Significance: Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has proven to be a feasible application for real-time intraoperative assessment of tissue perfusion, although quantification of NIR fluorescence signals is pivotal for standardized assessment of tissue perfusion. Aim: Four patients are described with possible compromised bowel perfusion after mesenteric resection. Based on these patients we want to emphasize the difficulties in the quantification of NIR fluorescence imaging for perfusion analysis. Approach: During image-guided fluorescence assessment, 5 mg of ICG (2.5 mg / ml) was intravenously administered by the anesthesiologist. NIR fluorescence imaging was done with the open camera system of Quest Medical Imaging. Fluorescence data taken from the regions of interest (bowel at risk, transition zone of bowel at risk and adjacent normally perfused bowel, and normally perfused reference bowel) were quantitatively analyzed after surgery for fluorescence intensity-and perfusion time-related parameters. Results: Bowel perfusion, as assessed clinically by independent surgeons based on NIR fluorescence imaging, resulted in different treatment strategies, three with excellent clinical outcome, but one with a perfusion related complication. Post-surgery quantitative analysis of fluorescence dynamics showed different patterns in the affected bowel segment compared to the unaffected reference segments for the four patients. Conclusions: Similar intraoperative fluorescence results could lead to different surgical treatment strategies, which demonstrated the difficulties in interpretation of uncorrected fluorescence signals. Real-time quantification and standardization of NIR fluorescence perfusion imaging could probably aid surgeons in the nearby future.

中文翻译：

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使用吲哚菁绿进行定量动态近红外荧光成像分析肠系膜切除术后肠道灌注

意义：使用吲哚菁绿 (ICG) 的近红外 (NIR) 荧光成像已被证明是组织灌注实时术中评估的可行应用，尽管 NIR 荧光信号的量化对于组织灌注的标准化评估至关重要。目的：描述了四名患者在肠系膜切除术后可能出现肠道灌注受损。基于这些患者，我们想强调在灌注分析中量化 NIR 荧光成像的困难。方法：在图像引导荧光评估期间，麻醉师静脉注射 5 毫克 ICG（2.5 毫克/毫升）。NIR 荧光成像是使用 Quest Medical Imaging 的开放式相机系统完成的。来自感兴趣区域的荧光数据（有风险的肠道，手术后定量分析处于危险中的肠和相邻正常灌注肠以及正常灌注参考肠的过渡区的荧光强度和灌注时间相关参数。结果：由独立外科医生根据 NIR 荧光成像进行临床评估的肠灌注导致了不同的治疗策略，三种具有出色的临床结果，但一种具有灌注相关并发症。荧光动力学的术后定量分析显示，与四名患者的未受影响的参考段相比，受影响的肠段的模式不同。结论：类似的术中荧光结果可能导致不同的手术治疗策略，这表明解读未校正的荧光信号存在困难。