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Picart T, Gautheron A, Caredda C, Ray C, Mahieu-Williame L, Montcel B, Guyotat J. Fluorescence-Guided Surgical Techniques in Adult Diffuse Low-Grade Gliomas: State-of-the-Art and Emerging Techniques: A Systematic Review. Cancers (Basel) 2024; 16:2698. [PMID: 39123426 PMCID: PMC11311317 DOI: 10.3390/cancers16152698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024] Open
Abstract
Diffuse low-grade gliomas are infiltrative tumors whose margins are not distinguishable from the adjacent healthy brain parenchyma. The aim was to precisely examine the results provided by the intraoperative use of macroscopic fluorescence in diffuse low-grade gliomas and to describe the new fluorescence-based techniques capable of guiding the resection of low-grade gliomas. Only about 20% and 50% of low-grade gliomas are macroscopically fluorescent after 5-amino-levulinic acid (5-ALA) or fluorescein sodium intake, respectively. However, 5-ALA is helpful for detecting anaplastic foci, and thus choosing the best biopsy targets in diffuse gliomas. Spectroscopic detection of 5-ALA-induced fluorescence can detect very low and non-macroscopically visible concentrations of protoporphyrin IX, a 5-ALA metabolite, and, consequently, has excellent performances for the detection of low-grade gliomas. Moreover, these tumors have a specific spectroscopic signature with two fluorescence emission peaks, which is useful for distinguishing them not only from healthy brain but also from high-grade gliomas. Confocal laser endomicroscopy can generate intraoperative optic biopsies, but its sensitivity remains limited. In the future, the coupled measurement of autofluorescence and induced fluorescence, and the introduction of fluorescence detection technologies providing a wider field of view could result in the development of operator-friendly tools implementable in the operative routine.
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Affiliation(s)
- Thiebaud Picart
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France
- Cancer Research Centre of Lyon (CRCL) Inserm 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
| | - Arthur Gautheron
- Laboratoire Hubert Curien UMR 5516, Institut d’Optique Graduate School, CNRS, Université Jean Monnet Saint-Etienne, 42023 Saint-Etienne, France;
- CREATIS CNRS, Inserm, UMR 5220, U1294, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, 69100 Lyon, France; (C.C.); (C.R.); (L.M.-W.); (B.M.)
| | - Charly Caredda
- CREATIS CNRS, Inserm, UMR 5220, U1294, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, 69100 Lyon, France; (C.C.); (C.R.); (L.M.-W.); (B.M.)
| | - Cédric Ray
- CREATIS CNRS, Inserm, UMR 5220, U1294, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, 69100 Lyon, France; (C.C.); (C.R.); (L.M.-W.); (B.M.)
| | - Laurent Mahieu-Williame
- CREATIS CNRS, Inserm, UMR 5220, U1294, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, 69100 Lyon, France; (C.C.); (C.R.); (L.M.-W.); (B.M.)
| | - Bruno Montcel
- CREATIS CNRS, Inserm, UMR 5220, U1294, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, 69100 Lyon, France; (C.C.); (C.R.); (L.M.-W.); (B.M.)
| | - Jacques Guyotat
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France
- CREATIS CNRS, Inserm, UMR 5220, U1294, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, 69100 Lyon, France; (C.C.); (C.R.); (L.M.-W.); (B.M.)
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2
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Gautheron A, Bernstock JD, Picart T, Guyotat J, Valdés PA, Montcel B. 5-ALA induced PpIX fluorescence spectroscopy in neurosurgery: a review. Front Neurosci 2024; 18:1310282. [PMID: 38348134 PMCID: PMC10859467 DOI: 10.3389/fnins.2024.1310282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
The review begins with an overview of the fundamental principles/physics underlying light, fluorescence, and other light-matter interactions in biological tissues. It then focuses on 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX) fluorescence spectroscopy methods used in neurosurgery (e.g., intensity, time-resolved) and in so doing, describe their specific features (e.g., hardware requirements, main processing methods) as well as their strengths and limitations. Finally, we review current clinical applications and future directions of 5-ALA-induced protoporphyrin IX (PpIX) fluorescence spectroscopy in neurosurgery.
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Affiliation(s)
- A. Gautheron
- Université Jean Monnet Saint-Etienne, CNRS, Institut d Optique Graduate School, Laboratoire Hubert Curien UMR 5516, Saint-Étienne, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France
| | - J. D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - T. Picart
- Department of Neurosurgical Oncology and Vascular Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - J. Guyotat
- Department of Neurosurgical Oncology and Vascular Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France
| | - P. A. Valdés
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, United States
- Department of Neurobiology, University of Texas Medical Branch, Galveston, TX, United States
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, United States
| | - B. Montcel
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France
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3
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Alfonso-Garcia A, Anbunesan SN, Bec J, Lee HS, Jin LW, Bloch O, Marcu L. In vivo characterization of the human glioblastoma infiltrative edge with label-free intraoperative fluorescence lifetime imaging. BIOMEDICAL OPTICS EXPRESS 2023; 14:2196-2208. [PMID: 37206147 PMCID: PMC10191664 DOI: 10.1364/boe.481304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 05/21/2023]
Abstract
Challenges in identifying a glioblastoma's infiltrative edge during neurosurgical procedures result in rapid recurrence. A label-free fluorescence lifetime imaging (FLIm) device was used to evaluate glioblastoma's infiltrative edge in vivo in 15 patients (89 samples). FLIm data were analyzed according to tumor cell density, infiltrating tissue type (gray and white matter), and diagnosis history (new or recurrent). Infiltrations in white matter from new glioblastomas showed decreasing lifetimes and a spectral red shift with increasing tumor cell density. Areas of high versus low tumor cell density were separated through a linear discriminant analysis with a ROC-AUC=0.74. Current results support the feasibility of intraoperative FLIm for real-time in vivo brain measurements and encourage refinement to predict glioblastoma infiltrative edge, underscoring the ability of FLIm to optimize neurosurgical outcomes.
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Affiliation(s)
- Alba Alfonso-Garcia
- Biomedical Engineering Department,
University of California, Davis, One Shields Ave, Davis, CA 95616, USA
| | - Silvia Noble Anbunesan
- Biomedical Engineering Department,
University of California, Davis, One Shields Ave, Davis, CA 95616, USA
| | - Julien Bec
- Biomedical Engineering Department,
University of California, Davis, One Shields Ave, Davis, CA 95616, USA
| | - Han Sung Lee
- Pathology and Laboratory Medicine Department, University of California, Davis, 4400 V St, Sacramento, CA 95817, USA
| | - Lee-Way Jin
- Pathology and Laboratory Medicine Department, University of California, Davis, 4400 V St, Sacramento, CA 95817, USA
| | - Orin Bloch
- Neurological Surgery Department, University of California, Davis, 4860 Y St, Sacramento, CA 95817, USA
| | - Laura Marcu
- Biomedical Engineering Department,
University of California, Davis, One Shields Ave, Davis, CA 95616, USA
- Neurological Surgery Department, University of California, Davis, 4860 Y St, Sacramento, CA 95817, USA
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Anbunesan SN, Alfonso-Garcia A, Zhou X, Bec J, Lee HS, Jin LW, Bloch O, Marcu L. Intraoperative detection of IDH-mutant glioma using fluorescence lifetime imaging. JOURNAL OF BIOPHOTONICS 2023; 16:e202200291. [PMID: 36510639 PMCID: PMC10522274 DOI: 10.1002/jbio.202200291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/26/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Identifying isocitrate dehydrogenase (IDH)-mutation and glioma subtype during surgery instead of days later can aid in modifying tumor resection strategies for better survival outcomes. We report intraoperative identification of IDH-mutant glioma (N = 12 patients) with a clinically compatible fluorescence lifetime imaging (FLIm) device (excitation: 355 nm; emission spectral bands: 390/40 nm, 470/28 nm, 542/50 nm). The fluorescence-derived parameters were analyzed to study the optical contrast between IDH-mutant tumors and surrounding brain tissue. IDH-mutant oligodendrogliomas exhibited shorter lifetimes (3.3 ± 0.1 ns) than IDH-mutant astrocytomas (4.1 ± 0.1 ns). Both IDH-mutant glioma subtypes had shorter lifetimes than white matter (4.6 ± 0.4 ns) but had comparable lifetimes to cortex. Lifetimes also increased with malignancy grade within IDH-mutant oligodendrogliomas (grade 2: 2.96 ± 0.08 ns, grade 3: 3.4 ± 0.3 ns) but not within IDH-mutant astrocytomas. The current results support the feasibility of FLIm as a surgical adjuvant for identifying IDH-mutant glioma tissue.
