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Van Den Hoven P, Tange F, Van Der Valk J, Nerup N, Putter H, Van Rijswijk C, Van Schaik J, Schepers A, Vahrmeijer A, Hamming J, Van Der Vorst J. Normalization of Time-Intensity Curves for Quantification of Foot Perfusion Using Near-Infrared Fluorescence Imaging With Indocyanine Green. J Endovasc Ther 2022; 30:364-371. [PMID: 35236169 DOI: 10.1177/15266028221081085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) is gaining popularity for the quantification of tissue perfusion, including foot perfusion in patients with lower extremity arterial disease (LEAD). However, the absolute fluorescence intensity is influenced by patient-and system-related factors limiting reliable and valid quantification. To enhance the quality of quantitative perfusion assessment using ICG NIR fluorescence imaging, normalization of the measured time-intensity curves seems useful. MATERIALS AND METHODS In this cohort study, the effect of normalization on 2 aspects of ICG NIR fluorescence imaging in assessment of foot perfusion was measured: the repeatability and the region selection. Following intravenous administration of ICG, the NIR fluorescence intensity in both feet was recorded for 10 mins using the Quest Spectrum platform®. The effect of normalization on repeatability was measured in the nontreated foot in patients undergoing unilateral revascularization preprocedural and postprocedural (repeatability group). The effect of normalization on region selection was performed in patients without LEAD (region selection group). Absolute and normalized time-intensity curves were compared. RESULTS Successful ICG NIR fluorescence imaging was performed in 54 patients (repeatability group, n = 38; region selection group, n = 16). For the repeatability group, normalization of the time-intensity curves displayed a comparable inflow pattern for repeated measurements. For the region selection group, the maximum fluorescence intensity (Imax) demonstrated significant differences between the 3 measured regions of the foot (P = .002). Following normalization, the time-intensity curves in both feet were comparable for all 3 regions. CONCLUSION This study shows the effect of normalization of time-intensity curves on both the repeatability and region selection in ICG NIR fluorescence imaging. The significant difference between absolute parameters in various regions of the foot demonstrates the limitation of absolute intensity in interpreting tissue perfusion. Therefore, normalization and standardization of camera settings are essential steps toward reliable and valid quantification of tissue perfusion using ICG NIR fluorescence imaging.
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Affiliation(s)
- Pim Van Den Hoven
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Floris Tange
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurrian Van Der Valk
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nikolaj Nerup
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Catharina Van Rijswijk
- Department of Interventional Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Van Schaik
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost Van Der Vorst
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Van den Hoven P, S Weller F, Van De Bent M, Goncalves LN, Ruig M, D Van Den Berg S, Ooms S, Mieog J, Ea Van De Bogt K, Van Schaik J, Schepers A, Vahrmeijer AL, Hamming JF, Van Der Vorst JR. Near-infrared fluorescence imaging with indocyanine green for quantification of changes in tissue perfusion following revascularization. Vascular 2021; 30:867-873. [PMID: 34320878 DOI: 10.1177/17085381211032826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Current diagnostic modalities for patients with peripheral artery disease (PAD) mainly focus on the macrovascular level. For assessment of tissue perfusion, near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) seems promising. In this prospective cohort study, ICG NIR fluorescence imaging was performed pre- and post-revascularization to assess changes in foot perfusion. METHODS ICG NIR fluorescence imaging was performed in 36 patients with PAD pre- and post-intervention. After intravenous bolus injection of 0.1 mg/kg ICG, the camera registered the NIR fluorescence intensity over time on the dorsum of the feet for 15 min using the Quest Spectrum Platform®. Time-intensity curves were plotted for three regions of interest (ROI): (1) the dorsum of the foot, (2) the forefoot, and (3) the hallux. Time-intensity curves were normalized for maximum fluorescence intensity. Extracted parameters were the maximum slope, area under the curve (AUC) for the ingress, and the AUC for the egress. The non-treated contralateral leg was used as a control group. RESULTS Successful revascularization was performed in 32 patients. There was a significant increase for the maximum slope and AUC egress in all three ROIs. The most significant difference was seen for the maximum slope in ROI 3 (3.7%/s to 6.6%/s, p < 0.001). In the control group, no significant differences were seen for the maximum slope and AUC egress in all ROIs. CONCLUSIONS This study shows the potential of ICG NIR fluorescence imaging in assessing the effect of revascularization procedures on foot perfusion. Future studies should focus on the use of this technique in predicting favorable outcome of revascularization procedures.
