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Quantification of ICG fluorescence for the evaluation of intestinal perfusion: comparison between two software-based algorithms for quantification

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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.

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Acknowledgements

The authors are grateful to Guy Temporal for proofreading the manuscript.

Funding

This work was supported by the ARC Foundation for cancer research (ELIOS project, www.fondation-arc.org) and the Odense University Hospital Free Research Fund (Grant No. 34-A1806). The funding sources had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

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Authors and Affiliations

  1. Research Unit for Surgery, Odense University Hospital, J. B. Winsløws Vej 4, Indgang 20, Penthouse, 5000, Odense C, Denmark

    Kristina Gosvig, Signe Steenstrup Jensen, Niels Qvist & Mark Bremholm Ellebæk

  2. University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark

    Kristina Gosvig, Signe Steenstrup Jensen, Niels Qvist & Mark Bremholm Ellebæk

  3. Department of Surgical Gastroenterology, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, Afsnit 2212, 2100, Copenhagen, Denmark

    Nikolaj Nerup

  4. IHU-Strasbourg, Institute of Image-Guided Surgery, 1 Place de l’Hôpital, 67091, Strasbourg, France

    Vincent Agnus & Michele Diana

  5. IRCAD, Research Institute Against Digestive Cancer, 1 Place de l’Hôpital, 67091, Strasbourg, France

    Michele Diana

  6. Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 1 Rue David Richard, 67000, Strasbourg, France

    Michele Diana

  7. ICube Lab, Photonics Instrumentation for Health, 300 Bd Sébastien Brant, 67400, Illkirch-Graffenstaden, France

    Michele Diana

Authors
  1. Kristina Gosvig
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  2. Signe Steenstrup Jensen
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  3. Niels Qvist
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  4. Nikolaj Nerup
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  5. Vincent Agnus
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  6. Michele Diana
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  7. Mark Bremholm Ellebæk
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Corresponding author

Correspondence to Kristina Gosvig.

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Disclosures

Michele Diana is a member of the Advisory Board of Diagnostic Green. Drs. Kristina Gosvig, Signe Steenstrup Jensen, Niels Qvist, Nikolaj Nerup, Vincent Agnus, and Mark Bremholm Ellebæk have no conflicts of interest or financial ties to disclose.

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Gosvig, K., Jensen, S.S., Qvist, N. et al. Quantification of ICG fluorescence for the evaluation of intestinal perfusion: comparison between two software-based algorithms for quantification. Surg Endosc 35, 5043–5050 (2021). https://doi.org/10.1007/s00464-020-07986-7

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  • DOI: https://doi.org/10.1007/s00464-020-07986-7

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