Perfusion Patterns in Patients with Chronic Limb-Threatening Ischemia versus Control Patients Using Near-Infrared Fluorescence Imaging with Indocyanine Green

Abstract

In assessing the severity of lower extremity arterial disease (LEAD), physicians rely on clinical judgements supported by conventional measurements of macrovascular blood flow. However, current diagnostic techniques provide no information about regional tissue perfusion and are of limited value in patients with chronic limb-threatening ischemia (CLTI). Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has been used extensively in perfusion studies and is a possible modality for tissue perfusion measurement in patients with CLTI. In this prospective cohort study, ICG NIR fluorescence imaging was performed in patients with CLTI and control patients using the Quest Spectrum Platform® (Middenmeer, The Netherlands). The time–intensity curves were analyzed using the Quest Research Framework. Fourteen parameters were extracted. Successful ICG NIR fluorescence imaging was performed in 19 patients with CLTI and in 16 control patients. The time to maximum intensity (seconds) was lower for CLTI patients (90.5 vs. 143.3, p = 0.002). For the inflow parameters, the maximum slope, the normalized maximum slope and the ingress rate were all significantly higher in the CLTI group. The inflow parameters observed in patients with CLTI were superior to the control group. Possible explanations for the increased inflow include damage to the regulatory mechanisms of the microcirculation, arterial stiffness, and transcapillary leakage.

Near-Infrared Fluorescence with Indocyanine Green to Assess Bone Perfusion: A Systematic Review

“…Future studies on NIRF assessment of bone perfusion should report objective outcome measures, including maximum and relative bone fluorescence intensity, after their use is confirmed in fundamental studies. When reporting absolute perfusion parameters, van den Hoven et al propagated the normalization of the time-intensity curves to minimize the effect of multiple influencing factors, including camera distance and ICG dosage [30]. Bipartite bone perfusion raises the question on ideal NIRF camera position in relation to the evaluated bone.…”

Quantitative perfusion assessment using indocyanine green during surgery — current applications and recommendations for future use

“…The system is compatible with videos in various file types and any imaging system, as a plug and play solution [32]. The Quest Research Framework® program, which is proprietary software to the Quest Spectrum platform®, enables the generation of normalized time-intensity curves [76]. This program has a built-in motion tracker adjusting for movement, limiting influence of target area movement in the horizontal plane.…”

A quantitative assessment of perfusion of the gastric conduit after oesophagectomy using near-infrared fluorescence with indocyanine green

“…With this subjective approach, it can be challenging to distinguish well-perfused from poorly-perfused parts of the gastric conduit [12]. We hypothesized that quantification of the NIR fluorescence signal could be used to objectively assess various perfusion patterns [13].…”