dysfunction. It was shown that the body mass index, forced expiratory volume at the first second, systolic and diastolic blood pressure together determine the peak systolic blood flow velocity from the midbrain artery. Conclusions. The cerebral blood flow in patients with COPD + HTN is characterized by a change in arterial blood flow at the level of both intra- and extracranial vessels, while maintaining a normal cerebral blood flow index, as well as the formation of arteriovenous dyshemia against the background of remodeling of the cerebral vascular bed.

Cerebral blood flow index image as a simple indicator for the fate of acute ischemic lesion

2003 ◽  
pp. 241-246 ◽  
Author(s):  
Hironaka Igarashi ◽  
M. Hamamoto ◽  
H. Yamaguchi ◽  
S. Ookubo ◽  
J. Nagashima ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Index ◽  
Ischemic Lesion ◽  
Blood Flow Index ◽  
Simple Indicator

Reproducibility of the blood flow index as noninvasive, bedside estimation of cerebral blood flow

2003 ◽  
Vol 29 (2) ◽  
pp. 196-200 ◽  
Author(s):  
Bendicht P. Wagner ◽  
Susanne Gertsch ◽  
Roland A. Ammann ◽  
Juerg Pfenninger
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Index ◽  
Blood Flow Index

Comparison of Renal Blood Flow and Transit Times Measured by Means of 99mTc-Labelled Erythrocytes and Indocyanine Green in Humans with Normal and Diseased Kidneys

1976 ◽  
Vol 51 (2) ◽  
pp. 151-159
Author(s):  
F. C. Reubi ◽  
C. Vorburger ◽  
Gertrud Pfeiffer ◽  
S. Golder
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Renal Blood Flow ◽  
Transit Time ◽  
Mean Transit Time ◽  
Common Mechanism ◽  
Dilution Method ◽  
Appearance Time ◽  
Vascular Volume ◽  
Transit Times

1. In nineteen patients with normal or diseased kidneys, renal blood flow, transit times and vascular volume were determined by means of an indicator-dilution method. Two different indicators, plasma-bound Indocyanine Green (IG) and 99mTc-labelled erythrocytes, were used simultaneously. 2. Comparison of the results indicates that IG slightly overestimates renal blood flow, appearance time, mean transit time and vascular volume, as the erythrocyte/IG ratios averaged 0·972, 0·903, 0·93 and 0·921 respectively. Overestimation of the mean transit time was less apparent when it was prolonged. In patients with reduced renal function, the average blood flow values obtained with the two indicators were in good agreement. 3. It is unlikely that axial streaming of erythrocytes accounts for their shorter mean transit time, because the individual erythrocyte/IG mean transit time ratios were independent of the rate of blood flow and the peripheral packed cell volume. 4. Since the erythrocyte/IG mean transit time ratios correlated significantly with the erythrocyte/IG ratios for appearance time and renal blood flow, the common mechanism leading to a depression of all erythrocyte/IG ratios is presumably extravascular circulation and delayed recovery of a small fraction of IG.

scholarly journals Near-Infrared Spectroscopy Assessment of Cerebral Oxygen Metabolism in the Developing Premature Brain

2011 ◽  
Vol 32 (3) ◽  
pp. 481-488 ◽  
Author(s):  
Nadège Roche-Labarbe ◽  
Angela Fenoglio ◽  
Alpna Aggarwal ◽  
Mathieu Dehaes ◽  
Stefan A Carp ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Correlation Spectroscopy ◽  
Chronological Age ◽  
Flow Index ◽  
P Value ◽  
Blood Flow Index

Little is known about cerebral blood flow, cerebral blood volume (CBV), oxygenation, and oxygen consumption in the premature newborn brain. We combined quantitative frequency-domain near-infrared spectroscopy measures of cerebral hemoglobin oxygenation (SO2) and CBV with diffusion correlation spectroscopy measures of cerebral blood flow index (BFix) to determine the relationship between these measures, gestational age at birth (GA), and chronological age. We followed 56 neonates of various GA once a week during their hospital stay. We provide absolute values of SO2 and CBV, relative values of BFix, and relative cerebral metabolic rate of oxygen (rCMRO2) as a function of postmenstrual age (PMA) and chronological age for four GA groups. SO2 correlates with chronological age ( r=−0.54, P value 0.001) but not with PMA ( r=−0.07), whereas BFix and rCMRO2 correlate better with PMA ( r=0.37 and 0.43, respectively, P value 0.001). Relative CMRO2 during the first month of life is lower when GA is lower. Blood flow index and rCMRO2 are more accurate biomarkers of the brain development than SO2 in the premature newborns.

