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Grygoryev K, Lu H, Sørensen S, Talebi Varnosfaderani O, Georgel R, Li L, Burke R, Andersson-Engels S. Miniature, multi-dichroic instrument for measuring the concentration of multiple fluorophores. BIOMEDICAL OPTICS EXPRESS 2024; 15:2377-2391. [PMID: 38633072 PMCID: PMC11019676 DOI: 10.1364/boe.516574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
Identification of tumour margins during resection of the brain is critical for improving the post-operative outcomes. Due to the highly infiltrative nature of glioblastoma multiforme (GBM) and limited intraoperative visualization of the tumour margin, incomplete surgical resection has been observed to occur in up to 80 % of GBM cases, leading to nearly universal tumour recurrence and overall poor prognosis of 14.6 months median survival. This research presents a miniaturized, SiPMT-based optical system for simultaneous measurement of powerful DRS and weak auto-fluorescence for brain tumour detection. The miniaturisation of the optical elements confined the spatial separation of eight select wavelengths into footprint measuring 1.5 × 2 × 16 mm. The small footprint enables this technology to be integrated with existing surgical guidance instruments in the operating room. It's dynamic ability to subtract any background illumination and measure signal intensities across a broad range from pW to mWs make this design much more suitable for clinical environments as compared to spectrometer-based systems with limited dynamic ranges and high integration times. Measurements using optical tissue phantoms containing mixed fluorophores demonstrate correlation coefficients between the fitted response and actual concentration using PLS regression being 0.95, 0.87 and 0.97 for NADH, FAD and PpIX , respectively. These promising results indicate that our proposed miniaturized instrument could serve as an effective alternative in operating rooms, assisting surgeons in identifying brain tumours to achieving positive surgical outcomes for patients.
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Affiliation(s)
| | - Huihui Lu
- Tyndall National Institute, Lee Maltings Complex, Dyke Parade, Cork, Ireland
| | - Simon Sørensen
- Tyndall National Institute, Lee Maltings Complex, Dyke Parade, Cork, Ireland
| | | | - Rachel Georgel
- Tyndall National Institute, Lee Maltings Complex, Dyke Parade, Cork, Ireland
| | - Liyao Li
- Tyndall National Institute, Lee Maltings Complex, Dyke Parade, Cork, Ireland
| | - Ray Burke
- Tyndall National Institute, Lee Maltings Complex, Dyke Parade, Cork, Ireland
| | - Stefan Andersson-Engels
- Tyndall National Institute, Lee Maltings Complex, Dyke Parade, Cork, Ireland
- Department of Physics, University College Cork, College Road, Cork, Ireland
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2
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Gautheron A, Bernstock JD, Picart T, Guyotat J, Valdés PA, Montcel B. 5-ALA induced PpIX fluorescence spectroscopy in neurosurgery: a review. Front Neurosci 2024; 18:1310282. [PMID: 38348134 PMCID: PMC10859467 DOI: 10.3389/fnins.2024.1310282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
The review begins with an overview of the fundamental principles/physics underlying light, fluorescence, and other light-matter interactions in biological tissues. It then focuses on 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX) fluorescence spectroscopy methods used in neurosurgery (e.g., intensity, time-resolved) and in so doing, describe their specific features (e.g., hardware requirements, main processing methods) as well as their strengths and limitations. Finally, we review current clinical applications and future directions of 5-ALA-induced protoporphyrin IX (PpIX) fluorescence spectroscopy in neurosurgery.
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Affiliation(s)
- A. Gautheron
- Université Jean Monnet Saint-Etienne, CNRS, Institut d Optique Graduate School, Laboratoire Hubert Curien UMR 5516, Saint-Étienne, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France
| | - J. D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - T. Picart
- Department of Neurosurgical Oncology and Vascular Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - J. Guyotat
- Department of Neurosurgical Oncology and Vascular Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France
| | - P. A. Valdés
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, United States
- Department of Neurobiology, University of Texas Medical Branch, Galveston, TX, United States
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, United States
| | - B. Montcel
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France
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Suero Molina E, Black D, Walke A, Azemi G, D’Alessandro F, König S, Stummer W. Unraveling the blue shift in porphyrin fluorescence in glioma: The 620 nm peak and its potential significance in tumor biology. Front Neurosci 2023; 17:1261679. [PMID: 38027504 PMCID: PMC10657867 DOI: 10.3389/fnins.2023.1261679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
In glioma surgery, the low-density infiltration zone of tumors is difficult to detect by any means. While, for instance, 5-aminolevulinic acid (5-ALA)-induced fluorescence is a well-established surgical procedure for maximizing resection of malignant gliomas, a cell density in tumor tissue of 20-30% is needed to observe visual fluorescence. Hyperspectral imaging is a powerful technique for the optical characterization of brain tissue, which accommodates the complex spectral properties of gliomas. Thereby, knowledge about the signal source is essential to generate specific separation (unmixing) procedures for the different spectral characteristics of analytes and estimate compound abundances. It was stated that protoporphyrin IX (PpIX) fluorescence consists mainly of emission peaks at 634 nm (PpIX634) and 620 nm (PpIX620). However, other members of the substance group of porphyrins fluoresce similarly to PpIX due to their common tetrapyrrole core structure. While the PpIX634 signal has reliably been assigned to PpIX, it has not yet been analyzed if PpIX620 might result from a different porphyrin rather than being a second photo state of PpIX. We thus reviewed more than 200,000 spectra from various tumors measured in almost 600 biopsies of 130 patients. Insufficient consideration of autofluorescence led to artificial inflation of the PpIX620 peak in the past. Recently, five basis spectra (PpIX634, PpIX620, flavin, lipofuscin, and NADH) were described and incorporated into the analysis algorithm, which allowed more accurate unmixing of spectral abundances. We used the improved algorithm to investigate the PpIX620 signal more precisely and investigated coproporphyrin III (CpIII) fluorescence phantoms for spectral unmixing. Our findings show that the PpIX634 peak was the primary source of the 5-ALA-induced fluorescence. CpIII had a similar spectral characteristic to PpIX620. The supplementation of 5-ALA may trigger the increased production of porphyrins other than PpIX within the heme biosynthesis pathway, including that of CpIII. It is essential to correctly separate autofluorescence from the main PpIX634 peak to analyze the fluorescence signal. This article highlights the need for a comprehensive understanding of the spectral complexity in gliomas and suggests less significance of the 620 nm fluorescence peak for PpIX analysis and visualization.
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Affiliation(s)
- Eric Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
- Computational NeuroSurgery (CNS) Lab, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - David Black
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Anna Walke
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
- Core Unit Proteomics, Interdisciplinary Centre for Clinical Research, University of Münster, Münster, Germany
| | - Ghasem Azemi
- Computational NeuroSurgery (CNS) Lab, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Fabio D’Alessandro
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
- Core Unit Proteomics, Interdisciplinary Centre for Clinical Research, University of Münster, Münster, Germany
| | - Simone König
- Core Unit Proteomics, Interdisciplinary Centre for Clinical Research, University of Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
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Marois M, Olson JD, Wirth DJ, Elliott JT, Fan X, Davis SC, Paulsen KD, Roberts DW. A birefringent spectral demultiplexer enables fast hyper-spectral imaging of protoporphyrin IX during neurosurgery. Commun Biol 2023; 6:341. [PMID: 36991092 PMCID: PMC10060426 DOI: 10.1038/s42003-023-04701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
Hyperspectral imaging and spectral analysis quantifies fluorophore concentration during fluorescence-guided surgery1-6. However, acquisition of the multiple wavelengths required to implement these methods can be time-consuming and hinder surgical workflow. To this end, a snapshot hyperspectral imaging system capable of acquiring 64 channels of spectral data simultaneously was developed for rapid hyperspectral imaging during neurosurgery. The system uses a birefringent spectral demultiplexer to split incoming light and redirect wavelengths to different sections of a large format microscope sensor. Its configuration achieves high optical throughput, accepts unpolarized input light and exceeds channel count of prior image-replicating imaging spectrometers by 4-fold. Tissue-simulating phantoms consisting of serial dilutions of the fluorescent agent characterize system linearity and sensitivity, and comparisons to performance of a liquid crystal tunable filter based hyperspectral imaging device are favorable. The new instrument showed comparable, if not improved, sensitivity at low fluorophore concentrations; yet, acquired wide-field images at more than 70-fold increase in frame rate. Image data acquired in the operating room during human brain tumor resection confirm these findings. The new device is an important advance in achieving real-time quantitative imaging of fluorophore concentration for guiding surgery.
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Affiliation(s)
- Mikael Marois
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Jonathan D Olson
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Dennis J Wirth
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Jonathan T Elliott
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth-Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
| | - David W Roberts
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth-Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Walke A, Black D, Valdes PA, Stummer W, König S, Suero-Molina E. Challenges in, and recommendations for, hyperspectral imaging in ex vivo malignant glioma biopsy measurements. Sci Rep 2023; 13:3829. [PMID: 36882505 PMCID: PMC9992662 DOI: 10.1038/s41598-023-30680-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
The visualization of protoporphyrin IX (PPIX) fluorescence with the help of surgical microscopes during 5-aminolevulinic acid-mediated fluorescence-guided resection (FGR) of gliomas is still limited at the tumor margins. Hyperspectral imaging (HI) detects PPIX more sensitively but is not yet ready for intraoperative use. We illustrate the current status with three experiments and summarize our own experience using HI: (1) assessment of HI analysis algorithm using pig brain tissue, (2) a partially retrospective evaluation of our experience from HI projects, and (3) device comparison of surgical microscopy and HI. In (1), we address the problem that current algorithms for evaluating HI data are based on calibration with liquid phantoms, which have limitations. Their pH is low compared to glioma tissue; they provide only one PPIX photo state and only PPIX as fluorophore. Testing the HI algorithm with brain homogenates, we found proper correction for optical properties but not pH. Considerably more PPIX was measured at pH 9 than at pH 5. In (2), we indicate pitfalls and guide HI application. In (3), we found HI superior to the microscope for biopsy diagnosis (AUC = 0.845 ± 0.024 (cut-off 0.75 µg PPIX/ml) vs. 0.710 ± 0.035). HI thus offers potential for improved FGR.
