scholarly journals Improved Diagnostic Imaging of Brain Tumors by Multimodal Microscopy and Deep Learning

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1806
Author(s):  
Johanna Gesperger ◽  
Antonia Lichtenegger ◽  
Thomas Roetzer ◽  
Matthias Salas ◽  
Pablo Eugui ◽  
...  
Keyword(s):  
Brain Tumor ◽  
High Resolution ◽  
Tumor Tissue ◽  
Intraoperative Imaging ◽  
Large Field ◽  
Low Grade ◽  
Lower Grade ◽  
Optical Coherence ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery

Fluorescence-guided surgery is a state-of-the-art approach for intraoperative imaging during neurosurgical removal of tumor tissue. While the visualization of high-grade gliomas is reliable, lower grade glioma often lack visible fluorescence signals. Here, we present a hybrid prototype combining visible light optical coherence microscopy (OCM) and high-resolution fluorescence imaging for assessment of brain tumor samples acquired by 5-aminolevulinic acid (5-ALA) fluorescence-guided surgery. OCM provides high-resolution information of the inherent tissue scattering and absorption properties of tissue. We here explore quantitative attenuation coefficients derived from volumetric OCM intensity data and quantitative high-resolution 5-ALA fluorescence as potential biomarkers for tissue malignancy including otherwise difficult-to-assess low-grade glioma. We validate our findings against the gold standard histology and use attenuation and fluorescence intensity measures to differentiate between tumor core, infiltrative zone and adjacent brain tissue. Using large field-of-view scans acquired by a near-infrared swept-source optical coherence tomography setup, we provide initial assessments of tumor heterogeneity. Finally, we use cross-sectional OCM images to train a convolutional neural network that discriminates tumor from non-tumor tissue with an accuracy of 97%. Collectively, the present hybrid approach offers potential to translate into an in vivo imaging setup for substantially improved intraoperative guidance of brain tumor surgeries.

scholarly journals The Neurosurgeon’s Armamentarium for Gliomas: An Update on Intraoperative Technologies to Improve Extent of Resection

2021 ◽  
Vol 10 (2) ◽  
pp. 236
Author(s):  
Alexander J. Schupper ◽  
Raymund L. Yong ◽  
Constantinos G. Hadjipanayis
Keyword(s):  
Tumor Tissue ◽  
Imaging Techniques ◽  
Intraoperative Imaging ◽  
Standard Of Care ◽  
Extent Of Resection ◽  
Guided Surgery ◽  
Current State ◽  
Fluorescence Guided Surgery ◽  
Neurosurgical Treatment ◽  
Intraoperative Visualization

Maximal safe resection is the standard of care in the neurosurgical treatment of high-grade gliomas. To aid surgeons in the operating room, adjuvant techniques and technologies centered around improving intraoperative visualization of tumor tissue have been developed. In this review, we will discuss the most advanced technologies, specifically fluorescence-guided surgery, intraoperative imaging, neuromonitoring modalities, and microscopic imaging techniques. The goal of these technologies is to improve detection of tumor tissue beyond what conventional microsurgery has permitted. We describe the various advances, the current state of the literature that have tested the utility of the different adjuvants in clinical practice, and future directions for improving intraoperative technologies.

Time-domain and spectral-domain optical coherence tomography in the analysis of brain tumor tissue

2006 ◽  
Vol 38 (6) ◽  
pp. 588-597 ◽  
Author(s):  
H.J. Böhringer ◽  
D. Boller ◽  
J. Leppert ◽  
U. Knopp ◽  
E. Lankenau ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Brain Tumor ◽  
Time Domain ◽  
Tumor Tissue ◽  
Spectral Domain ◽  
Optical Coherence

scholarly journals Macroscopic fluorescence-lifetime imaging of NADH and protoporphyrin IX improves the detection and grading of 5-aminolevulinic acid-stained brain tumors

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mikael T. Erkkilä ◽  
David Reichert ◽  
Johanna Gesperger ◽  
Barbara Kiesel ◽  
Thomas Roetzer ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Fluorescence Lifetime ◽  
Tumor Tissue ◽  
Aminolevulinic Acid ◽  
Protoporphyrin Ix ◽  
Low Grade ◽  
Wide Field ◽  
Fluorescence Lifetime Imaging ◽  
Lifetime Imaging

