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Abstract：
BACKGROUND: Small bowel malperfusion (SBM) can cause high morbidity and severe surgical consequences. However, there is no standardized objective measuring tool for the quantification of SBM. Indocyanine green (ICG) imaging can be used for visualization, but lacks standardization and objectivity. Hyperspectral imaging (HSI) as a newly emerging technology in medicine might present advantages over conventional ICG fluorescence or in combination with it.
METHODS: HSI baseline data from physiological small bowel, avascular small bowel and small bowel after intravenous application of ICG was recorded in a total number of 54 in-vivo pig models. Visualizations of avascular small bowel after mesotomy were compared between HSI only (1), ICG-augmented HSI (IA-HSI) (2), clinical evaluation through the eyes of the surgeon (3) and conventional ICG imaging (4). The primary research focus was the localization of resection borders as suggested by each of the four methods. Distances between these borders were measured and histological samples were obtained from the regions in between in order to quantify necrotic changes 6 h after mesotomy for every region.
RESULTS: StO2 images (1) were capable of visualizing areas of physiological perfusion and areas of clearly impaired perfusion. However, exact borders where physiological perfusion started to decrease could not be clearly identified. Instead, IA-HSI (2) suggested a sharp-resection line where StO2 values started to decrease. Clinical evaluation (3) suggested a resection line 23 mm (±7 mm) and conventional ICG imaging (4) even suggested a resection line 53 mm (±13 mm) closer towards the malperfused region. Histopathological evaluation of the region that was sufficiently perfused only according to conventional ICG (R3) already revealed a significant increase in pre-necrotic changes in 27% (±9%) of surface area. Therefore, conventional ICG seems less sensitive than IA-HSI with regards to detection of insufficient tissue perfusion.
CONCLUSIONS: In this experimental animal study, IA-HSI (2) was superior for the visualization of segmental SBM compared to conventional HSI imaging (1), clinical evaluation (3) or conventional ICG imaging (4) regarding histopathological safety. ICG application caused visual artifacts in the StO2 values of the HSI camera as values significantly increase. This is caused by optical properties of systemic ICG and does not resemble a true increase in oxygenation levels. However, this empirical finding can be used to visualize segmental SBM utilizing ICG as contrast agent in an approach for IA-HSI. Clinical applicability and relevance will have to be explored in clinical trials.
METHODS: Not applicable. Translational animal science. Original article.
METHODS: HSI baseline data from physiological small bowel, avascular small bowel and small bowel after intravenous application of ICG was recorded in a total number of 54 in-vivo pig models. Visualizations of avascular small bowel after mesotomy were compared between HSI only (1), ICG-augmented HSI (IA-HSI) (2), clinical evaluation through the eyes of the surgeon (3) and conventional ICG imaging (4). The primary research focus was the localization of resection borders as suggested by each of the four methods. Distances between these borders were measured and histological samples were obtained from the regions in between in order to quantify necrotic changes 6 h after mesotomy for every region.
RESULTS: StO2 images (1) were capable of visualizing areas of physiological perfusion and areas of clearly impaired perfusion. However, exact borders where physiological perfusion started to decrease could not be clearly identified. Instead, IA-HSI (2) suggested a sharp-resection line where StO2 values started to decrease. Clinical evaluation (3) suggested a resection line 23 mm (±7 mm) and conventional ICG imaging (4) even suggested a resection line 53 mm (±13 mm) closer towards the malperfused region. Histopathological evaluation of the region that was sufficiently perfused only according to conventional ICG (R3) already revealed a significant increase in pre-necrotic changes in 27% (±9%) of surface area. Therefore, conventional ICG seems less sensitive than IA-HSI with regards to detection of insufficient tissue perfusion.
CONCLUSIONS: In this experimental animal study, IA-HSI (2) was superior for the visualization of segmental SBM compared to conventional HSI imaging (1), clinical evaluation (3) or conventional ICG imaging (4) regarding histopathological safety. ICG application caused visual artifacts in the StO2 values of the HSI camera as values significantly increase. This is caused by optical properties of systemic ICG and does not resemble a true increase in oxygenation levels. However, this empirical finding can be used to visualize segmental SBM utilizing ICG as contrast agent in an approach for IA-HSI. Clinical applicability and relevance will have to be explored in clinical trials.
