title: Real-Time In Vivo Characterization of Primary Liver Tumors With Diffuse Optical Spectroscopy During Percutaneous Needle Interventions: Feasibility Study in Woodchucks.
abstract: OBJECTIVE
  This study presents the first in vivo real-time optical tissue characterization during image-guided percutaneous intervention using near-infrared diffuse optical spectroscopy sensing at the tip of a needle. The goal of this study was to indicate transition boundaries from healthy tissue to tumors, namely, hepatic carcinoma, based on the real-time feedback derived from the optical measurements.
  
  
  METHODS
  Five woodchucks with hepatic carcinoma were used for this study. The woodchucks were imaged with contrast-enhanced cone beam computed tomography with a flat panel detector C-arm system to visualize the carcinoma in the liver. In each animal, 3 insertions were performed, starting from the skin surface toward the hepatic carcinoma under image guidance. In 2 woodchucks, each end point of the insertion was confirmed with pathologic examination of a biopsy sample. While advancing the needle in the animals under image guidance such as fluoroscopy overlaid with cone beam computed tomography slice and ultrasound, optical spectra were acquired at the distal end of the needles. Optical tissue characterization was determined by translating the acquired optical spectra into clinical parameters such as blood, water, lipid, and bile fractions; tissue oxygenation levels; and scattering amplitude related to tissue density. The Kruskal-Wallis test was used to study the difference in the derived clinical parameters from the measurements performed within the healthy tissue and the hepatic carcinoma. Kurtoses were calculated to assess the dispersion of these parameters within the healthy and carcinoma tissues.
  
  
  RESULTS
  Blood and lipid volume fractions as well as tissue oxygenation and reduced scattering amplitude showed to be significantly different between the healthy part of the liver and the hepatic carcinoma (P < 0.05) being higher in normal liver tissue. A decrease in blood and lipid volume fractions and tissue oxygenation as well as an increase in scattering amplitude were observed when the tip of the needle crossed the margin from the healthy liver tissue to the carcinoma. The kurtosis for each derived clinical parameter was high in the hepatic tumor as compared with that in the healthy liver indicating intracarcinoma variability.
  
  
  CONCLUSIONS
  Tissue blood content, oxygenation level, lipid content, and tissue density all showed significant differences when the needle tip was guided from the healthy tissue to the carcinoma and can therefore be used to identify tissue boundaries during percutaneous image-guided interventions.
authors.affiliation: From the *Interventional X-ray Department, Philips Healthcare, Best; †In-Body Systems Department, Philips Research, Eindhoven, the Netherlands; Departments of ‡Radiology and §Veterinary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; and Departments of ∥Molecular Pathology and ¶Surgical Oncology, Netherland Cancer Institute, Amsterdam, the Netherlands.
authors.forename: Rami
authors.initials: R
authors.lastname: Nachabé
authors.forename: Benno H W
authors.initials: BH
authors.lastname: Hendriks
authors.forename: Ross
authors.initials: R
authors.lastname: Schierling
authors.forename: Jasmine
authors.initials: J
authors.lastname: Hales
authors.forename: Judy M
authors.initials: JM
authors.lastname: Racadio
authors.forename: Sven
authors.initials: S
authors.lastname: Rottenberg
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Ruers
authors.forename: Drazenko
authors.initials: D
authors.lastname: Babic
authors.forename: John M
authors.initials: JM
authors.lastname: Racadio
mesh_terms: D000818:Animals; D003199:Computer Systems; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005240:Feasibility Studies; D061705:Image-Guided Biopsy / Q000295:instrumentation / Q000379:methods*; D008113:Liver Neoplasms / Q000737:chemistry* / Q000473:pathology*; D008392:Marmota; D009339:Needles; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013057:Spectrum Analysis / Q000379:methods*