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Affiliation(s)
- Silvia Noble Anbunesan
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Alba Alfonso-Garcia
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Xiangnan Zhou
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Julien Bec
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Han Sung Lee
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA
| | - Lee-Way Jin
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA
| | - Orin Bloch
- Department of Neurological Surgery, University of California Davis, Sacramento, California, USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
- Department of Neurological Surgery, University of California Davis, Sacramento, California, USA
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5
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Mehidine H, Devaux B, Varlet P, Abi Haidar D. Comparative Study Between a Customized Bimodal Endoscope and a Benchtop Microscope for Quantitative Tissue Diagnosis. Front Oncol 2022; 12:881331. [PMID: 35686105 PMCID: PMC9171499 DOI: 10.3389/fonc.2022.881331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/31/2022] [Indexed: 12/24/2022] Open
Abstract
Nowadays, surgical removal remains the standard method to treat brain tumors. During surgery, the neurosurgeon may encounter difficulties to delimitate tumor boundaries and the infiltrating areas as they have a similar visual appearance to adjacent healthy zones. These infiltrating residuals increase the tumor recurrence risk, which decreases the patient’s post-operation survival time. To help neurosurgeons improve the surgical act by accurately delimitating healthy from cancerous areas, our team is developing an intraoperative multimodal imaging tool. It consists of a two-photon fluorescence fibered endomicroscope that is intended to provide a fast, real-time, and reliable diagnosis information. In parallel to the instrumental development, a large optical database is currently under construction in order to characterize healthy and tumor brain tissues with their specific optical signature using multimodal analysis of the endogenous fluorescence. Our previous works show that this multimodal analysis could provide a reliable discrimination response between different tissue types based on several optical indicators. Here, our goal is to show that the two-photon fibered endomicroscope is able to provide, based on the same approved indicators in the tissue database, the same reliable response that could be used intraoperatively. We compared the spectrally resolved and time-resolved fluorescence signal, generated by our two-photon bimodal endoscope from 46 fresh brain tissue samples, with a similar signal provided by a standard reference benchtop multiphoton microscope that has been validated for tissue diagnosis. The higher excitation efficiency and collection ability of an endogenous fluorescence signal were shown for the endoscope setup. Similar molecular ratios and fluorescence lifetime distributions were extracted from the two compared setups. Spectral discrimination ability of the bimodal endoscope was validated. As a preliminary step before tackling multimodality, the ability of the developed bimodal fibered endoscope to excite and to collect efficiently as well as to provide a fast exploitable high-quality signal that is reliable to discriminate different types of human brain tissues was validated.
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Affiliation(s)
| | - Bertrand Devaux
- Université Paris Cité - Faculté de Médecine Paris Descartes, Paris, France.,Service de Neurochirurgie, Hôpital Lariboisière, Paris, France.,Department of Neurosurgery, GHU Paris Psychiatrie et Neuroscience, Paris, France
| | - Pascale Varlet
- Université Paris Cité - Faculté de Médecine Paris Descartes, Paris, France.,Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France.,IMA BRAIN, INSERM UMR S1266, Centre de Psychiatrie et de Neurosciences, Paris, France
| | - Darine Abi Haidar
- Université Paris-Saclay, CNRS/IN2P3, IJCLab, Orsay, France.,Université Paris Cité, IJCLab, Orsay, France
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6
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Alfonso-Garcia A, Bec J, Weyers B, Marsden M, Zhou X, Li C, Marcu L. Mesoscopic fluorescence lifetime imaging: Fundamental principles, clinical applications and future directions. JOURNAL OF BIOPHOTONICS 2021; 14:e202000472. [PMID: 33710785 PMCID: PMC8579869 DOI: 10.1002/jbio.202000472] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 05/16/2023]
Abstract
Fluorescence lifetime imaging (FLIm) is an optical spectroscopic imaging technique capable of real-time assessments of tissue properties in clinical settings. Label-free FLIm is sensitive to changes in tissue structure and biochemistry resulting from pathological conditions, thus providing optical contrast to identify and monitor the progression of disease. Technical and methodological advances over the last two decades have enabled the development of FLIm instrumentation for real-time, in situ, mesoscopic imaging compatible with standard clinical workflows. Herein, we review the fundamental working principles of mesoscopic FLIm, discuss the technical characteristics of current clinical FLIm instrumentation, highlight the most commonly used analytical methods to interpret fluorescence lifetime data and discuss the recent applications of FLIm in surgical oncology and cardiovascular diagnostics. Finally, we conclude with an outlook on the future directions of clinical FLIm.
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Affiliation(s)
- Alba Alfonso-Garcia
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Julien Bec
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Brent Weyers
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Mark Marsden
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Xiangnan Zhou
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Cai Li
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, Davis, California
- Department Neurological Surgery, University of California, Davis, California
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7
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Lukina M, Yashin K, Kiseleva EE, Alekseeva A, Dudenkova V, Zagaynova EV, Bederina E, Medyanic I, Becker W, Mishra D, Berezin M, Shcheslavskiy VI, Shirmanova M. Label-Free Macroscopic Fluorescence Lifetime Imaging of Brain Tumors. Front Oncol 2021; 11:666059. [PMID: 34109119 PMCID: PMC8181388 DOI: 10.3389/fonc.2021.666059] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/27/2021] [Indexed: 01/20/2023] Open
Abstract
Advanced stage glioma is the most aggressive form of malignant brain tumors with a short survival time. Real-time pathology assisted, or image guided surgical procedures that eliminate tumors promise to improve the clinical outcome and prolong the lives of patients. Our work is focused on the development of a rapid and sensitive assay for intraoperative diagnostics of glioma and identification of optical markers essential for differentiation between tumors and healthy brain tissues. We utilized fluorescence lifetime imaging (FLIM) of endogenous fluorophores related to metabolism of the glioma from freshly excised brains tissues. Macroscopic time-resolved fluorescence images of three intracranial animal glioma models and surgical samples of patients' glioblastoma together with the white matter have been collected. Several established and new algorithms were applied to identify the imaging markers of the tumors. We found that fluorescence lifetime parameters characteristic of the glioma provided background for differentiation between the tumors and intact brain tissues. All three rat tumor models demonstrated substantial differences between the malignant and normal tissue. Similarly, tumors from patients demonstrated statistically significant differences from the peritumoral white matter without infiltration. While the data and the analysis presented in this paper are preliminary and further investigation with a larger number of samples is required, the proposed approach based on the macroscopic FLIM has a high potential for diagnostics of glioma and evaluation of the surgical margins of gliomas.
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Affiliation(s)
- Maria Lukina
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Konstantin Yashin
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Elena E. Kiseleva
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Anna Alekseeva
- Department of Neuromorphology, Research Institute of Human Morphology, Moscow, Russia
| | - Varvara Dudenkova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Elena V. Zagaynova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
- Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - Evgenia Bederina
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Igor Medyanic
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | | | - Deependra Mishra
- Department of Radiology, Washington University School of Medicine, St Louis, MO, United States
| | - Mikhail Berezin
- Department of Radiology, Washington University School of Medicine, St Louis, MO, United States
| | - Vladislav I. Shcheslavskiy
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
- Becker&Hickl GmbH, Berlin, Germany
| | - Marina Shirmanova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
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Erkkilä MT, Reichert D, Gesperger J, Kiesel B, Roetzer T, Mercea PA, Drexler W, Unterhuber A, Leitgeb RA, Woehrer A, Rueck A, Andreana M, Widhalm G. Macroscopic fluorescence-lifetime imaging of NADH and protoporphyrin IX improves the detection and grading of 5-aminolevulinic acid-stained brain tumors. Sci Rep 2020; 10:20492. [PMID: 33235233 PMCID: PMC7686506 DOI: 10.1038/s41598-020-77268-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/05/2020] [Indexed: 12/14/2022] Open
Abstract
Maximal safe tumor resection remains the key prognostic factor for improved prognosis in brain tumor patients. Despite 5-aminolevulinic acid-based fluorescence guidance the neurosurgeon is, however, not able to visualize most low-grade gliomas (LGG) and infiltration zone of high-grade gliomas (HGG). To overcome the need for a more sensitive visualization, we investigated the potential of macroscopic, wide-field fluorescence lifetime imaging of nicotinamide adenine dinucleotide (NADH) and protoporphyrin IX (PPIX) in selected human brain tumors. For future intraoperative use, the imaging system offered a square field of view of 11 mm at 250 mm free working distance. We performed imaging of tumor tissue ex vivo, including LGG and HGG as well as brain metastases obtained from 21 patients undergoing fluorescence-guided surgery. Half of all samples showed visible fluorescence during surgery, which was associated with significant increase in PPIX fluorescence lifetime. While the PPIX lifetime was significantly different between specific tumor tissue types, the NADH lifetimes did not differ significantly among them. However, mainly necrotic areas exhibited significantly lower NADH lifetimes compared to compact tumor in HGG. Our pilot study indicates that combined fluorescence lifetime imaging of NADH/PPIX represents a sensitive tool to visualize brain tumor tissue not detectable with conventional 5-ALA fluorescence.
