Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China.
Department of Urology, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China.
Theranostics. 2020 Feb 19;10(8):3636-3651. doi: 10.7150/thno.41127. eCollection 2020.
: Biliary tract injury remains the most dreaded complication during laparoscopic cholecystectomy. New intraoperative guidance technologies, including near-infrared (NIR) fluorescence cholangiography with indocyanine green (ICG), are under comprehensive evaluation. Previous studies had shown the limitations of traditional NIR light (NIR-I, 700-900 nm) in visualizing the biliary tract structures in specific clinical situations. The aim of this study was to evaluate the feasibility of performing the extrahepatic cholangiography in the second NIR window (NIR-II, 900-1700 nm) and compare it to the conventional NIR-I imaging. : The absorption and emission spectra, as well as fluorescence intensity and photostability of ICG-bile solution in the NIR-II window were recorded and measured. intralipid phantom imaging was performed to evaluate tissue penetrating depth in NIR-I and NIR-II window. Different clinical scenarios were modeled by broadening the penetration distance or generating bile duct injuries, and bile duct visualization and lesion site diagnosis in the NIR-II window were evaluated and compared with NIR-I imaging. : The fluorescence spectrum of ICG-bile solution extends well into the NIR-II region, exhibiting intense emission value and excellent photostability sufficient for NIR-II biliary tract imaging. Extrahepatic cholangiography using ICG in the NIR-II window obviously reduced background signal and enhanced penetration depth, providing more structural information and improved visualization of the bile duct or lesion location in simulated clinical scenarios, outperforming the NIR-I window imaging. : The conventional clinically approved agent ICG is an excellent fluorophore for NIR-II bile duct imaging. Fluorescence cholangiography with ICG in the NIR-II window could provide adequate visualization of the biliary tract structures with increased resolution and penetration depth and might be a valid option to increase the safety of cholecystectomy in difficult cases.
胆道损伤仍然是腹腔镜胆囊切除术最可怕的并发症。新的术中指导技术，包括近红外（NIR）荧光胆管造影与吲哚菁绿（ICG），正在全面评估中。以前的研究表明，传统近红外光（NIR-I，700-900nm）在特定临床情况下可视化胆道结构存在局限性。本研究旨在评估在第二近红外窗口（NIR-II，900-1700nm）进行肝外胆管造影的可行性，并将其与传统的 NIR-I 成像进行比较。
记录和测量了 NIR-II 窗口中 ICG-胆汁溶液的吸收和发射光谱、荧光强度和光稳定性。在 NIR-I 和 NIR-II 窗口中进行了 Intralipid 体模成像，以评估组织穿透深度。通过拓宽穿透距离或产生胆管损伤来模拟不同的临床情况，并评估和比较 NIR-II 窗口中的胆管可视化和病变部位诊断与 NIR-I 成像。
ICG-胆汁溶液的荧光光谱很好地扩展到 NIR-II 区域，表现出强烈的发射值和极好的光稳定性，足以进行 NIR-II 胆管成像。在 NIR-II 窗口中使用 ICG 进行肝外胆管造影明显降低了背景信号并增强了穿透深度，在模拟的临床情况下提供了更多的结构信息，并改善了胆管或病变位置的可视化效果，优于 NIR-I 窗口成像。
传统的临床批准的 ICG 是 NIR-II 胆管成像的优秀荧光团。NIR-II 窗口中的 ICG 荧光胆管造影可以提供足够的胆道结构可视化，具有更高的分辨率和穿透深度，可能是增加困难情况下胆囊切除术安全性的有效选择。