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Affiliation(s)
- Anna Walke
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.,Core Unit Proteomics, Interdisciplinary Centre for Clinical Research, University of Münster, Münster, Germany
| | - David Black
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada
| | - Pablo A Valdes
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Simone König
- Core Unit Proteomics, Interdisciplinary Centre for Clinical Research, University of Münster, Münster, Germany
| | - Eric Suero-Molina
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.
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Suero Molina E, Black D, Kaneko S, Müther M, Stummer W. Double dose of 5-aminolevulinic acid and its effect on protoporphyrin IX accumulation in low-grade glioma. J Neurosurg 2022; 137:943-952. [PMID: 35213830 DOI: 10.3171/2021.12.jns211724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Administration of 5-aminolevulinic acid (5-ALA) does not regularly elicit fluorescence in low-grade glioma (LGG) at currently established doses and timing of administration. One explanation may be differences in blood-brain barrier (BBB) integrity compared to high-grade glioma. The authors hypothesized that for a BBB semipermeable to 5-ALA there might be a relationship between plasma 5-ALA concentration and its movement into the brain. A higher dose would elicit more 5-ALA conversion into protoporphyrin IX (PPIX). The authors present a case series of patients harboring LGG who received higher doses of 5-ALA. METHODS Patients undergoing surgery for indeterminate glioma later diagnosed as LGG were included in this study. 5-ALA was administered at a standard dose of 20 mg/kg body weight (bw) 4 hours prior to induction of anesthesia. A subgroup of patients received a higher dose of 40 mg/kg bw. Fluorescence was evaluated visually and PPIX concentration (cPPIX) was determined ex vivo by hyperspectral measurements in freshly extracted tissue. All adverse events were recorded. RESULTS A total of 23 patients harboring diffuse low-grade astrocytomas (n = 19) and oligodendrogliomas (n = 4) were analyzed. Thirteen patients received 20 mg/kg bw, and 10 patients received 40 mg/kg bw of 5-ALA. In the 20 mg/kg group, 30.8% (4 of 13) of tumors harbored areas of visible fluorescence, compared to 60% of cases (n = 6 of 10) with 40 mg/kg bw. The threshold to visibility was 1 μg/ml in both groups. Measured over all biopsies, the mean cPPIX was significantly higher in the double-dose group (1.8 vs 0.45 μg/ml; p < 0.001). In non-visibly fluorescent tissue the mean cPPIX was 0.146 μg/ml in the 20 mg/kg and 0.347 μg/ml in the 40 mg/kg group, indicating an increase of 138% (p < 0.001). CONCLUSIONS These observations demonstrate different regions with different levels of PPIX accumulation in LGG. With higher 5-ALA doses cPPIX increases, leading to more regions surpassing the visibility threshold of 1 μg/ml. These observations can be explained by the fact that the BBB in LGG is semipermeable to 5-ALA. Higher 5-ALA doses result in more PPIX conversion, an observation with implications for future dosing in LGG.
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Affiliation(s)
| | - David Black
- 2Carl Zeiss Meditec AG, Oberkochen, Germany
- 3Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Sadahiro Kaneko
- 1Department of Neurosurgery, University Hospital of Münster
- 4Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michael Müther
- 1Department of Neurosurgery, University Hospital of Münster
| | - Walter Stummer
- 1Department of Neurosurgery, University Hospital of Münster
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Oxygen saturation and blood volume analysis by Photoacoustic imaging to identify pre and post-PDT vascular changes. Saudi J Biol Sci 2022; 29:103304. [PMID: 35574285 PMCID: PMC9092990 DOI: 10.1016/j.sjbs.2022.103304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/07/2022] [Accepted: 04/17/2022] [Indexed: 11/22/2022] Open
Abstract
In this study, the blood volume and oxygen saturation of tumors were measured after photoacoustic imaging (PAI) under conditions of pre-photodynamic therapy (PDT), post-PDT, and 4 hrs, and 24 hrs post-PDT. PDTs with aminolevulinic acid (ALA) and low and high doses of benzoporphyrin derivative (BPD) were conducted to observe oxygen saturation changes, and the rapid oxygen consumption in the blood detected due to the action of BPD at the vascular level resulted in the recovery of PDT completion. Likewise, blood volume changes followed by ALA-PDT and BPD-PDT at low and high doses depicted a fast expansion of the blood volume after treatment. The tumor subjected to a high dose of ALA-PDT showed a partial alteration of Hb-pO2 in the first 24 hrs, as did the tumors treated with two ALA- and BPD-mediated PDTs. The Hb-pO2 started reducing immediately post-PDT and was less than 30% after 4 hrs until 24 hrs post-PDT. Reduced vascular demand was possibly due to tumor necrosis, as shown by the permanent damage in the cancer cells' bioluminescence signal. The ALA-mediated PDT-subjected tumor showed a 50% drop in BV at 24 hrs post-PDT, which is suggestive of vascular pruning. The studied data of blood volume against BLI showed the blood volume and oxygenation variations validating the cells' metabolic activity, including cell death.
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8
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Suero Molina E, Kaneko S, Black D, Stummer W. 5-Aminolevulinic Acid-Induced Porphyrin Contents in Various Brain Tumors: Implications Regarding Imaging Device Design and Their Validation. Neurosurgery 2021; 89:1132-1140. [PMID: 34670277 DOI: 10.1093/neuros/nyab361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/04/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fluorescence-guided resections using 5-aminolevulinic acid (5-ALA)-induced tumor porphyrins have been established as an adjunct for malignant glioma surgery based on a phase III study using specifically adapted microscopes for visualizing fluorescing protoporphyrin IX (PPIX). New hardware technologies are being introduced, which claim the same performance as the original technology for visualizing fluorescence. This assumes that qualitative fluorescence detection is equivalent to the established standard, an assumption that needs to be critically assessed. OBJECTIVE To determine PPIX concentrations (cPPIX) in tissue that can be detected visually using the established BLUE400 filter system (Carl Zeiss Meditec, Oberkochen, Germany) as a basis for defining the performance of this system. METHODS Utilizing a hyperspectral imaging system, tumor samples from patients harboring different tumor tissues, with or without visible fluorescence, were analyzed. Absolute values of cPPIX were calculated after calibrating the system with fluorescence phantoms with known cPPIX. RESULTS A total of 524 tumor samples from 162 patients were analyzed. Visual fluorescence under the BLUE400 filter was documented by experienced neurosurgeons. A 0.9 μg/ml threshold of cPPIX was defined as the minimal concentration required to detect and discriminate visual fluorescence. CONCLUSION This is the first report providing data on the threshold of cPPIX, which is visually detected using the current generation of microscopes, thus defining the specificity and sensitivity of this technology as initially tested in a randomized trial. Novel technologies should show similar characteristics in order to be used safely and effectively. If more sensitive, such technologies require further assessments of tumor selectivity.
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Affiliation(s)
- Eric Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Sadahiro Kaneko
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany.,Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - David Black
- Carl Zeiss Meditec AG, Oberkochen, Germany.,University of British Columbia, Vancouver, Canada
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
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9
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Characterization of autofluorescence and quantitative protoporphyrin IX biomarkers for optical spectroscopy-guided glioma surgery. Sci Rep 2021; 11:20009. [PMID: 34625597 PMCID: PMC8501114 DOI: 10.1038/s41598-021-99228-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/14/2021] [Indexed: 01/04/2023] Open
Abstract
5-Aminolevulinic acid (5-ALA)-mediated fluorescence does not effectively depict low grade gliomas (LGG) or the infiltrative tumor portion of high-grade gliomas (HGG). While spectroscopy improves sensitivity and precision, this is currently limited by autofluorescence and a second protoporphyrin IX (PpIX) fluorescence state at 620 nm. We investigated the autofluorescence to better characterize the present spectra and thus increase PpIX quantification precision and sensitivity. This study included 128 patients undergoing surgery for malignant glioma. 5-ALA (Gliolan) was administered before anesthesia, and fluorescence was measured using a hyperspectral device. It was found that all 2692 measured spectra consisted of contributions from 620 to 634 nm PpIX, NADH, lipofuscin, and flavins. The basis spectra were characterized and their use in spectral unmixing led to 82.4% lower fitting error for weakly fluorescing areas (p < 0.001), and 92.3% fewer false positive tumor identifications in control measurements (p = 0.0065) compared to previous works. They also decreased the PpIX620 contribution, thus halving the mean Ratio620/634 (p < 0.001). The ratio was approximately 0 for HGGs and increasing for LGGs, as demonstrated previously. Additionally, the Ratio620/634, the MIB-1/Ki-67 proliferation index, and the PpIX peak blue-shift were found to be significantly related to WHO grade, fluorescence visibility, and PpIX contribution (p < 0.001), and the value of these three as quantitative biomarkers is discussed.
