Background
Currently, only x-ray fluoroscopy is available for visualization of the extrahepatic
bile ducts intraoperatively. We hypothesized that with an appropriate fluorophore
and imaging system, invisible near-infrared (NIR) light could be used for image-guided
procedures on the extrahepatic bile ducts.
Methods
We quantified the performance of three 800 nm NIR fluorophores, differing primarily
in their degree of hydrophilicity, for real-time imaging of the extrahepatic bile
ducts in rats and pigs: IR-786, indocyanine green (ICG), and the carboxylic form of
IRDye™ 800CW (CW800-CA). The signal-to-background ratio (SBR) of the common bile duct
relative to liver and pancreas was measured as a function of the dose of contrast
agent, injection site, and kinetics using an intraoperative NIR fluorescence imaging
system described previously. Bile samples were examined by high performance liquid
chromatography tandem mass spectrometry (HPLC/MS) to determine the chemical form of
fluorophores in bile.
Results
Non-sulfonated (IR-786) and di-sulfonated (ICG) NIR fluorophores had poor efficiency
and kinetics of excretion into bile. Tetra-sulfonated CW800-CA, however, provided
sensitive, specific, and real-time visualization of the extrahepatic bile ducts after
a single low-dose given either intraportally or intravenously via systemic vein. A
SBR ≥2 provided sensitive assessment of extrahepatic bile duct anatomy and function
for over 30 min post-injection, including the detection of millimeter-sized, radiolucent
inclusions in pigs. CW800-CA remained intact chemically after secretion into bile.
Conclusion
The combination of invisible NIR light and an IV injection of CW800-CA provides prolonged,
real-time visualization of the extrahepatic bile duct, without ionizing radiation
and without changing the look of the operative field.
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Article info
Publication history
Published online: May 27, 2008
Accepted:
March 25,
2008
Footnotes
This work was funded by NIH grants R01-CA-115296 and R01-EB-005805 to JVF.
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
