Steve S Cho1,2, Ryan Salinas2, Emma De Ravin1,2, Clare W Teng1,2, Carrie Li1,2, Kalil G Abdullah2, Love Buch2, Jasmin Hussain2, Fahad Ahmed2, Jay Dorsey3, Suyash Mohan4, Steven Brem2, Sunil Singhal5, John Y K Lee6. 1. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 2. Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 3. Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 4. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 5. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 6. Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. leejohn@uphs.upenn.edu.
Abstract
PURPOSE: Intraoperative molecular imaging with tumor-targeting fluorophores offers real-time detection of neoplastic tissue. The second window indocyanine green (SWIG) technique relies on passive accumulation of indocyanine green (ICG), a near-infrared fluorophore, in neoplastic tissues. In this study, we explore the ability of SWIG to detect neoplastic tissue and to predict postoperative magnetic resonance imaging (MRI) findings intraoperatively. PROCEDURES: Retrospective data were collected from 36 patients with primary high-grade gliomas (HGG) enrolled as part of a larger trial between October 2014 and October 2018. Patients received systemic ICG infusions at 2.5-5 mg/kg 24 h preoperatively. Near-infrared fluorescence was recorded throughout the case and from biopsy specimens. The presence/location of residual SWIG signal after resection was compared to the presence/location of residual gadolinium enhancement on postoperative MRI. The extent of resection was not changed based on near-infrared imaging. RESULTS: All 36 lesions demonstrated strong near-infrared fluorescence (signal-to-background = 6.8 ± 2.2) and 100 % of tumors reaching the cortex were visualized before durotomy. In 78 biopsy specimens, near-infrared imaging demonstrated higher sensitivity and accuracy than white light for diagnosing neoplastic tissue intraoperatively. Furthermore, near-infrared imaging predicted gadolinium enhancement on postoperative MRI with 91 % accuracy, with visualization of residual enhancement as small as 0.3 cm3. Patients with no residual near-infrared signal after resection were significantly more likely to have complete resection on postoperative MRI (p value < 0.0001). CONCLUSIONS: Intraoperative imaging with SWIG demonstrates highly sensitive detection of HGG tissue in real time. Furthermore, post-resection near-infrared imaging correlates with postoperative MRI. Overall, our findings suggest that SWIG can provide surgeons with MRI-like results in real time, potentially increasing resection rates.
PURPOSE: Intraoperative molecular imaging with tumor-targeting fluorophores offers real-time detection of neoplastic tissue. The second window indocyanine green (SWIG) technique relies on passive accumulation of indocyanine green (ICG), a near-infrared fluorophore, in neoplastic tissues. In this study, we explore the ability of SWIG to detect neoplastic tissue and to predict postoperative magnetic resonance imaging (MRI) findings intraoperatively. PROCEDURES: Retrospective data were collected from 36 patients with primary high-grade gliomas (HGG) enrolled as part of a larger trial between October 2014 and October 2018. Patients received systemic ICG infusions at 2.5-5 mg/kg 24 h preoperatively. Near-infrared fluorescence was recorded throughout the case and from biopsy specimens. The presence/location of residual SWIG signal after resection was compared to the presence/location of residual gadolinium enhancement on postoperative MRI. The extent of resection was not changed based on near-infrared imaging. RESULTS: All 36 lesions demonstrated strong near-infrared fluorescence (signal-to-background = 6.8 ± 2.2) and 100 % of tumors reaching the cortex were visualized before durotomy. In 78 biopsy specimens, near-infrared imaging demonstrated higher sensitivity and accuracy than white light for diagnosing neoplastic tissue intraoperatively. Furthermore, near-infrared imaging predicted gadolinium enhancement on postoperative MRI with 91 % accuracy, with visualization of residual enhancement as small as 0.3 cm3. Patients with no residual near-infrared signal after resection were significantly more likely to have complete resection on postoperative MRI (p value < 0.0001). CONCLUSIONS: Intraoperative imaging with SWIG demonstrates highly sensitive detection of HGG tissue in real time. Furthermore, post-resection near-infrared imaging correlates with postoperative MRI. Overall, our findings suggest that SWIG can provide surgeons with MRI-like results in real time, potentially increasing resection rates.
Authors: Jack X Jiang; Jane J Keating; Elizabeth M De Jesus; Ryan P Judy; Brian Madajewski; Ollin Venegas; Olugbenga T Okusanya; Sunil Singhal Journal: Am J Nucl Med Mol Imaging Date: 2015-06-15
Authors: Oluwakanyinsolami Netufo; Kate Connor; Liam P Shiels; Kieron J Sweeney; Dan Wu; Donal F O'Shea; Annette T Byrne; Ian S Miller Journal: Pharmaceuticals (Basel) Date: 2022-04-29
Authors: Evgenii Belykh; Xiaochun Zhao; Brandon Ngo; Dara S Farhadi; Vadim A Byvaltsev; Jennifer M Eschbacher; Peter Nakaji; Mark C Preul Journal: Front Oncol Date: 2020-12-04 Impact factor: 6.244
Authors: Giuseppe Palmieri; Fabio Cofano; Luca Francesco Salvati; Matteo Monticelli; Pietro Zeppa; Giuseppe Di Perna; Antonio Melcarne; Roberto Altieri; Giuseppe La Rocca; Giovanni Sabatino; Giuseppe Maria Barbagallo; Fulvio Tartara; Francesco Zenga; Diego Garbossa Journal: Technol Cancer Res Treat Date: 2021 Jan-Dec
Authors: Alexander J Schupper; Manasa Rao; Nicki Mohammadi; Rebecca Baron; John Y K Lee; Francesco Acerbi; Constantinos G Hadjipanayis Journal: Front Neurol Date: 2021-06-16 Impact factor: 4.003