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10
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Sun T, Zhu C. Empirical method for rapid quantification of intrinsic fluorescence signals of key metabolic probes from optical spectra measured on tissue-mimicking turbid medium. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210046R. [PMID: 33893727 PMCID: PMC8062794 DOI: 10.1117/1.jbo.26.4.045001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/07/2021] [Indexed: 05/27/2023]
Abstract
SIGNIFICANCE Optical fluorescence spectroscopy technique has been explored extensively to quantify both glucose uptake and mitochondrial metabolism with proper fluorescent probes in small tumor models in vivo. However, it remains a great challenge to rapidly quantify the intrinsic metabolic fluorophores from the optically measured fluorescence spectra that contain significant distortions due to tissue absorption and scattering. AIM To enable rapid spectral data processing and quantify the in vivo metabolic parameters in real-time, we present an empirical ratio-metric method for rapid fluorescence spectra attenuation correction with high accuracy. APPROACH A first-order approximation of intrinsic fluorescence spectra can be obtained by dividing the fluorescence spectra by diffuse reflectance spectra with some variable powers. We further developed this approximation for rapid extraction of intrinsic key metabolic probes (2-NBDG for glucose uptake and TMRE for mitochondrial function) by dividing the distorted fluorescence spectra by diffuse reflectance intensities recorded at excitation and emission peak with a pair of system-dependent powers. Tissue-mimicking phantom studies were conducted to evaluate the method. RESULTS The tissue-mimicking phantom studies demonstrated that our empirical method could quantify the key intrinsic metabolic probes in near real-time with an average percent error of ∼5 % . CONCLUSIONS An empirical method was demonstrated for rapid quantification of key metabolic probes from fluorescence spectra measured on a tissue-mimicking turbid medium. The proposed method will potentially facilitate real-time monitoring of key metabolic parameters of tumor models in vivo using optical spectroscopy, which will significantly advance translational cancer research.
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Affiliation(s)
- Tengfei Sun
- University of Kentucky, Department of Biomedical Engineering, Lexington, Kentucky, United States
| | - Caigang Zhu
- University of Kentucky, Department of Biomedical Engineering, Lexington, Kentucky, United States
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11
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Wirth D, Byrd B, Meng B, Strawbridge RR, Samkoe KS, Davis SC. Hyperspectral imaging and spectral unmixing for improving whole-body fluorescence cryo-imaging. BIOMEDICAL OPTICS EXPRESS 2021; 12:395-408. [PMID: 33520389 PMCID: PMC7818953 DOI: 10.1364/boe.410810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 05/06/2023]
Abstract
Whole-animal fluorescence cryo-imaging is an established technique that enables visualization of the biodistribution of labeled drugs, contrast agents, functional reporters and cells in detail. However, many tissues produce endogenous autofluorescence, which can confound interpretation of the cryo-imaging volumes. We describe a multi-channel, hyperspectral cryo-imaging system that acquires densely-sampled spectra at each pixel in the 3-dimensional stack. This information enables the use of spectral unmixing to isolate the fluorophore-of-interest from autofluorescence and/or other fluorescent reporters. In phantoms and a glioma xenograft model, we show that the approach improves detection limits, increases tumor contrast, and can dramatically alter image interpretation.
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Affiliation(s)
- Dennis Wirth
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
- Indicates equal contributions
| | - Brook Byrd
- Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH 03755, USA
- Indicates equal contributions
| | - Boyu Meng
- Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH 03755, USA
| | | | - Kimberley S. Samkoe
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
- Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH 03755, USA
| | - Scott C. Davis
- Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH 03755, USA
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12
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Kaneko S, Brokinkel B, Suero Molina E, Warneke N, Holling M, Bunk EC, Hess K, Senner V, Paulus W, Stummer W. Real-time in vivo kinetics of protoporphyrin IX after administration of 5-aminolevulinic acid in meningiomas and comparative analyses with glioblastomas. Acta Neurochir (Wien) 2020; 162:2197-2202. [PMID: 32361907 DOI: 10.1007/s00701-020-04353-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The usefulness of 5-aminolevulinic acid (5-ALA)-mediated fluorescence-guided surgery (FGS) in meningiomas is intensely discussed. However, data about kinetics of 5-ALA and protoporphyrin (Pp) IX in meningiomas are lacking. METHODS As the first study so far, we performed longitudinal intraoperative real-time ex situ measurements of fluorescence intensity and PpIX concentrations during FGS of ten benign and two atypical meningiomas. Kinetics were subsequently compared with data from 229 glioblastomas. RESULTS Spectroscopy revealed fluorescence (median 2945.65 a.u.) and PpIX accumulation (median 18.31 μg/ml) in all 43 analyzed samples. Fluorescence intensity (2961.50 a.u. vs 118.41 a.u.; p < .001) and PpIX concentrations (18.72 μg/ml vs .98 μg/ml; p < .001) were higher in samples with (N = 30) than without (N = 2) visible intraoperative tumor fluorescence. ROC curve analyses revealed a PpIX cut-off concentration of 3.85 μg/ml (AUC = .992, p = .005) and a quantitative fluorescence cut-off intensity of 286.73 a.u. (AUC = .983, p = .006) for intraoperative visible tumor fluorescence. Neither fluorescence intensity (p = .356) nor PpIX (p = .631) differed between atypical and benign meningiomas. Fluorescence and PpIX peaked 7-8 h following administration of 5-ALA. Meningiomas displayed a higher fluorescence intensity (p = .012) and PpIX concentration (p = .005) than glioblastomas 5-6 h after administration of 5-ALA. Although fluorescence was basically maintained, PpIX appeared to be cleared faster in meningiomas than in glioblastomas. CONCLUSIONS Kinetics of PpIX and fluorescence intensity differ between meningiomas and glioblastomas in the early phase after 5-ALA administration. Modification of the timing of drug administration might impact visibility of intraoperative fluorescence and helpfulness of FGS and should be investigated in future analyses.
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Affiliation(s)
- Sadahiro Kaneko
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany.
| | - Eric Suero Molina
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Nils Warneke
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Markus Holling
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Eva Christina Bunk
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Katharina Hess
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Volker Senner
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
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13
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Beaulieu E, Laurence A, Birlea M, Sheehy G, Angulo-Rodriguez L, Latour M, Albadine R, Saad F, Trudel D, Leblond F. Wide-field optical spectroscopy system integrating reflectance and spatial frequency domain imaging to measure attenuation-corrected intrinsic tissue fluorescence in radical prostatectomy specimens. BIOMEDICAL OPTICS EXPRESS 2020; 11:2052-2072. [PMID: 32341866 PMCID: PMC7173915 DOI: 10.1364/boe.388482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/13/2020] [Accepted: 03/08/2020] [Indexed: 06/11/2023]
Abstract
The development of a multimodal optical imaging system is presented that integrates endogenous fluorescence and diffuse reflectance spectroscopy with single-wavelength spatial frequency domain imaging (SFDI) and surface profilometry. The system images specimens at visible wavelengths with a spatial resolution of 70 µm, a field of view of 25 cm2 and a depth of field of ∼1.5 cm. The results of phantom experiments are presented demonstrating the system retrieves absorption and reduced scattering coefficient maps using SFDI with <6% reconstruction errors. A phase-shifting profilometry technique is implemented and the resulting 3-D surface used to compute a geometric correction ensuring optical properties reconstruction errors are maintained to <6% in curved media with height variations <20 mm. Combining SFDI-computed optical properties with data from diffuse reflectance spectra is shown to correct fluorescence using a model based on light transport in tissue theory. The system is used to image a human prostate, demonstrating its ability to distinguish prostatic tissue (anterior stroma, hyperplasia, peripheral zone) from extra-prostatic tissue (urethra, ejaculatory ducts, peri-prostatic tissue). These techniques could be integrated in robotic-assisted surgical systems to enhance information provided to surgeons and improve procedural accuracy by minimizing the risk of damage to extra-prostatic tissue during radical prostatectomy procedures and eventually detect residual cancer.
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Affiliation(s)
- Emile Beaulieu
- Polytechnique Montreal, Dept. of
Engineering Physics, C.P. 6079, Succ. Centre-ville, Montreal, QC H3C
3A7, Canada
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
| | - Audrey Laurence
- Polytechnique Montreal, Dept. of
Engineering Physics, C.P. 6079, Succ. Centre-ville, Montreal, QC H3C
3A7, Canada
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
| | - Mirela Birlea
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
- University of Montreal, Dept. of Pathology
and Cellular Biology, C.P. 6128, Succ. Centre-ville, Montreal, QC
H3 T 1J4, Canada
| | - Guillaume Sheehy
- Polytechnique Montreal, Dept. of
Engineering Physics, C.P. 6079, Succ. Centre-ville, Montreal, QC H3C
3A7, Canada
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
| | - Leticia Angulo-Rodriguez
- Polytechnique Montreal, Dept. of
Engineering Physics, C.P. 6079, Succ. Centre-ville, Montreal, QC H3C
3A7, Canada
| | - Mathieu Latour
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
- University of Montreal, Dept. of Pathology
and Cellular Biology, C.P. 6128, Succ. Centre-ville, Montreal, QC
H3 T 1J4, Canada
| | - Roula Albadine
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
- University of Montreal, Dept. of Pathology
and Cellular Biology, C.P. 6128, Succ. Centre-ville, Montreal, QC
H3 T 1J4, Canada
| | - Fred Saad
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
| | - Dominique Trudel
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
- University of Montreal, Dept. of Pathology
and Cellular Biology, C.P. 6128, Succ. Centre-ville, Montreal, QC
H3 T 1J4, Canada
| | - Frédéric Leblond
- Polytechnique Montreal, Dept. of
Engineering Physics, C.P. 6079, Succ. Centre-ville, Montreal, QC H3C
3A7, Canada
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
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14
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Zhang DY, Singhal S, Lee JYK. Optical Principles of Fluorescence-Guided Brain Tumor Surgery: A Practical Primer for the Neurosurgeon. Neurosurgery 2019; 85:312-324. [PMID: 30085129 DOI: 10.1093/neuros/nyy315] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 06/18/2018] [Indexed: 01/21/2023] Open
Abstract
Fluorescence-guided surgery is a rapidly growing field that has produced some of the most important innovations in surgical oncology in the past decade. These intraoperative imaging technologies provide information distinguishing tumor tissue from normal tissue in real time as the surgery proceeds and without disruption of the workflow. Many of these fluorescent tracers target unique molecular or cellular features of tumors, which offers the opportunity for identifying pathology with high precision to help surgeons achieve their primary objective of a maximal safe resection. As novel fluorophores and fluorescent probes emerge from preclinical development, a practical understanding of the principles of fluorescence remains critical for evaluating the clinical utility of these agents and identifying opportunities for further innovation. In this review, we provide an "in-text glossary" of the fundamental principles of fluorescence with examples of direct applications to fluorescence-guided brain surgery. We offer a detailed discussion of the various advantages and limitations of the most commonly used intraoperative imaging agents, including 5-aminolevulinic acid, indocyanine green, and fluorescein, with a particular focus on the photophysical properties of these specific agents as they provide a framework through which to understand the new agents that are entering clinical trials. To this end, we conclude with a survey of the fluorescent properties of novel agents that are currently undergoing or will soon enter clinical trials for the intraoperative imaging of brain tumors.