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Affiliation(s)
- Mikael T Erkkilä
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - David Reichert
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory OPTRAMED, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Johanna Gesperger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Roetzer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Petra A Mercea
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Angelika Unterhuber
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Rainer A Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory OPTRAMED, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Adelheid Woehrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Angelika Rueck
- Core Facility Confocal and Multiphoton Microscopy, Ulm University, N24/4105, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Marco Andreana
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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9
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Alfonso-Garcia A, Bec J, Sridharan S, Hartl B, Unger J, Bobinski M, Lechpammer M, Girgis F, Boggan J, Marcu L. Real-time augmented reality for delineation of surgical margins during neurosurgery using autofluorescence lifetime contrast. JOURNAL OF BIOPHOTONICS 2020; 13:e201900108. [PMID: 31304655 PMCID: PMC7510838 DOI: 10.1002/jbio.201900108] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 05/05/2023]
Abstract
Current clinical brain imaging techniques used for surgical planning of tumor resection lack intraoperative and real-time feedback; hence surgeons ultimately rely on subjective evaluation to identify tumor areas and margins. We report a fluorescence lifetime imaging (FLIm) instrument (excitation: 355 nm; emission spectral bands: 390/40 nm, 470/28 nm, 542/50 nm and 629/53 nm) that integrates with surgical microscopes to provide real-time intraoperative augmentation of the surgical field of view with fluorescent derived parameters encoding diagnostic information. We show the functionality and safety features of this instrument during neurosurgical procedures in patients undergoing craniotomy for the resection of brain tumors and/or tissue with radiation damage. We demonstrate in three case studies the ability of this instrument to resolve distinct tissue types and pathology including cortex, white matter, tumor and radiation-induced necrosis. In particular, two patients with effects of radiation-induced necrosis exhibited longer fluorescence lifetimes and increased optical redox ratio on the necrotic tissue with respect to non-affected cortex, and an oligodendroglioma resected from a third patient reported shorter fluorescence lifetime and a decrease in optical redox ratio than the surrounding white matter. These results encourage the use of FLIm as a label-free and non-invasive intraoperative tool for neurosurgical guidance.
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Affiliation(s)
- Alba Alfonso-Garcia
- Dept. Biomedical Engineering, University of California, Davis, California, United States
| | - Julien Bec
- Dept. Biomedical Engineering, University of California, Davis, California, United States
| | - Shamira Sridharan
- Dept. Biomedical Engineering, University of California, Davis, California, United States
| | - Brad Hartl
- Dept. Biomedical Engineering, University of California, Davis, California, United States
| | - Jakob Unger
- Dept. Biomedical Engineering, University of California, Davis, California, United States
| | - Matthew Bobinski
- Dept. Radiology, University of California, Davis, California, United States
| | - Mirna Lechpammer
- Dept. Pathology and Laboratory Medicine, University of California, Davis, California, United States
| | - Fady Girgis
- Dept. Neurological Surgery, University of California, Davis, California, United States
| | - James Boggan
- Dept. Neurological Surgery, University of California, Davis, California, United States
| | - Laura Marcu
- Dept. Biomedical Engineering, University of California, Davis, California, United States
- Dept. Neurological Surgery, University of California, Davis, California, United States
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Multispectral Depth-Resolved Fluorescence Lifetime Spectroscopy Using SPAD Array Detectors and Fiber Probes. SENSORS 2019; 19:s19122678. [PMID: 31200569 PMCID: PMC6631026 DOI: 10.3390/s19122678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 01/29/2023]
Abstract
Single Photon Avalanche Diode (SPAD) arrays are increasingly exploited and have demonstrated potential in biochemical and biomedical research, both for imaging and single-point spectroscopy applications. In this study, we explore the application of SPADs together with fiber-optic-based delivery and collection geometry to realize fast and simultaneous single-point time-, spectral-, and depth-resolved fluorescence measurements at 375 nm excitation light. Spectral information is encoded across the columns of the array through grating-based dispersion, while depth information is encoded across the rows thanks to a linear arrangement of probe collecting fibers. The initial characterization and validation were realized against layered fluorescent agarose-based phantoms. To verify the practicality and feasibility of this approach in biological specimens, we measured the fluorescence signature of formalin-fixed rabbit aorta samples derived from an animal model of atherosclerosis. The initial results demonstrate that this detection configuration can report fluorescence spectral and lifetime contrast originating at different depths within the specimens. We believe that our optical scheme, based on SPAD array detectors and fiber-optic probes, constitute a powerful and versatile approach for the deployment of multidimensional fluorescence spectroscopy in clinical applications where information from deeper tissue layers is important for diagnosis.
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11
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Hage CH, Leclerc P, Fabert M, Bardet SM, Brevier J, Ducourthial G, Mansuryan T, Leray A, Kudlinski A, Louradour F. A readily usable two-photon fluorescence lifetime microendoscope. JOURNAL OF BIOPHOTONICS 2019; 12:e201800276. [PMID: 30548419 DOI: 10.1002/jbio.201800276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/09/2018] [Accepted: 12/10/2018] [Indexed: 06/09/2023]
Abstract
A two-photon fluorescence lifetime (2P-FLIM) microendoscope, capable of energetic metabolism imaging through the intracellular nicotinamide adenine dinucleotide (NADH) autofluorescence, at sub-cellular resolution, is demonstrated. It exhibits readily usable characteristics such as convenient endoscope probe diameter (≈2 mm), fiber length (>5 m) and data accumulation rate (16 frames per second (fps)), leading to a FLIM refreshing rate of ≈0.1 to 1 fps depending on the sample. The spiral scanning image formation does not influence the instrument response function (IRF) characteristics of the system. Near table-top microscope performances are achieved through a comprehensive system including a home-designed spectro-temporal pulse shaper and a custom air-silica double-clad photonic crystal fiber, which enables to reach up to 40 mW of ≈100 fs pulses @ 760 nm with a 80 MHz repetition rate. A GRadient INdex (GRIN) lens provides a lateral resolution of 0.67 μm at the focus of the fiber probe. Intracellular NADH fluorescence lifetime data are finally acquired on cultured cells at 16 fps.
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Affiliation(s)
- Charles-Henri Hage
- Université de Limoges, XLIM - Pôle Photonique, UMR CNRS 7252, Limoges, France
| | - Pierre Leclerc
- Université de Limoges, XLIM - Pôle Photonique, UMR CNRS 7252, Limoges, France
| | - Marc Fabert
- Université de Limoges, XLIM - Pôle Photonique, UMR CNRS 7252, Limoges, France
| | - Sylvia M Bardet
- Université de Limoges, XLIM - Pôle Photonique, UMR CNRS 7252, Limoges, France
| | - Julien Brevier
- Université de Limoges, XLIM - Pôle Photonique, UMR CNRS 7252, Limoges, France
| | | | - Tigran Mansuryan
- Université de Limoges, XLIM - Pôle Photonique, UMR CNRS 7252, Limoges, France
| | - Aymeric Leray
- Laboratoire Interdisciplinaire Carnot de Bourgogne, UMR CNRS 6303, Université Bourgogne Franche-Comté, Dijon, France
| | - Alexandre Kudlinski
- Laboratoire de Physique des Lasers, Atomes et Molécules (PhLAM), Université Lille, CNRS, UMR 8523, Lille, France
| | - Frédéric Louradour
- Université de Limoges, XLIM - Pôle Photonique, UMR CNRS 7252, Limoges, France
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12
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Fujita H, Zhong C, Arai S, Suzuki M. Bright Dots and Smart Optical Microscopy to Probe Intracellular Events in Single Cells. Front Bioeng Biotechnol 2019; 6:204. [PMID: 30662896 PMCID: PMC6328461 DOI: 10.3389/fbioe.2018.00204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/12/2018] [Indexed: 11/13/2022] Open
Abstract
Probing intracellular events is a key step in developing new biomedical methodologies. Optical microscopy has been one of the best options to observe biological samples at single cell and sub-cellular resolutions. Morphological changes are readily detectable in brightfield images. When stained with fluorescent molecules, distributions of intracellular organelles, and biological molecules are made visible using fluorescence microscopes. In addition to these morphological views of cells, optical microscopy can reveal the chemical and physical status of defined intracellular spaces. This review begins with a brief overview of genetically encoded fluorescent probes and small fluorescent chemical dyes. Although these are the most common approaches, probing is also made possible by using tiny materials that are incorporated into cells. When these tiny materials emit enough photons, it is possible to draw conclusions about the environment in which the tiny material resides. Recent advances in these tiny but sufficiently bright fluorescent materials are nextly reviewed to show their applications in tracking target molecules and in temperature imaging of intracellular spots. The last section of this review addresses purely optical methods for reading intracellular status without staining with probes. These non-labeling methods are especially essential when biospecimens are thereafter required for in vivo uses, such as in regenerative medicine.