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Affiliation(s)
- Pim Van den Hoven
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Floris S Weller
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Merel Van De Bent
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Lauren N Goncalves
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Melissa Ruig
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Simen D Van Den Berg
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Sophie Ooms
- Department of Vascular Surgery, Haga Ziekenhuis, The Hague, The Netherlands
| | - Jsd Mieog
- Department of Surgical Oncology, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Koen Ea Van De Bogt
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Van Schaik
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Abbey Schepers
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Alex L Vahrmeijer
- Department of Surgical Oncology, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap F Hamming
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Joost R Van Der Vorst
- Department of Vascular Surgery, 4501Leiden University Medical Center, Leiden, The Netherlands
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Goncalves LN, van den Hoven P, van Schaik J, Leeuwenburgh L, Hendricks CHF, Verduijn PS, van der Bogt KEA, van Rijswijk CSP, Schepers A, Vahrmeijer AL, Hamming JF, van der Vorst JR. Perfusion Parameters in Near-Infrared Fluorescence Imaging with Indocyanine Green: A Systematic Review of the Literature. Life (Basel) 2021; 11:life11050433. [PMID: 34064948 PMCID: PMC8151115 DOI: 10.3390/life11050433] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 01/16/2023] Open
Abstract
(1) Background: Near-infrared fluorescence imaging is a technique capable of assessing tissue perfusion and has been adopted in various fields including plastic surgery, vascular surgery, coronary arterial disease, and gastrointestinal surgery. While the usefulness of this technique has been broadly explored, there is a large variety in the calculation of perfusion parameters. In this systematic review, we aim to provide a detailed overview of current perfusion parameters, and determine the perfusion parameters with the most potential for application in near-infrared fluorescence imaging. (2) Methods: A comprehensive search of the literature was performed in Pubmed, Embase, Medline, and Cochrane Review. We included all clinical studies referencing near-infrared perfusion parameters. (3) Results: A total of 1511 articles were found, of which, 113 were suitable for review, with a final selection of 59 articles. Near-infrared fluorescence imaging parameters are heterogeneous in their correlation to perfusion. Time-related parameters appear superior to absolute intensity parameters in a clinical setting. (4) Conclusions: This literature review demonstrates the variety of parameters selected for the quantification of perfusion in near-infrared fluorescence imaging.
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Abstract
UNLABELLED Heel ulcerations are a significant burden of care in both hospital and long-term care settings. The presence of peripheral arterial disease as a contributing factor to delayed healing is often not recognized, resulting in prolonged healing and high patient morbidity and mortality. Formal vascular evaluation and intervention is often not performed as these patients can have palpable pedal pulses while having localized ischemia of the heel. As routine noninvasive vascular studies can be affected by medial calcinosis and collateralization and do not specifically assess tissue perfusion to the heel, a false sense of security of adequate perfusion for healing can result. Indocyanine green fluorescence angiography (ICGFA) allows for real-time visualization and objective assessment of site specific tissue perfusion not limited by the factors that can make routine noninvasive vascular studies unreliable or unobtainable. A retrospective medical record review of a subset of patients with chronic heel ulceration from a prospective institutional review board-approved study in which serial ICGFA was performed during their treatment course was performed. ICGFA was able to identify local heel ischemia and expedite vascular intervention. ICGFA should be considered as an additional vascular study in patients presenting with chronic, nonhealing heel ulcerations. LEVELS OF EVIDENCE Level IV: Diagnostic, Case series.
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Affiliation(s)
- Valerie S Marmolejo
- University Place, Washington (VSM)
- Great River Wound and Hyperbaric Medicine Clinic, Great River Medical Center, West Burlington, Iowa (JFA)
| | - Jonathan F Arnold
- University Place, Washington (VSM)
- Great River Wound and Hyperbaric Medicine Clinic, Great River Medical Center, West Burlington, Iowa (JFA)
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Han YH, Kankala RK, Wang SB, Chen AZ. Leveraging Engineering of Indocyanine Green-Encapsulated Polymeric Nanocomposites for Biomedical Applications. NANOMATERIALS (BASEL, SWITZERLAND) 2018; 8:E360. [PMID: 29882932 PMCID: PMC6027497 DOI: 10.3390/nano8060360] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 01/09/2023]
Abstract
In recent times, photo-induced therapeutics have attracted enormous interest from researchers due to such attractive properties as preferential localization, excellent tissue penetration, high therapeutic efficacy, and minimal invasiveness, among others. Numerous photosensitizers have been considered in combination with light to realize significant progress in therapeutics. Along this line, indocyanine green (ICG), a Food and Drug Administration (FDA)-approved near-infrared (NIR, >750 nm) fluorescent dye, has been utilized in various biomedical applications such as drug delivery, imaging, and diagnosis, due to its attractive physicochemical properties, high sensitivity, and better imaging view field. However, ICG still suffers from certain limitations for its utilization as a molecular imaging probe in vivo, such as concentration-dependent aggregation, poor in vitro aqueous stability and photodegradation due to various physicochemical attributes. To overcome these limitations, much research has been dedicated to engineering numerous multifunctional polymeric composites for potential biomedical applications. In this review, we aim to discuss ICG-encapsulated polymeric nanoconstructs, which are of particular interest in various biomedical applications. First, we emphasize some attractive properties of ICG (including physicochemical characteristics, optical properties, metabolic features, and other aspects) and some of its current limitations. Next, we aim to provide a comprehensive overview highlighting recent reports on various polymeric nanoparticles that carry ICG for light-induced therapeutics with a set of examples. Finally, we summarize with perspectives highlighting the significant outcome, and current challenges of these nanocomposites.
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Affiliation(s)
- Ya-Hui Han
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, China.
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China.
| | - Ranjith Kumar Kankala
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, China.
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China.
- Fujian Provincial Key Laboratory of Biochemical Technology, Xiamen 361021, China.
| | - Shi-Bin Wang
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, China.
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China.
- Fujian Provincial Key Laboratory of Biochemical Technology, Xiamen 361021, China.
| | - Ai-Zheng Chen
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, China.
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China.
- Fujian Provincial Key Laboratory of Biochemical Technology, Xiamen 361021, China.
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