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Affiliation(s)
- Daniel Y Zhang
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sunil Singhal
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Reinert M, Piffaretti D, Wilzbach M, Hauger C, Guckler R, Marchi F, D'Angelo ML. Quantitative Modulation of PpIX Fluorescence and Improved Glioma Visualization. Front Surg 2019; 6:41. [PMID: 31380388 PMCID: PMC6646670 DOI: 10.3389/fsurg.2019.00041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/21/2019] [Indexed: 11/13/2022] Open
Abstract
5-Aminolevulinic acid (5-ALA) induced fluorescence to augment surgical resection for high grade glioma has become a standard of care. Protoporphyrin IX (PpIX) visibility is however subject to the variability of the single tumor expression and to the interobserver interpretation. We therefore hypothesized that in different glioma cell lines with variable 5-ALA induced fluorescence, the signal can be pharmacologically increased. We therefore analyzed in three different GBM cell lines, with different expression of epidermal growth factor receptor (EGFR), the variability of 5-ALA induced PpIX fluorescence after the pharmacological blockade at different steps of PpIX breakdown and influencing the outbound transport of PpIX. Using flow cytometry, fluorescence microplate reader, and confocal microscopy the PpIX fluorescence was analyzed after exposure to tin protoporphyrin IX (SnPP), deferoxamine (DFO), and genistein. We furthermore constructed a microscope (Qp9-microscope) being able to measure quantitatively the concentration of PpIX. These values were compared with the extraction of PpIX in tumor biopsy taken during the GBM surgery. Although all three cell lines showed an increase to 5-ALA induced fluorescence their baseline activity was different. Treatment with either SnPP, DFO and genistein was able to increase 5-ALA induced fluorescence. Qp9-microscopy of tumor sample produced a color coded PpIX concentration map which was overlaid on the tumor image. The PpIX extraction from tumor sample analyzed using the plate reader gave lower values of the concentration, as compared to the expected values of the Qp9-microscope, however still in the same decimal range of μg/mL. This may be due to homogenization of the values during extraction and cell disaggregation. In conclusion pharmacological augmentation in GBM cell lines of PpIX signal is possible. A quantitative PpIX map for surgery is feasible and may help refine surgical excision. Further correlations of tumor tissue samples and Qp9-microscopy is needed, prior to develop an intraoperative surgical adjunct to the already existing 5-ALA induced surgery.
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Affiliation(s)
- Michael Reinert
- Laboratory for Biomedical Neurosciences, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Torricella-Taverne, Switzerland.,Department of Neurosurgery, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Neurosciences, Università Della Svizzera Italiana, Lugano, Switzerland.,Medical Faculty, University of Bern, Bern, Switzerland
| | - Deborah Piffaretti
- Laboratory for Biomedical Neurosciences, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Torricella-Taverne, Switzerland.,Faculty of Medicine, Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | | | | | | | - Francesco Marchi
- Laboratory for Biomedical Neurosciences, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Torricella-Taverne, Switzerland.,Department of Neurosurgery, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Maria Luisa D'Angelo
- Laboratory for Biomedical Neurosciences, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Torricella-Taverne, Switzerland
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16
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Valdes PA, Juvekar P, Agar NYR, Gioux S, Golby AJ. Quantitative Wide-Field Imaging Techniques for Fluorescence Guided Neurosurgery. Front Surg 2019; 6:31. [PMID: 31245380 PMCID: PMC6563771 DOI: 10.3389/fsurg.2019.00031] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/15/2019] [Indexed: 11/26/2022] Open
Abstract
Fluorescence guided surgery (FGS) has fueled the development of novel technologies aimed at maximizing the utility of fluorescence imaging to help clinicians diagnose and in certain cases treat diseases across a breadth of disciplines such as dermatology, gynecology, oncology, ophthalmology, and neurosurgery. In neurosurgery, the goal of FGS technologies is to provide the neurosurgeon with additional information which can serve as a visual aid to better identify tumor tissue and associated margins. Yet, current clinical FGS technologies are qualitative in nature, limiting the ability to make accurate, reliable, and repeatable measurements. To this end, developments in fluorescence quantification are needed to overcome current limitations of FGS. Here we present an overview of the recent developments in quantitative fluorescence guidance technologies and conclude with the most recent developments aimed at wide-field quantitative fluorescence imaging approaches in neurosurgery.
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Affiliation(s)
- Pablo A Valdes
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Parikshit Juvekar
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Nathalie Y R Agar
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Sylvain Gioux
- ICube Laboratory, University of Strasbourg, Télécom Physique Strasbourg, Alsace, France
| | - Alexandra J Golby
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
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17
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Kaneko S, Suero Molina E, Ewelt C, Warneke N, Stummer W. Fluorescence-Based Measurement of Real-Time Kinetics of Protoporphyrin IX After 5-Aminolevulinic Acid Administration in Human In Situ Malignant Gliomas. Neurosurgery 2019; 85:E739-E746. [DOI: 10.1093/neuros/nyz129] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/31/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Five-aminolevulinic acid (5-ALA) is well established for fluorescence-guided resections of malignant gliomas by eliciting the accumulation of fluorescent protoporphyrin IX (PpIX) in tumors. Because of the assumed time point of peak fluorescence, 5-ALA is recommended to be administered 3 h before surgery. However, the actual time dependency of tumor fluorescence has not yet been evaluated in humans and may have important implications.
OBJECTIVE
To investigate the time dependency of PpIX by measuring fluorescence intensities in tumors at various time points during surgery.
METHODS
Patients received 5-ALA (20 mg/kg b.w.) 3 to 4 h before surgery. Fluorescence intensities (FI) and estimated tumor PpIX concentrations (CPPIX) were measured in the tumors over time with a hyperspectral camera. CPPIX was assessed using hyperspectral imaging and by evaluating fluorescence phantoms with known CPPIX.
RESULTS
A total of 201 samples from 68 patients were included in this study. On average, maximum values of calculated FI and CPPIX were observed between 7 and 8 h after 5-ALA administration. FI and CPPIX both reliably distinguished central strong and marginal weak fluorescence, and grade III compared to grade IV gliomas. Interestingly, marginal (weak) fluorescence was observed to peak later than strong fluorescence (8-9 vs 7-8 h).
CONCLUSION
In human in Situ brain tumor tissue, we determined fluorescence after 5-ALA administration to be maximal later than previously thought. In consequence, 5-ALA should be administered 4 to 5 h before surgery, with timing adjusted to internal logistical circumstances and factors related to approaching the tumor.
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Affiliation(s)
- Sadahiro Kaneko
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Eric Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Christian Ewelt
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Nils Warneke
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
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18
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St-Georges-Robillard A, Masse M, Cahuzac M, Strupler M, Patra B, Orimoto AM, Kendall-Dupont J, Péant B, Mes-Masson AM, Leblond F, Gervais T. Fluorescence hyperspectral imaging for live monitoring of multiple spheroids in microfluidic chips. Analyst 2019; 143:3829-3840. [PMID: 29999046 DOI: 10.1039/c8an00536b] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tumor spheroids represent a realistic 3D in vitro cancer model because they provide a missing link between monolayer cell culture and live tissues. While microfluidic chips can easily form and assay thousands of spheroids simultaneously, few commercial instruments are available to analyze this massive amount of data. Available techniques to measure spheroid response to external stimuli, such as confocal imaging and flow cytometry, are either not appropriate for 3D cultures, or destructive. We designed a wide-field hyperspectral imaging system to analyze multiple spheroids trapped in a microfluidic chip in a single acquisition. The system and its fluorescence quantification algorithm were assessed using liquid phantoms mimicking spheroid optical properties. Spectral unmixing was tested on three overlapping spectral entities. Hyperspectral images of co-culture spheroids expressing two fluorophores were compared with confocal microscopy and spheroid growth was measured over time. The system can spectrally analyze multiple fluorescent markers simultaneously and allows multiple time-points assays, providing a fast and versatile solution for analyzing lab on a chip devices.
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Affiliation(s)
- Amélie St-Georges-Robillard
- Department of Engineering Physics, Polytechnique Montréal, C.P. 6079, Succ. Centre-ville, Montreal, Qc H3C 3A7, Canada.
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19
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Zhang Y, Hou H, Zhang Y, Wang Y, Zhu L, Dong M, Liu Y. Tissue intrinsic fluorescence recovering by an empirical approach based on the PSO algorithm and its application in type 2 diabetes screening. BIOMEDICAL OPTICS EXPRESS 2018; 9:1795-1808. [PMID: 29675320 PMCID: PMC5905924 DOI: 10.1364/boe.9.001795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/25/2018] [Accepted: 02/26/2018] [Indexed: 05/05/2023]
Abstract
In order to reduce the influence of scattering and absorption on tissue fluorescence spectra, after tissue fluorescence and diffuse reflectance in different tissue optical properties were simulated by the Monte Carlo method, a tissue intrinsic fluorescence recovering algorithm making use of diffuse reflectance spectrum was developed. The empirical parameters in the tissue intrinsic fluorescence recovering algorithm were coded as a particle in the solution domain, the classification performance was defined as the fitness, and then a particle swarm optimization (PSO) algorithm was established for empirical parameters optimization. The skin autofluorescence and diffuse reflectance spectra of 327 subjects were collected in Anhui Provincial Hospital. The skin intrinsic autofluorescence spectra were recovered by using the empirical approach and the integration area of the spectra were calculated as fluorescence intensity. Receiver operating characteristic (ROC) analysis for fluorescence intensity was applied to evaluate the classification performance in type 2 diabetes screening. In addition, a support vector machine (SVM) method was implemented to improve the performance of the classification. The results showed that the sensitivity and specificity were 32% and 76% respectively, and the area under the curve was 0.54 before recovering, while the sensitivity and specificity were 72% and 86% respectively, and the area under the curve was 0.86 after recovering. Furthermore, the sensitivity and specificity increased to 83% and 86% respectively when using linear SVM while 84% and 88%, respectively, when using nonlinear SVM. The results indicate that using the tissue fluorescence spectrum recovery algorithm based on PSO can improve the application of tissue fluorescence spectroscopy effectively.
