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

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.

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Feasibility and Comparison of Laparoscopic Laser Speckle Contrast Imaging to Near-Infrared Display of Indocyanine Green in Intraoperative Tissue Blood Flow/Tissue Perfusion and Extrahepatic Bile Ducts in Preclinical Porcine Models

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2021.07.143 ◽

2021 ◽

Vol 233 (5) ◽

pp. S78-S79

Author(s):

Chibueze A. Nwaiwu ◽

Vasiliy E. Buharin ◽

Anderson Mach ◽

Robin Grandl ◽

Alyson F. Dechert ◽

...

Keyword(s):

Blood Flow ◽

Indocyanine Green ◽

Bile Ducts ◽

Near Infrared ◽

Tissue Perfusion ◽

Laser Speckle ◽

Tissue Blood Flow ◽

Contrast Imaging ◽

Speckle Contrast ◽

Extrahepatic Bile Ducts

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Assessment of Endothelial and Microvascular Function in CKD: Older and Newer Techniques, Associated Risk Factors, and Relations with Outcomes

American Journal of Nephrology ◽

10.1159/000512263 ◽

2020 ◽

pp. 1-19

Author(s):

Marieta P. Theodorakopoulou ◽

Maria Schoina ◽

Pantelis Sarafidis

Keyword(s):

Endothelial Dysfunction ◽

Near Infrared ◽

Inflammatory Responses ◽

Target Organ Damage ◽

Venous Occlusion ◽

Microvascular Function ◽

Laser Speckle ◽

Contrast Imaging ◽

Renal Disease Progression ◽

Noninvasive Methods

Background: Endothelium is the inner cellular lining of the vessels that modulates multiple biological processes including vasomotor tone, permeability, inflammatory responses, hemostasis, and angiogenesis. Endothelial dysfunction, the basis of atherosclerosis, is characterized by an imbalance between endothelium-derived relaxing factors and endothelium-derived contracting factors. Summary: Starting from the semi-invasive venous occlusion plethysmography, several functional techniques have been developed to evaluate microvascular function and subsequently used in patients with CKD. Flow-mediated dilatation of the forearm is considered to be the “gold standard,” while in the last years, novel, noninvasive methods such as laser speckle contrast imaging and near-infrared spectroscopy are scarcely used. Moreover, several circulating biomarkers of endothelial function have been used in studies in CKD patients. This review summarizes available functional methods and biochemical markers for the assessment of endothelial and microvascular function in CKD and discusses existing evidence on their associations with comorbid conditions and outcomes in this population. Key Messages: Accumulated evidence suggests that endothelial dysfunction occurs early in CKD and is associated with target organ damage, progression of renal injury, cardiovascular events, and mortality. Novel methods evaluating microvascular function can offer a detailed, real-time assessment of underlying phenomena and should be increasingly used to shed more light on the role of endothelial dysfunction on cardiovascular and renal disease progression in CKD.

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Evaluation to Differentiate between Tumor Lesions and the Parenchyma in Partial Nephrectomies for Renal Tumors Based on Quantitative Fluorescence Imaging Using Indocyanine Green Dye

Current Urology ◽

10.1159/000499289 ◽

2019 ◽

Vol 13 (2) ◽

pp. 74-81

Author(s):

Norihito Soga ◽

Akihito Inoko ◽

Jun Furusawa ◽

Yuji Ogura

Keyword(s):

Indocyanine Green ◽

Success Rate ◽

Fluorescence Imaging ◽

Partial Nephrectomy ◽

Near Infrared ◽

Clear Cell ◽

Ex Vivo ◽

Renal Tumors ◽

Contrast Imaging ◽

Malignant Lesions

Introduction: Near-infrared fluorescence imaging with indocyanine green is a useful tool during partial nephrectomy. Because an accurate method for judging hasn't been established yet, the success rate may be slightly different and inconsistent. Materials and Methods: A total of 21 cases with suspected renal cancers who had undergone a partial nephrectomy were enrolled. We examined differences in the success rate between malignant lesions and the parenchyma by quantifying fluorescence in the pre-resection and ex vivo phases. Results: Pre-resection imaging showed a significant degradation of fluorescence in the focused lesion in 76.2% (16/21) of cases. A significant degradation was observed in 73.7% (14/19) of the total malignant lesions, 70.5% (12/17) of cases with a clear cell lesion, 100% (2/2) of cases with non-clear cell lesions, and 100% (2/2) of benign angiomyolipomas. In contrast, imaging of the ex vivo resected specimens showed a significant degradation in fluorescence of the focused lesions in 85.7% (18/21) of cases. A significantly degradation was observed in 84.2% (16/19) of the total malignant lesions, 82.3% (14/17) of cases with a clear cell lesion, 100% (2/2) of cases with non-clear cell lesions, and 100% (2/2) of benign angiomyolipomas. Conclusion: We firstly evaluated the efficacy of quantitative indocyanine green-based fluorescence as an objective method.

