Page 79 - Fluorescence-guided cancer surgery

Table 2 shows the imaging characteristics of the detected lesions. In ve patients, no uorescent signal was observed in the adenoma. In three patients, only weak uorescence (qualitatively rated as +/-) was observed and in the case of one patient, uorescent signal was rated as + (#9). The observed FCRs were con rmed by quantitative analysis, wherein a mean FCR of normal pituitary gland to adenoma of 1.5 ± 0.2 was obtained. In addition, two patients su ering from a microadenoma (#6 and #7) exhibited an FCR of 1.3 and 1.4 respectively. In one patient (#2), no discrimination in NIR uorescent signal between normal gland and adenoma could be observed due to suboptimal timing of the imaging. In this patient, NIR uorescence imaging was performed according to protocol just before opening of the dura. During resection of the adenoma, venous bleeding occurred that stopped after resection of the adenoma. After the second ICG administration and imaging, no remnant tissue was observed. Therefore, no NIR uorescent images of the adenoma could be obtained.
Table 2. Imaging characteristics
Imaging in pituitary surgery 77
Patient ID
1 2 3
4 5 6
7
8 9
10
Identi cation of normal gland and stalk on MRI
NIR Fluorescence Imaging
Cranial on top of adenoma Stalk R; clear normal gland R
Stalk L; suggestion of normal gland
Stalk R; no normal gland Stalk R; clear normal gland R
Stalk mid; clear normal gland
Stalk mid; clear normal gland
Stalk R; clear normal gland R
Stalk L; suggestion of normal gland
Stalk L; suggestion of normal gland
NP Normal
Remnant left side
Normal Normal Normal
Normal
Normal
Remnant left side
Remnant left side
IV IIBE left IIIa
IIC IIAE left I
I
IIAE left IIB
IIBE right
10 R 10 L 10 R
10 Mid 10 L 10 R
10 R
10 L 5 R
15 R
-L
++ - 1.4
No distinction possible
++ +/- 1.7
+ - 1.8
+ - 1.3
+ +/- 1.3
+ +/- 1.4
+ - 1.4
+++ 1.5
++- 1.8
Abbreviations: FCR, Fluorescence Contrast Ratio; L, left; mid; midline; N/A, not applicable; NP, not performed; R, right; WH-class, Wilson-Hardy classi cation
Preoperative
Post-operative
WH-class. grade
Dose ICG received (mg)
Location of adenoma
Fluorescent signal pituitary gland
Fluorescent signal adenoma
FCR