Department of Radiology Washington University, St. Louis, MO 63110, USA.
Department of Biomedical Engineering Washington University, St. Louis, MO 63110, USA.
Transl Res. 2013 Nov;162(5):324-331. doi: 10.1016/j.trsl.2013.05.002. Epub 2013 Jun 5.
Surgical resections remain the primary curative interventions for hepatocellular carcinoma (HCC). However, lack of real-time intraoperative image guidance confines surgeons to subjective visual assessment of the surgical bed, leading to poor visualization of small positive nodules and the extension of diffuse HCC. To address this problem, we developed a wearable fluorescence imaging and display system (fluorescence goggle) for intraoperative imaging of HCCs in human patients. In this pilot study, both intravenous (IV) and transarterial hepatic (TAH) delivery of indocyanine green (ICG) were explored to facilitate fluorescence goggle-mediated HCC imaging. The results show that all primary tumors in patients (n = 4) who received TAH delivery of ICG were identified successfully by the fluorescence goggle. In addition, 6 satellite tumors were also detected by the goggle, 5 of which were neither identifiable via preoperative magnetic resonance imaging (MRI) and computed tomography (CT) nor by visual inspection and palpation. In the group (n = 5) that received ICG intravenously, only 2 of 6 tumors visible by preoperative MRI or CT were identified with the fluorescence goggle, demonstrating the limitation of this delivery route for a non-tumor-selective imaging agent. Comparative analysis shows that the HCC-to-liver florescence contrast detected by the goggle was significantly greater in patients that received TAH than IV delivery of ICG (P = 0.013). This pilot study demonstrates the feasibility of using the fluorescence goggle to identify multifocal lesions and small tumor deposits using TAH ICG delivery in HCC patients.
手术切除仍然是治疗肝细胞癌 (HCC) 的主要方法。然而，缺乏实时术中图像引导限制了外科医生对手术床的主观视觉评估，导致对小阳性结节和弥漫性 HCC 的扩展的可视化效果不佳。为了解决这个问题，我们开发了一种可穿戴的荧光成像和显示系统（荧光镜），用于对人类 HCC 进行术中成像。在这项初步研究中，探索了静脉内（IV）和经动脉肝内（TAH）递送吲哚菁绿（ICG）以促进荧光镜介导的 HCC 成像。结果表明，接受 TAH 递送 ICG 的所有患者（n=4）的原发性肿瘤均被荧光镜成功识别。此外，荧光镜还检测到 6 个卫星肿瘤，其中 5 个肿瘤在术前磁共振成像（MRI）和计算机断层扫描（CT）以及肉眼观察和触诊中均无法识别。在接受 ICG 静脉内递送的组（n=5）中，仅在术前 MRI 或 CT 可见的 6 个肿瘤中的 2 个可通过荧光镜识别，表明这种非肿瘤选择性造影剂的递送途径存在局限性。比较分析表明，接受 TAH 比 IV 递送 ICG 的患者的 HCC 与肝脏荧光对比度明显更高（P=0.013）。这项初步研究表明，使用荧光镜结合 TAH 递送 ICG 识别 HCC 患者的多灶性病变和小肿瘤沉积物是可行的。
