Mechanistic Background and Clinical Applications of Indocyanine Green Fluorescence Imaging of Hepatocellular Carcinoma

Abstract

Preserved portal uptake of ICG in differentiated HCC cells by NTCP and OATP8 with concomitant biliary excretion disorders causes accumulation of ICG in the cancerous tissues after preoperative intravenous administration. This enables highly sensitive identification of HCC by intraoperative ICG fluorescence imaging.

Review on near-infrared heptamethine cyanine dyes as theranostic agents for tumor imaging, targeting, and photodynamic therapy

“…53 The ICG in combination with NIFR imaging of HCC has been developed for intraoperative navigation during open surgery and laparoscopic surgery. 54,55 But it is known that ICG can make normal tissues emit fluorescence signals with high intensity during some surgical procedures, such as partial nephrectomy, 56 which is similar to the observations made in ICG-receiving (i.v. route) mouse models for monitoring renal perfusion.…”

“…53 In addition, Ishizawa et al found that the portal uptake of ICG in HCC cells is mediated by Na þ ∕taurocholate transport protein and OATP1B3 after preoperative intravenous administration. 54 Serum components, such as albumin and low-density lipoprotein (LDL), play important roles in the delivery of hydrophobic NIRF dye to cells. For example, Pz 247 is taken up by cells into lysosomes through LDL receptor-mediated endocytosis, leading to accumulation in lysosomes and accompanied NIR emission.…”

Technical description and feasibility of laparoscopic adrenal contouring using fluorescence imaging

“…Tobis et al [15] demonstrated the feasibility of ICG to distinguish cortical tumors from normal tissue in partial nephrectomies. Ishizawa et al [16] described the identification and resection of hepatocarcinomas using ICG and near-infrared light.…”

Role of (Drug) Transporters in Imaging in Health and Disease

“…Of note, the latter study also demonstrated NTCP-mediated ICG transport. The in vivo relevance of these findings on ICG is supported by the positive association of ICG accumulation in hepatocellular carcinomas with the expression of NTCP and OATP1B3 (Ishizawa et al, 2014). ICG is excreted into bile by the ATP-binding cassette (ABC) transporter multidrug resistance-associated transporter (MRP) 2.…”