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Affiliation(s)
- Yuanzhi Zhang
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Hefei, Anhui 230088, China
- Wanjiang Center for Development of Emerging Industrial Technology, Tongling, Anhui 244000, China
- Authors contributed equally to this work
| | - Huayi Hou
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Hefei, Anhui 230088, China
- Authors contributed equally to this work
| | - Yang Zhang
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Hefei, Anhui 230088, China
- Wanjiang Center for Development of Emerging Industrial Technology, Tongling, Anhui 244000, China
| | - Yikun Wang
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Hefei, Anhui 230088, China
- Wanjiang Center for Development of Emerging Industrial Technology, Tongling, Anhui 244000, China
| | - Ling Zhu
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Hefei, Anhui 230088, China
- Wanjiang Center for Development of Emerging Industrial Technology, Tongling, Anhui 244000, China
| | - Meili Dong
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Hefei, Anhui 230088, China
- Wanjiang Center for Development of Emerging Industrial Technology, Tongling, Anhui 244000, China
| | - Yong Liu
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Hefei, Anhui 230088, China
- Wanjiang Center for Development of Emerging Industrial Technology, Tongling, Anhui 244000, China
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20
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Xie Y, Thom M, Ebner M, Wykes V, Desjardins A, Miserocchi A, Ourselin S, McEvoy AW, Vercauteren T. Wide-field spectrally resolved quantitative fluorescence imaging system: toward neurosurgical guidance in glioma resection. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-14. [PMID: 29139243 PMCID: PMC6742512 DOI: 10.1117/1.jbo.22.11.116006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/26/2017] [Indexed: 05/03/2023]
Abstract
In high-grade glioma surgery, tumor resection is often guided by intraoperative fluorescence imaging. 5-aminolevulinic acid-induced protoporphyrin IX (PpIX) provides fluorescent contrast between normal brain tissue and glioma tissue, thus achieving improved tumor delineation and prolonged patient survival compared with conventional white-light-guided resection. However, commercially available fluorescence imaging systems rely solely on visual assessment of fluorescence patterns by the surgeon, which makes the resection more subjective than necessary. We developed a wide-field spectrally resolved fluorescence imaging system utilizing a Generation II scientific CMOS camera and an improved computational model for the precise reconstruction of the PpIX concentration map. In our model, the tissue's optical properties and illumination geometry, which distort the fluorescent emission spectra, are considered. We demonstrate that the CMOS-based system can detect low PpIX concentration at short camera exposure times, while providing high-pixel resolution wide-field images. We show that total variation regularization improves the contrast-to-noise ratio of the reconstructed quantitative concentration map by approximately twofold. Quantitative comparison between the estimated PpIX concentration and tumor histopathology was also investigated to further evaluate the system.
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Affiliation(s)
- Yijing Xie
- University College London, Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, United Kingdom
- Address all correspondence to: Yijing Xie,
| | - Maria Thom
- University College London, Institute of Neurology, Department of Neuropathology, London, United Kingdom
| | - Michael Ebner
- University College London, Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, United Kingdom
| | - Victoria Wykes
- University College London, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Adrien Desjardins
- University College London, Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, United Kingdom
| | - Anna Miserocchi
- University College London, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Sebastien Ourselin
- University College London, Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, United Kingdom
| | - Andrew W. McEvoy
- University College London, Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, United Kingdom
- University College London, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Tom Vercauteren
- University College London, Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, United Kingdom
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21
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Hyperspectral data processing improves PpIX contrast during fluorescence guided surgery of human brain tumors. Sci Rep 2017; 7:9455. [PMID: 28842674 PMCID: PMC5572708 DOI: 10.1038/s41598-017-09727-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/28/2017] [Indexed: 12/02/2022] Open
Abstract
Fluorescence guided surgery (FGS) using aminolevulinic-acid (ALA) induced protoporphyrin IX (PpIX) provides intraoperative visual contrast between normal and malignant tissue during resection of high grade gliomas. However, maps of the PpIX biodistribution within the surgical field based on either visual perception or the raw fluorescence emissions can be masked by background signals or distorted by variations in tissue optical properties. This study evaluates the impact of algorithmic processing of hyperspectral imaging acquisitions on the sensitivity and contrast of PpIX maps. Measurements in tissue-simulating phantoms showed that (I) spectral fitting enhanced PpIX sensitivity compared with visible or integrated fluorescence, (II) confidence-filtering automatically determined the lower limit of detection based on the strength of the PpIX spectral signature in the collected emission spectrum (0.014–0.041 μg/ml in phantoms), and (III) optical-property corrected PpIX estimates were more highly correlated with independent probe measurements (r = 0.98) than with spectral fitting alone (r = 0.91) or integrated fluorescence (r = 0.82). Application to in vivo case examples from clinical neurosurgeries revealed changes to the localization and contrast of PpIX maps, making concentrations accessible that were not visually apparent. Adoption of these methods has the potential to maintain sensitive and accurate visualization of PpIX contrast over the course of surgery.
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22
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Sheng W, He S, Seare WJ, Almutairi A. Review of the progress toward achieving heat confinement-the holy grail of photothermal therapy. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:80901. [PMID: 28776627 PMCID: PMC5544355 DOI: 10.1117/1.jbo.22.8.080901] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/23/2017] [Indexed: 06/01/2023]
Abstract
Photothermal therapy (PTT) involves the application of normally benign light wavelengths in combination with efficient photothermal (PT) agents that convert the absorbed light to heat to ablate selected cancers. The major challenge in PTT is the ability to confine heating and thus direct cellular death to precisely where PT agents are located. The dominant strategy in the field has been to create large libraries of PT agents with increased absorption capabilities and to enhance their delivery and accumulation to achieve sufficiently high concentrations in the tissue targets of interest. While the challenge of material confinement is important for achieving “heat and lethality confinement,” this review article suggests another key prospective strategy to make this goal a reality. In this approach, equal emphasis is placed on selecting parameters of light exposure, including wavelength, duration, power density, and total power supplied, based on the intrinsic properties and geometry of tissue targets that influence heat dissipation, to truly achieve heat confinement. This review highlights significant milestones researchers have achieved, as well as examples that suggest future research directions, in this promising technique, as it becomes more relevant in clinical cancer therapy and other noncancer applications.
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Affiliation(s)
- Wangzhong Sheng
- University of California, Laboratory for Bioresponsive Materials, Department of Mechanical and Aerospace Engineering, Materials Science Program, La Jolla, San Diego, California, United States
- University of California, Laboratory for Bioresponsive Materials, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, San Diego, California, United States
| | - Sha He
- University of California, Laboratory for Bioresponsive Materials, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, San Diego, California, United States
- University of California, Laboratory for Bioresponsive Materials, Department of Nanoengineering, La Jolla, San Diego, California, United States
| | | | - Adah Almutairi
- University of California, Laboratory for Bioresponsive Materials, Department of Mechanical and Aerospace Engineering, Materials Science Program, La Jolla, San Diego, California, United States
- University of California, Laboratory for Bioresponsive Materials, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, San Diego, California, United States
- University of California, Laboratory for Bioresponsive Materials, Department of Nanoengineering, La Jolla, San Diego, California, United States
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23
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Sibai M, Fisher C, Veilleux I, Elliott JT, Leblond F, Roberts DW, Wilson BC. Preclinical evaluation of spatial frequency domain-enabled wide-field quantitative imaging for enhanced glioma resection. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:76007. [PMID: 28697235 PMCID: PMC5995142 DOI: 10.1117/1.jbo.22.7.076007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/21/2017] [Indexed: 05/19/2023]
Abstract
5-Aminolevelunic acid-induced protoporphyrin IX (PpIX) fluorescence-guided resection (FGR) enables maximum safe resection of glioma by providing real-time tumor contrast. However, the subjective visual assessment and the variable intrinsic optical attenuation of tissue limit this technique to reliably delineating only high-grade tumors that display strong fluorescence. We have previously shown, using a fiber-optic probe, that quantitative assessment using noninvasive point spectroscopic measurements of the absolute PpIX concentration in tissue further improves the accuracy of FGR, extending it to surgically curable low-grade glioma. More recently, we have shown that implementing spatial frequency domain imaging with a fluorescent-light transport model enables recovery of two-dimensional images of [PpIX], alleviating the need for time-consuming point sampling of the brain surface. We present first results of this technique modified for <italic<in vivo</italic< imaging on an RG2 rat brain tumor model. Despite the moderate errors in retrieving the absorption and reduced scattering coefficients in the subdiffusive regime of 14% and 19%, respectively, the recovered [PpIX] maps agree within 10% of the point [PpIX] values measured by the fiber-optic probe, validating its potential as an extension or an alternative to point sampling during glioma resection.
