A multispectral fluorescence imaging system: Design and initial clinic tests in intra-operative photofrin-photodynamic therapy of brain tumors

Background and Objectives: Intra-operative identification of tumor by fluorescence may improve surgical resection or photodynamic therapy (PDT). A novel instrument was designed, constructed, and tested for this purpose. Study Design/Materials and Methods: The instrument was designed to provide high-resolution, multi-spectral (five band) fluorescence imaging, and non-contact point spectroscopy, with long working distance (similar to50 cm), large field-of-view (similar to3 cm diameter), large depth of view (similar to2 cm), and 'point-and-shoot' operation. Its performance was determined in tissue-simulating phantoms and in pilot studies in brain tumor resection patients, with or without intra-operative Photofrin-PDT. Results: In phantoms the imaging resolution was similar to150 mum, while Photofrin concentrations as low as 0.05 or 0.1 mug/g could be detected at the tissue surface or at 0.5 mm depth, respectively. Red Photofrin fluorescence could be clearly visualized post radical resection in all PDT patients, with biopsy confirmation of residual tumor tissue in regions that were not seen as tumor under white light. Photobleaching of Photofrin during PDT was also demonstrated. Conclusions: The system performed to specification under realistic operating conditions and could reveal unresected residual tumor tissue. It may be used for either PDT dosimetry/monitoring and/or for surgical guidance. (C) 2003 Wiley-Liss, Inc.