KleinJan Gijs H, Karakullukçu Baris, Klop W Martin C, Engelen Thijs, van den Berg Nynke S, van Leeuwen Fijs W B
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, C2-S zone, 9600, 2300 RC, Leiden, the Netherlands.
Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
EJNMMI Res. 2017 Aug 17;7(1):65. doi: 10.1186/s13550-017-0312-1.
Intraoperative sentinel node (SN) identification in patients with head-and-neck malignancies can be challenging due to unexpected drainage patterns and anatomical complexity. Here, intraoperative navigation-based guidance technologies may provide outcome. In this study, gamma camera-based freehandSPECT was evaluated in combination with the hybrid tracer ICG-Tc-nanocolloid.
Eight patients with melanoma located in the head-and-neck area were included. Indocyanine green (ICG)-Tc-nanocolloid was injected preoperatively, whereafter lymphoscintigraphy and SPECT/CT imaging were performed in order to define the location of the SN(s). FreehandSPECT scans were generated in the operation room using a portable gamma camera. For lesion localization during surgery, freehandSPECT scans were projected in an augmented reality video-view that was used to spatially position a gamma-ray detection probe. Intraoperative fluorescence imaging was used to confirm the accuracy of the navigation-based approach and identify the exact location of the SNs.
Preoperatively, 15 SNs were identified, of which 14 were identified using freehandSPECT. Navigation towards these nodes using the freehandSPECT approach was successful in 13 nodes. Fluorescence imaging provided optical confirmation of the navigation accuracy in all patients. In addition, fluorescence imaging allowed for the identification of (clustered) SNs that could not be identified based on navigation alone.
The use of gamma camera-based freehandSPECT aids intraoperative lesion identification and, with that, supports the transition from pre- to intraoperative imaging via augmented reality display and directional guidance.
由于引流模式意外和解剖结构复杂，对头颈部恶性肿瘤患者进行术中前哨淋巴结（SN）识别可能具有挑战性。在此，基于术中导航的引导技术可能会带来良好结果。在本研究中，对基于γ相机的徒手单光子发射计算机断层扫描（SPECT）结合混合示踪剂吲哚菁绿（ICG）-锝纳米胶体进行了评估。
纳入8例头颈部黑色素瘤患者。术前注射吲哚菁绿（ICG）-锝纳米胶体，随后进行淋巴闪烁显像和SPECT/CT成像以确定前哨淋巴结的位置。在手术室使用便携式γ相机进行徒手SPECT扫描。为了在手术中定位病变，将徒手SPECT扫描投影到增强现实视频视图中，该视图用于在空间上定位γ射线检测探头。术中荧光成像用于确认基于导航方法的准确性并确定前哨淋巴结的确切位置。
术前确定了15个前哨淋巴结，其中14个通过徒手SPECT确定。使用徒手SPECT方法对这些淋巴结的导航在13个淋巴结中成功。荧光成像在所有患者中提供了导航准确性的光学确认。此外，荧光成像能够识别仅基于导航无法识别的（聚集的）前哨淋巴结。
基于γ相机的徒手SPECT的使用有助于术中病变识别，从而通过增强现实显示和定向引导支持从前瞻性成像到术中成像的转变。