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Affiliation(s)
- Hideaki Fujita
- WASEDA Bioscience Research Institute in Singapore, Singapore, Singapore
| | - Chongxia Zhong
- Institute for Protein Research, Osaka University, Osaka, Japan
| | - Satoshi Arai
- Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
- PRIME-AMED, Tokyo, Japan
| | - Madoka Suzuki
- Institute for Protein Research, Osaka University, Osaka, Japan
- PRESTO, Japan Science and Technology Agency, Saitama, Japan
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13
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Shalaby N, Al-Ebraheem A, Le D, Cornacchi S, Fang Q, Farrell T, Lovrics P, Gohla G, Reid S, Hodgson N, Farquharson M. Time-resolved fluorescence (TRF) and diffuse reflectance spectroscopy (DRS) for margin analysis in breast cancer. Lasers Surg Med 2018; 50:236-245. [DOI: 10.1002/lsm.22795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Nourhan Shalaby
- School of Interdisciplinary Science; McMaster University; Ontario Canada
| | - Alia Al-Ebraheem
- School of Interdisciplinary Science; McMaster University; Ontario Canada
| | - Du Le
- School of Interdisciplinary Science; McMaster University; Ontario Canada
| | - Sylvie Cornacchi
- Faculty of Health Sciences, Department of Surgery; McMaster University; Hamilton Ontario Canada
| | - Qiyin Fang
- Faculty of Engineering; McMaster University; Hamilton Ontario Canada
| | - Thomas Farrell
- Juravinski Hospital and Cancer Centre; Hamilton Ontario Canada
| | - Peter Lovrics
- Faculty of Health Sciences, Department of Surgery; McMaster University; Hamilton Ontario Canada
- St. Joseph's Healthcare; Hamilton Ontario Canada
| | - Gabriela Gohla
- St. Joseph's Healthcare; Hamilton Ontario Canada
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton Ontario Canada
| | - Susan Reid
- Juravinski Hospital and Cancer Centre; Hamilton Ontario Canada
| | - Nicole Hodgson
- Juravinski Hospital and Cancer Centre; Hamilton Ontario Canada
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14
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Zanello M, Poulon F, Pallud J, Varlet P, Hamzeh H, Abi Lahoud G, Andreiuolo F, Ibrahim A, Pages M, Chretien F, Di Rocco F, Dezamis E, Nataf F, Turak B, Devaux B, Abi Haidar D. Multimodal optical analysis discriminates freshly extracted human sample of gliomas, metastases and meningiomas from their appropriate controls. Sci Rep 2017; 7:41724. [PMID: 28150726 PMCID: PMC5288720 DOI: 10.1038/srep41724] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/23/2016] [Indexed: 01/20/2023] Open
Abstract
Delineating tumor margins as accurately as possible is of primordial importance in surgical oncology: extent of resection is associated with survival but respect of healthy surrounding tissue is necessary for preserved quality of life. The real-time analysis of the endogeneous fluorescence signal of brain tissues is a promising tool for defining margins of brain tumors. The present study aims to demonstrate the feasibility of multimodal optical analysis to discriminate fresh samples of gliomas, metastases and meningiomas from their appropriate controls. Tumor samples were studied on an optical fibered endoscope using spectral and fluorescence lifetime analysis and then on a multimodal set-up for acquiring spectral, one and two-photon fluorescence images, second harmonic generation signals and two-photon fluorescence lifetime datasets. The obtained data allowed us to differentiate healthy samples from tumor samples. These results confirmed the possible clinical relevance of this real-time multimodal optical analysis. This technique can be easily applied to neurosurgical procedures for a better delineation of surgical margins.
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Affiliation(s)
- Marc Zanello
- IMNC Laboratory, UMR 8165-CNRS/IN2P3, Paris-Saclay university, 91405 Orsay, France.,Neurosurgery Department, Sainte-Anne Hospital, France.,Paris Descartes University, Paris, France
| | - Fanny Poulon
- IMNC Laboratory, UMR 8165-CNRS/IN2P3, Paris-Saclay university, 91405 Orsay, France
| | - Johan Pallud
- Neurosurgery Department, Sainte-Anne Hospital, France.,Paris Descartes University, Paris, France
| | - Pascale Varlet
- Paris Descartes University, Paris, France.,Neuropathology Department, Sainte-Anne Hospital, France
| | - H Hamzeh
- Center of Advanced European Studies and Research (caesar), 53175 Bonn, Germany
| | - Georges Abi Lahoud
- Neurosurgery Department, Sainte-Anne Hospital, France.,Paris Descartes University, Paris, France
| | - Felipe Andreiuolo
- Paris Descartes University, Paris, France.,Neuropathology Department, Sainte-Anne Hospital, France
| | - Ali Ibrahim
- IMNC Laboratory, UMR 8165-CNRS/IN2P3, Paris-Saclay university, 91405 Orsay, France
| | - Mélanie Pages
- Paris Descartes University, Paris, France.,Neuropathology Department, Sainte-Anne Hospital, France
| | - Fabrice Chretien
- Paris Descartes University, Paris, France.,Neuropathology Department, Sainte-Anne Hospital, France
| | | | - Edouard Dezamis
- Neurosurgery Department, Sainte-Anne Hospital, France.,Paris Descartes University, Paris, France
| | - François Nataf
- Neurosurgery Department, Sainte-Anne Hospital, France.,Paris Descartes University, Paris, France
| | - Baris Turak
- Neurosurgery Department, Sainte-Anne Hospital, France.,Paris Descartes University, Paris, France
| | - Bertrand Devaux
- Neurosurgery Department, Sainte-Anne Hospital, France.,Paris Descartes University, Paris, France
| | - Darine Abi Haidar
- IMNC Laboratory, UMR 8165-CNRS/IN2P3, Paris-Saclay university, 91405 Orsay, France.,Paris Diderot University, Sorbonne Paris Cité, F-75013, Paris, France
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15
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Du Le VN, Provias J, Murty N, Patterson MS, Nie Z, Hayward JE, Farrell TJ, McMillan W, Zhang W, Fang Q. Dual-modality optical biopsy of glioblastomas multiforme with diffuse reflectance and fluorescence: ex vivo retrieval of optical properties. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:27002. [PMID: 28157245 DOI: 10.1117/1.jbo.22.2.027002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/12/2017] [Indexed: 05/23/2023]
Abstract
Glioma itself accounts for 80% of all malignant primary brain tumors, and glioblastoma multiforme (GBM) accounts for 55% of such tumors. Diffuse reflectance and fluorescence spectroscopy have the potential to discriminate healthy tissues from abnormal tissues and therefore are promising noninvasive methods for improving the accuracy of brain tissue resection. Optical properties were retrieved using an experimentally evaluated inverse solution. On average, the scattering coefficient is 2.4 times higher in GBM than in low grade glioma (LGG), and the absorption coefficient is 48% higher. In addition, the ratio of fluorescence to diffuse reflectance at the emission peak of 460 nm is 2.6 times higher for LGG while reflectance at 650 nm is 2.7 times higher for GBM. The results reported also show that the combination of diffuse reflectance and fluorescence spectroscopy could achieve sensitivity of 100% and specificity of 90% in discriminating GBM from LGG during ex vivo measurements of 22 sites from seven glioma specimens. Therefore, the current technique might be a promising tool for aiding neurosurgeons in determining the extent of surgical resection of glioma and, thus, improving intraoperative tumor identification for guiding surgical intervention.
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Affiliation(s)
- Vinh Nguyen Du Le
- McMaster University, Radiation Sciences Graduate Program, Hamilton, Ontario, Canada
| | - John Provias
- McMaster University, Department of Anatomical Pathology, Hamilton, Ontario, Canada
| | - Naresh Murty
- McMaster University, Department of Surgery, Hamilton, Ontario, Canada
| | | | - Zhaojun Nie
- McMaster University, School of Biomedical Engineering, Hamilton, Ontario, Canada
| | - Joseph E Hayward
- Juravinski Cancer Centre, Hamilton, Ontario, CanadafMcMaster University, School of Interdisciplinary Science, Hamilton, Ontario, Canada
| | - Thomas J Farrell
- Juravinski Cancer Centre, Hamilton, Ontario, CanadafMcMaster University, School of Interdisciplinary Science, Hamilton, Ontario, Canada
| | - William McMillan
- Juravinski Cancer Centre, Hamilton, Ontario, CanadagMcMaster University, Department of Oncology, Hamilton, Ontario, Canada
| | - Wenbin Zhang
- Shanghai Jiaotong University Medical School, Shanghai 9th People's Hospital, Shanghai, China
| | - Qiyin Fang
- McMaster University, School of Biomedical Engineering, Hamilton, Ontario, CanadaiMcMaster University, Department of Engineering Physics, Hamilton, Ontario, Canada
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16
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Senders JT, Muskens IS, Schnoor R, Karhade AV, Cote DJ, Smith TR, Broekman MLD. Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results. Acta Neurochir (Wien) 2017; 159:151-167. [PMID: 27878374 PMCID: PMC5177668 DOI: 10.1007/s00701-016-3028-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/09/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fluorescence-guided surgery (FGS) is a technique used to enhance visualization of tumor margins in order to increase the extent of tumor resection in glioma surgery. In this paper, we systematically review all clinically tested fluorescent agents for application in FGS for glioma and all preclinically tested agents with the potential for FGS for glioma. METHODS We searched the PubMed and Embase databases for all potentially relevant studies through March 2016. We assessed fluorescent agents by the following outcomes: rate of gross total resection (GTR), overall and progression-free survival, sensitivity and specificity in discriminating tumor and healthy brain tissue, tumor-to-normal ratio of fluorescent signal, and incidence of adverse events. RESULTS The search strategy resulted in 2155 articles that were screened by titles and abstracts. After full-text screening, 105 articles fulfilled the inclusion criteria evaluating the following fluorescent agents: 5-aminolevulinic acid (5-ALA) (44 studies, including three randomized control trials), fluorescein (11), indocyanine green (five), hypericin (two), 5-aminofluorescein-human serum albumin (one), endogenous fluorophores (nine) and fluorescent agents in a pre-clinical testing phase (30). Three meta-analyses were also identified. CONCLUSIONS 5-ALA is the only fluorescent agent that has been tested in a randomized controlled trial and results in an improvement of GTR and progression-free survival in high-grade gliomas. Observational cohort studies and case series suggest similar outcomes for FGS using fluorescein. Molecular targeting agents (e.g., fluorophore/nanoparticle labeled with anti-EGFR antibodies) are still in the pre-clinical phase, but offer promising results and may be valuable future alternatives.
