Perfusion Quantification from Endoscopic Videos: Learning to Read Tumor Signatures

Zhuk, Sergiy; Epperlein, Jonathan P.; Nair, Rahul; Tirupathi, Seshu; Aonghusa, Pól Mac; O’Shea, Donal F.; Ra, Chisei

doi:10.1007/978-3-030-59716-0_68

Cited by 17 publications

(11 citation statements)

References 17 publications

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“…Detailed region by region biopsy collated to continuous FI perfusion criteria may too yield digital tumour margin delineation and heterogeneity appreciation. Greater patient numbers is of course needed too and, with early proof of principle now provided, a larger clinical study is now ongoing to develop and validate these findings 32 while AI methods are also being developed to enable real-time deployment 34 .…”

Section: Discussionmentioning

confidence: 99%

Digital dynamic discrimination of primary colorectal cancer using systemic indocyanine green with near-infrared endoscopy

Dalli

Loughman

Hardy

et al. 2021

Sci Rep

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As indocyanine green (ICG) with near-infrared (NIR) endoscopy enhances real-time intraoperative tissue microperfusion appreciation, it may also dynamically reveal neoplasia distinctively from normal tissue especially with video software fluorescence analysis. Colorectal tumours of patients were imaged mucosally following ICG administration (0.25 mg/kg i.v.) using an endo-laparoscopic NIR system (PINPOINT Endoscopic Fluorescence System, Stryker) including immediate, continuous in situ visualization of rectal lesions transanally for up to 20 min. Spot and dynamic temporal fluorescence intensities (FI) were quantified using ImageJ (including videos at one frame/second, fps) and by a bespoke MATLAB® application that provided digitalized video tracking and signal logging at 30fps (Fluorescence Tracker App downloadable via MATLAB® file exchange). Statistical analysis of FI-time plots compared tumours (benign and malignant) against control during FI curve rise, peak and decline from apex. Early kinetic FI signal measurement delineated discriminative temporal signatures from tumours (n = 20, 9 cancers) offering rich data for analysis versus delayed spot measurement (n = 10 cancers). Malignant lesion dynamic curves peaked significantly later with a shallower gradient than normal tissue while benign lesions showed significantly greater and faster intensity drop from apex versus cancer. Automated tracker quantification efficiently expanded manual results and provided algorithmic KNN clustering. Photobleaching appeared clinically irrelevant. Analysis of a continuous stream of intraoperatively acquired early ICG fluorescence data can act as an in situ tumour-identifier with greater detail than later snapshot observation alone. Software quantification of such kinetic signatures may distinguish invasive from non-invasive neoplasia with potential for real-time in silico diagnosis.

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Section: Discussionmentioning

confidence: 99%

Digital dynamic discrimination of primary colorectal cancer using systemic indocyanine green with near-infrared endoscopy

Dalli

Loughman

Hardy

et al. 2021

Sci Rep

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“…Secondly, we use temporal‐fluorescence signal profiles to direct attention to the timing of these peaks and troughs [11,12]. Using a bespoke tracker [13], signal profile interrogation revealed lower absolute intensities at the periphery of the image despite well‐perfused inflows. Operators are thus prone to overestimate central image perfusion.…”

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confidence: 99%

Challenges in the interpretation of colorectal indocyanine green fluorescence angiography – A video vignette

et al. 2021

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“…For fluorescence signal analysis, videos (30 frames per second) of four intraoperative ICG angiograms used in the prior study were analyzed using a boutique intensity tracker (IBM Research Ireland [ 9 ]) to generate quantitative plots over time of the fluorescence signal at the transection points selected by expert users ( n = 6) (see Fig. 1 ) (camera movement and instrument intrusion compromised continuous transection point machine-based tracking in the remaining five videos from the prior study and so these were not useable in this work).…”

Section: Methodsmentioning

confidence: 99%

Deconstructing mastery in colorectal fluorescence angiography interpretation

et al. 2022

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Introduction Indocyanine green fluorescence angiography (ICGFA) is commonly used in colorectal anastomotic practice with limited pre-training. Recent work has shown that there is considerable inconsistency in signal interpretation between surgeons with minimal or no experience versus those consciously invested in mastery of the technique. Here, we deconstruct the fluorescence signal patterns of expert-annotated surgical ICGFA videos to understand better their correlation and combine this with structured interviews to ascertain whether such interpretative capability is conscious or unconscious. Methods For fluorescence signal analysis, expert-annotated ICGFA videos (n = 24) were quantitatively interrogated using a boutique intensity tracker (IBM Research) to generate signal time plots. Such fluorescence intensity data were examined for inter-observer correlation (Intraclass Correlation Coefficients, ICC) at specific curve milestones: the maximum fluorescence signal (Fmax), the times to both achieve this maximum (Tmax), as well as half this maximum (T1/2max) and the ratio between these (T1/2/Tmax). Formal tele-interview with contributing experts (n = 6) was conducted with the narrative transcripts being thematically mapped, plotted, and qualitatively analyzed. Results Correlation by mathematical measures was excellent (ICC0.9–1.0) for Fmax, Tmax, and T1/2max (0.95, 0.938, and 0.925, respectively) and moderate (0.5–0.75) for T1/2/Tmax (0.729). While all experts narrated a deliberate viewing strategy, their specific dynamic signal appreciation differed in the manner of description. Conclusion Expert ICGFA users demonstrate high correlation in mathematical measures of their signal interpretation although do so tacitly. Computational quantification of expert behavior can help develop the necessary lexicon and training sets as well as computer vision methodology to better exploit ICGFA technology.

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Perfusion Quantification from Endoscopic Videos: Learning to Read Tumor Signatures

Cited by 17 publications

References 17 publications

Digital dynamic discrimination of primary colorectal cancer using systemic indocyanine green with near-infrared endoscopy

Digital dynamic discrimination of primary colorectal cancer using systemic indocyanine green with near-infrared endoscopy

Challenges in the interpretation of colorectal indocyanine green fluorescence angiography – A video vignette

Deconstructing mastery in colorectal fluorescence angiography interpretation

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