METHODS: Not applicable. Translational animal science. Original article.
摘要：
背景：小肠灌注不良（SBM）可导致高发病率和严重的手术后果。然而,SBM的量化没有标准化的客观测量工具。吲哚菁绿（ICG）成像可用于可视化，但缺乏规范性和客观性。高光谱成像（HSI）作为一种新兴的医学技术，可能比传统的ICG荧光或与之结合具有优势。
方法：来自生理小肠的HSI基线数据，在总共54个体内猪模型中记录了静脉内应用ICG后的无血管小肠和小肠。肠系膜切开术后无血管小肠的可视化显示仅在HSI之间进行了比较(1)，ICG增强的HSI（IA-HSI）（2），通过外科医生的眼睛进行临床评估（3）和常规ICG成像（4）。主要研究重点是四种方法中每种方法所建议的切除边界的定位。测量这些边界之间的距离，并从之间的区域获得组织学样本，以量化每个区域切开术后6小时的坏死变化。
结果：StO2图像（1）能够可视化生理灌注区域和明显受损的灌注区域。然而,无法明确确定生理灌注开始减少的确切边界.相反，IA-HSI(2)提出了一个尖锐的切除线,其中StO2值开始降低。临床评价(3)建议切除线23mm(±7mm),并且常规ICG成像(4)甚至建议切除线53mm(±13mm)更靠近不灌注区域。仅根据常规ICG（R3）进行充分灌注的区域的组织病理学评估已经显示出27％（±9％）表面积的坏死前变化显着增加。因此,在检测组织灌注不足方面，常规ICG似乎不如IA-HSI敏感。
结论：在本实验动物研究中，IA-HSI(2)在节段性SBM的可视化方面优于常规HSI成像(1)，关于组织病理学安全性的临床评估（3）或常规ICG成像（4）。ICG应用在HSI相机的StO2值中引起视觉伪影,因为数值显著增加。这是由全身性ICG的光学特性引起的，与氧合水平的真正增加并不相似。然而,这一经验发现可用于在IA-HSI方法中利用ICG作为造影剂可视化节段性SBM。临床适用性和相关性必须在临床试验中进行探索。
方法：不适用。翻译动物科学。原创文章。
方法：来自生理小肠的HSI基线数据，在总共54个体内猪模型中记录了静脉内应用ICG后的无血管小肠和小肠。肠系膜切开术后无血管小肠的可视化显示仅在HSI之间进行了比较(1)，ICG增强的HSI（IA-HSI）（2），通过外科医生的眼睛进行临床评估（3）和常规ICG成像（4）。主要研究重点是四种方法中每种方法所建议的切除边界的定位。测量这些边界之间的距离，并从之间的区域获得组织学样本，以量化每个区域切开术后6小时的坏死变化。
结果：StO2图像（1）能够可视化生理灌注区域和明显受损的灌注区域。然而,无法明确确定生理灌注开始减少的确切边界.相反，IA-HSI(2)提出了一个尖锐的切除线,其中StO2值开始降低。临床评价(3)建议切除线23mm(±7mm),并且常规ICG成像(4)甚至建议切除线53mm(±13mm)更靠近不灌注区域。仅根据常规ICG（R3）进行充分灌注的区域的组织病理学评估已经显示出27％（±9％）表面积的坏死前变化显着增加。因此,在检测组织灌注不足方面，常规ICG似乎不如IA-HSI敏感。
结论：在本实验动物研究中，IA-HSI(2)在节段性SBM的可视化方面优于常规HSI成像(1)，关于组织病理学安全性的临床评估（3）或常规ICG成像（4）。ICG应用在HSI相机的StO2值中引起视觉伪影,因为数值显著增加。这是由全身性ICG的光学特性引起的，与氧合水平的真正增加并不相似。然而,这一经验发现可用于在IA-HSI方法中利用ICG作为造影剂可视化节段性SBM。临床适用性和相关性必须在临床试验中进行探索。
方法：不适用。翻译动物科学。原创文章。