AbstractMaximal safe tumor resection remains the key prognostic factor for improved prognosis in brain tumor patients. Despite 5-aminolevulinic acid-based fluorescence guidance the neurosurgeon is, however, not able to visualize most low-grade gliomas (LGG) and infiltration zone of high-grade gliomas (HGG). To overcome the need for a more sensitive visualization, we investigated the potential of macroscopic, wide-field fluorescence lifetime imaging of nicotinamide adenine dinucleotide (NADH) and protoporphyrin IX (PPIX) in selected human brain tumors. For future intraoperative use, the imaging system offered a square field of view of 11 mm at 250 mm free working distance. We performed imaging of tumor tissue ex vivo, including LGG and HGG as well as brain metastases obtained from 21 patients undergoing fluorescence-guided surgery. Half of all samples showed visible fluorescence during surgery, which was associated with significant increase in PPIX fluorescence lifetime. While the PPIX lifetime was significantly different between specific tumor tissue types, the NADH lifetimes did not differ significantly among them. However, mainly necrotic areas exhibited significantly lower NADH lifetimes compared to compact tumor in HGG. Our pilot study indicates that combined fluorescence lifetime imaging of NADH/PPIX represents a sensitive tool to visualize brain tumor tissue not detectable with conventional 5-ALA fluorescence.

scholarly journals 5-Aminolevulinic Acid–Protoporphyrin IX Fluorescence-Guided Surgery for CNS Tumors

2018 ◽  
Vol 27 (1) ◽  
pp. 13-19
Author(s):  
Ricardo Ramina ◽  
Erasmo Barros Da Silva Júnior ◽  
Maurício Coelho Neto ◽  
Leonardo Gilmone Ruschel ◽  
Felipe Andrés Constanzo Navarrette
Keyword(s):  
Aminolevulinic Acid ◽  
Protoporphyrin Ix ◽  
High Grade Glioma ◽  
Awake Surgery ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
High Grade ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
High Grade Gliomas

Introduction: In the last two decades the 5-aminolevulinic acid (5-ALA) has been utilized in primary brain lesions and metastases surgery to aid the identification of tumor limits and infiltration. Objectives: In this retrospective study, we demonstrate our experience with the first 41 cases Latin America of surgical resection of central nervous system (CNS) lesions with 5-ALA. Methods: In 41 consecutive patients, we recorded age, sex, histopathological diagnosis, intraoperative 5-ALA fluorescence tumor response, 5-ALA post-resection resection grade through magnetic resonance image (MRI) and other concomitantintra-operative techniques utilized (transoperative imaging, awake surgery, electrophysiological stimulation and monitoring). Results: Twenty seven high-grade gliomas and 4 non-glial lesions were 5-ALA fluorescence positive; 6 low-grade gliomas, 1 high-grade glioma and a hippocampal gliosis were 5-ALA fluorescence negative. In one case of a low-grade glioma, the patient developed a cardiac arrhythmia, probably not related to 5-ALA administration, but the surgery was suspended. Conclusions: 5-ALA fluorescence-guided surgery is a safe and easy technique to be used, increasing tumor total gross resection in glioma cases, proving to be an invaluable neurosurgical tool for intracranial tumor surgery. There was no serious side effect in this series. This dye should be utilized in all cases of high-grade gliomas. 

scholarly journals Combination of hand-held probe and microscopy for fluorescence guided surgery in the brain tumor marginal zone

2017 ◽  
Vol 18 ◽  
pp. 185-192 ◽  
Author(s):  
Johan C.O. Richter ◽  
Neda Haj-Hosseini ◽  
Martin Hallbeck ◽  
Karin Wårdell
Keyword(s):  
Brain Tumor ◽  
Marginal Zone ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
The Brain

The role of fluorescence-guided surgical resection in the combined treatment of malignant glioma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2085-2085
Author(s):  
Carmine Maria Carapella ◽  
Piero Andrea Oppido ◽  
Antonello Vidiri ◽  
Fabio Cattani ◽  
Stefano Maria Telera ◽  
...  
Keyword(s):  
Overall Survival ◽  
Malignant Glioma ◽  
Surgical Resection ◽  
Tumor Tissue ◽  
Combined Treatment ◽  
Guided Surgery ◽  
Postoperative Mri ◽  
Present Experience ◽  
Fluorescence Guided Surgery ◽  
Recurrent Gbm

