Intraoperative fluorescence imaging systems. (A) Dual-channel FLARE imaging system [,], (B) endoscopic imaging system [], (C) multiscale multispectral imaging system [,], and (D) da Vinci Surgical System []. NIR, near-infrared; CCD, charge-coupled device; LED, light emitting diode; FLARE, Fluorescence-Assisted Resection and Exploration.|@|~(^,^)~|@|The NIR window and NIR fluorophores for image-guided surgery. (A) In vivo penetration of fluorescence light and photon travel according to wavelength [], and (B) chemical structures and optical properties of NIR fluorophores for MB, ICG, and ZW800-1 []. NIR, near-infrared; MB, methylene blue; ICG, indocyanine green.|@|~(^,^)~|@|Dual-channel imaging of cartilage and bone. (A) Chemical structures of C700-OMe [] and P800SO3 [] for cartilage- and bone-specific imaging, respectively. (B) Simultaneous cartilage and bone imaging in mice (top) and pigs (bottom). Scale bars=1 cm. C700-SO3 and P800-SO3 were injected intravenously 4 hours prior to imaging [].|@|~(^,^)~|@|Intraoperative imaging of vasculature and nerves. (A) Atherosclerotic (top) and normal (bottom) arteries from a rabbit injected with 1.5 mg/kg of ICG 45 minutes prior to imaging []. Scale bar=2 cm. (B) Intraoperative cardiac imaging using IR786-labeled bone marrow stem cells in a Yorkshire pig []. (C) Intraoperative imaging of brachial plexus and sciatic nerve 4 hours post-injection of Ox4 (200 nmol) in Sprague-Dawley rats []. Arrowheads indicate fluorescence signals in nervous tissue and bundles. Scale bars=1 cm. NIR, near-infrared; MB, methylene blue; ICG, indocyanine green.|@|~(^,^)~|@|Clinical imaging of the thymus in young child patients and preclinical imaging of the thymus in rodents and pigs. (A) CT scan shows a thymus with enlarged lymph nodes and a thymic mass with a necrotic core []. CT, computed tomography. (B) Ultrasound of a normal thymus (arrows) with smooth borders and echotexture between liver and thyroid []. AA, aortic arch; PA, pulmonary artery. (C) A CT/sagittal positron emission tomography scan showing a normal thymus in a young patient with Burkitt lymphoma injected with 18F-FDG []. Arrows indicate thymic tissues without FDG avidity. FDG, fludeoxyglucose. (D) Chemical structure of Ox170 and intraoperative thymus imaging in mice. Dose-dependent imaging of Ox170 was obtained 4 hours after an intravenous injection []. (E) 10 μmol of Ox170 was injected into 35-kg Yorkshire pigs 8 hours prior to imaging []. Th, thymus (arrowhead); He, heart; Lu, lung; LN, lymph node; Ne, nerve; Tr, trachea; TG, thyroid gland (arrow). Scale bars=1 cm.|@|~(^,^)~|@|Intraoperative tumor-specific imaging in lungs. (A) Adenocarcinomas in a lung tumor mouse model injected with 6CQNIR fluorophores (20 nmol) 6 hours prior to imaging []. Cancerous lung tissues highlighted with increased fluorescence (white dashed circle) were then analyzed by hematoxylin and eosin (H&E) staining. Scale bars=100 μm. (B) Preoperative CT and intraoperative fluorescence imaging of thymic carcinosarcoma []. An anterior mediastinal mass was resected in a patient with primary sarcoma via NIR fluorescence image guidance after injecting ICG 24 hours prior to resection (5 mg/kg). (C) Thoracoscopic tumor imaging highlighted by a percutaneous injection of ICG (0.5 mL; <0.125 mg/mL) 15 minutes prior to imaging into lung cancer patients []. Lobectomy of primary lung cancer was performed in all patients. Resected tumor specimen with lung nodule highlighted in yellow circle. (D) NIR imaging was used to detect a pulmonary nodule tumor 24 hours after injection of 5 mg/kg of ICG during open thoracotomy []. H&E staining was performed on resected tumors and an NIR microscopy image was taken under a 760-nm light source at ×100 magnification. NIR, near-infrared; ICG, indocyanine green; CT, computed tomography.|@|~(^,^)~|@|SLN resection in mice, pigs, and humans using small-molecule fluorophores. (A) Chemical structures of ICG, ESNF14, and ZW800-3a. (B) 100 nmol (0.1 mL, 1 mg/mL) of ICG solution was injected into the armpit of a mouse 10 minutes prior to imaging and resection. NIR, color, and merged images obtained before and after resection of SLNs []. (C) NIR fluorescence-guided SLN mapping and resection was performed in humans 10–15 minutes after injection of ICG (1–2 mL, 2.5 mg/mL) []. (D) Dual-channel intraoperative NIR imaging of pan lymph nodes and SLN mapping. ESNF14 (5 nmol) was injected intradermally (NIR #1, red) and 320 nmol of ZW800-3a (NIR #2, lime green) was injected intravenously into the same Yorkshire pig 5 minutes and 4 hours before imaging, respectively []. Circle indicates SLN; arrowheads indicate pan lymph nodes. SLN, sentinel lymph node; ICG, indocyanine green; NIR, near-infrared.

Korean J Thorac Cardiovasc Surg 2019;52:205~220 https://doi.org/10.5090/kjtcs.2019.52.4.205