Zheng Sheng, Zhang Zeyu, Qu Yawei, Zhang Xiaojun, Guo Hongbo, Shi Xiaojing, Cai Meishan, Cao Caiguang, Hu Zhenhua, Liu Haifeng, Tian Jie
Department of Gastroenterology The Third Medical Centre Chinese PLA General Hospital Beijing 100039 China.
Department of Gastroenterology Anhui No.2 Provincial People's Hospital Hefei 230041 China.
Adv Sci (Weinh). 2019 Apr 24;6(13):1900159. doi: 10.1002/advs.201900159. eCollection 2019 Jul 3.
Radical resection is the most effective method for malignant tumor treatments. However, conventional imaging cannot fully satisfy the clinical needs of surgical navigation. This study presents a novel triple-modality positron emission tomography (PET)-Cerenkov radiation energy transfer (CRET)-confocal laser endomicroscopy (CLE) imaging strategy for intraoperative tumor imaging and surgical navigation. Using clinical radiopharmaceuticals and fluorescein sodium (FS), this strategy can accurately detect the tumor and guide the tumor surgery. The FS emission property under Cerenkov radiation excitation is investigated using 2-deoxy-2-F-fluoroglucose and C-choline. Performances of the PET-CRET-CLE imaging and the CRET-CLE image-guided surgery are evaluated on mouse models. The CRET signal at 8 mm depth is stronger than the Cerenkov luminescence at 1 mm depth in phantoms. In vivo experiments indicate that 0.5 mL kg of 10% FS generates the strongest CRET signal, which can be observed immediately after FS injection. A surgical navigation study shows that the tumors are precisely detected and resected using intraoperative CRET-CLE. In summary, a PET-CRET-CLE triple-modality imaging strategy is developed. This strategy can detect the tumors and precisely guide the tumor resection using clinical pharmaceuticals. This triple-modality imaging shows high potential in surgical navigation research and clinical translation.
根治性切除是恶性肿瘤治疗最有效的方法。然而，传统成像无法完全满足手术导航的临床需求。本研究提出了一种新型的三模态正电子发射断层扫描（PET）-切伦科夫辐射能量转移（CRET）-共聚焦激光内镜显微镜（CLE）成像策略，用于术中肿瘤成像和手术导航。使用临床放射性药物和荧光素钠（FS），该策略能够准确检测肿瘤并指导肿瘤手术。利用2-脱氧-2-F-氟葡萄糖和碳-胆碱研究了切伦科夫辐射激发下FS的发射特性。在小鼠模型上评估了PET-CRET-CLE成像和CRET-CLE图像引导手术的性能。在体模中，8毫米深度处的CRET信号比1毫米深度处的切伦科夫发光更强。体内实验表明，0.5 mL/kg的10%FS产生最强的CRET信号，在注射FS后可立即观察到。一项手术导航研究表明，使用术中CRET-CLE能够精确检测并切除肿瘤。总之，开发了一种PET-CRET-CLE三模态成像策略。该策略能够使用临床药物检测肿瘤并精确指导肿瘤切除。这种三模态成像在手术导航研究和临床转化中显示出很高的潜力。
