Fluorescence of non-neoplastic, magnetic resonance imaging-enhancing tissue by 5-aminolevulinic acid: case report

Abstract

Objective: It has been established that fluorescence-guided resection using 5-aminolevulinic acid is useful in glioma surgery. In this study, we describe three cases in which even perinecrotic tissue could be recognized as fluorescence positive.

Methods: Three cases of central nervous system disease, showing gadolinium enhancement on magnetic resonance imaging scans, were operated on with the aid of fluorescence derived from 5-aminolevulinic acid. Two of these were diagnosed as radiation necrosis and the other as a neurodegenerative demyelinating disease.

Results: In all cases, at least some parts of the gadolinium-enhanced area could be labeled as fluorescence positive, whereas centers of necrotic tissue were negative for fluorescence. Histologically, cell infiltration was marked in each case that showed fluorescence activity.

Conclusion: Both malignant tumors and the perinecrotic area in radiation necrosis or neurodegenerative disease can be labeled as fluorescence positive using 5-aminolevulinic acid.