Article

A Review of Indocyanine Green Fluorescent Imaging in Surgery

Department of Electrical Engineering and Energy Technology, University of Vaasa, Vaasa, Finland.
International Journal of Biomedical Imaging 04/2012; 2012(1):940585. DOI: 10.1155/2012/940585
Source: PubMed

ABSTRACT

The purpose of this paper is to give an overview of
the recent surgical intraoperational applications of indocyanine
green fluorescence imaging methods, the basics of the technology,
and instrumentation used. Well over 200 papers describing this
technique in clinical setting are reviewed. In addition to the surgical
applications, other recent medical applications of ICG are briefly
examined.

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    • "This illumination wavelength is a manufacturer preset and cannot be altered. Nearinfrared CLE imaging, however, is not available yet in a CE marked system and we felt that adequate signal was achieved in the system described, as the fluorophore has attractive properties relevant for clinical liver and bile duct imaging[26]. Although porcine models are frequently used to evaluate novel surgical technologies[28,29], the resulting findings have to be interpreted with caution. "
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    ABSTRACT: Background: Laparoscopic liver ablation therapy can be used for the treatment of primary and secondary liver malignancy. The increased incidence of cancer recurrence associated with this approach, has been attributed to the inability of monitoring the extent of ablated liver tissue. Methods: The feasibility of assessing liver ablation with probe-based confocal laser endomicroscopy (CLE) was studied in a porcine model of laparoscopic microwave liver ablation. Following the intravenous injection of the fluorophores fluorescein and indocyanine green, CLE images were recorded at 488 nm and 660 nm wavelength and compared to liver histology. Statistical analysis was performed to assess if fluorescence intensity change can predict the presence of ablated liver tissue. Results: CLE imaging of fluorescein at 488 nm provided good visualization of the hepatic microvasculature; whereas, CLE imaging of indocyanine green at 660 nm enabled detailed visualization of hepatic sinusoid architecture and interlobular septations. Fluorescence intensity as measured in relative fluorescence units was found to be 75-100% lower in ablated compared to healthy liver regions. General linear mixed modeling and ROC analysis found the decrease in fluorescence to be statistically significant. Conclusion: Laparoscopic, dual wavelength CLE imaging using two different fluorophores enables clinically useful visualization of multiple liver tissue compartments, in greater detail than is possible at a single wavelength. CLE imaging may provide valuable intraoperative information on the extent of laparoscopic liver ablation. Lasers Surg. Med. © 2015 Wiley Periodicals, Inc.
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    • "Indocyanine green (ICG) and methylene blue (MB) are blood pooled and not targeted agents but clinical trials demonstrated that they are able to highlight tumors and SLN. ICG is the most widely used, either as free dye [7] or bounded on native serum albumin or on colloidal albumin [8]. Fluorescence imaging for guiding surgery is able to detect probes close from the surface of the surgical field. "
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    ABSTRACT: In laparotomy surgery guided by near-infrared fluorescence imaging, the access to the field of operation is limited by the illumination and/or the imaging field. The side of cavities or organs such as the liver or the heart cannot be examined with the systems available on the market, which are too large and too heavy. In this article, we describe and evaluate a palm sized probe, whose properties, weight, size and sensitivity are adapted for guiding laparotomy surgery.Different experiments have been performed to determine its main characteristics, both on the illumination and imaging sides. The device has been tested for fluorescent molecular probe imaging in preclinical procedures, to prove its ability to be used in cancer nodule detection during surgery. This system is now CE certified for clinical procedures and Indocyanine Green imaging has been performed during clinical investigations: lymphedema and surgical resection of liver metastases of colorectal cancers.
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    • "Since it fluoresces when excited by near-infrared (NIR) light, it allows for imaging of the biliary system without the use of radiation and without any incisions into biliary structures. It is safe, easy to use, has low cost, and high sensitivity and contrast (Alander et al., 2012). Preliminary research with mice and pig models has shown promise in aiding correct identification of normal anatomy, as well as differentiating pathology such as CBD stones, obstructions, or leaks (Figueiredo, Nahrendorf, Vinegoni, & Weissleder, 2010; Matsui et al., 2010). "
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    ABSTRACT: A medical imaging technique known as Indocyanine Green (ICG) fluorescence cholangiography can potentially improve safety and reduce cost in minimally invasive surgery, but is not widely used. Refinement of existing ICG imaging prototypes would facilitate more widespread use of the technology. The goal of this research was to optimize the display of an ICG imaging prototype, post-hoc. Images produced by the prototype were systematically manipulated by altering brightness and contrast levels, and corresponding changes in perceived image quality were measured. Results showed that perceived image quality increased when either brightness or contrast of the original image was increased by 10% and 20%, respectively. With high quality images, similar manipulations of brightness or contrast did not improve the perceived image quality, nor did they degrade the perceived image quality significantly. These adjustments are expected to increase the overall clinical utility of the prototype as the perceived quality of the images most in need of improvement was enhanced.
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