Tange Floris P, Peul Roderick C, van den Hoven Pim, Koning Stefan, Kruiswijk Mo W, Faber Robin A, Verduijn Pieter S, van Rijswijk Carla S P, Galema Hidde A, Hilling Denise E, van Dijk Sam P J, van Ginhoven Tessa M, Keereweer Stijn, Mureau Marc A M, Feitsma Eline A, Noltes Milou E, Kruijff Schelto, Driessen Caroline, Achiam Michael P, Schepers Abbey, van Schaik Jan, Mieog J Sven D, Vahrmeijer Alexander L, Hamming Jaap F, van der Vorst Joost R
Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Department of Plastic and Reconstructive Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
Langenbecks Arch Surg. 2025 Jan 8;410(1):28. doi: 10.1007/s00423-024-03589-1.
Assessment of tissue perfusion using near-infrared fluorescence (NIR) with indocyanine green (ICG) is gaining popularity, however reliable and objective interpretation remains a challenge. Therefore, this study aimed to establish reference curves for vital tissue perfusion across target tissues using this imaging modality.
Data from five prospective study cohorts conducted in three Dutch academic medical centres between December 2018 and June 2023 was included. Quantitative analysis using time-intensity curves was performed in ten target tissues, including the colon, ileum, gastric conduit, deep inferior epigastric artery perforator (DIEP) flap, skin of the foot, trachea, sternocleidomastoid muscle (SCM), carotid artery, parathyroid gland, and skin of the neck.
A total of 178 patients were included in this study, representing 303 target tissues. Three different patterns of reference curves were identified based on a subjective assessment. Seven out of ten tissues showed a reference curve with rapid inflow (median time-to-max (tmax): 13.0-17.8 s, median maximum-normalized-slope (slope norm): 10.6-12.6%/sec), short outflow (median area-under-the-curve of tmax + 60 s (AUC60): 65.0-85.1%) followed by a gradual/absent outflow. Secondly, the DIEP flap and SCM tissue showed a reference curve with longer inflow (median tmax: 24.0, 22.0 s, median slope norm: 9.3, 9.7%/sec respectively) and reduced outflow (median AUC60: 89.1, 89.0% respectively). Thirdly, the skin of the foot showed slow inflow (median tmax 141.1 s, median norm slope 2.1%/sec) without outflow.
This study demonstrates reference curves for vital tissue perfusion of multiple target tissues identified with ICG NIR fluorescence imaging, providing a critical step towards the clinical implementation of this technique.
使用近红外荧光（NIR）结合吲哚菁绿（ICG）评估组织灌注正变得越来越普遍，然而可靠且客观的解读仍然是一项挑战。因此，本研究旨在使用这种成像方式建立跨目标组织的重要组织灌注参考曲线。
纳入了2018年12月至2023年6月期间在三个荷兰学术医疗中心进行的五个前瞻性研究队列的数据。在十个目标组织中进行了使用时间-强度曲线的定量分析，这些组织包括结肠、回肠、胃导管、腹壁下深动脉穿支（DIEP）皮瓣、足部皮肤、气管、胸锁乳突肌（SCM）、颈动脉、甲状旁腺和颈部皮肤。
本研究共纳入178例患者，代表303个目标组织。基于主观评估确定了三种不同的参考曲线模式。十个组织中有七个显示出具有快速流入（中位达峰时间（tmax）：13.0 - 17.8秒，中位最大归一化斜率（斜率norm）：10.6 - 12.6%/秒）、短流出（tmax + 60秒曲线下面积（AUC60）中位值：65.0 - 85.1%）随后是逐渐/无流出的参考曲线。其次，DIEP皮瓣和SCM组织显示出具有较长流入（中位tmax：24.0、22.0秒，中位斜率norm：分别为9.3、9.7%/秒）和减少流出（中位AUC60：分别为89.1、89.0%）的参考曲线。第三，足部皮肤显示出缓慢流入（中位tmax 141.1秒，中位规范斜率2.1%/秒）且无流出。
本研究展示了通过ICG NIR荧光成像确定的多个目标组织的重要组织灌注参考曲线，为该技术的临床应用迈出了关键一步。
