Quantitative Fluorescence Imaging of Perfusion—An Algorithm to Predict Anastomotic Leakage

Abstract

This study tests fluorescence imaging-derived quantitative parameters for perfusion evaluation of the gastric tube during surgery and correlates these parameters with patient outcomes in terms of anastomotic leakage. Poor fundus perfusion is seen as a major factor for the development of anastomotic leakage and strictures. Fluorescence perfusion imaging may reduce the incidence of complications. Parameters for the quantification of the fluorescence signal are still lacking. Quantitative parameters in terms of maximal intensity, mean slope and influx timepoint were tested for significant differences between four perfusion areas of the gastric tube in 22 patients with a repeated ANOVA test. These parameters were compared with patient outcomes. Maximal intensity, mean slope and influx timepoint were significantly different between the base of the gastric tube and the fundus (p < 0.0001). Patients who developed anastomotic leakage showed a mean slope of almost 0 in Location 4. The distance of the demarcation of ICG to the fundus was significantly higher in the three patients who developed anastomotic leakage (p < 0.0001). This study presents quantitative intra-operative perfusion imaging with fluorescence. Quantification of the fluorescence signal allows for early risk stratification of necrosis.

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

“…Interestingly, three perfusion patterns were reported: the 'normal flow' pattern that was similar to our pattern 1, the 'inflow delayed' pattern that was similar to our pattern 3, and the 'outflow delayed' pattern that was similar to our pattern 2. A study by Jansen et al [14] analysed quantitative ICG-FA videos of 20 patients undergoing oesophagectomy with gastric conduit reconstruction. Four preselected ROI's were analysed.…”

Feasibility of Novel Software-Based Perfusion Indicators for the Ileal J-Pouch—On the Path towards Objective and Quantifiable Intraoperative Perfusion Assessment with Indocyanine Green Near-Infrared Fluorescence

“…A graphic depiction of fluorescence intensity over time for defined ROIs resulted in perfusion graphs, which in turn were composed of perfusion curves following a reproducible pattern. So far, only a few clinical feasibility studies mention perfusion-time curves; however, none investigate the ileal J-pouch in a standardized manner or examine ingress and egress in detail [ 39 , 40 ].…”

Perfusion assessment by fluorescence time curves in esophagectomy with gastric conduit reconstruction: a prospective clinical study

“…In the group without AL ( n = 18), the mean slope was 2.0 (± 2.41) compared to 0.2 (± 0.07) in the group with AL ( n = 4). [ 21 ]. To find a statistical difference in the slope at a significance level of 0.05 and with a power of 80%, the least count of the group with AL should be at least 17 patients.…”