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Affiliation(s)
- Mira Sibai
- University of Toronto, Department of Medical Biophysics, Faculty of Medicine, Ontario, Canada
- University Health Network, Princess Margaret Cancer Center, Ontario, Canada
| | - Carl Fisher
- University of Toronto, Department of Medical Biophysics, Faculty of Medicine, Ontario, Canada
- University Health Network, Princess Margaret Cancer Center, Ontario, Canada
| | - Israel Veilleux
- University Health Network, Princess Margaret Cancer Center, Ontario, Canada
| | - Jonathan T. Elliott
- Dartmouth College, Thayer School of Engineering, New Hampshire, United States
| | - Frederic Leblond
- École Polytechnique De Montreal, Department of Engineering Physics, Québec, Canada
| | - David W. Roberts
- Dartmouth Hitchcock Medical Center, Department of Neurosurgery, New Hampshire, United States
| | - Brian C. Wilson
- University of Toronto, Department of Medical Biophysics, Faculty of Medicine, Ontario, Canada
- University Health Network, Princess Margaret Cancer Center, Ontario, Canada
- Address all correspondence to: Brian C. Wilson, E-mail:
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24
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Valdés PA, Roberts DW, Lu FK, Golby A. Optical technologies for intraoperative neurosurgical guidance. Neurosurg Focus 2016; 40:E8. [PMID: 26926066 DOI: 10.3171/2015.12.focus15550] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Biomedical optics is a broadly interdisciplinary field at the interface of optical engineering, biophysics, computer science, medicine, biology, and chemistry, helping us understand light-tissue interactions to create applications with diagnostic and therapeutic value in medicine. Implementation of biomedical optics tools and principles has had a notable scientific and clinical resurgence in recent years in the neurosurgical community. This is in great part due to work in fluorescence-guided surgery of brain tumors leading to reports of significant improvement in maximizing the rates of gross-total resection. Multiple additional optical technologies have been implemented clinically, including diffuse reflectance spectroscopy and imaging, optical coherence tomography, Raman spectroscopy and imaging, and advanced quantitative methods, including quantitative fluorescence and lifetime imaging. Here we present a clinically relevant and technologically informed overview and discussion of some of the major clinical implementations of optical technologies as intraoperative guidance tools in neurosurgery.
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Affiliation(s)
- Pablo A Valdés
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, Harvard Medical School, Boston Children's Hospital, Boston
| | - David W Roberts
- Section of Neurosurgery, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Alexandra Golby
- Departments of 1 Neurosurgery and.,Radiology, and.,Dana Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital
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25
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Marois M, Bravo J, Davis SC, Kanick SC. Characterization and standardization of tissue-simulating protoporphyrin IX optical phantoms. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:35003. [PMID: 26968385 PMCID: PMC5994807 DOI: 10.1117/1.jbo.21.3.035003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/19/2016] [Indexed: 05/04/2023]
Abstract
Optical devices for measuring protoporphryin IX (PpIX) fluorescence in tissue are routinely validated by measurements in optical phantoms. Yet there exists limited data to form a consensus on the recipe for phantoms that both mimic the optical properties found in tissue and yield a reliable and stable relationship between PpIX concentration and the fluorescence remission intensity. This study characterizes the influence of multiple phantom components on PpIX fluorescence emission intensity, using Intralipid as the scattering source, bovine whole blood as the background absorber, and Tween as a surfactant to prevent PpIX aggregation. Optical measurements showed a linear proportionality (r > 0.99) between fluorescence intensity and PpIX concentration (0.1 to 10 μg/mL) over a range of Intralipid (1 to 2%) and whole blood (0.5 to 3%) for phantoms containing low surfactant (≤ 0.1%), with fluorescence intensities and scattering and absorption properties stable for 5 h after mixing. The role of surfactant in PpIX phantoms was found to be complex, as aggregation was evident in aqueous nonturbid phantoms with no surfactant (0% Tween), and avoided in phantoms containing Intralipid as the scattering source with no additional or low amounts of added surfactant (≤ 0.1% Tween). Conversely, phantoms containing higher surfactant content (>0.1% Tween) and whole blood showed interactions that distorted the fluorescence emissions.
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Affiliation(s)
- Mikael Marois
- Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
- Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755, United States
| | - Jaime Bravo
- Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Scott C. Davis
- Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755, United States
- Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03766, United States
| | - Stephen Chad Kanick
- Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755, United States
- Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03766, United States
- Address all correspondence to: Stephen Chad Kanick,
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26
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Zhu C, Chen S, Chui CHK, Tan BK, Liu Q. Early detection and differentiation of venous and arterial occlusion in skin flaps using visible diffuse reflectance spectroscopy and autofluorescence spectroscopy. BIOMEDICAL OPTICS EXPRESS 2016; 7:570-80. [PMID: 26977363 PMCID: PMC4771472 DOI: 10.1364/boe.7.000570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 05/22/2023]
Abstract
Our previous preclinical study demonstrated that both visible diffuse reflectance and autofluorescence spectroscopy, each of which yields a different set of physiological information, can predict skin flap viability with high accuracy in a MacFarlane rat dorsal skin flap model. In this report, we further evaluated our technique for the early detection and differentiation of venous occlusion and arterial occlusion in a rat groin flap model. We performed both diffuse reflectance and autofluorescence measurements on the skin flap model and statistically differentiated between flaps with and without occlusions as well as between flaps with venous occlusion and those with arterial occlusion based on these non-invasive optical measurements. Our preliminary results suggested that visible diffuse reflectance and autofluorescence spectroscopy can be potentially used clinically to detect both venous and arterial occlusion and differentiate one from the other accurately at an early time point.
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Affiliation(s)
- Caigang Zhu
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 637457, Singapore
- Currently with the Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Shuo Chen
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 637457, Singapore
- Currently with the Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, 110819 China
| | | | - Bien-Keem Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Quan Liu
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 637457, Singapore
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27
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Jermyn M, Gosselin Y, Valdes PA, Sibai M, Kolste K, Mercier J, Angulo L, Roberts DW, Paulsen KD, Petrecca K, Daigle O, Wilson BC, Leblond F. Improved sensitivity to fluorescence for cancer detection in wide-field image-guided neurosurgery. BIOMEDICAL OPTICS EXPRESS 2015; 6:5063-74. [PMID: 26713218 PMCID: PMC4679278 DOI: 10.1364/boe.6.005063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 05/19/2023]
Abstract
In glioma surgery, Protoporphyrin IX (PpIX) fluorescence may identify residual tumor that could be resected while minimizing damage to normal brain. We demonstrate that improved sensitivity for wide-field spectroscopic fluorescence imaging is achieved with minimal disruption to the neurosurgical workflow using an electron-multiplying charge-coupled device (EMCCD) relative to a state-of-the-art CMOS system. In phantom experiments the EMCCD system can detect at least two orders-of-magnitude lower PpIX. Ex vivo tissue imaging on a rat glioma model demonstrates improved fluorescence contrast compared with neurosurgical fluorescence microscope technology, and the fluorescence detection is confirmed with measurements from a clinically-validated spectroscopic probe. Greater PpIX sensitivity in wide-field fluorescence imaging may improve the residual tumor detection during surgery with consequent impact on survival.
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Affiliation(s)
- Michael Jermyn
- Brain Tumour Research Centre, Montreal Neurological Institute and Hospital, Dept. Neurology and Neurosurgery, McGill University, 3801 University St., Montreal, QC, H3A 2B4,
Canada
- Dept. Engineering Physics, Polytechnique Montreal, CP 6079, Succ. Centre-Ville, Montreal, QC, H3C 3A7,
Canada
| | - Yoann Gosselin
- Dept. Engineering Physics, Polytechnique Montreal, CP 6079, Succ. Centre-Ville, Montreal, QC, H3C 3A7,
Canada
| | - Pablo A. Valdes
- Dept. Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115,
USA
| | - Mira Sibai
- Dept. Medical Biophysics, University of Toronto/University Health Network, Toronto, ON, M5G 1L7,
Canada
| | - Kolbein Kolste
- Thaver School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH 03755,
USA
| | - Jeanne Mercier
- Dept. Engineering Physics, Polytechnique Montreal, CP 6079, Succ. Centre-Ville, Montreal, QC, H3C 3A7,
Canada
| | - Leticia Angulo
- Dept. Engineering Physics, Polytechnique Montreal, CP 6079, Succ. Centre-Ville, Montreal, QC, H3C 3A7,
Canada
| | - David W. Roberts
- Dept. Neurosurgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756,
USA
| | - Keith D. Paulsen
- Thaver School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH 03755,
USA
| | - Kevin Petrecca
- Brain Tumour Research Centre, Montreal Neurological Institute and Hospital, Dept. Neurology and Neurosurgery, McGill University, 3801 University St., Montreal, QC, H3A 2B4,
Canada
| | - Olivier Daigle
- Nuvu cameras, 5155 Decelles avenue, Pavillon JA Bombardier, Montreal, QC, H3T 2B1,
Canada
| | - Brian C. Wilson
- Dept. Medical Biophysics, University of Toronto/University Health Network, Toronto, ON, M5G 1L7,
Canada
| | - Frederic Leblond
- Dept. Engineering Physics, Polytechnique Montreal, CP 6079, Succ. Centre-Ville, Montreal, QC, H3C 3A7,
Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, rue Saint-Denis, Que, H2X 0A9,
Canada
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28
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Rollakanti KR, Anand S, Davis SC, Pogue BW, Maytin EV. Noninvasive Optical Imaging of UV-Induced Squamous Cell Carcinoma in Murine Skin: Studies of Early Tumor Development and Vitamin D Enhancement of Protoporphyrin IX Production. Photochem Photobiol 2015. [PMID: 26223149 DOI: 10.1111/php.12503] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Better noninvasive techniques are needed to monitor protoporphyrin IX (PpIX) levels before and during photodynamic therapy (PDT) of squamous cell carcinoma (SCC) of the skin. Our aim was to evaluate (1) multispectral fluorescent imaging of ultraviolet light (UV)-induced cancer and precancer in a mouse model of SCC and (2) multispectral imaging and probe-based fluorescence detection as a tool to study vitamin D (VD) effects on aminolevulinic acid (ALA)-induced PpIX synthesis. Dorsal skin of hairless mice was imaged weekly during a 24-week UV carcinogenesis protocol. Hot spots of PpIX fluorescence were detectable by multispectral imaging beginning at 14 weeks of UV exposure. Many hot spots disappeared after cessation of UV at week 20, but others persisted or became visible after week 20, and corresponded to tumors that eventually became visible by eye. In SCC-bearing mice pretreated with topical VD before ALA application, our optical techniques confirmed that VD preconditioning induces a tumor-selective increase in PpIX levels. Fluorescence-based optical imaging of PpIX is a promising tool for detecting early SCC lesions of the skin. Pretreatment with VD can increase the ability to detect early tumors, providing a potential new way to improve efficacy of ALA-PDT.
