Red-light excitation of protoporphyrin IX fluorescence for subsurface tumor detection
| Autor: | Mikael Marois, Jonathan D. Olson, Keith D. Paulsen, David W. Roberts, Xiaoyao Fan, Linton T. Evans, Jaime Bravo, Frederic Leblond, Kolbein Kolste, Stephen C. Kanick, Brian C. Wilson |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Pathology medicine.medical_specialty Fluorophore Brain tumor Protoporphyrins 01 natural sciences Article Fluorescence Neurosurgical Procedures 010309 optics 03 medical and health sciences chemistry.chemical_compound Young Adult 0302 clinical medicine Nuclear magnetic resonance Glioma 0103 physical sciences medicine Image Processing Computer-Assisted Humans Red light Aged Fluorescent Dyes Protoporphyrin IX business.industry Brain Neoplasms General Medicine Middle Aged medicine.disease Magnetic Resonance Imaging Levulinic Acids Tumor detection chemistry Microscopy Fluorescence Female business Meningioma 030217 neurology & neurosurgery Excitation Craniotomy Photic Stimulation |
| Popis: | OBJECTIVEThe objective of this study was to detect 5-aminolevulinic acid (ALA)-induced tumor fluorescence from glioma below the surface of the surgical field by using red-light illumination.METHODSTo overcome the shallow tissue penetration of blue light, which maximally excites the ALA-induced fluorophore protoporphyrin IX (PpIX) but is also strongly absorbed by hemoglobin and oxyhemoglobin, a system was developed to illuminate the surgical field with red light (620–640 nm) matching a secondary, smaller absorption peak of PpIX and detecting the fluorescence emission through a 650-nm longpass filter. This wide-field spectroscopic imaging system was used in conjunction with conventional blue-light fluorescence for comparison in 29 patients undergoing craniotomy for resection of high-grade glioma, low-grade glioma, meningioma, or metastasis.RESULTSAlthough, as expected, red-light excitation is less sensitive to PpIX in exposed tumor, it did reveal tumor at a depth up to 5 mm below the resection bed in 22 of 24 patients who also exhibited PpIX fluorescence under blue-light excitation during the course of surgery.CONCLUSIONSRed-light excitation of tumor-associated PpIX fluorescence below the surface of the surgical field can be achieved intraoperatively and enables detection of subsurface tumor that is not visualized under conventional blue-light excitation.Clinical trial registration no.: NCT02191488 (clinicaltrials.gov) |
| Databáze: | OpenAIRE |
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