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Clinical Trial
. 2011;47(2):90-7.
doi: 10.1159/000329411. Epub 2011 Jun 30.

Near-infrared fluorescence imaging in patients undergoing pancreaticoduodenectomy

M Hutteman  1 , J R van der Vorst, J S D Mieog, B A Bonsing, H H Hartgrink, P J K Kuppen, C W G M Löwik, J V Frangioni, C J H van de Velde, A L Vahrmeijer
Affiliations
Clinical Trial

Near-infrared fluorescence imaging in patients undergoing pancreaticoduodenectomy

M Hutteman et al. Eur Surg Res. 2011.

Abstract

Background: Intraoperative visualization of pancreatic tumors has the potential to improve radical resection rates. Intraoperative visualization of the common bile duct and bile duct anastomoses could be of added value. In this study, we explored the use of indocyanine green (ICG) for these applications and attempted to optimize injection timing and dose.

Methods: Eight patients undergoing a pancreaticoduodenectomy were injected intravenously with 5 or 10 mg ICG. During and after injection, the pancreas, tumor, common bile duct and surrounding organs were imaged in real time using the Mini-FLARE™ near-infrared (NIR) imaging system.

Results: No clear tumor-to-pancreas contrast was observed, except for incidental contrast in 1 patient. The common bile duct was clearly visualized using NIR fluorescence, within 10 min after injection, with a maximal contrast between 30 and 90 min after injection. Patency of biliary anastomoses could be visualized due to biliary excretion of ICG.

Conclusion: No useful tumor demarcation could be visualized in pancreatic cancer patients after intravenous injection of ICG. However, the common bile duct and biliary anastomoses were clearly visualized during the observation period. Therefore, these imaging strategies could be beneficial during biliary surgery in cases where the surgical anatomy is aberrant or difficult to identify.

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Figures

Fig. 1
Fig. 1
Tumor-to-pancreas contrast using NIR fluorescence and ICG: tumor-to-pancreas ratios (means ± SD) of the pancreatic tumors over time, per dose group (a). b Color video (left panel), NIR fluorescence (middle panel) and a color-NIR overlay (right panel) of intraoperative imaging of the pancreas. In this example, clear contrast (arrow) is shown between pancreatic tumor and normal pancreatic tissue (P) 20 min after administration of 10 mg of ICG. However, this was an incidental finding in 1 patient. D = Duodenum.
Fig. 2
Fig. 2
Intraoperative imaging of the common bile duct using NIR fluorescence and ICG: SBRs (means ± SD) of the common bile duct over time, per dose group (a). SBRs for the common bile duct were calculated. A background region-of-interest was drawn on directly surrounding tissue. b Color video (left panel), NIR fluorescence (middle panel) and a color-NIR overlay (right panel) of intraoperative imaging of the common bile duct in a patient who underwent a cholecystectomy during previous surgery 30 min after administration of 5 mg of ICG. A clear contrast is shown between the common bile duct (arrow) and surrounding tissue. c Color video (left panel), NIR fluorescence (middle panel) and a color-NIR overlay (right panel) of a choledochojejunostomy (arrow) 30 min after completion of the anastomosis. NIR fluorescence signal of excreted ICG is visualized intraluminally in the jejunum, indicating anastomotic patency and absence of leakage.
Fig. 3
Fig. 3
Biodistribution of ICG in organs exposed during pancreaticoduodenectomy: shown are NIR fluorescence intensities of organs exposed during pancreaticoduodenectomy. Measurements of the duodenum were taken over an area not containing bile. Intensities are shown over time for both 5-mg (left panel) and 10-mg (right panel) groups.
See this image and copyright information in PMC

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