Protoporphyrin IX (PpIX) is a fluorophore being currently used to localize tumoral tissues. The tissue is usually excited at one wavelength, e.g., 405 nm, and the fluorescence signal is used to estimate the amount of PpIX during surgery. However, other fluorophores (baseline) whose emission spectra are close to the one of PpIX impair the quantification of PpIX and consequently the tissue pathological status classification. An efficient multi-excitation wavelengths method, free from any a priori on the baseline shape, has been proposed to cope with this issue. This method requires decorrelated measurements in the range of PpIX emission at multiple excitation wavelengths. We investigated the influence of the source bandwith on this decorelation by comparing two experimental setups using either LED or laser diode sources. The experimental setup using laser diodes for excitation increases the decorrelation by 35.3 % compared to the one using LEDs in the spectral range of PpIX emission.
Gliomas are diffuse brain tumors still hardly curable due to the difficulties to identify margins. 5-ALA induced PpIX fluorescence measurements enable to gain in sensitivity but are still limited to discriminate margin from healthy tissue. In this fluorescence spectroscopic study, we compare an expert-based model assuming that two states of PpIX contribute to total fluorescence and machine learning-based models. We show that machine learning retrieves the main features identified by the expert approach. We also show that machine learning approach slightly overpasses expert-based model for the identification of healthy tissues. These results might help to improve fluorescence-guided resection of gliomas by discriminating healthy tissues from tumor margins.
Intraoperative optical imaging is a localization technique for the functional areas of the human brain cortex during neurosurgical procedures. However, it still lacks robustness to be used as a clinical standard. In particular, new biomarkers of brain functionality with improved sensitivity and specificity are needed. We present a method for the computation of hemodynamics-based functional brain maps using an RGB camera and a white light source. We measure the quantitative oxy and deoxyhemoglobin concentration changes in the human brain cortex with the modified Beer–Lambert law and Monte Carlo simulations. A functional model has been implemented to evaluate the functional brain areas following neuronal activation by physiological stimuli. The results show a good correlation between the computed quantitative functional maps and the brain areas localized by electrical brain stimulation (EBS). We demonstrate that an RGB camera combined with a quantitative modeling of brain hemodynamics biomarkers can evaluate in a robust way the functional areas during neurosurgery and serve as a tool of choice to complement EBS.
Gliomas are diffuse brain tumors still hardly curable due to the difficulties to identify their margins. 5-ALA induced PpIX fluorescence measurements have enabled to gain in sensitivity for discriminating margin from healthy tissue but they remain limited. In this study, we assume that two states of PpIX contribute to total fluorescence. We show that fluorescence in low density margins of high grade gliomas or in low grade gliomas comes mainly from PpIX peak centered at 620 nm. These results could help to improve fluorescence-guided resection of gliomas by discriminating healthy tissues from tumor margins.
5-ALA-induced protoporphyrin IX (PpIX) has shown its relevance in medical assisting techniques, notably in the detection of glioma (brain tumors). Validation of instruments on phantoms is mandatory and a standardization procedure has recently been proposed. This procedure yields phantoms recipes to realize a linear relationship between PpIX concentration and fluorescence emission intensity. The present study puts forward phantoms where this linear relationship cannot be used. We propose a model that considers two states of PpIX, corresponding to two different aggregates of PpIX, with fluorescence spectra peaking at 634 and 620 nm, respectively. We characterize the influence of these two states on PpIX fluorescence emission spectra in phantoms with steady concentration of PpIX and various microenvironment parameters (surfactant, Intralipid or bovine blood concentration, and pH). We show that, with fixed PpIX concentration, a modification of the microenvironment induces a variation of the emitted spectrum, notably a shift in its central wavelength. We show that this modification reveals a variation of proportions of the two states. This establishes phantom microenvironment regimes where the usual single state model is biased while a linear combination of the two spectra enables accurate recovering of any measured spectra.
We show the feasibility of using an intraoperative spectroscopic device to identify tumors margins during glioma resection. The collected fluorescence spectra is fitted with two reference spectra of PpIX and the contribution of each spectrum enables to overcome the sensitivity of current techniques by seeing tumor margins and low grade gliomas.
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