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Nerve-highlighting fluorescent contrast agents for image-guided surgery.

Summer L Gibbs-Strauss1, Khaled A Nasr, Kenneth M Fish

  • 1Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

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Summary

New fluorescent agents highlight nerves during surgery. These agents cross the blood-nerve barrier, enabling better nerve sparing and image-guided procedures to prevent surgical nerve damage.

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Area of Science:

  • Biomedical Engineering
  • Surgical Technology
  • Medical Imaging

Background:

  • Nerve damage is a significant cause of surgical morbidity, leading to chronic pain and functional loss.
  • Identifying nerves during surgery is challenging due to obscuring surrounding tissues.
  • Systemic nerve-highlighting contrast agents for image-guided surgery are currently unavailable.

Purpose of the Study:

  • To characterize novel fluorescent agents for in vivo nerve highlighting.
  • To evaluate their potential for nerve-sparing image-guided surgery.
  • To establish a foundation for developing ideal nerve-highlighting fluorophores.

Main Methods:

  • Physicochemical and optical properties of BMB and GE3082 were characterized in vitro and in vivo.
  • Agents' ability to cross the blood-nerve and blood-brain barriers was assessed.
  • Dose and kinetic studies were performed in mice, rats, and pigs, with FLARE™ imaging system utilized.

Main Results:

  • Both BMB and GE3082 successfully highlighted myelinated nerves after systemic injection by crossing key biological barriers.
  • GE3082 demonstrated a spectral shift in adipose tissue, allowing for signal elimination via hyperspectral deconvolution.
  • Simultaneous fluorescence imaging of blood vessels and nerves was achieved in pigs during surgery.

Conclusions:

  • Developed fluorescent agents can effectively highlight nerves in vivo, crossing the blood-nerve barrier.
  • GE3082's spectral properties offer improved nerve visualization by minimizing background signal.
  • These findings pave the way for advanced image-guided surgical techniques to enhance nerve preservation.