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Throckmorton GA, Haugen E, Thomas G, Willmon P, Baba JS, Solórzano CC, Mahadevan-Jansen A. Label-free intraoperative nerve detection and visualization using ratiometric diffuse reflectance spectroscopy. Sci Rep 2023; 13:7599. [PMID: 37165016 PMCID: PMC10172349 DOI: 10.1038/s41598-023-34054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/24/2023] [Indexed: 05/12/2023] Open
Abstract
Iatrogenic nerve injuries contribute significantly to postoperative morbidity across various surgical disciplines and occur in approximately 500,000 cases annually in the US alone. Currently, there are no clinically adopted means to intraoperatively visualize nerves beyond the surgeon's visual assessment. Here, we report a label-free method for nerve detection using diffuse reflectance spectroscopy (DRS). Starting with an in vivo rat model, fiber- and imaging-based DRS independently identified similar wavelengths that provided optimal contrast for nerve identification with an accuracy of 92%. Optical property measurements of rat and human cadaver tissues verify that the source of contrast between nerve and surrounding tissues is largely due to higher scattering in nerve and differences in oxygenated hemoglobin content. Clinical feasibility was demonstrated in patients undergoing thyroidectomies using both probe-based and imaging-based approaches where the nerve were identified with 91% accuracy. Based on our preliminary results, DRS has the potential to both provide surgeons with a label-free, intraoperative means of nerve visualization and reduce the incidence of iatrogenic nerve injuries along with its detrimental complications.
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Affiliation(s)
- Graham A Throckmorton
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37235, USA
| | - Ezekiel Haugen
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37235, USA
| | - Giju Thomas
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37235, USA
| | - Parker Willmon
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37235, USA
| | | | - Carmen C Solórzano
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Anita Mahadevan-Jansen
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA.
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37235, USA.
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
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Sun Y, Dumont AP, Arefin MS, Patil CA. Model-based characterization platform of fiber optic extended-wavelength diffuse reflectance spectroscopy for identification of neurovascular bundles. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:095002. [PMID: 36088529 PMCID: PMC9463544 DOI: 10.1117/1.jbo.27.9.095002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
SIGNIFICANCE Fiber-optic extended-wavelength diffuse reflectance spectroscopy (EWDRS) using both visible/near-infrared and shortwave-infrared detectors enables improved detection of spectral absorbances arising from lipids, water, and collagen and has demonstrated promise in a variety of applications, including detection of nerves and neurovascular bundles (NVB). Development of future applications of EWDRS for nerve detection could benefit from the use of model-based analyses including Monte Carlo (MC) simulations and evaluation of agreement between model systems and empirical measurements. AIM The aim of this work is to characterize agreement between EWDRS measurements and simulations and inform future applications of model-based studies of nerve-detecting applications. APPROACH A model-based platform consisting of an ex vivo microsurgical nerve dissection model, unique two-layer optical phantoms, and MC model simulations of fiber-optic EWDRS spectroscopic measurements were used to characterize EWDRS and compare agreement across models. In addition, MC simulations of an EWDRS measurement scenario are performed to provide a representative example of future analyses. RESULTS EWDRS studies performed in the common chicken thigh femoral nerve microsurgical dissection model indicate similar spectral features for classification of NVB versus adjacent tissues as reported in porcine models and human subjects. A comparison of measurements from unique EWDRS issue mimicking optical phantoms and MC simulations indicates high agreement between the two in homogeneous and two-layer optical phantoms, as well as in dissected tissues. Finally, MC simulations of measurement over a simulated NVB indicate the potential of future applications for measurement of nerve plexus. CONCLUSIONS Characterization of agreement between fiber-optic EWDRS measurements and MC simulations demonstrates strong agreement across a variety of tissues and optical phantoms, offering promise for further use to guide the continued development of EWDRS for translational applications.
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Affiliation(s)
- Yu Sun
- Temple University, Department of Bioengineering, Philadelphia, Pennsylvania, United States
| | - Alexander P. Dumont
- Temple University, Department of Bioengineering, Philadelphia, Pennsylvania, United States
| | | | - Chetan A. Patil
- Temple University, Department of Bioengineering, Philadelphia, Pennsylvania, United States
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Gonzales J, Pirovano G, Chow CY, de Souza Franca PD, Carter LM, Klint JK, Guru N, Lewis JS, King GF, Reiner T. Fluorescence labeling of a Na V1.7-targeted peptide for near-infrared nerve visualization. EJNMMI Res 2020; 10:49. [PMID: 32409881 PMCID: PMC7225226 DOI: 10.1186/s13550-020-00630-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/08/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Accidental peripheral nerve injury during surgical intervention results in a broad spectrum of potentially debilitating side effects. Tissue distortion and poor visibility can significantly increase the risk of nerve injury with long-lasting consequences for the patient. We developed and characterized Hs1a-FL, a fluorescent near-infrared molecule for nerve visualization in the operating theater with the aim of helping physicians to visualize nerves during surgery. Hs1a was derived from the venom of the Chinese bird spider, Haplopelma schmidti, and conjugated to Cy7.5 dye. Hs1a-FL was injected intravenously in mice, and harvested nerves were imaged microscopically and with epifluorescence. RESULTS Hs1a-FL showed specific and stable binding to the sodium channel NaV1.7, present on the surface of human and mouse nerves. Hs1a-FL allowed epifluorescence visualization of sciatic mouse nerves with favorable nerve-to-muscle contrast. CONCLUSIONS Fluorescent NaV1.7-targeted tracers have the potential to be adopted clinically for the intraoperative visualization of peripheral nerves during surgery, providing guidance for the surgeon and potentially improving the standard of care.