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Comparison of Indocyanine Green Angiography and Laser Speckle Contrast Imaging for the Assessment of Vasculature Perfusion

Neurosurgery ◽

10.1227/neu.0b013e31826adf88 ◽

2012 ◽

Vol 71 (5) ◽

pp. 1023-1031 ◽

Cited By ~ 23

Author(s):

Erica L. Towle ◽

Lisa M. Richards ◽

S. M. Shams Kazmi ◽

Douglas J. Fox ◽

Andrew K. Dunn

Keyword(s):

Blood Flow ◽

Indocyanine Green ◽

Single Point ◽

Tissue Perfusion ◽

Laser Speckle ◽

Optical Methods ◽

Contrast Imaging ◽

Laser Speckle Contrast Imaging ◽

Speckle Contrast ◽

Excellent Method

Abstract BACKGROUND: Assessment of the vasculature is critical for overall success in cranial vascular neurological surgery procedures. Although several methods of monitoring cortical perfusion intraoperatively are available, not all are appropriate or convenient in a surgical environment. Recently, 2 optical methods of care have emerged that are able to obtain high spatial resolution images with easily implemented instrumentation: indocyanine green (ICG) angiography and laser speckle contrast imaging (LSCI). OBJECTIVE: To evaluate the usefulness of ICG and LSCI in measuring vessel perfusion. METHODS: An experimental setup was developed that simultaneously collects measurements of ICG fluorescence and LSCI in a rodent model. A 785-nm laser diode was used for both excitation of the ICG dye and the LSCI illumination. A photothrombotic clot model was used to occlude specific vessels within the field of view to enable comparison of the 2 methods for monitoring vessel perfusion. RESULTS: The induced blood flow change demonstrated that ICG is an excellent method for visualizing the volume and type of vessel at a single point in time; however, it is not always an accurate representation of blood flow. In contrast, LSCI provides a continuous and accurate measurement of blood flow changes without the need of an external contrast agent. CONCLUSION: These 2 methods should be used together to obtain a complete understanding of tissue perfusion.

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

Surgical Innovation ◽

10.1177/1553350620956437 ◽

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.

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Fluorescence visualization of the intersegmental plane by bronchoscopic instillation of indocyanine green into the targeted segmental bronchus: determination of the optimal settings

Journal of International Medical Research ◽

10.1177/0300060521990202 ◽

2021 ◽

Vol 49 (2) ◽

pp. 030006052199020

Author(s):

Takashi Anayama ◽

Kentaro Hirohashi ◽

Ryohei Miyazaki ◽

Hironobu Okada ◽

Marino Yamamoto ◽

...

Keyword(s):

Indocyanine Green ◽

Near Infrared ◽

Characteristic Curve ◽

Area Under The Curve ◽

Green Fluorescence ◽

Indocyanine Green Fluorescence ◽

Segmental Bronchus ◽

Segment Volume ◽

Intersegmental Plane

Objective To determine the appropriate amount of indocyanine green for bronchial insufflation. Methods We enrolled 20 consecutive patients scheduled for anatomical segmentectomy in the Kochi Medical School Hospital. After inducing general anesthesia, 6 to 60 mL of 200-fold-diluted indocyanine green (0.0125 mg/mL) was insufflated into the subsegmental bronchi in the targeted pulmonary segmental bronchus. The volume of the targeted pulmonary segments was calculated using preoperative computed tomography. Fluorescence spread in the segmental alveoli was visualized using a dedicated near-infrared thoracoscope. Results The targeted segment was uniformly visualized by indocyanine green fluorescence in 16/20 (80.0%) cases after insufflating indocyanine green. A receiver operating characteristic curve indicated that the area under the curve was 0.984; the optimal cut-off volume of diluted indocyanine green for insufflation was 8.91% of the calculated targeted pulmonary segment volume. Conclusions The setting for indocyanine green insufflation was optimized for near-infrared fluorescence image-guided anatomical segmentectomy. By injecting the correct amount of indocyanine green, fluorescence-guided anatomical segmentation may be performed more appropriately.

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Intraoperative Near-Infrared Autofluorescence and Indocyanine Green Imaging to Identify Parathyroid Glands: A Comparison

International Journal of Endocrinology ◽

10.1155/2019/4687951 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Max Lerchenberger ◽

Norah Al Arabi ◽

Julia K. S. Gallwas ◽

Herbert Stepp ◽

Klaus K. J. Hallfeldt ◽

...

Keyword(s):

Adipose Tissue ◽

Indocyanine Green ◽

Near Infrared ◽

False Negative ◽

Parathyroid Glands ◽

Surrounding Tissue ◽

True Positive ◽

Negative Results ◽

Nir Light ◽

False Negative Results

Objective. To investigate the feasibility of near-infrared autofluorescence (AF) and indocyanine green (ICG) fluorescence to identify parathyroid glands intraoperatively. Methods. Fluorescence imaging was carried out during open parathyroid and thyroid surgery. After visual identification, parathyroid glands were exposed to near-infrared (NIR) light with a wavelength between 690 and 770 nm. The camera of the Storz® NIR/ICG endoscopic system used detects NIR light as a blue signal. Therefore, parathyroid AF was expected to be displayed in the blue color channel in contrast to the surrounding tissue. Following AF imaging, a bolus of 5 mg ICG was applied intravenously. ICG fluorescence was detected using the same NIR/ICG imaging system. Well-vascularized parathyroid glands were expected to show a strong fluorescence in contrast to surrounding lymphatic and adipose tissue. Results. We investigated 78 parathyroid glands from 50 patients. 64 parathyroid glands (82%) displayed AF showing the typical bluish violet color. 63 parathyroid glands (81%) showed a strong and persistent fluorescence after application of ICG. The sensitivity of identifying a parathyroid gland by AF was 82% (64 true positive and 14 false negative results), while ICG imaging showed a sensitivity of 81% (63 true positive and 15 false negative results). The Fisher exact test revealed no significant difference between both groups at p<0.05. Neither lymph nodes nor adipose tissue revealed substantial AF or ICG fluorescence. Conclusion. AF and ICG fluorescence reveal a high degree of sensitivity in identifying parathyroid glands. Further, ICG imaging facilitates the assessment of parathyroid perfusion. However, in the current setting both techniques are not suitable as screening tools to identify parathyroid glands at an early stage of the operation.

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