2024, Vol. 28 ›› Issue (32): 5225-5230

Near-infrared fluorescence imaging for intraoperative neuroimaging: current applications and future development

Gao Wenping1, Zhang Zhihua2, Han Fei1, Hao Weiguo1   

Abstract: BACKGROUND: Existing neuroimaging techniques, including magnetic resonance imaging, computed tomography, and high-resolution ultrasound, lack the capability to provide real-time intraoperative positioning images to surgeons. However, the clinical implementation of near-infrared fluorescence imaging technology has made it possible to directly visualize surgical target areas, offering a novel solution for real-time nerve identification during surgery.
OBJECTIVE: To provide a summary and overview of the research progress in near-infrared fluorescence imaging technology for intraoperative neuroimaging.
METHODS: The first author used the computer to search for the documents published from January 2010 to July 2023 in WanFang, CNKI, and PubMed with the key words of “near-infrared fluorescence imaging, optical imaging, nerve imaging” in Chinese and English. A few classic old documents were also included. Initial screening was performed by reading the titles and abstracts; duplicate, low-quality, and irrelevant content documents were excluded. A total of 69 articles were finally included for review.
RESULTS AND CONCLUSION: Near-infrared fluorescence imaging guided by indocyanine green has been clinically used to identify and locate tubular organs such as blood vessels, ureters, and bile ducts, as well as various tumors during surgery. This technique is currently considered a well-established imaging method in precision surgery. In the field of intraoperative neurofluorescence imaging, indocyanine green is currently the only near-infrared fluorescent dye used in clinical research. The ideal neuroimaging agent should possess certain characteristics, including easy administration in the perioperative period, logD between 0.5 and 3 at pH=7.4, molecular mass below 500 Da, excitation and emission wavelengths within the near-infrared window, long-term retention in nerve tissue, high signal-to-background ratio, and high safety. In the future, the development of near-infrared neurofluorescence imaging agents should focus on synthesizing complexes of indocyanine green and neural-specific targets. This technology not only enables intraoperative neurofluorescence imaging, but also holds promising prospects for in-situ monitoring of nerve regeneration and diagnosis of neurological diseases.

Key words: near-infrared fluorescence imaging technology, optical imaging, neuroimaging, fluorescence-guided surgery, contrast agent, precision surgery, indocyanine green, targeted surgery