2085 Background: Malignant glioma represents a relevant therapeutic issue and the value of extensive surgical resection remains debated; recent evidence suggests that radical removal is associated with better survival. An interesting tool for identifying tumor tissue and increasing the extent of surgery is represented by fluorescence-guided resection, taking advantage of metabolic and structural changes induced by a natural precursor of heme biosynthetic pathway, 5-amino-levulinic acid (ALA). Methods: The present experience is related to 32 patients affected by malignant glioma (18 newly diagnosed: 16 glioblastoma (GBM), 2 anaplastic oligodendroglioma; and 14 recurrent GBM) eligible for fluorescence-guided resection, operated on in our Institute since fall of 2009. All patients underwent preoperative and early postoperative MRI, showing contrast enhancing lesions. An oral dose of 20 mg 5-ALA /kg bw was administered to each patient. Microsurgical resection was performed by an operating microscope enabled to visualize the fluorescence. All the patients, as first line treatment, have been submitted to radiotherapy and chemotherapy; second and in some cases third line treatments were utilized in recurrent cases. The patients follow-up ranged from 2 years to 6 months. Results: In more than 90% of patients tumor tissue showed intraoperative red fluorescence; mainly in recurrent GBM, when MRI documented heterogeneous lesions with enhancing areas mixed with non enhancing gliotic scars, fluorescence-guided surgery allowed a better definition of active tumor, with net margins from perilesional “healthy” brain. Early postoperative MRI confirmed gross total resection without contrast enhancement in 80 % of patients. In the present experience the procedure did not determine any relevant additional neurological deficit. Considering overall survival of recurrent patients we obtained a median extension of at least 9.0 months (3 – 16+ months). Conclusions: Fluorescence-guided surgery improves tumor detection and allows extended resection of malignant glioma, without any relevant impact on neurological status, resulting helpful mainly in the recurrent setting with a consistent effect on overall survival.

Fluorescence-guided surgery with aminolevulinic acid for low-grade gliomas

2018 ◽  
Vol 141 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Benjamin K. Hendricks ◽  
Nader Sanai ◽  
Walter Stummer
Keyword(s):  
Aminolevulinic Acid ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery

Intraoperative MRI-guided Resection in Pediatric Brain Tumor Surgery: A Meta-analysis of Extent of Resection and Safety Outcomes

2020 ◽  
Vol 82 (01) ◽  
pp. 064-074
Author(s):  
Johannes Wach ◽  
Mohammad Banat ◽  
Valeri Borger ◽  
Hartmut Vatter ◽  
Hannes Haberl ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Meta Analysis ◽  
Pediatric Brain Tumor ◽  
Extent Of Resection ◽  
Low Grade ◽  
Brain Tumor Surgery ◽  
Glioma Surgery ◽  
Guided Surgery ◽  
The Mean ◽  
Pediatric Brain

Abstract Background The objective of this meta-analysis was to analyze the impact of intraoperative magnetic resonance imaging (iMRI) on pediatric brain tumor surgery with regard to the frequency of histopathologic entities, additional resections secondary to iMRI, rate of gross total resections (GTR) in glioma surgery, extent of resection (EoR) in supra- and infratentorial compartment, surgical site infections (SSIs), and neurologic outcome after surgery. Methods MEDLINE/PubMed Service was searched for the terms “intraoperative MRI,” “pediatric,” “brain,” “tumor,” “glioma,” and “surgery.” The review produced 126 potential publications; 11 fulfilled the inclusion criteria, including 584 patients treated with iMRI-guided resections. Studies reporting about patients <18 years, setup of iMRI, surgical workflow, and extent of resection of iMRI-guided glioma resections were included. Results IMRI-guided surgery is mainly used for pediatric low-grade gliomas. The mean rate of GTR in low- and high-grade gliomas was 78.5% (207/254; 95% confidence interval [CI]: 64.6–89.7, p < 0.001). The mean rate of GTR in iMRI-assisted low-grade glioma surgery was 74.3% (35/47; 95% CI: 61.1–85.5, p = 0.759). The rate of SSI in surgery assisted by iMRI was 1.6% (6/482; 95% CI: 0.7–2.9). New onset of transient postoperative neurologic deficits were observed in 37 (33.0%) of 112 patients. Conclusion IMRI-guided surgery seems to improve the EoR in pediatric glioma surgery. The rate of SSI and the frequency of new neurologic deficits after IMRI-guided surgery are within the normal range of pediatric neuro-oncologic surgery.

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