Near-Infrared Imaging with Second-Window Indocyanine Green in Newly Diagnosed High-Grade Gliomas Predicts Gadolinium Enhancement on Postoperative Magnetic Resonance Imaging

Cho, Steve S.; Salinas, Ryan; Ravin, Emma De; Teng, Clare W; Li, Carrie; Abdullah, Kalil G.; Buch, Love; Hussain, Jasmin; Ahmed, Fahad; Dorsey, Jay F.; Mohan, Suyash; Brem, Steven; Singhal, Sunil; Lee, John Y.K.

doi:10.1007/s11307-019-01455-x

Cited by 26 publications

(22 citation statements)

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“…Other studies have demonstrated ICG's ability to visualize chordoma, craniopharyngioma, pineocytoma, and intraventricular tumors. 16,22,23 Because the ultimate goal of FGS is to maximize extent of resection, studies by Cho et al in 2020 24 and Teng et al 76 comparing NIR fluorescence to the gold standard postoperative MRI showed that the absence of re- sidual NIR signal postresection closely correlated to GTR of HGGs (p < 0.0001) and intracranial metastases (p = 0.007) on MRI. One limitation of these findings, however, is intrinsic to the SWIG technique itself.…”

Section: Clinical Trials Of Icg For Fluorescence-guided Intracranial mentioning

confidence: 99%

“…25 mg ICG video angiography in 54 HGGs, 17 LGGs, 14 meningiomas, 12 metastases, & 3 hemangioblastomas can monitor blood flow in exposed tumoral & peritumoral vessels Zeh et al, 2017 9 HGG Mean SBR of 7.5 w/ 2.5-5.0 mg/kg SWIG in 10 pts, plateau of ICG NIRF up to 48 hrs postinfusion Cho et al, 2020 24 Newly diagnosed HGG showing weak or no protoporphyrin-IX fluorescence but strong SWIG fluorescence. 29 Another comparison study demonstrated that ICG was superior to 5-ALA in visualizing areas of increased angiogenesis, a process essential for metastasis of solid tumors.…”

Section: Gliomamentioning

confidence: 99%

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Applications of indocyanine green in brain tumor surgery: review of clinical evidence and emerging technologies

Teng

Huang

Arguelles

et al. 2021

Neurosurgical Focus

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Indocyanine green (ICG) is a water-soluble dye that was approved by the FDA for biomedical purposes in 1956. Initially used to measure cardiocirculatory and hepatic functions, ICG’s fluorescent properties in the near-infrared (NIR) spectrum soon led to its application in ophthalmic angiography. In the early 2000s, ICG was formally introduced in neurosurgery as an angiographic tool. In 2016, the authors’ group pioneered a novel technique with ICG named second-window ICG (SWIG), which involves infusion of a high dose of ICG (5.0 mg/kg) in patients 24 hours prior to surgery. To date, applications of SWIG have been reported in patients with high-grade gliomas, meningiomas, brain metastases, pituitary adenomas, craniopharyngiomas, chordomas, and pinealomas.The applications of ICG have clearly expanded rapidly across different specialties since its initial development. As an NIR fluorophore, ICG has advantages over other FDA-approved fluorophores, all of which are currently in the visible-light spectrum, because of NIR fluorescence’s increased tissue penetration and decreased autofluorescence. Recently, interest in the latest applications of ICG in brain tumor surgery has grown beyond its role as an NIR fluorophore, extending into shortwave infrared imaging and integration into nanotechnology. This review aims to summarize reported clinical studies on ICG fluorescence–guided surgery of intracranial tumors, as well as to provide an overview of the literature on emerging technologies related to the utility of ICG in neuro-oncological surgeries, including the following aspects: 1) ICG fluorescence in the NIR-II window; 2) ICG for photoacoustic imaging; and 3) ICG nanoparticles for combined diagnostic imaging and therapy (theranostic) applications.

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Section: Clinical Trials Of Icg For Fluorescence-guided Intracranial mentioning

confidence: 99%

Section: Gliomamentioning

confidence: 99%

Applications of indocyanine green in brain tumor surgery: review of clinical evidence and emerging technologies

Teng

Huang

Arguelles

et al. 2021

Neurosurgical Focus

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“…Our experience with the new operating microscope in Blue400 and Yellow560 modes demonstrates that the two channels can be alternated without compromising image quality. Concurrent FNa-contrasted CLE may be advantageous during surgeries performed using near-infrared guidance (e.g., using indocyanine green [ICG]) because of the absence of spectral overlap with FNa (24,25). Confocal-assisted fluorescence microscopy with ICG as a contrast has also been reported (26,27).…”