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Affiliation(s)
- Kishore R Rollakanti
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
| | - Sanjay Anand
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH.,Department of Dermatology, Cleveland Clinic, Cleveland, OH
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Edward V Maytin
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH.,Department of Dermatology, Cleveland Clinic, Cleveland, OH
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29
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Valdés PA, Jacobs V, Harris BT, Wilson BC, Leblond F, Paulsen KD, Roberts DW. Quantitative fluorescence using 5-aminolevulinic acid-induced protoporphyrin IX biomarker as a surgical adjunct in low-grade glioma surgery. J Neurosurg 2015; 123:771-80. [PMID: 26140489 DOI: 10.3171/2014.12.jns14391] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECT Previous studies in high-grade gliomas (HGGs) have indicated that protoporphyrin IX (PpIX) accumulates in higher concentrations in tumor tissue, and, when used to guide surgery, it has enabled improved resection leading to increased progression-free survival. Despite the benefits of complete resection and the advances in fluorescence-guided surgery, few studies have investigated the use of PpIX in low-grade gliomas (LGGs). Here, the authors describe their initial experience with 5-aminolevulinic acid (ALA)-induced PpIX fluorescence in a series of patients with LGG. METHODS Twelve patients with presumed LGGs underwent resection of their tumors after receiving 20 mg/kg of ALA approximately 3 hours prior to surgery under an institutional review board-approved protocol. Intraoperative assessments of the resulting PpIX emissions using both qualitative, visible fluorescence and quantitative measurements of PpIX concentration were obtained from tissue locations that were subsequently biopsied and evaluated histopathologically. Mixed models for random effects and receiver operating characteristic curve analysis for diagnostic performance were performed on the fluorescence data relative to the gold-standard histopathology. RESULTS Five of the 12 LGGs (1 ganglioglioma, 1 oligoastrocytoma, 1 pleomorphic xanthoastrocytoma, 1 oligodendroglioma, and 1 ependymoma) demonstrated at least 1 instance of visible fluorescence during surgery. Visible fluorescence evaluated on a specimen-by-specimen basis yielded a diagnostic accuracy of 38.0% (cutoff threshold: visible fluorescence score ≥ 1, area under the curve = 0.514). Quantitative fluorescence yielded a diagnostic accuracy of 67% (for a cutoff threshold of the concentration of PpIX [CPpIX] > 0.0056 μg/ml, area under the curve = 0.66). The authors found that 45% (9/20) of nonvisibly fluorescent tumor specimens, which would have otherwise gone undetected, accumulated diagnostically significant levels of CPpIX that were detected quantitatively. CONCLUSIONS The authors' initial experience with ALA-induced PpIX fluorescence in LGGs concurs with other literature reports that the resulting visual fluorescence has poor diagnostic accuracy. However, the authors also found that diagnostically significant levels of CPpIX do accumulate in LGGs, and the resulting fluorescence emissions are very often below the detection threshold of current visual fluorescence imaging methods. Indeed, at least in the authors' initial experience reported here, if quantitative detection methods are deployed, the diagnostic performance of ALA-induced PpIX fluorescence in LGGs approaches the accuracy associated with visual fluorescence in HGGs.
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Affiliation(s)
- Pablo A Valdés
- Department of Neurosurgery, Brigham and Women's/Boston Children's Hospitals, Harvard Medical School;,Geisel School of Medicine at Dartmouth, Hanover;,Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon;,Thayer School of Engineering, Hanover, New Hampshire
| | - Valerie Jacobs
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts;,Geisel School of Medicine at Dartmouth, Hanover
| | | | - Brian C Wilson
- Ontario Cancer Institute, University of Toronto, Ontario; and
| | - Frederic Leblond
- Department of Engineering Physics, Polytechnique Montreal, Quebec, Canada
| | | | - David W Roberts
- Geisel School of Medicine at Dartmouth, Hanover;,Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon
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30
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Kolste KK, Kanick SC, Valdés PA, Jermyn M, Wilson BC, Roberts DW, Paulsen KD, Leblond F. Macroscopic optical imaging technique for wide-field estimation of fluorescence depth in optically turbid media for application in brain tumor surgical guidance. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:26002. [PMID: 25652704 PMCID: PMC4405086 DOI: 10.1117/1.jbo.20.2.026002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/05/2015] [Indexed: 05/13/2023]
Abstract
A diffuse imaging method is presented that enables wide-field estimation of the depth of fluorescent molecular markers in turbid media by quantifying the deformation of the detected fluorescence spectra due to the wavelength-dependent light attenuation by overlying tissue. This is achieved by measuring the ratio of the fluorescence at two wavelengths in combination with normalization techniques based on diffuse reflectance measurements to evaluate tissue attenuation variations for different depths. It is demonstrated that fluorescence topography can be achieved up to a 5 mm depth using a near-infrared dye with millimeter depth accuracy in turbid media having optical properties representative of normal brain tissue. Wide-field depth estimates are made using optical technology integrated onto a commercial surgical microscope, making this approach feasible for real-world applications.
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Affiliation(s)
- Kolbein K. Kolste
- Dartmouth College, Thayer School of Engineering, Hanover, 14 Engineering Drive, New Hampshire 03755, United States
| | - Stephen C. Kanick
- Dartmouth College, Thayer School of Engineering, Hanover, 14 Engineering Drive, New Hampshire 03755, United States
| | - Pablo A. Valdés
- Dartmouth College, Thayer School of Engineering, Hanover, 14 Engineering Drive, New Hampshire 03755, United States
- Dartmouth College, Geisel School of Medicine, Hanover, 1 Rope Ferry Road, New Hampshire 03755, United States
| | - Michael Jermyn
- Polytechnique Montreal, Engineering Physics Department, Montreal, Québec H3C 3A7, Canada
| | - Brian C. Wilson
- University of Toronto, Ontario Cancer Institute, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - David W. Roberts
- Dartmouth-Hitchcock Medical Center, Section of Neurosurgery, 1 Medical Center Drive, Lebanon, New Hampshire 03756, United States
| | - Keith D. Paulsen
- Dartmouth College, Thayer School of Engineering, Hanover, 14 Engineering Drive, New Hampshire 03755, United States
| | - Frederic Leblond
- Polytechnique Montreal, Engineering Physics Department, Montreal, Québec H3C 3A7, Canada
- Address all correspondence to: Frederic Leblond, E-mail:
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31
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Valdes PA, Bekelis K, Harris BT, Wilson BC, Leblond F, Kim A, Simmons NE, Erkmen K, Paulsen KD, Roberts DW. 5-Aminolevulinic acid-induced protoporphyrin IX fluorescence in meningioma: qualitative and quantitative measurements in vivo. Neurosurgery 2014; 10 Suppl 1:74-82; discussion 82-3. [PMID: 23887194 DOI: 10.1227/neu.0000000000000117] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence has shown promise as a surgical adjunct for maximizing the extent of surgical resection in gliomas. To date, the clinical utility of 5-ALA in meningiomas is not fully understood, with most descriptive studies using qualitative approaches to 5-ALA-PpIX. OBJECTIVE To assess the diagnostic performance of 5-ALA-PpIX fluorescence during surgical resection of meningioma. METHODS ALA was administered to 15 patients with meningioma undergoing PpIX fluorescence-guided surgery at our institution. At various points during the procedure, the surgeon performed qualitative, visual assessments of fluorescence by using the surgical microscope, followed by a quantitative fluorescence measurement by using an intraoperative probe. Specimens were collected at each point for subsequent neuropathological analysis. Clustered data analysis of variance was used to ascertain a difference between groups, and receiver operating characteristic analyses were performed to assess diagnostic capabilities. RESULTS Red-pink fluorescence was observed in 80% (12/15) of patients, with visible fluorescence generally demonstrating a strong, homogenous character. Quantitative fluorescence measured diagnostically significant PpIX concentrations (cPpIx) in both visibly and nonvisibly fluorescent tissues, with significantly higher cPpIx in both visibly fluorescent (P < .001) and tumor tissue (P = .002). Receiver operating characteristic analyses also showed diagnostic accuracies up to 90% for differentiating tumor from normal dura. CONCLUSION ALA-induced PpIX fluorescence guidance is a potential and promising adjunct in accurately detecting neoplastic tissue during meningioma resective surgery. These results suggest a broader reach for PpIX as a biomarker for meningiomas than was previously noted in the literature.