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Affiliation(s)
- Joeky T Senders
- Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ivo S Muskens
- Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rosalie Schnoor
- Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Aditya V Karhade
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, 02115, USA
| | - David J Cote
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, 02115, USA
| | - Timothy R Smith
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, 02115, USA
| | - Marike L D Broekman
- Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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17
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Valdés PA, Roberts DW, Lu FK, Golby A. Optical technologies for intraoperative neurosurgical guidance. Neurosurg Focus 2016; 40:E8. [PMID: 26926066 DOI: 10.3171/2015.12.focus15550] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Biomedical optics is a broadly interdisciplinary field at the interface of optical engineering, biophysics, computer science, medicine, biology, and chemistry, helping us understand light-tissue interactions to create applications with diagnostic and therapeutic value in medicine. Implementation of biomedical optics tools and principles has had a notable scientific and clinical resurgence in recent years in the neurosurgical community. This is in great part due to work in fluorescence-guided surgery of brain tumors leading to reports of significant improvement in maximizing the rates of gross-total resection. Multiple additional optical technologies have been implemented clinically, including diffuse reflectance spectroscopy and imaging, optical coherence tomography, Raman spectroscopy and imaging, and advanced quantitative methods, including quantitative fluorescence and lifetime imaging. Here we present a clinically relevant and technologically informed overview and discussion of some of the major clinical implementations of optical technologies as intraoperative guidance tools in neurosurgery.
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Affiliation(s)
- Pablo A Valdés
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, Harvard Medical School, Boston Children's Hospital, Boston
| | - David W Roberts
- Section of Neurosurgery, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Alexandra Golby
- Departments of 1 Neurosurgery and.,Radiology, and.,Dana Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital
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18
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Real time optical Biopsy: Time-resolved Fluorescence Spectroscopy instrumentation and validation. Sci Rep 2016; 6:38190. [PMID: 27929039 PMCID: PMC5144092 DOI: 10.1038/srep38190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 10/26/2016] [Indexed: 11/08/2022] Open
Abstract
The Time-resolved fluorescence spectroscopy (TR-FS) has the potential to differentiate tumor and normal tissue in real time during surgical excision. In this manuscript, we describe the design of a novel TR-FS device, along with preliminary data on detection accuracy for fluorophores in a mixture. The instrument is capable of near real-time fluorescence lifetime acquisition in multiple spectral bands and analysis. It is also able to recover fluorescence lifetime with sub-20ps accuracy as validated with individual organic fluorescence dyes and dye mixtures yielding lifetime values for standard fluorescence dyes that closely match with published data. We also show that TR-FS is able to quantify the relative concentration of fluorescence dyes in a mixture by the unmixing of lifetime decays. We show that the TR-FS prototype is able to identify in near-real time the concentrations of dyes in a complex mixture based on previously trained data. As a result, we demonstrate that in complex mixtures of fluorophores, the relative concentration information is encoded in the fluorescence lifetime across multiple spectral bands. We show for the first time the temporal and spectral measurements of a mixture of fluorochromes and the ability to differentiate relative concentrations of each fluorochrome mixture in real time.
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19
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Markwardt NA, Haj-Hosseini N, Hollnburger B, Stepp H, Zelenkov P, Rühm A. 405 nm versus 633 nm for protoporphyrin IX excitation in fluorescence-guided stereotactic biopsy of brain tumors. JOURNAL OF BIOPHOTONICS 2016; 9:901-12. [PMID: 26564058 DOI: 10.1002/jbio.201500195] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 05/23/2023]
Abstract
Fluorescence diagnosis may be used to improve the safety and reliability of stereotactic brain tumor biopsies using biopsy needles with integrated fiber optics. Based on 5-aminolevulinic-acid-induced protoporphyrin IX (PpIX) fluorescence, vital tumor tissue can be localized in vivo during the excision procedure to reduce the number of necessary samples for a reliable diagnosis. In this study, the practical suitability of two different PpIX excitation wavelengths (405 nm, 633 nm) was investigated on optical phantoms. Violet excitation at 405 nm provides a 50-fold higher sensitivity for the bulk tumor; this factor increases up to 100 with decreasing fluorescent volume as shown by ray tracing simulations. Red excitation at 633 nm, however, is noticeably superior with regard to blood layers obscuring the fluorescence. Experimental results on the signal attenuation through blood layers of well-defined thicknesses could be confirmed by ray tracing simulations. Typical interstitial fiber probe measurements were mimicked on agarose-gel phantoms. Even in direct contact, blood layers of 20-40 µm between probe and tissue must be expected, obscuring 405-nm-excited PpIX fluorescence almost completely, but reducing the 633-nm-excited signal only by 25.5%. Thus, 633 nm seems to be the wavelength of choice for PpIX-assisted detection of high-grade gliomas in stereotactic biopsy. PpIX signal attenuation through clinically relevant blood layers for 405 nm (violet) and 633 nm (red) excitation.
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Affiliation(s)
- Niklas A Markwardt
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany.
| | - Neda Haj-Hosseini
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Bastian Hollnburger
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany
| | - Herbert Stepp
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany
| | | | - Adrian Rühm
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany
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20
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Rudys R, Bagdonas S, Kirdaitė G, Papečkienė J, Rotomskis R. Multidimensional visualization of healthy and sensitized rabbit knee tissues by means of confocal microscopy. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:051035. [PMID: 25672969 DOI: 10.1117/1.jbo.20.5.051035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 01/19/2015] [Indexed: 06/04/2023]
Abstract
This study combines several fluorescence detection methods to distinguish structural features of the synovium and cartilage tissues and to visualize the localization of endogenous porphyrins in the sensitized tissues. Specimens of synovium and cartilage tissues obtained from rabbits with antigen-induced monoarthritis after intra-articular 5-aminolevulinic acid methyl ester injection and those from healthy rabbits were investigated ex vivo by means of fluorescence spectroscopy, fluorescence intensity, and lifetime microscopy. The presence of endogenous porphyrins was confirmed with the fluorescence spectra measured on sliced sensitized specimens. Application of the lifetime-gating method on fast fluorescence lifetime imaging microscopy images, allowed separate visualization of tissue structures possessing different average lifetimes. The presence of the structures has been validated by histopathological imaging based on conventional rapid hematoxylin–eosin staining of the specimens. The fluorescence lifetime of endogenous protoporphyrin IX has been assessed and employed for visualization of sensitized tissues.
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Affiliation(s)
- Romualdas Rudys
- The National Cancer Institute, P. Baublio 3b, Vilnius LT 08406, LithuaniabState Research Institute, Center for Innovative Medicine, Žygimantu 9, Vilnius LT 01102, Lithuania
| | - Saulius Bagdonas
- Vilnius University, Biophotonics Group of Laser Research Center, Faculty of Physics, Sauletekio 9, Building 3, Vilnius LT-10222, Lithuania
| | - Gailutė Kirdaitė
- State Research Institute, Center for Innovative Medicine, Žygimantu 9, Vilnius LT 01102, Lithuania
| | - Jurga Papečkienė
- State Research Institute, Center for Innovative Medicine, Žygimantu 9, Vilnius LT 01102, Lithuania
| | - Ričardas Rotomskis
- The National Cancer Institute, P. Baublio 3b, Vilnius LT 08406, LithuaniacVilnius University, Biophotonics Group of Laser Research Center, Faculty of Physics, Sauletekio 9, Building 3, Vilnius LT-10222, Lithuania
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21
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Walsh AJ, Shah AT, Sharick JT, Skala MC. Fluorescence Lifetime Measurements of NAD(P)H in Live Cells and Tissue. SPRINGER SERIES IN CHEMICAL PHYSICS 2015. [DOI: 10.1007/978-3-319-14929-5_14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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Klatt J, Gerich CE, Gröbe A, Opitz J, Schreiber J, Hanken H, Salomon G, Heiland M, Kluwe L, Blessmann M. Fractal dimension of time-resolved autofluorescence discriminates tumour from healthy tissues in the oral cavity. J Craniomaxillofac Surg 2013; 42:852-4. [PMID: 24444757 DOI: 10.1016/j.jcms.2013.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/12/2013] [Accepted: 12/17/2013] [Indexed: 11/15/2022] Open
Abstract
Early detection and complete resection of oral carcinomas is of crucial importance for patient survival. This could be significantly improved by developing a non-invasive, sensitive and real-time detection technique. Time-resolved autofluorescence measurement is state-of-the-art technology originally developed for non-destructive inspection of material. In this study, we measured time-resolved autofluorescence in tumours and healthy tissues of the oral cavity ex vivo and calculated the corresponding fractal dimension which was significantly higher in tumours than in healthy tissues (1.8 vs. 1.6, P < 0.001, unpaired t-test) with non-overlapping 95% confidential intervals 1.88-1.84 and 1.57-1.69, respectively. Very high specificity (86%) could be reached at 100% sensitivity. The area under the curve was 99%, further suggesting the superior prediction potential of fractal dimension based on time-resolved autofluorescence spectra.
