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. 2018 Apr 20;9(5):2284-2296.
doi: 10.1364/BOE.9.002284. eCollection 2018 May 1.

5-ALA fluorescence and laser Doppler flowmetry for guidance in a stereotactic brain tumor biopsy

Neda Haj-Hosseini  1 , Johan C O Richter  1   2 , Peter Milos  2 , Martin Hallbeck  3 , Karin Wårdell  1
Affiliations

5-ALA fluorescence and laser Doppler flowmetry for guidance in a stereotactic brain tumor biopsy

Neda Haj-Hosseini et al. Biomed Opt Express. .

Abstract

A fiber optic probe was developed for guidance during stereotactic brain biopsy procedures to target tumor tissue and reduce the risk of hemorrhage. The probe was connected to a setup for the measurement of 5-aminolevulinic acid (5-ALA) induced fluorescence and microvascular blood flow. Along three stereotactic trajectories, fluorescence (n = 109) and laser Doppler flowmetry (LDF) (n = 144) measurements were done in millimeter increments. The recorded signals were compared to histopathology and radiology images. The median ratio of protoporphyrin IX (PpIX) fluorescence and autofluorescence (AF) in the tumor was considerably higher than the marginal zone (17.3 vs 0.9). The blood flow showed two high spots (3%) in total. The proposed setup allows simultaneous and real-time detection of tumor tissue and microvascular blood flow for tracking the vessels.

Keywords: (000.0000) General; (000.2700) General science.

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Conflict of interest statement

NH, JCOR, KW: (P).

Figures

Fig. 1
Fig. 1
a) The system design concept and b) configuration of the fibers in the probe. The system was composed of a fluorescence spectroscopy and a laser Doppler flowmetry system. The probe incorporated several optical fibers that were connected to the two systems. Fl: fluorescence, LDF: Laser Doppler flowmetry, em: emission, ex: excitation, AF: autofluorescence, TLI: total backscattered laser light intensity, PpIX: protoporphyrin IX.
Fig. 2
Fig. 2
Radiology images from the three patients. The markers show the planned entry and target points where the solid lines are the planned insertion trajectories. The images are oblique and in the same plane as the displayed trajectory.
Fig. 3
Fig. 3
a) The probe positioned in the mechanical insertion device and the stereotactic frame, b) the concept of measurements along the trajectory towards the tumor, c) MR image with precalculated targets in Surgiplan where the green markers are in displayed plane and the red markers are in a different plane d) example of IPpIX along the insertion trajectory and e) the histopathology slide image from the target point.
Fig. 4
Fig. 4
a) Fluorescence (Fl) and b) LDF signals measured with the systems shown in Fig. 1.
Fig. 5
Fig. 5
PpIX fluorescence and autofluorescence intensity measured from cortex down to the tumor in the three patient cases. a) Fluorescence ratio and blood perfusion, b) IPpIX, IAF(510) and fluorescence ratio, and c) IAF(510) and TLI. Biopsies were taken from the points mentioned in Table 1. IAF(510): autofluorescence at 510nm, TLI: total light reflection at 780 nm, IPpIX: PpIX fluorescence intensity at 635nm.
See this image and copyright information in PMC

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