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Affiliation(s)
- Pablo A Valdes
- *Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; ‡Thayer School of Engineering, Hanover, New Hampshire; §Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; ‖Departments of Pathology and Neurology, Georgetown University Medical Center, Washington, DC; ¶Ontario Cancer Institute, University of Toronto, Toronto, Ontario, Canada; #Engineering Physics Department, École Polytechnique de Montréal, Montreal, Quebec, Canada; **Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Loshchenov M, Zelenkov P, Potapov A, Goryajnov S, Borodkin A. Endoscopic fluorescence visualization of 5-ALA photosensitized central nervous system tumors in the neural tissue transparency spectral range. ACTA ACUST UNITED AC 2014. [DOI: 10.1515/plm-2013-0017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Fluorescence endoscopy systems for photosensitizer visualization have proved to be powerful tools for highlighting malignant tumor boundaries as well as detecting small, visually non-detectable, residual parts during photodynamic therapy. Most of these devices use excitation wavelengths in the blue visual spectrum range (405 nm) which limits the penetration depth in the tissue.Objective:In the study being presented in this article an apparatus and a method were developed for performing endoscopic fluorescence diagnostics of photosensitizer accumulation using excitation light in the red part of visual spectrum, i.e., 635 nm, which allows not only a deeper penetration of light into the tissue but also better scanning abilities and a higher diagnostic quality. Additionally, 635-nm radiation can penetrate thin layers of blood which appear during surgery.Material and methods:In order to use 635-nm excitation, a specially designed video endoscopy system was developed. The key feature of the video system is a dual camera video receiver where one sensitive B/W camera receives the fluorescence signal and a color camera receives the real-time image in natural colors during navigation. The software developed for the apparatus allows overlaying of the video output of fluorescence image on top of the conventional color image in real-time. The experimental setup and method were tested on Intralipid-based phantoms with protoporphyrin IX (PpIX) concentrations of 0.5–5 mg/kg, and then on two patients during surgery. The patients were administered 20 mg/kg 5-ALA photosensitizer 3 h before surgery according to standard practice of 5-ALA in neurosurgery.Results:The experiments demonstrate that the designed setup is sensitive enough for clear visualization of biological concentrations of PpIX in both phantoms with 0.5 mg/kg PpIX and previously photosensitized tissues of patients.Conclusion:Further prospective validation is needed to translate the results to clinical practice.
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33
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Kanick SC, Davis SC, Zhao Y, Hasan T, Maytin EV, Pogue BW, Chapman MS. Dual-channel red/blue fluorescence dosimetry with broadband reflectance spectroscopic correction measures protoporphyrin IX production during photodynamic therapy of actinic keratosis. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:75002. [PMID: 24996661 PMCID: PMC4082494 DOI: 10.1117/1.jbo.19.7.075002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/27/2014] [Indexed: 05/10/2023]
Abstract
Dosimetry for aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) photodynamic therapy of actinic keratosis was examined with an optimized fluorescence dosimeter to measure PpIX during treatment. While insufficient PpIX generation may be an indicator of incomplete response, there exists no standardized method to quantitate PpIX production at depths in the skin during clinical treatments. In this study, a spectrometer-based point probe dosimeter system was used to sample PpIX fluorescence from superficial (blue wavelength excitation) and deeper (red wavelength excitation) tissue layers. Broadband white light spectroscopy (WLS) was used to monitor aspects of vascular physiology and inform a correction of fluorescence for the background optical properties. Measurements in tissue phantoms showed accurate recovery of blood volume fraction and reduced scattering coefficient from WLS, and a linear response of PpIX fluorescence versus concentration down to 1.95 and 250 nM for blue and red excitations, respectively. A pilot clinical study of 19 patients receiving 1-h ALA incubation before treatment showed high intrinsic variance in PpIX fluorescence with a standard deviation/mean ratio of > 0.9. PpIX fluorescence was significantly higher in patients reporting higher pain levels on a visual analog scale. These pilot data suggest that patient-specific PpIX quantitation may predict outcome response.
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Affiliation(s)
- Stephen Chad Kanick
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
- Address all correspondence to: Stephen Chad Kanick, E-mail:
| | - Scott C. Davis
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Yan Zhao
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114
| | | | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114
- Department of Surgery, Section of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766
| | - M. Shane Chapman
- Department of Surgery, Section of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766
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Valdes PA, Jacobs VL, Wilson BC, Leblond F, Roberts DW, Paulsen KD. System and methods for wide-field quantitative fluorescence imaging during neurosurgery. OPTICS LETTERS 2013; 38:2786-8. [PMID: 23903142 DOI: 10.1364/ol.38.002786] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We report an accurate, precise and sensitive method and system for quantitative fluorescence image-guided neurosurgery. With a low-noise, high-dynamic-range CMOS array, we perform rapid (integration times as low as 50 ms per wavelength) hyperspectral fluorescence and diffuse reflectance detection and apply a correction algorithm to compensate for the distorting effects of tissue absorption and scattering. Using this approach, we generated quantitative wide-field images of fluorescence in tissue-simulating phantoms for the fluorophore PpIX, having concentrations and optical absorption and scattering variations over clinically relevant ranges. The imaging system was tested in a rodent model of glioma, detecting quantitative levels down to 20 ng/ml. The resulting performance is a significant advance on existing wide-field quantitative imaging techniques, and provides performance comparable to a point-spectroscopy probe that has previously demonstrated significant potential for improved detection of malignant brain tumors during surgical resection.
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Affiliation(s)
- Pablo A Valdes
- Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Li Y, Rey-Dios R, Roberts DW, Valdés PA, Cohen-Gadol AA. Intraoperative fluorescence-guided resection of high-grade gliomas: a comparison of the present techniques and evolution of future strategies. World Neurosurg 2013; 82:175-85. [PMID: 23851210 DOI: 10.1016/j.wneu.2013.06.014] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/15/2013] [Accepted: 06/29/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Fluorescence guidance has a demonstrated potential in maximizing the extent of high-grade glioma resection. Different fluorophores (fluorescent biomarkers), including 5-aminolevulinic acid (5-ALA) and fluorescein, have been examined with the use of several imaging techniques. Our goal was to review the state of this technology and discuss strategies for more widespread adoption. METHODS We performed a Medline search using the key words "fluorescence," "intraoperative fluorescence-guided resection," "intraoperative image-guided resection," and "brain glioma" for articles from 1960 until the present. This initial search revealed 267 articles. Each abstract and article was reviewed and the reference lists from select articles were further evaluated for relevance. A total of 64 articles included information about the role of fluorescence in resection of high-grade gliomas and therefore were selectively included for our analysis. RESULTS 5-ALA and fluorescein sodium have shown promise as fluorescent markers in detecting residual tumor intraoperatively. These techniques have demonstrated a significant increase in the extent of tumor resection. Regulatory barriers have limited the use of 5-ALA and technological challenges have restricted the use of fluorescein and its derivatives in the United States. Limitations to this technology currently exist, such as the fact that fluorescence at tumor margins is not always reliable for identification of tumor-brain interface. CONCLUSIONS These techniques are safe and effective for increasing gross total resection. The development of more tumor-specific fluorophores is needed to resolve problems with subjective interpretation of fluorescent signal at tumor margins. Techniques such as quantum dots and polymer or iron oxide-based nanoparticles have shown promise as potential future tools.
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Affiliation(s)
- Yiping Li
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Roberto Rey-Dios
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - David W Roberts
- Section of Neurosurgery, Department of Surgery, Dartmouth Medical School, Lebanon, New Hampshire, USA; Dartmouth Medical School, Hanover, New Hampshire, USA
| | - Pablo A Valdés
- Section of Neurosurgery, Department of Surgery, Dartmouth Medical School, Lebanon, New Hampshire, USA; Dartmouth Medical School, Hanover, New Hampshire, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Rollakanti KR, Kanick SC, Davis SC, Pogue BW, Maytin EV. Techniques for fluorescence detection of protoporphyrin IX in skin cancers associated with photodynamic therapy. ACTA ACUST UNITED AC 2013; 2:287-303. [PMID: 25599015 DOI: 10.1515/plm-2013-0030] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Photodynamic therapy (PDT) is a treatment modality that uses a specific photosensitizing agent, molecular oxygen, and light of a particular wavelength to kill cells targeted by the therapy. Topically administered aminolevulinic acid (ALA) is widely used to effectively treat cancerous and precancerous skin lesions, resulting in targeted tissue damage and little to no scarring. The targeting aspect of the treatment arises from the fact that ALA is preferentially converted into protoporphyrin IX (PpIX) in neoplastic cells. To monitor the amount of PpIX in tissues, techniques have been developed to measure PpIX-specific fluorescence, which provides information useful for monitoring the abundance and location of the photosensitizer before and during the illumination phase of PDT. This review summarizes the current state of these fluorescence detection techniques. Non-invasive devices are available for point measurements, or for wide-field optical imaging, to enable monitoring of PpIX in superficial tissues. To gain access to information at greater tissue depths, multi-modal techniques are being developed which combine fluorescent measurements with ultrasound or optical coherence tomography, or with microscopic techniques such as confocal or multiphoton approaches. The tools available at present, and newer devices under development, offer the promise of better enabling clinicians to inform and guide PDT treatment planning, thereby optimizing therapeutic outcomes for patients.
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Affiliation(s)
- Kishore R Rollakanti
- Department of Chemical and Biomedical Engineering, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH 44115, USA; and Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Stephen C Kanick
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH 03755, USA
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH 03755, USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH 03755, USA
| | - Edward V Maytin
- Department of Chemical and Biomedical Engineering, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH 44115, USA; Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; and Department of Dermatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Valdés PA, Leblond F, Jacobs VL, Wilson BC, Paulsen KD, Roberts DW. Quantitative, spectrally-resolved intraoperative fluorescence imaging. Sci Rep 2012; 2:798. [PMID: 23152935 PMCID: PMC3497712 DOI: 10.1038/srep00798] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/01/2012] [Indexed: 01/19/2023] Open
Abstract
Intraoperative visual fluorescence imaging (vFI) has emerged as a promising aid to surgical guidance, but does not fully exploit the potential of the fluorescent agents that are currently available. Here, we introduce a quantitative fluorescence imaging (qFI) approach that converts spectrally-resolved data into images of absolute fluorophore concentration pixel-by-pixel across the surgical field of view (FOV). The resulting estimates are linear, accurate, and precise relative to true values, and spectral decomposition of multiple fluorophores is also achieved. Experiments with protoporphyrin IX in a glioma rodent model demonstrate in vivo quantitative and spectrally-resolved fluorescence imaging of infiltrating tumor margins for the first time. Moreover, we present images from human surgery which detect residual tumor not evident with state-of-the-art vFI. The wide-field qFI technique has broad implications for intraoperative surgical guidance because it provides near real-time quantitative assessment of multiple fluorescent biomarkers across the operative field.
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Affiliation(s)
- Pablo A Valdés
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA.
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