Section: Implications For Practice: Incorporation Of Cle Into the Wormentioning

confidence: 99%

Intraoperative Confocal Laser Endomicroscopy Ex Vivo Examination of Tissue Microstructure During Fluorescence-Guided Brain Tumor Surgery

et al. 2020

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BackgroundNoninvasive intraoperative optical biopsy that provides real-time imaging of histoarchitectural (cell resolution) features of brain tumors, especially at the margin of invasive tumors, would be of great value. To assess clinical-grade confocal laser endomicroscopy (CLE) and to prepare for its use intraoperatively in vivo, we performed an assessment of CLE ex vivo imaging in brain lesions.MethodsTissue samples from patients who underwent intracranial surgeries with fluorescein sodium (FNa)–based wide-field fluorescence guidance were acquired for immediate intraoperative ex vivo optical biopsies with CLE. Hematoxylin-eosin–stained frozen section analysis of the same specimens served as the gold standard for blinded neuropathology comparison. FNa 2 to 5 mg/kg was administered upon induction of anesthesia, and FNa 5 mg/kg was injected for CLE contrast improvement. Histologic features were identified, and the diagnostic accuracy of CLE was assessed.ResultsOf 77 eligible patients, 47 patients with 122 biopsies were enrolled, including 32 patients with gliomas and 15 patients with other intracranial lesions. The positive predictive value of CLE optical biopsies was 97% for all specimens and 98% for gliomas. The specificity of CLE was 90% for all specimens and 94% for gliomas. The second FNa injection in seven patients, a mean of 2.6 h after the first injection, improved image quality and increased the percentage of accurately diagnosed images from 67% to 93%. Diagnostic CLE features of lesional glioma biopsies and normal brain were identified. Seventeen histologic features were identified.ConclusionsResults demonstrated high specificity and positive predictive value of ex vivo intraoperative CLE optical biopsies and justify an in vivo intraoperative trial. This new portable, noninvasive intraoperative imaging technique provides diagnostic features to discriminate lesional tissue with high specificity and is feasible for incorporation into the fluorescence-guided surgery workflow, particularly for patients with invasive brain tumors.

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“…Zeh et al administered doses above the FDA-approved limit of 2 mg/kg in rodents implanted with human glioma xenografts and demonstrated a broad plateau period extending up to 72 h, thus allowing for optimal imaging of glioma as compared to normal brain ( 20 ). With the SWIG approach, combining the natural permeability of the tumor vascularity with poor clearance allows for high doses of ICG to penetrate the tumor, a high dose (5 mg/kg) of intravenous ICG is given a day (24 h) prior to surgery, yielding improved intraoperative visualization of the tumor compared to white light ( 15 , 27 , 28 ). In a series of 15 gliomas featuring 11 HGG, sensitivity was 98% and specificity 45% ( 27 ).…”

Section: Indocyanine Green (Icg)mentioning

confidence: 99%

Fluorescence-Guided Surgery: A Review on Timing and Use in Brain Tumor Surgery

et al. 2021

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Fluorescence-guided surgery (FGS) allows surgeons to have improved visualization of tumor tissue in the operating room, enabling maximal safe resection of malignant brain tumors. Over the past two decades, multiple fluorescent agents have been studied for FGS, including 5-aminolevulinic acid (5-ALA), fluorescein sodium, and indocyanine green (ICG). Both non-targeted and targeted fluorescent agents are currently being used in clinical practice, as well as under investigation, for glioma visualization and resection. While the efficacy of intraoperative fluorescence in studied fluorophores has been well established in the literature, the effect of timing on fluorophore administration in glioma surgery has not been as well depicted. In the past year, recent studies of 5-ALA use have shown that intraoperative fluorescence may persist beyond the previously studied window used in prior multicenter trials. Additionally, the use of fluorophores for different brain tumor types is discussed in detail, including a discussion of choosing the right fluorophore based on tumor etiology. In the following review, the authors will describe the temporal nature of the various fluorophores used in glioma surgery, what remains uncertain in FGS, and provide a guide for using fluorescence as a surgical adjunct in brain tumor surgery.

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Near-Infrared Imaging with Second-Window Indocyanine Green in Newly Diagnosed High-Grade Gliomas Predicts Gadolinium Enhancement on Postoperative Magnetic Resonance Imaging

Cited by 26 publications

References 44 publications

Applications of indocyanine green in brain tumor surgery: review of clinical evidence and emerging technologies

Applications of indocyanine green in brain tumor surgery: review of clinical evidence and emerging technologies

Intraoperative Confocal Laser Endomicroscopy Ex Vivo Examination of Tissue Microstructure During Fluorescence-Guided Brain Tumor Surgery

Fluorescence-Guided Surgery: A Review on Timing and Use in Brain Tumor Surgery

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