Intraoperative Imaging-Guided Cancer Surgery: From Current Fluorescence Molecular Imaging Methods to Future Multi-Modality Imaging Technology

Abstract

Cancer is a major threat to human health. Diagnosis and treatment using precision medicine is expected to be an effective method for preventing the initiation and progression of cancer. Although anatomical and functional imaging techniques such as radiography, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have played an important role for accurate preoperative diagnostics, for the most part these techniques cannot be applied intraoperatively. Optical molecular imaging is a promising technique that provides a high degree of sensitivity and specificity in tumor margin detection. Furthermore, existing clinical applications have proven that optical molecular imaging is a powerful intraoperative tool for guiding surgeons performing precision procedures, thus enabling radical resection and improved survival rates. However, detection depth limitation exists in optical molecular imaging methods and further breakthroughs from optical to multi-modality intraoperative imaging methods are needed to develop more extensive and comprehensive intraoperative applications. Here, we review the current intraoperative optical molecular imaging technologies, focusing on contrast agents and surgical navigation systems, and then discuss the future prospects of multi-modality imaging technology for intraoperative imaging-guided cancer surgery.

Gliomas: Motexafin Gadolinium-enhanced Molecular MR Imaging and Optical Imaging for Potential Intraoperative Delineation of Tumor Margins

“…This improves tumor visualization during surgery and allows for more complete tumor resection (13). Fluorescence-guided resection with 5-aminolevulinic acid also has been used as a promising tool in localizing tumors and guiding resection (5,(13)(14)(15). However, each of these modalities has inherent limitations and disadvantages.…”

“…MGd has been used in clinical trials as a radiation and chemotherapy sensitizer (23,(28)(29)(30), an intracellular tumor-related deaths worldwide (1,2). To achieve the most durable long-term survival benefit for patients with gliomas, complete eradication of tumors while sparing the normal brain parenchyma remains the most challenging task for neurosurgeons (3,6,14,15). Because of this daunting task in patients with gliomas, numerous intraoperative imaging-guided surgical techniques have been developed in an effort to extend survival and improve quality of life (5,6,12,25,26).…”

Novel l_2,1-norm optimization method for fluorescence molecular tomography reconstruction

“…Therefore, more effective and universal reconstruction methods need be developed in the future. It is believed that FMT will provide more potentials for earlier detection and characterization of the disease and evaluation of the treatment with rapid development of 3-D reconstruction algorithms [45].…”

Theranostic Probes for Targeting Tumor Microenvironment: An Overview

“…This assists the doctors efficiently, especially during key-hole or laparoscopic surgery to view the inner body image and to monitor the surgery [6]. Thus, optical imaging proves to be a powerful tool for intra-operative imaging due to its high sensitivity and specificity, guiding the doctors to perform precise procedures.…”