title: First in-human intraoperative imaging of HCC using the fluorescence goggle system and transarterial delivery of near-infrared fluorescent imaging agent: a pilot study.
abstract: Surgical resections remain the primary curative interventions for hepatocellular carcinoma (HCC). However, lack of real-time intraoperative image guidance confines surgeons to subjective visual assessment of the surgical bed, leading to poor visualization of small positive nodules and the extension of diffuse HCC. To address this problem, we developed a wearable fluorescence imaging and display system (fluorescence goggle) for intraoperative imaging of HCCs in human patients. In this pilot study, both intravenous (IV) and transarterial hepatic (TAH) delivery of indocyanine green (ICG) were explored to facilitate fluorescence goggle-mediated HCC imaging. The results show that all primary tumors in patients (n = 4) who received TAH delivery of ICG were identified successfully by the fluorescence goggle. In addition, 6 satellite tumors were also detected by the goggle, 5 of which were neither identifiable via preoperative magnetic resonance imaging (MRI) and computed tomography (CT) nor by visual inspection and palpation. In the group (n = 5) that received ICG intravenously, only 2 of 6 tumors visible by preoperative MRI or CT were identified with the fluorescence goggle, demonstrating the limitation of this delivery route for a non-tumor-selective imaging agent. Comparative analysis shows that the HCC-to-liver florescence contrast detected by the goggle was significantly greater in patients that received TAH than IV delivery of ICG (P = 0.013). This pilot study demonstrates the feasibility of using the fluorescence goggle to identify multifocal lesions and small tumor deposits using TAH ICG delivery in HCC patients.
authors.affiliation: Department of Radiology Washington University, St. Louis, MO 63110, USA.|Department of Biomedical Engineering Washington University, St. Louis, MO 63110, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R., China.
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Zhao
authors.affiliation: Department of Radiology Washington University, St. Louis, MO 63110, USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Akers
authors.affiliation: Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R., China.
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
authors.affiliation: Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R., China.
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.affiliation: Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R., China.
authors.forename: Hui-Chuan
authors.initials: HC
authors.lastname: Sun
authors.affiliation: Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R., China.
authors.forename: Qing-Hai
authors.initials: QH
authors.lastname: Ye
authors.affiliation: Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P.R., China.
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Radiology Washington University, St. Louis, MO 63110, USA.|Department of Biomedical Engineering Washington University, St. Louis, MO 63110, USA.|Department of Biochemistry & Molecular Biophysics, Washington University, St. Louis, MO 63110, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Achilefu
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery; D003287:Contrast Media; D003952:Diagnostic Imaging / Q000295:instrumentation* / Q000379:methods*; D005240:Feasibility Studies; D005456:Fluorescent Dyes / Q000008:administration & dosage; D006801:Humans; D007259:Infrared Rays; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D016343:Monitoring, Intraoperative
chemical_list: D003287:Contrast Media; D005456:Fluorescent Dyes
keywords: CT; FDA; Food and Drug Administration; H&E; HCC; ICG; IUS; IV; LCI; Liver Cancer Institute; MRI; NIR; PET; TAH; computed tomography; hematoxylin and eosin; hepatocellular carcinoma; indocyanine green; intraoperative ultrasonography; intravenous; magnetic resonance imaging; near infrared; positron emission tomography; transarterial hepatic