scholarly journals Noninvasive Measurement of Regional Cerebral Blood Flow by Near-Infrared Spectroscopy and Indocyanine Green

1998 ◽  
Vol 18 (4) ◽  
pp. 445-456 ◽  
Author(s):  
Wolfgang M. Kuebler ◽  
Axel Sckell ◽  
Oliver Habler ◽  
Martin Kleen ◽  
Gerhard E. H. Kuhnle ◽  
...  
Keyword(s):  
Blood Flow ◽  
Infrared Spectroscopy ◽  
Indocyanine Green ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Calculated Data ◽  
Practical Method ◽  
Flow Index ◽  
Noninvasive Technique ◽  
Blood Flow Index

Clinicians lack a practical method for measuring CBF rapidly, repeatedly, and noninvasively at the bedside. A new noninvasive technique for estimation of cerebral hemodynamics by use of near-infrared spectroscopy (NIRS) and an intravenously infused tracer dye is proposed. Kinetics of the infrared tracer indocyanine green were monitored on the intact skull in pigs. According to an algorithm derived from fluorescein flowmetry, a relative blood flow index (BFI) was calculated. Data obtained were compared with cerebral and galeal blood flow values assessed by radioactive microspheres under baseline conditions and during hemorrhagic shock and resuscitation. Blood flow index correlated significantly ( rs = 0.814, P < 0.001) with cortical blood flow but not with galeal blood flow ( rs = 0.258). However, limits of agreement between BFI and CBF are rather wide (± 38.2 ± 6.4 mL 100 g−1 min−1) and require further studies. Data presented demonstrate that detection of tracer kinetics in the cerebrovasculature by NIRS may serve as valuable tool for the noninvasive estimation of regional CBF. Indocyanine green dilution curves monitored noninvasively on the intact skull by NIRS reflect dye passage through the cerebral, not extracerebral, circulation.

Near-infrared spectroscopy extended with indocyanine green dye dilution for cerebral blood flow measurement: Median values in healthy volunteers

2008 ◽  
Vol 16 (3) ◽  
Author(s):  
R. Mudra ◽  
C. Muroi ◽  
P. Niederer ◽  
E. Keller
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Infrared Spectroscopy ◽  
Indocyanine Green ◽  
Healthy Volunteers ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Flow Index ◽  
Vascular Perfusion ◽  
Dye Dilution

AbstractThe cerebral blood flow (CBF) is an important vital parameter in neurointensive care. Currently, there is no non-invasive method for its measurement that can easily be applied at the bedside. A new tool to determine CBF is based on near-infrared spectroscopy (NIRS) applied together with indocyanine green (ICG) dye dilution. From a bilateral measurement on selected regions on the head of infrared (IR) absorption at various wavelengths during the dilution maneuver, the vascular perfusion characteristics of the two brain hemispheres can be determined in terms of mean transit time (mtt) of ICG, cerebral blood volume (CBV) and CBF.So far, on nine healthy volunteers, NIRS ICG dye dilution bihemispheric measurements were performed, which yielded to mtt given as median (range) of 9.3 s (5.1–16.3 s), CBV of 3.5 ml/100 g (1.7–4.1 ml/100 g), and CBF of 18.2 ml/(100 g×min) [11.1–48.6 ml/(100 g×min)]. Additionally, the blood flow index (BFI) was calculated with BFI= 13.8 mg/(100 g×s) [6.6–15.2 mg/(100 g×s)]. The Spearman rank correlation coefficient between CBF and BFI was RS = 0.76. However, as the Bland & Altman plot between CBFNIRS and the CBFBFI documents, the limits of agreement are rather wide (21.9±6.7). Under physiological conditions in healthy volunteers, no differences could be detected between the hemispheres.

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