Yashin Konstantin S, Kiseleva Elena B, Gubarkova Ekaterina V, Moiseev Alexander A, Kuznetsov Sergey S, Shilyagin Pavel A, Gelikonov Grigory V, Medyanik Igor A, Kravets Leonid Ya, Potapov Alexander A, Zagaynova Elena V, Gladkova Natalia D
Microneurosurgery Group, University Clinic, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
Laboratory of Optical Coherence Tomography, Research Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
Front Oncol. 2019 Apr 2;9:201. doi: 10.3389/fonc.2019.00201. eCollection 2019.
This paper considers valuable visual assessment criteria for distinguishing between tumorous and non-tumorous tissues, intraoperatively, using cross-polarization OCT (CP OCT)-OCT with a functional extension, that enables detection of the polarization properties of the tissues in addition to their conventional light scattering. The study was performed on 176 human specimens obtained from 30 glioma patients. To measure the degree to which the typical parameters of CP OCT images can be matched to the actual histology, 100 images of tumors and white matter were selected for visual analysis to be undertaken by three "single-blinded" investigators. An evaluation of the inter-rater reliability between the investigators was performed. Application of the identified visual CP OCT criteria for intraoperative use was performed during brain tumor resection in 17 patients. The CP OCT image parameters that can typically be used for visual assessment were separated: (1) signal intensity; (2) homogeneity of intensity; (3) attenuation rate; (4) uniformity of attenuation. The degree of match between the CP OCT images and the histology of the specimens was significant for the parameters "signal intensity" in both polarizations, and "homogeneity of intensity" as well as the "uniformity of attenuation" in co-polarization. A test based on the identified criteria showed a diagnostic accuracy of 87-88%. Intraoperative CP OCT images of white matter and tumors have similar signals to ones, whereas the cortex is characterized by indicative vertical striations arising from the "shadows" of the blood vessels; these are not seen in images or in the case of tumor invasion. Visual assessment of CP OCT images enables tumorous and non-tumorous tissues to be distinguished. The most powerful aspect of CP OCT images that can be used as a criterion for differentiation between tumorous tissue and white matter is the signal intensity. In distinguishing white matter from tumors the diagnostic accuracy using the identified visual CP OCT criteria was 87-88%. As the CP OCT data is easily associated with intraoperative neurophysiological and neuronavigation findings this can provide valuable complementary information for the neurosurgeon tumor resection.
本文探讨了在术中使用具有功能扩展的交叉极化光学相干断层扫描（CP OCT）来区分肿瘤组织和非肿瘤组织的重要视觉评估标准。CP OCT除了能检测组织的传统光散射外，还能检测其极化特性。该研究对从30例神经胶质瘤患者身上获取的176份人体标本进行。为了测量CP OCT图像的典型参数与实际组织学的匹配程度，选择了100张肿瘤和白质图像进行视觉分析，由三位“单盲”研究者进行。对研究者之间的评分者间信度进行了评估。在17例患者的脑肿瘤切除术中应用了确定的视觉CP OCT标准用于术中。通常可用于视觉评估的CP OCT图像参数被区分出来：（1）信号强度；（2）强度均匀性；（3）衰减率；（4）衰减均匀性。CP OCT图像与标本组织学之间在两个极化方向上的“信号强度”参数、同极化方向上的“强度均匀性”以及“衰减均匀性”参数的匹配程度都很显著。基于确定标准的测试显示诊断准确率为87 - 88%。术中白质和肿瘤的CP OCT图像信号相似，而皮质的特征是由血管“阴影”产生的指示性垂直条纹；在肿瘤侵犯的情况下，这些条纹在图像中不可见。对CP OCT图像的视觉评估能够区分肿瘤组织和非肿瘤组织。CP OCT图像中最能作为区分肿瘤组织和白质标准的有力方面是信号强度。使用确定的视觉CP OCT标准区分白质和肿瘤时，诊断准确率为87 - 88%。由于CP OCT数据很容易与术中神经生理学和神经导航结果相关联，这可以为神经外科医生进行肿瘤切除提供有价值的补充信息。
