Quantitative perfusion assessment using indocyanine green during surgery — current applications and recommendations for future use

• Published in: Langenbeck's archives of surgery Vol. 408; no. 1; p. 67
• Main Authors: Van Den Hoven, P., Osterkamp, J., Nerup, N., Svendsen, M. B. S., Vahrmeijer, Alexander, Van Der Vorst, J. R., Achiam, M. P.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 26-01-2023
• Subjects: Abdominal Surgery; Cardiac Surgery; General Surgery; Humans; Indocyanine Green; Medicine; Medicine & Public Health; Perfusion; Review; Thoracic Surgery; Traumatic Surgery; Vascular Surgery; Indocyanine green; Quantification; Near-infrared fluorescence imaging; Perfusion
• ISSN: 1435-2451; 1435-2443; 1435-2451
• DOI: 10.1007/s00423-023-02780-0

Purpose
Incorrect assessment of tissue perfusion carries a significant risk of complications in surgery. The use of near-infrared (NIR) fluorescence imaging with Indocyanine Green (ICG) presents a possible solution. However, only through quantification of the fluorescence signal can an objective and reproducible evaluation of tissue perfusion be obtained. This narrative review aims to provide an overview of the available quantification methods for perfusion assessment using ICG NIR fluorescence imaging and to present an overview of current clinically utilized software implementations.
Methods
PubMed was searched for clinical studies on the quantification of ICG NIR fluorescence imaging to assess tissue perfusion. Data on the utilized camera systems and performed methods of quantification were collected.
Results
Eleven software programs for quantifying tissue perfusion using ICG NIR fluorescence imaging were identified. Five of the 11 programs have been described in three or more clinical studies, including Flow® 800, ROIs Software, IC Calc, SPY-Q™, and the Quest Research Framework®. In addition, applying normalization to fluorescence intensity analysis was described for two software programs.
Conclusion
Several systems or software solutions provide a quantification of ICG fluorescence; however, intraoperative applications are scarce and quantification methods vary abundantly. In the widespread search for reliable quantification of perfusion with ICG NIR fluorescence imaging, standardization of quantification methods and data acquisition is essential.