Standardized and Quantitative ICG Perfusion Assessment: Feasibility and Reproducibility in a Multicentre Setting
Life, vol. 15, pp. 1868
Abstract
Indocyanine green near-infrared fluorescence (ICG-NIRF) imaging is widely used to assess tissue perfusion, yet its subjective interpretation limits correlation with postoperative parathyroid function. To address this, the Workflow model for ICG-angiography integrating Standardization and Quantification (WISQ) was developed. This exploratory prospective multicenter study evaluated the reproducibility of WISQ in adults undergoing total thyroidectomy at two Dutch university centres. Patients with contraindications to ICG or prior neck surgery were excluded. Intraoperative imaging used standardized camera settings with blood volume-adjusted ICG dosing, and perfusion curves were analyzed using predefined regions of interest. Eighty patients were included. Significant inter-centre variability was observed in maximum fluorescence intensity, inflow slope, and outflow slope (n = 30). At the lead centre, outflow was the most promising predictor of postoperative hypoparathyroidism (HPT) (median −0.33 [IQR −0.49–−0.15] a.f.u./s for HPT vs. −0.68 [−0.91–−0.41], n = 17, p = 0.08), although no parameter significantly predicted HPT. Repeated ICG injections consistently produced lower maximal intensities irrespective of injection rate, and reproducible curves were achieved only when ICG was freshly dissolved at 0.5 mg/mL instead of 2.5 mg/mL. These findings indicate that ICG concentration and injection technique influence perfusion kinetics and underscore the need to update WISQ with standardized injection dilution to improve its clinical utility.
Authors 15
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University Medical Center Groningen
Affiliation as printed
Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
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University Medical Center Groningen · Karolinska Institutet
Affiliation as printed
Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden
Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
Department of Plastic Surgery, Karolinska Institutet, SE-171 77 Stockholm, Sweden
Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
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Erasmus MC · Erasmus MC Cancer Institute
Affiliation as printed
Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
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University Medical Center Groningen
Affiliation as printed
Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
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University Medical Center Groningen
Affiliation as printed
Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
Department of Radiology, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
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Affiliation as printed
Department of Surgery, Frisius MC, 8934 AD Leeuwarden, The Netherlands
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University Medical Center Groningen · Martini Ziekenhuis
Affiliation as printed
Department of Surgery, Martini Hospital, 9728 NT Groningen, The Netherlands
Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
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Erasmus MC · Erasmus MC Cancer Institute
Affiliation as printed
Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
Erasmus MC Academic Centre for Thyroid Disease, Department of Surgery, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
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University Medical Center Groningen · Martini Ziekenhuis
Affiliation as printed
Department of Surgery, Martini Hospital, 9728 NT Groningen, The Netherlands
Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
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University Medical Center Groningen
Affiliation as printed
Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
TRACER Europe BV, 9723 JJ Groningen, The Netherlands
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Affiliation as printed
Department of Medicinal Chemistry, Photopharmacology and Imaging, Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands
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University Medical Center Groningen · Martini Ziekenhuis
Affiliation as printed
Department of Surgery, Martini Hospital, 9728 NT Groningen, The Netherlands
Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
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Schelto Kruijff corresponding
University Medical Center Groningen · Karolinska Institutet
Affiliation as printed
Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden
Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
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