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Affiliation(s)
- Jan Klatt
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola E Gerich
- Fraunhofer Institute for Non-Destructive Testing, Laboratory of Optical Diagnostics, Dresden, Germany
| | - Alexander Gröbe
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Opitz
- Fraunhofer Institute for Non-Destructive Testing, Laboratory of Optical Diagnostics, Dresden, Germany
| | - Jürgen Schreiber
- Fraunhofer Institute for Non-Destructive Testing, Laboratory of Optical Diagnostics, Dresden, Germany
| | - Henning Hanken
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Salomon
- Martiniclinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lan Kluwe
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Marco Blessmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Li Y, Rey-Dios R, Roberts DW, Valdés PA, Cohen-Gadol AA. Intraoperative fluorescence-guided resection of high-grade gliomas: a comparison of the present techniques and evolution of future strategies. World Neurosurg 2013; 82:175-85. [PMID: 23851210 DOI: 10.1016/j.wneu.2013.06.014] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/15/2013] [Accepted: 06/29/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Fluorescence guidance has a demonstrated potential in maximizing the extent of high-grade glioma resection. Different fluorophores (fluorescent biomarkers), including 5-aminolevulinic acid (5-ALA) and fluorescein, have been examined with the use of several imaging techniques. Our goal was to review the state of this technology and discuss strategies for more widespread adoption. METHODS We performed a Medline search using the key words "fluorescence," "intraoperative fluorescence-guided resection," "intraoperative image-guided resection," and "brain glioma" for articles from 1960 until the present. This initial search revealed 267 articles. Each abstract and article was reviewed and the reference lists from select articles were further evaluated for relevance. A total of 64 articles included information about the role of fluorescence in resection of high-grade gliomas and therefore were selectively included for our analysis. RESULTS 5-ALA and fluorescein sodium have shown promise as fluorescent markers in detecting residual tumor intraoperatively. These techniques have demonstrated a significant increase in the extent of tumor resection. Regulatory barriers have limited the use of 5-ALA and technological challenges have restricted the use of fluorescein and its derivatives in the United States. Limitations to this technology currently exist, such as the fact that fluorescence at tumor margins is not always reliable for identification of tumor-brain interface. CONCLUSIONS These techniques are safe and effective for increasing gross total resection. The development of more tumor-specific fluorophores is needed to resolve problems with subjective interpretation of fluorescent signal at tumor margins. Techniques such as quantum dots and polymer or iron oxide-based nanoparticles have shown promise as potential future tools.
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Affiliation(s)
- Yiping Li
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Roberto Rey-Dios
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - David W Roberts
- Section of Neurosurgery, Department of Surgery, Dartmouth Medical School, Lebanon, New Hampshire, USA; Dartmouth Medical School, Hanover, New Hampshire, USA
| | - Pablo A Valdés
- Section of Neurosurgery, Department of Surgery, Dartmouth Medical School, Lebanon, New Hampshire, USA; Dartmouth Medical School, Hanover, New Hampshire, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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24
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Marcu L, Hartl BA. Fluorescence Lifetime Spectroscopy and Imaging in Neurosurgery. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2012; 18:1465-1477. [PMID: 28053498 PMCID: PMC5205025 DOI: 10.1109/jstqe.2012.2185823] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Clinical outcome of patients diagnosed with primary brain tumor has been correlated with the extent of surgical resection. In treating this disease, the neurosurgeon must balance between an aggressive, radical resection and minimizing the loss of healthy, functionally significant brain tissue. Numerous intra-operative methodologies and technological approaches have been explored as a means to improve the accuracy of surgical resection. This paper presents an overview of current conventional techniques and new emerging technologies with potential to impact the area of image-guided surgery of brain tumors. Emphasis is placed on techniques based on endogenous fluorescence lifetime contrast and their potential for intraoperative diagnosis of brain tumors.
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Affiliation(s)
- Laura Marcu
- University of California, Davis, Davis, CA 95616 USA
| | - Brad A Hartl
- University of California, Davis, Davis, CA 95616 USA
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25
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Stroud MR, Hansen SJ, Olson JM. In vivo bio-imaging using chlorotoxin-based conjugates. Curr Pharm Des 2012; 17:4362-71. [PMID: 22204434 DOI: 10.2174/138161211798999375] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 11/02/2011] [Indexed: 01/10/2023]
Abstract
Surgical resection remains the primary component of cancer therapy. The precision required to successfully separate cancer tissue from normal tissue relies heavily on the surgeon's ability to delineate the tumor margins. Despite recent advances in surgical guidance and monitoring systems, intra-operative identification of these margins remains imprecise and directly influences patient prognosis. If the surgeon had improved tools to distinguish these margins, tumor progression and unacceptable morbidity could be avoided. In this article, we review the history of chlorotoxin and its tumor specificity and discuss the research currently being generated to target optical imaging agents to cancer tissue.
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Affiliation(s)
- Mark R Stroud
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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26
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Valdés PA, Kim A, Leblond F, Conde OM, Harris BT, Paulsen KD, Wilson BC, Roberts DW. Combined fluorescence and reflectance spectroscopy for in vivo quantification of cancer biomarkers in low- and high-grade glioma surgery. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:116007. [PMID: 22112112 PMCID: PMC3221714 DOI: 10.1117/1.3646916] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 09/12/2011] [Accepted: 09/16/2011] [Indexed: 05/19/2023]
Abstract
Biomarkers are indicators of biological processes and hold promise for the diagnosis and treatment of disease. Gliomas represent a heterogeneous group of brain tumors with marked intra- and inter-tumor variability. The extent of surgical resection is a significant factor influencing post-surgical recurrence and prognosis. Here, we used fluorescence and reflectance spectral signatures for in vivo quantification of multiple biomarkers during glioma surgery, with fluorescence contrast provided by exogenously-induced protoporphyrin IX (PpIX) following administration of 5-aminolevulinic acid. We performed light-transport modeling to quantify multiple biomarkers indicative of tumor biological processes, including the local concentration of PpIX and associated photoproducts, total hemoglobin concentration, oxygen saturation, and optical scattering parameters. We developed a diagnostic algorithm for intra-operative tissue delineation that accounts for the combined tumor-specific predictive capabilities of these quantitative biomarkers. Tumor tissue delineation achieved accuracies of up to 94% (specificity = 94%, sensitivity = 94%) across a range of glioma histologies beyond current state-of-the-art optical approaches, including state-of-the-art fluorescence image guidance. This multiple biomarker strategy opens the door to optical methods for surgical guidance that use quantification of well-established neoplastic processes. Future work would seek to validate the predictive power of this proof-of-concept study in a separate larger cohort of patients.
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Affiliation(s)
- Pablo A Valdés
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, USA.
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27
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Jiang PC, Grundfest WS, Stafsudd OM. Quasi-real-time fluorescence imaging with lifetime dependent contrast. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:086001. [PMID: 21895313 DOI: 10.1117/1.3609229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Conventional fluorescence lifetime imaging requires complicated algorithms to extract lifetimes of fluorophores and acquisition of multiple data points at progressively longer delay times to characterize tissues. To address diminishing signal-to-noise ratios at these progressively longer time delays, we report a time-resolved fluorescence imaging method, normalized fluorescence yield imaging that does not require the extraction of lifetimes. The concept is to extract the "contrast" instead of the lifetime value of the fluorophores by using simple mathematical algorithms. This process converts differences in decay times directly to different intensities. The technique was verified experimentally using a gated iCCD camera and an ultraviolet light-emitting diode light source. It was shown that this method can distinguish between chemical dyes (Fluorescein and Rhodamine-B) and biomedical samples, such as powders of elastin and collagen. Good contrast was obtained between fluorophores that varied by less than 6% in lifetime. Additionally, it was shown that long gate times up to 16 ns achieve good contrast depending upon the samples to be studied. These results support the feasibility of time-resolved fluorescence imaging without lifetime extraction, which has a potential clinical role in noninvasive real-time imaging.
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Affiliation(s)
- Pei-Chi Jiang
- University of California Los Angeles, Department of Electrical Engineering, Room 18-135 Engineering IV, Los Angeles, California 90095-1594, USA
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28
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Butte PV, Mamelak AN, Nuno M, Bannykh SI, Black KL, Marcu L. Fluorescence lifetime spectroscopy for guided therapy of brain tumors. Neuroimage 2011; 54 Suppl 1:S125-35. [PMID: 21055475 PMCID: PMC3335732 DOI: 10.1016/j.neuroimage.2010.11.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 10/27/2010] [Accepted: 11/01/2010] [Indexed: 11/30/2022] Open
Abstract
This study evaluates the potential of time-resolved laser induced fluorescence spectroscopy (TR-LIFS) as intra-operative tool for the delineation of brain tumor from normal brain. Forty two patients undergoing glioma (WHO grade I-IV) surgery were enrolled in this study. A TR-LIFS prototype apparatus (gated detection, fast digitizer) was used to induce in-vivo fluorescence using a pulsed N2 laser (337 nm excitation, 0.7 ns pulse width) and to record the time-resolved spectrum (360-550 nm range, 10 nm interval). The sites of TR-LIFS measurement were validated by conventional histopathology (H&E staining). Parameters derived from the TR-LIFS data including intensity values and time-resolved intensity decay features (average fluorescence lifetime and Laguerre coefficients values) were used for tissue characterization and classification. 71 areas of tumor and normal brain were analyzed. Several parameters allowed for the differentiation of distinct tissue types. For example, normal cortex (N=35) and normal white matter (N=12) exhibit a longer-lasting fluorescence emission at 390 nm (τ390=2.12±0.10 ns) when compared with 460 nm (τ460=1.16±0.08 ns). High grade glioma (grades III and IV) samples (N=17) demonstrate emission peaks at 460 nm, with large variation at 390 nm while low grade glioma (I and II) samples (N=7) demonstrated a peak fluorescence emission at 460 nm. A linear discriminant algorithm allowed for the classification of low-grade gliomas with 100% sensitivity and 98% specificity. High-grade glioma demonstrated a high degree of heterogeneity thus reducing the discrimination accuracy of these tumors to 47% sensitivity and 94% specificity. Current findings demonstrate that TR-LIFS holds the potential to diagnose brain tumors intra-operatively and to provide a valuable tool for aiding the neurosurgeon-neuropathologist team in to rapidly distinguish between tumor and normal brain during surgery.
