Examples of successful (5 mg/kg) and unsuccessful (2.5 mg/kg) tumor localization through dura/cortex (IMAGE)
Caption
A-E: The patient was infused intravenously with 5 mg/kg ICG approximately 24 hours before surgery. T1 MRI was performed with gadolinium at 1-mm resolution. The axial image (A) demonstrated a contrast-enhancing superficial mass extending to the cortex, consistent with a metastasis. Intraoperatively, after craniotomy and prior to dura opening, near-infrared (NIR) fluorescence was visualized in both pseudocolor overlay (B) and black and white (C), demonstrating successful visualization of the tumor through the intact dura. After durotomy, the NIR cortex view was imaged (D and E) and the localization of tumor on the dura view and cortex view was consistent (E). Demonstration of the method of signal-to-background ratio (SBR) calculation: signal = 92.7, background = 9.2, SBR = 10.1. F-J: The patient was infused intravenously with 2.5 mg/kg ICG approximately 24 hours before surgery. T1 MRI was performed with gadolinium at 1-mm resolution. The axial image (F) demonstrated a contrast-enhancing superficial mass extending to the cortex, consistent with a metastasis. Intraoperatively, after craniotomy and prior to dura opening, the NIR fluorescence image was visualized (G and H). The location of the tumor was unable to be determined solely based on the dura view. After durotomy, the NIR cortex view was visualized. In this case, the location of the tumor was successfully visualized on the cortex view. Some nonspecific signal from the skull is seen in the lower-left corner (I and J).
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Copyright 2021 AANS
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