Intraoperative Parathyroid Localization Using DOCI

使用 DOCI 进行术中甲状旁腺定位

• 批准号: 10054185
• 负责人: MAIE A ST JOHN
• 金额: $ 48.15万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-12-05 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10054185
• 关键词: Anesthesia procedures; Award; Beds; Belief; Biopsy; Bone Density; Calcium; Clinical; Clinical Protocols; Clinical Trials; Companions; Data; Diagnostic; Disease of parathyroid glands; Dyslipidemias; Ensure; Excision; Fatty acid glycerol esters; Feedback; Generations; Gland; Goals; Histologic; Histology; Hypercalcemia; Hyperparathyroidism; Hyperplasia; Image; Image Analysis; Image-Guided Surgery; Imagery; Imaging Device; Imaging technology; Insulin Resistance; Lead; Length; Lesion; Lighting; Location; Lymph; Maps; Measurement; Methods; Morbidity - disease rate; Multi-Institutional Clinical Trial; Neck; Nephrolithiasis; Nerve; Operative Surgical Procedures; Optical Methods; Optics; PTH gene; Palpation; Parathyroid Gland Tissue; Parathyroid gland; Parathyroidectomy; Pathologic; Patient-Focused Outcomes; Patients; Postoperative Period; Preparation; Procedures; Prognosis; Property; Research; Resected; Residual state; Risk; Sampling; Sensitivity and Specificity; Speed; Surgeon; System; Techniques; Technology; Testing; Thymic Tissue; Thyroid Diseases; Thyroidectomy; Time; Tissues; Validation; Visual; Work; adenoma; base; contrast imaging; cost; efficacy evaluation; efficacy validation; imaging modality; imaging system; improved; improved outcome; in vivo; in vivo imaging system; instrument; lens; novel; optical imaging; preservation; prevent; prospective; real-time images; risk minimization; standard of care; tool

Project Abstract Primary hyperparathyroidism, often caused by a single adenoma (80-85%) or four-gland hyperplasia (10-15%), can lead to elevated parathyroid hormone (PTH) levels and resultant hypercalcemia. Surgical excision of offending lesions is the standard of care, as the removal of pathologic adenomas reduces PTH and calcium values to baseline and avoids the risk of associated morbidities like insulin resistance, dyslipidemia, low mineral bone density, and nephrolithiasis. The small size, variable location, and indistinct external features of parathyroid glands can make their identification quite challenging intraoperatively. Distinguishing them from adjacent fat, lymph tissue, or thymus tissue may be complicated further in previously operated necks. Patient prognosis depends heavily on complete resection of the involved parathyroid glands. The inability to accurately localize the parathyroid glands during parathyroidectomy and thyroidectomy procedures can prevent patients from achieving postoperative normocalcemia. There is a critical need for an improved intraoperative method for real-time parathyroid localization. The goal of this proposal is to develop new optical methods based on Dynamic Optical Contrast Imaging (DOCI) characterized by speed, low cost, and improved sensitivity and specificity, for enhancing intraoperative parathyroid localization. The imaging system leverages a novel realization of temporally dependent measurements of tissue autofluorescence that allow the acquisition of specific tissue properties over a large field of view. This system is optimized such that it can be used by surgeons at the time of resection surgery to localize parathyroid tissue and has been extensively validated in ex vivo samples. Companion histology has verified the sensitivity and specificity of the technique. In the proposed work we will reconfigure the imaging system for a large field of view (FOV), then pursue an intraoperative study using DOCI to localize parathyroid tissue. Companion visible imagery and histology will be analyzed at all stages of the work ensuring statistical diagnostic power of the technique. The goal of these surgeries is to remove the diseased thyroid or parathyroid tissues while minimizing risks to surrounding nerves and vessels. Noninvasive, real-time imaging methods that can accurately and efficiently identify parathyroid gland tissue in vivo and differentiate it from surrounding neck tissues would be transformative in gland localization. We hypothesize that the accuracy and efficiency of parathyroid resection will improve significantly when aided by our optical imaging technology. This intraoperative instrument would be the first of its kind, giving us the potential to significantly improve the rapid localization of parathyroid tissue, thus enabling the surgeon to preserve healthy tissue and improve patient outcomes.

项目摘要 原发性甲状旁腺功能亢进，通常由单个腺瘤（80-85%）或四腺增生（10-15%）引起， 可导致甲状旁腺激素（PTH）水平升高并导致高钙血症。手术切除 侵犯性病变是标准治疗，因为切除病理性腺瘤会降低PTH和钙 并避免了相关疾病的风险，如胰岛素抵抗、血脂异常、低血糖、低血糖和高血糖。 矿物质骨密度和肾结石小的尺寸，可变的位置，和模糊的外部特征， 甲状旁腺在术中的识别是相当困难的。使他们不同于 邻近的脂肪、淋巴组织或胸腺组织可能在先前手术的颈部中进一步复杂化。患者 预后很大程度上取决于所涉及的甲状旁腺的完全切除。无法准确 在甲状旁腺切除术和甲状腺切除术中定位甲状旁腺可以防止患者 术后血钙正常迫切需要一种改进的术中方法， 实时甲状旁腺定位该提案的目标是开发新的光学方法， 动态光学对比成像（DOCI）的特点是速度快，成本低，灵敏度提高， 特异性，用于增强术中甲状旁腺定位。成像系统利用了一种新颖的 实现组织自发荧光的时间依赖性测量， 在大视场内观察特定组织特性。该系统经过优化，可用于 外科医生在切除手术时定位甲状旁腺组织，并已在 离体样品。伴随组织学已经证实了该技术的敏感性和特异性。在 建议的工作，我们将重新配置成像系统的大视场（FOV），然后追求 使用DOCI定位甲状旁腺组织的术中研究。伴随可见图像和组织学将是 在工作的所有阶段进行分析，确保该技术的统计诊断能力。这些目标 手术的目的是切除病变的甲状腺或甲状旁腺组织，同时将周围神经的风险降至最低。 和船只。可以准确有效地识别甲状旁腺的非侵入性实时成像方法 体内的腺体组织并将其与周围的颈部组织区分开来将对腺体产生变革 本地化我们假设甲状旁腺切除术的准确性和效率将显著提高 在我们的光学成像技术的帮助下这种手术器械将是同类器械中的第一种， 使我们有可能显著提高甲状旁腺组织的快速定位，从而使 保护健康组织并改善患者结局。