Near-Infrared Window II Fluorescence Image-Guided Surgery of High-Grade Gliomas Prolongs the Progression-Free Survival of Patients

Biophysics Medical Imaging Life Sciences Neurosurgery Medicine Oncology
Near-Infrared Window II Fluorescence Image-Guided Surgery High-Grade Gliomas Progression-Free Survival Surgical Outcome

Research Process

Near-Infrared Window II Fluorescence Imaging-Guided Surgery Prolongs Progression-Free Survival for High-Grade Glioma Patients

Research Background

High-grade glioma (HGG) is the most common malignant primary tumor in the central nervous system, with glioblastoma (GBM) having the worst prognosis. To improve the treatment outcomes for GBM patients, increase tumor resection rates during surgery, and reduce postoperative recurrence, researchers have conducted studies on surgery-guiding strategies based on near-infrared window II (NIR-II) fluorescence imaging. NIR-II fluorescence imaging features low tissue autofluorescence and deep penetration depth, promising to improve the precision and safety of tumor resection.

Paper Information

This study was jointly completed by Dr. Xiaojing Xia, Dr. Zhe Zhang, and others, who are affiliated with the Key Laboratory of Molecular Imaging of the Institute of Automation, Chinese Academy of Sciences, and several other research institutions. The results were published in the IEEE Transactions on Biomedical Engineering (Vol. 69, No. 6, June 2022). The article was received in November 2021 and the final version was published in May 2022.

Research Process

The research design was divided into several key steps:

a) Equipment Construction: The research team developed a multispectral imaging system capable of real-time acquisition of color, NIR-I (700-900 nm), and NIR-II (1000-1700 nm) images.

b) Patient Inclusion: Patients suspected to have newly diagnosed, untreated, and operable gliomas were included. Patients were randomly assigned to either fluorescence-guided surgery (FGS) or traditional white-light-guided surgery (WLS) groups.

c) Intraoperative Fluorescence Imaging: Patients in the FGS group were intravenously injected with indocyanine green (ICG) 48 hours before surgery and underwent intraoperative NIR-II fluorescence imaging.

d) Data Analysis: The study compared the complete resection rates, progression-free survival (PFS), overall survival (OS), and neurological function status between the two groups. It also performed fluorescence imaging and pathological diagnosis of tissue samples, analyzing the correlation between fluorescence intensity and tumor grade.

Research Results

The research results indicated:

  • The GBM detection rate in the FGS group was 100%. Surgery guided by NIR-II fluorescence imaging significantly improved the complete resection rate of the tumors.
  • The median PFS for the FGS group was 9 months, compared to 7 months for the WLS group. The median OS for the FGS group was 19 months, compared to 15.5 months for the WLS group.
  • Patients maintained good neurological function. The intraoperative NIR-II fluorescence imaging technology showed potential in protecting patients’ neurological functions.

Research Significance and Innovations

  • Scientific Value: The NIR-II FGS technology can significantly increase the total resection rate of GBM tumors and extend patients’ PFS and OS, providing a new precise and safe guiding strategy for GBM surgery.
  • Application Value: The study supports the application of NIR-II FGS technology in brain tumor surgeries, potentially enhancing surgical outcomes, reducing tumor recurrence rates, and improving patients’ long-term quality of life.
  • Novelty: The developed multispectral imaging system, combined with the FDA-approved ICG probe, provides a basis for clinical application of NIR-II fluorescence imaging, promoting the development and application of optical imaging technology in brain tumor surgeries.

Other Information

  • The study received support from the National Key Research and Development Program and the National Natural Science Foundation.
  • High-grade glioma WHO III patients were also separately analyzed, and the results indicated that NIR-II FGS could also improve surgical outcomes.

Conclusion

This study validated the clinical application prospects of NIR-II fluorescence imaging-guided surgery in high-grade gliomas, providing robust technical support for achieving precise neurosurgical procedures and offering new therapeutic hope for patients with GBM and other brain tumors.