Quantification of ICG fluorescence for the evaluation of intestinal perfusion: comparison between two software-based alg
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Quantification of ICG fluorescence for the evaluation of intestinal perfusion: comparison between two software‑based algorithms for quantification Kristina Gosvig1,2 · Signe Steenstrup Jensen1,2 · Niels Qvist1,2 · Nikolaj Nerup3 · Vincent Agnus4 · Michele Diana4,5,6,7 · Mark Bremholm Ellebæk1,2 Received: 6 June 2020 / Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Indocyanine green fluorescence imaging (ICG-FI) can be used to evaluate intestinal perfusion prior to anastomosis. Several software for the quantification of fluorescence have emerged, but these have not previously been compared. The aim of this study was to compare the results from quantitative ICG-FI analysis of relative perfusion in an experimental setting using two different software-based quantification algorithms (FLER and Q-ICG). Methods Twenty pigs received a laparotomy, and ischemic areas were created in three segments of the small intestine of each pig. For each ischemic area, fluorescence imaging was performed and the fluorescence recordings were quantitatively analyzed using FLER and Q-ICG. The quantitative analysis resulted in a set of perfusion lines for each software for either 30%, 60% or 100% relative perfusion. The perfusion lines were compared by registering the normalized slope for each set of perfusion lines, calculating the relative perfusion percentage in the FLER perfusion line according to Q-ICG, and measuring the length of the ischemic area for each analysis. Results Fifty-four fluorescence recordings from 18 pigs were included. The ischemic segment for FLER was significantly longer in the 30% perfusion group and significantly shorter in the 100% perfusion group as compared to Q-ICG. The normalized slope for the FLER perfusion lines was significantly higher in the 30% perfusion group and significantly lower in the 100% perfusion group as compared to the Q-ICG perfusion lines. For the perfusion lines defined by FLER as 30%, 60%, and 100%, Q-ICG found 35.2% (p = 0.07), 63.7% (p = 0.31), and 84.1% perfusion (p = 0.003) respectively. Conclusion The two software demonstrated significant differences in quantitative fluorescence analysis when perfusion was either very high or very low. The clinical relevance of these differences is unclear. Keywords Fluorescence-guided surgery · Indocyanine green · Quantification of fluorescence · Experimental surgery · Perfusion imaging · Abdominal surgery Establishing sufficient blood supply to the anastomotic area during gastrointestinal resection may reduce the risk of anastomotic leakage, which remains a major concern in several
gastrointestinal procedures [1]. The fluorescent properties of indocyanine green (ICG) have been used for the evaluation of perfusion in numerous surgical procedures, i.e., skin-flap
* Kristina Gosvig [email protected]
4
IHU‑Strasbourg, Institute of Image-Guided Surgery, 1 Place de l’Hôpital, 67091 Strasbourg, France
5
IRCAD, Research Institu
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