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Affiliation(s)
- Pramod V. Butte
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA – 90048
| | - Adam N. Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA – 90048
| | - Miriam Nuno
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA – 90048
| | - Serguei I. Bannykh
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA – 90048
| | - Keith L. Black
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA – 90048
| | - Laura Marcu
- Biomedical Engineering, University of California, Davis, CA – 95616
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29
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Vasefi F, Najiminaini M, Ng E, Kaminska B, Chapman GH, Carson JJL. Angular domain transillumination imaging optimization with an ultrafast gated camera. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:061710. [PMID: 21198158 DOI: 10.1117/1.3505020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
By employing high-aspect-ratio parallel microchannels as an angular filter, quasiballistic photons sensitive to internal structures in a turbid medium can be captured. Scattered photons exiting the turbid medium typically exhibit trajectories with random angles compared to the initial trajectory and are mostly rejected by the filter. However, angular filter arrays cannot differentiate between quasiballistic photons (early arriving) and photons that happen to attain a scattered trajectory that is within the acceptance angle (late arriving). Therefore, we have two objectives: (1) to experimentally characterize the angular distribution and proportion of minimally deviated quasiballistic photons and multiply scattered photons in a turbid medium and (2) to combine time and angular gating principles so that early and late arriving photons can be distinguished. From the angular distribution data, the angular filter with angular acceptance about 0.4 deg yields the highest image contrast for transillumination images. The use of angular domain imaging(ADI) with time-gating enables visualization of submillimeter absorbing objects with approximately seven times higher image contrast compared to ADI in a turbid medium with a scattering level of six times the reduced mean free path.
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Affiliation(s)
- Fartash Vasefi
- Simon Fraser University The School of Engineering Science Burnaby, British Columbia, Canada
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30
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Lloyd WR, Wilson RH, Chang CW, Gillispie GD, Mycek MA. Instrumentation to rapidly acquire fluorescence wavelength-time matrices of biological tissues. BIOMEDICAL OPTICS EXPRESS 2010; 1:574-586. [PMID: 21258491 PMCID: PMC3018017 DOI: 10.1364/boe.1.000574] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 08/06/2010] [Accepted: 08/07/2010] [Indexed: 05/20/2023]
Abstract
A fiber-optic system was developed to rapidly acquire tissue fluorescence wavelength-time matrices (WTMs) with high signal-to-noise ratio (SNR). The essential system components (473 nm microchip laser operating at 3 kHz repetition frequency, fiber-probe assemblies, emission monochromator, photomultiplier tube, and digitizer) were assembled into a compact and clinically-compatible unit. Data were acquired from fluorescence standards and tissue-simulating phantoms to test system performance. Fluorescence decay waveforms with SNR > 100 at the decay curve peak were obtained in less than 30 ms. With optimized data transfer and monochromator stepping functions, it should be feasible to acquire a full WTM at 5 nm emission wavelength intervals over a 200 nm range in under 2 seconds.
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Affiliation(s)
- William R. Lloyd
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109-2099, USA
| | - Robert H. Wilson
- Applied Physics Program, University of Michigan, Ann Arbor, MI 48109-0362, USA
| | - Ching-Wei Chang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109-2099, USA
| | | | - Mary-Ann Mycek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109-2099, USA
- Applied Physics Program, University of Michigan, Ann Arbor, MI 48109-0362, USA
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31
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Pogue BW, Gibbs-Strauss S, Valdés PA, Samkoe K, Roberts DW, Paulsen KD. Review of Neurosurgical Fluorescence Imaging Methodologies. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2010. [PMID: 20671936 DOI: 10.1109/jstqe.2010.2084074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Fluorescence imaging in neurosurgery has a long historical development, with several different biomarkers and biochemical agents being used, and several technological approaches. This review focuses on the different contrast agents, summarizing endogenous fluorescence, exogenously stimulated fluorescence and exogenous contrast agents, and then on tools used for imaging. It ends with a summary of key clinical trials that lead to consensus studies. The practical utility of protoporphyrin IX (PpIX) as stimulated by administration of δ-aminolevulinic acid (ALA) has had substantial pilot clinical studies and basic science research completed. Recently multi-center clinical trials using PpIx fluorescence to guide resection have shown efficacy for improved short term survival. Exogenous agents are being developed and tested pre-clinically, and hopefully hold the potential for long term survival benefit if they provide additional capabilities for resection of micro-invasive disease or certain tumor sub-types that do not produce PpIX or help delineate low grade tumors. The range of technologies used for measurement and imaging ranges widely, with most clinical trials being carried out with either point probes or modified surgical microscopes. At this point in time, optimized probe approaches are showing efficacy in clinical trials, and fully commercialized imaging systems are emerging, which will clearly help lead to adoption into neurosurgical practice.
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Affiliation(s)
- Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover NH 03755
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32
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Pogue BW, Gibbs-Strauss S, Valdés PA, Samkoe K, Roberts DW, Paulsen KD. Review of Neurosurgical Fluorescence Imaging Methodologies. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2010; 16:493-505. [PMID: 20671936 PMCID: PMC2910912 DOI: 10.1109/jstqe.2009.2034541] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Fluorescence imaging in neurosurgery has a long historical development, with several different biomarkers and biochemical agents being used, and several technological approaches. This review focuses on the different contrast agents, summarizing endogenous fluorescence, exogenously stimulated fluorescence and exogenous contrast agents, and then on tools used for imaging. It ends with a summary of key clinical trials that lead to consensus studies. The practical utility of protoporphyrin IX (PpIX) as stimulated by administration of δ-aminolevulinic acid (ALA) has had substantial pilot clinical studies and basic science research completed. Recently multi-center clinical trials using PpIx fluorescence to guide resection have shown efficacy for improved short term survival. Exogenous agents are being developed and tested pre-clinically, and hopefully hold the potential for long term survival benefit if they provide additional capabilities for resection of micro-invasive disease or certain tumor sub-types that do not produce PpIX or help delineate low grade tumors. The range of technologies used for measurement and imaging ranges widely, with most clinical trials being carried out with either point probes or modified surgical microscopes. At this point in time, optimized probe approaches are showing efficacy in clinical trials, and fully commercialized imaging systems are emerging, which will clearly help lead to adoption into neurosurgical practice.
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Affiliation(s)
- Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover NH 03755
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33
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Butte PV, Fang Q, Jo JA, Yong WH, Pikul BK, Black KL, Marcu L. Intraoperative delineation of primary brain tumors using time-resolved fluorescence spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:027008. [PMID: 20459282 PMCID: PMC4171753 DOI: 10.1117/1.3374049] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 01/18/2010] [Accepted: 02/09/2010] [Indexed: 05/20/2023]
Abstract
The goal of this study is to determine the potential of time-resolved laser-induced fluorescence spectroscopy (TR-LIFS) as an adjunctive tool for delineation of brain tumor from surrounding normal tissue in order to assist the neurosurgeon in near-complete tumor excision. A time-domain TR-LIFS prototype apparatus (gated photomultiplier detection, fast digitizer) was used for recording tissue autofluorescence in normal cortex (NC), normal white matter (NWM), and various grades of gliomas intraoperatively. Tissue fluorescence was induced with a pulsed nitrogen laser (337 nm, 700 ps), and the intensity decay profiles were recorded in the 360- to 550-nm spectral range (10-nm interval). Histopathological analysis (hematoxylin & eosin) of the biopsy samples taken from the site of TR-LIFS measurements was used for validation of spectroscopic results. Preliminary results on 17 patients demonstrate that normal cortex (N=16) and normal white matter (N=3) show two peaks of fluorescence emission at 390 nm (lifetime=1.8+/-0.3 ns) and 460 nm (lifetime=0.8+/-0.1 ns). The 390-nm emission peak is absent in low-grade glioma (N=5; lifetime=1.1 ns) and reduced in high-grade glioma (N=9; lifetime=1.7+/-0.4 ns). The emission characteristics at 460 nm in all tissues correlated with the nicotinamide adenine dinucleotide fluorescence (peak: 440 to 460 nm; lifetime: 0.8 to 1.0 ns). These findings demonstrate the potential of using TR-LIFS as a tool for enhanced delineation of brain tumors during surgery. In addition, this study evaluates similarities and differences between TR-LIFS signatures of brain tumors obtained in vivo and those previously reported in ex vivo brain tumor specimens.
