Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020;61(1):2-13.
doi: 10.1159/000508348. Epub 2020 Jul 13.

Intraoperative Imaging Techniques to Visualize Hepatic (Micro)Perfusion: An Overview

Zühre Uz  1   2 , Lucinda Shen  3   4 , Dan M J Milstein  5 , Krijn P van Lienden  6 , Rutger-Jan Swijnenburg  7 , Can Ince  3   4 , Thomas M van Gulik  7
Affiliations
Review

Intraoperative Imaging Techniques to Visualize Hepatic (Micro)Perfusion: An Overview

Zühre Uz et al. Eur Surg Res. 2020.

Abstract

The microcirculation plays a crucial role in the distribution of perfusion to organs. Studies have shown that microcirculatory dysfunction is an independent predictor of morbidity and mortality. Hence, assessment of liver perfusion offers valuable information on the (patho)physiological state of the liver. The current review explores techniques in perfusion imaging that can be used intraoperatively. Available modalities include dynamic contrast-enhanced ultrasound, handheld vital microscopes, indocyanine green fluorescence angiography, and laser contrast speckle imaging. Dynamic contrast-enhanced ultrasound relays information on deep tissue perfusion and is a commonly used technique to assess tumor perfusion. Handheld vital microscopes provide direct visualization of the sinusoidal architectural structure of the liver, which is a unique feature of this technique. Intraoperative fluorescence imaging uses indocyanine green, a dye that is administered intravenously to visualize microvascular perfusion when excited using near-infrared light. Laser speckle contrast imaging produces non-contact large surface-based tissue perfusion imaging free from movement- or pressure-related artefacts. In this review, we discuss the intrinsic advantages and disadvantages of these techniques and their clinical and/or scientific applications.

Keywords: Hepatic microcirculation; Imaging techniques; Intraoperative perfusion imaging; Perfusion.

PubMed Disclaimer

Conflict of interest statement

Prof. Dr. Ince is listed as one of the inventors of the SDFI on related patents commercialized by Microvision Medical (MVM) under a license from the Amsterdam UMC. He holds no shares of the company and receives no royalties or benefits from this license. He has not been involved with MVM for more than 6 years. Cytocam-IDFI was developed by the company Braedius Medical (BM), which is owned by a relative of Prof. Dr. Ince; however, he has no financial ties with BM of any sort (i.e., never owned shares or received consultancy or speaker fees). Prof. Dr. Ince runs an internet site which offers services (e.g., training, courses, analysis) related to clinical microcirculation (https://microcirculationacademy.org). The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Examples of liver perfusion imaging by handheld vital microscopy and indocyanine green (ICG) fluorescence imaging. a Screenshot of human hepatic microcirculation obtained using the Cytocam Handheld Video Microscope Imaging System (or IDFI). RBCs can be observed individually, the sinusoids (S) are easily imaged and also larger vessels (LV) branching out of the portal field (PF). b Real-time image of liver perfusion after ICG (green fluorescence) injection using an intraoperative fluorescence camera. Following clamping of the left portal vein and left hepatic artery, clear demarcation of liver perfusion is visualized, which guides the surgeon during performing, in this case, a left hemihepatectomy.
See this image and copyright information in PMC

References

    1. Ince C. Hemodynamic coherence and the rationale for monitoring the microcirculation. Crit Care. 2015;19((S3 Suppl 3)):S8. - PMC - PubMed
    1. Hernandez G, Regueira T, Bruhn A, Castro R, Rovegno M, Fuentealba A, et al. Relationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot study. Ann Intensive Care. 2012 Oct;2((1)):44. - PMC - PubMed
    1. Edul VS, Enrico C, Laviolle B, Vazquez AR, Ince C, Dubin A. Quantitative assessment of the microcirculation in healthy volunteers and in patients with septic shock. Crit Care Med. 2012 May;40((5)):1443–8. - PubMed
    1. Pulitano C, Joseph D, Sandroussi C, Verran D, Ho P, Debiasio A, et al. Postreperfusion microcirculatory derangements after liver transplantation: relationship to hemodynamics, serum mediators, and outcome. Liver Transpl. 2017 Apr;23((4)):527–36. - PubMed
    1. Coatney RW. Ultrasound imaging: principles and applications in rodent research. ILAR J. 2001;42((3)):233–47. - PubMed

Substances