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Affiliation(s)
- Junior Gonzales
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Giacomo Pirovano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Chun Yuen Chow
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland, 4072, Australia
| | | | - Lukas M Carter
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Julie K Klint
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland, 4072, Australia
- Current address: H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
| | - Navjot Guru
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jason S Lewis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Pharmacology, Weill-Cornell Medical College, New York, NY, 10065, USA
| | - Glenn F King
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland, 4072, Australia
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Center for Molecular Imaging and Nanotechnology (CMINT), Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA.
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Bunke J, Sheikh R, Reistad N, Malmsjö M. Extended-wavelength diffuse reflectance spectroscopy for a comprehensive view of blood perfusion and tissue response in human forearm skin. Microvasc Res 2019; 124:1-5. [PMID: 30721673 DOI: 10.1016/j.mvr.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was to investigate the possibility of using extended-wavelength diffuse reflectance spectroscopy (EW-DRS) to measure tissue response related to blood perfusion. The study was performed on a model that we have previously found to be useful for studying techniques for perfusion monitoring following the injection of epinephrine in a local anesthetic in the human forearm. METHODS Nine healthy subjects were included in the study. Spectroscopy was performed with an EW-DRS system using a combination of two spectrometers to resolve light in the visible (350 nm to 1100 nm) and the near-infrared regions (900 nm to 1700 nm). The change in signal upon the injection of lidocaine (20 mg/ml) + epinephrine (12.5 μg/ml) (LIDO +EPI), compared to a control injection with saline (9 mg/ml), was investigated. RESULTS Injection of lidocaine + epinephrine (12.5 μg/ml) caused a change in the EW-DRS signal in the wavelength intervals 510 to 610 nm, known to change upon deoxygenation of hemoglobin. When examining the full wavelength range (450 to 1550 nm) a decrease in reflectance upon LIDO +EPI injection was observed, suggesting that the broader spectrum provides more detailed information on the tissue response. The time to stable hypoperfusion was found to be 2.6 min. CONCLUSIONS EW-DRS appears to be a promising technique for monitoring perfusion, and could provide a useful tool in plastic and reconstructive surgery. The broad spectrum provides detailed information on the molecular changes taking place in the tissue. However, the technique must be thoroughly validated before it can be implemented in clinical practice.
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Affiliation(s)
- Josefine Bunke
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - Rafi Sheikh
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | | | - Malin Malmsjö
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden.
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Balthasar AJR, Bydlon TM, Ippel H, van der Voort M, Hendriks BHW, Lucassen GW, van Geffen GJ, van Kleef M, van Dijk P, Lataster A. Optical signature of nerve tissue-Exploratory ex vivo study comparing optical, histological, and molecular characteristics of different adipose and nerve tissues. Lasers Surg Med 2018; 50:948-960. [PMID: 29756651 PMCID: PMC6220981 DOI: 10.1002/lsm.22938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 02/02/2023]
Abstract
Background During several anesthesiological procedures, needles are inserted through the skin of a patient to target nerves. In most cases, the needle traverses several tissues—skin, subcutaneous adipose tissue, muscles, nerves, and blood vessels—to reach the target nerve. A clear identification of the target nerve can improve the success of the nerve block and reduce the rate of complications. This may be accomplished with diffuse reflectance spectroscopy (DRS) which can provide a quantitative measure of the tissue composition. The goal of the current study was to further explore the morphological, biological, chemical, and optical characteristics of the tissues encountered during needle insertion to improve future DRS classification algorithms. Methods To compare characteristics of nerve tissue (sciatic nerve) and adipose tissues, the following techniques were used: histology, DRS, absorption spectrophotometry, high‐resolution magic‐angle spinning nuclear magnetic resonance (HR‐MAS NMR) spectroscopy, and solution 2D 13C‐1H heteronuclear single‐quantum coherence spectroscopy. Tissues from five human freshly frozen cadavers were examined. Results Histology clearly highlights a higher density of cellular nuclei, collagen, and cytoplasm in fascicular nerve tissue (IFAS). IFAS showed lower absorption of light around 1200 nm and 1750 nm, higher absorption around 1500 nm and 2000 nm, and a shift in the peak observed around 1000 nm. DRS measurements showed a higher water percentage and collagen concentration in IFAS and a lower fat percentage compared to all other tissues. The scattering parameter (b) was highest in IFAS. The HR‐MAS NMR data showed three extra chemical peak shifts in IFAS tissue. Conclusion Collagen, water, and cellular nuclei concentration are clearly different between nerve fascicular tissue and other adipose tissue and explain some of the differences observed in the optical absorption, DRS, and HR‐NMR spectra of these tissues. Some differences observed between fascicular nerve tissue and adipose tissues cannot yet be explained but may be helpful in improving the discriminatory capabilities of DRS in anesthesiology procedures. Lasers Surg. Med. 50:948–960, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Andrea J R Balthasar
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Hans Ippel
- Department of Biochemistry, Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | | | - Benno H W Hendriks
- Philips Research, Eindhoven, The Netherlands.,Delft University of Technology, Department of BioMechanical Engineering, Delft, The Netherlands
| | | | - Geert-Jan van Geffen
- Department of Anesthesiology, University Medical Center St. Radboud, Nijmegen, The Netherlands
| | - Maarten van Kleef
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul van Dijk
- Department of Anatomy and Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Arno Lataster
- Department of Anatomy and Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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