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Affiliation(s)
- Pramod V Butte
- Cedars-Sinai Medical Center, Department of Neurosurgery, 8631 West 3rd Street, Suite 800E, Los Angeles, California 90048, USA
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34
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Pascu A, Romanitan MO, Delgado JM, Danaila L, Pascu ML. Laser-induced autofluorescence measurements on brain tissues. Anat Rec (Hoboken) 2010; 292:2013-22. [PMID: 19943354 DOI: 10.1002/ar.21034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It was demonstrated that comparison of the autofluorescence spectra induced with laser radiation in ultraviolet and visible allows the identification of brain tumor tissues and normal tissues as well as the difference between them. The measurements were performed on homogenates to ensure an optimal reproducibility of the results. We conclude that the autofluorescence spectra of the tumor samples are close to those measured for normal tissues, but there are differences between them that allow distinguishing the tumor from the normal tissue. One difference is that for each pair of tumor/normal tissue samples, the peak autofluorescence for the normal tissue is shifted with respect to that for the tumor-typically between 10 and 20 nm; overall autofluorescence intensity is also different for the components of the same pair, the difference being in the range 15%-30%. A parameter that can also be used is the variation of the ratio of some fluorescence intensity peaks between normal and tumor tissue samples. Measurements of this parameter yielded variations ranging between 10% and 40%. Another conclusion of the study is that in vitro experiments show that it is mandatory to use pairs of samples (normal/tumor tissue) taken from the same patient. The results show that, after further experimental in vitro tests, the method may be adapted to real-time intraoperative conditions by measuring the autofluorescence of the tumor and of the adjacent normal tissue.
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Affiliation(s)
- Alexandru Pascu
- Department of Laser, National Institute for Laser, Plasma and Radiation Physics, Str. Atomistilor nr. 409, Magurele, Bucharest, Romania
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35
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Marcu L. Fluorescence lifetime in cardiovascular diagnostics. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:011106. [PMID: 20210432 PMCID: PMC2847934 DOI: 10.1117/1.3327279] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 12/16/2009] [Indexed: 05/20/2023]
Abstract
We review fluorescence lifetime techniques including time-resolved laser-induced fluorescence spectroscopy (TR-LIFS) and fluorescence lifetime imaging microscopy (FLIM) instrumentation and associated methodologies that allow for characterization and diagnosis of atherosclerotic plaques. Emphasis is placed on the translational research potential of TR-LIFS and FLIM and on determining whether intrinsic fluorescence signals can be used to provide useful contrast for the diagnosis of high-risk atherosclerotic plaque. Our results demonstrate that these techniques allow for the discrimination of important biochemical features involved in atherosclerotic plaque instability and rupture and show their potential for future intravascular applications.
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Affiliation(s)
- Laura Marcu
- University of California, Davis, Department of Biomedical Engineering, Davis, California 95616, USA.
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36
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Yuan Y, Hwang JY, Krishnamoorthy M, Ye K, Zhang Y, Ning J, Wang RC, Deen MJ, Fang Q. High-throughput acousto-optic-tunable-filter-based time-resolved fluorescence spectrometer for optical biopsy. OPTICS LETTERS 2009; 34:1132-4. [PMID: 19340243 DOI: 10.1364/ol.34.001132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Time-resolved fluorescence spectroscopy has been studied to perform minimally invasive optical biopsy in clinical diagnostics. A critical barrier preventing current time-resolved techniques from clinical studies is their impractically long data acquisition time. We have developed an acousto-optic-tunable-filter (AOTF)-based time-resolved fluorescence spectrometer, which is capable of near real-time data acquisition. Both first-order diffraction beams are collected in this AOTF spectrometer, which results in significantly improved overall throughput. Using standard fluorescence dyes, we have demonstrated that this spectrometer can acquire 200 nm time-resolved spectra within 4 s, while its throughput is comparable to a grating-based spectrometer.
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Affiliation(s)
- Ye Yuan
- Department of Engineering Physics, School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
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37
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Dabir AS, Trivedi CA, Ryu Y, Pande P, Jo JA. Fully automated deconvolution method for on-line analysis of time-resolved fluorescence spectroscopy data based on an iterative Laguerre expansion technique. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:024030. [PMID: 19405759 DOI: 10.1117/1.3103342] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Time-resolved fluorescence spectroscopy (TRFS) is a powerful analytical tool for quantifying the biochemical composition of organic and inorganic materials. The potential of TRFS for tissue diagnosis has been recently demonstrated. To facilitate the translation of TRFS to the clinical arena, algorithms for online TRFS data analysis are essential. A fast model-free TRFS deconvolution algorithm based on the Laguerre expansion method has previously been introduced. One limitation of this method, however, is the need to heuristically select two parameters that are crucial for the accurate estimation of the fluorescence decay: the Laguerre parameter alpha and the expansion order. Here, a new implementation of the Laguerre deconvolution method is introduced, in which a nonlinear least-square optimization of the Laguerre parameter alpha is performed, and the optimal expansion order is selected based on a minimum description length criterion (MDL). In addition, estimation of the zero-time delay between the recorded instrument response and fluorescence decay is also performed based on normalized mean square error criterion (NMSE). The method is validated on experimental data from fluorescence lifetime standards, endogenous tissue fluorophores, and human tissue. The proposed automated Laguerre deconvolution method will facilitate online applications of TRFS, such as real-time clinical tissue diagnosis.
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Affiliation(s)
- Aditi S Dabir
- Texas A&M University, Department of Biomedical Engineering, College Station, Texas 77843, USA
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38
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Lin WC, Sandberg DI, Bhatia S, Johnson M, Morrison G, Ragheb J. Optical spectroscopy for in-vitro differentiation of pediatric neoplastic and epileptogenic brain lesions. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:014028. [PMID: 19256716 DOI: 10.1117/1.3080144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The objective of this in vitro tissue study is to investigate the feasibility of using optical spectroscopy to differentiate pediatric neoplastic and epileptogenic brain from normal brain. Specimens are collected from 17 patients with brain tumors, and from 26 patients with intractable epilepsy during surgical resection of epileptogenic cerebral cortex. Fluorescence spectra are measured at excitations of 337, 360, and 440 nm; diffuse reflectance spectra are measured between 400 and 900 nm from each specimen. Pathological analysis is performed to classify abnormalities in brain specimens, and its findings are correlated with spectral data. Statistically significant differences (p<0.01) are found for both raw and normalized diffuse reflectance and fluorescence spectra between 1. neoplastic brain and normal gray matter, 2. epileptogenic brain and normal gray matter, and 3. neoplastic brain and normal white matter. However, no distinct spectral features are identified that effectively separate epileptogenic brain from normal white matter. The outcomes of the study suggest that certain unique compositional and structural characteristics of pediatric neoplastic and epileptogenic brain can be detected using optical spectroscopy in vitro.
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Affiliation(s)
- Wei-Chiang Lin
- Miami Children's Hospital, Brain Institute and Florida International University, Department of Biomedical Engineering, 10555 West Flagler St, EAS 2673 Miami, Florida 33131, USA.
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Wang J, Yong WH, Sun Y, Vernier PT, Koeffler HP, Gundersen MA, Marcu L. Receptor-targeted quantum dots: fluorescent probes for brain tumor diagnosis. JOURNAL OF BIOMEDICAL OPTICS 2007; 12:044021. [PMID: 17867825 DOI: 10.1117/1.2764463] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The intraoperative diagnosis of brain tumors and the timely evaluation of biomarkers that can guide therapy are hindered by the paucity of rapid adjunctive studies. This study evaluates the feasibility and specificity of using quantum dot-labeled antibodies for rapid visualization of epidermal growth factor receptor (EGFR) expression in human brain tumor cells and in surgical frozen section slides of glioma tissue. Streptavidin-coated quantum dots (QDs) were conjugated to anti-EGFR antibodies and incubated with target cultured tumor cells and tissues. The experiments were conducted first in human glioma tumor cell lines with elevated levels of EGFR expression (SKMG-3, U87) and then in frozen tissue sections of glioblastoma multiforme and of oligodendroglioma. The bioconjugated QDs used in the study were found to bind selectively to brain tumor cells expressing EGFR. QD complexed quickly to the cell membrane (less than 15 min), and binding was highly specific and depended on the expression level of EGFR on the cell membrane. Tissue experiments showed that only tumor specimens expressing EGFR were labeled in less than 30 min by QD complexes. These findings demonstrate that QD-labeled antibodies can provide a quick and accurate method for characterizing the presence or absence of a specific predictive biomarker.
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Affiliation(s)
- Jingjing Wang
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California 90089, USA
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Elson DS, Jo JA, Marcu L. Miniaturized side-viewing imaging probe for fluorescence lifetime imaging (FLIM): validation with fluorescence dyes, tissue structural proteins and tissue specimens. NEW JOURNAL OF PHYSICS 2007; 9:127. [PMID: 19503759 PMCID: PMC2691608 DOI: 10.1088/1367-2630/9/5/127] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We report a side viewing fibre-based endoscope that is compatible with intravascular imaging and fluorescence lifetime imaging microscopy (FLIM). The instrument has been validated through testing with fluorescent dyes and collagen and elastin powders using the Laguerre expansion deconvolution technique to calculate the fluorescence lifetimes. The instrument has also been tested on freshly excised unstained animal vascular tissues.
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Affiliation(s)
- D S Elson
- Institute of Biomedical Engineering and Department of Biosurgery and Surgical Technology, Imperial College London, Exhibition Road, London SW7 2AZ, UK
| | - J A Jo
- Department of Biomedical Engineering, University of California Davis, Genome and Biomedical Sciences Building, 451 East Health Sciences Drive, Davis, CA 95616, USA E-mail:
| | - L Marcu
- Department of Biomedical Engineering, University of California Davis, Genome and Biomedical Sciences Building, 451 East Health Sciences Drive, Davis, CA 95616, USA E-mail:
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Laser literature watch. Photomed Laser Surg 2006; 24:537-71. [PMID: 16942439 DOI: 10.1089/pho.2006.24.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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