Optical coherence tomography (OCT) is a promising method for detecting cancer margins during tumor resection. This study focused on differentiating tumorous from nontumorous tissues in human brain tissues using cross-polarization OCT (CP OCT). The study was performed on fresh ex vivo human brain tissues from 30 patients with high- and low-grade gliomas. Different tissue types that neurosurgeons should clearly distinguish during surgery, such as the cortex, white matter, necrosis and tumorous tissue, were separately analyzed. Based on volumetric CP OCT data, tumorous and normal brain tissue were differentiated using two optical coefficients — attenuation and forward cross-scattering. Compared with white matter, tumorous tissue without necrotic areas had significantly lower optical attenuation and forward cross-scattering values. The presence of particular morphological patterns, such as necrosis and injured myelinated fibers, can lead to dramatic changes in coefficient values and create some difficulties in differentiating between tissues. Color-coded CP OCT maps based on optical coefficients provided a visual assessment of the tissue. This study demonstrated the high translational potential of CP OCT in differentiating tumorous tissue from white matter. The clinical use of CP OCT during surgery in patients with gliomas could increase the extent of tumor resection and improve overall and progression-free survival.

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. Materials and Methods: The study was performed on 176 ex vivo 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. Results: 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 in vivo CP OCT images of white matter and tumors have similar signals to ex vivo ones, whereas the cortex in vivo is characterized by indicative vertical striations arising from the “shadows” of the blood vessels; these are not seen in ex vivo images or in the case of tumor invasion. Conclusion: 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.

No abstract

The aim of the investigation was to evaluate the performance of multimodal OCT (MM OCT) for differential diagnostics of normal and diseased brain tissue using an experimental model of glioblastoma. Materials and Methods. The spectral domain MM OCT device developed at the Institute of Applied Physics of the Russian Academy of Sciences (Nizhny Novgorod, Russia) was used for the study. It provides two modes of investigation: cross-polarization OCT (CP OCT) and microangiographic OCT (MA OCT). The instrument features the following characteristics: rate of information gathering-20,000 A-scans per second; wavelength-1.3 µm; shot size-~4×2 mm; lateral resolution-20 µm; axial resolution-10-15 µm. The OCT investigation was performed on an experimental 101.8 rat brain glioblastoma tumor model inoculated and maintained in the Research Institute of Human Morphology. To evaluate the signal parameters typical of the tumor and of normal brain tissue, CP OCT and MA OCT images were compared with histological specimens (stained with hematoxylin and eosin). Analysis of the MA OCT images was performed on the basis of comparison with the findings of ZOOM-microscopy. Results. The model of the rat 101.8 glioblastoma helped to identify links between CP OCT images of areas of brain tissue and their morphological structure. We performed a comparative evaluation of the signals from the glial tumor and from normal brain tissue. MA OCT allowed the visualization of the blood vessels both in the tumor and in the normal brain tissues, revealing changes in the form and sizes typical of the tumor vessels. Conclusion. ММ OCT is an innovative technology with potential for use in intraoperational diagnoses of glial tumors of the brain. The ability to combine several modes of investigation enables information to be obtained simultaneously about the structure of the tissues and about any peculiarities of the structure of the different elements of their microvascular network.

Optical coherence tomography (OCT) has been recently suggested as a promising method to obtain in vivo and real-time high-resolution images of tissue structure in brain tumor surgery. This review focuses on the basics of OCT imaging, types of OCT images and currently suggested OCT scanner devices and the results of their application in neurosurgery. OCT can assist in achieving intraoperative precision identification of tumor infiltration within surrounding brain parenchyma by using qualitative or quantitative OCT image analysis of scanned tissue. OCT is able to identify tumorous tissue and blood vessels detection during stereotactic biopsy procedures. The combination of OCT with traditional imaging such as MRI, ultrasound and 5-ALA fluorescence has the potential to increase the safety and accuracy of the resection. OCT can improve the extent of resection by offering the direct visualization of tumor with cellular resolution when using microscopic OCT contact probes. The theranostic implementation of OCT as a part of intelligent optical diagnosis and automated lesion localization and ablation could achieve high precision, automation and intelligence in brain tumor surgery. We present this review for the increase of knowledge and formation of critical opinion in the field of OCT implementation in brain tumor surgery.