Abstract
Current clinical imaging modalities do not reliably identify brain tissue regions with necrosis following radiotherapy. This creates challenges for stereotaxic biopsies and surgical-decision making. Time-resolved fluorescence spectroscopy (TRFS) provides a means to rapidly identify necrotic tissue by its distinct autofluorescence signature resulting from tissue breakdown and altered metabolic profiles in regions with radiation damage. Studies conducted in a live animal model of radiation necrosis demonstrated that necrotic tissue is characterized by respective increases of 27% and 108% in average lifetime and redox ratio, when compared with healthy tissue. Moreover, radiation-damaged tissue not visible by MRI but confirmed by histopathology, was detected by TRFS. Current results demonstrate the ability of TRFS to identify radiation-damaged brain tissue in real-time and indicates its potential to assist with surgical guidance and MRI-guided biopsy procedures.
Highlights
Radiation-induced brain necrosis is a complication of radiation therapy (RT) which presents as an irreversible, progressive necrotic lesion within a few weeks after initial treatment, or can appear years after the initial treatment [1]
The current study demonstrates that necrotic tissue has three primary fluorescence features distinguishing it from healthy brain tissue: an increase in average lifetime at all wavelengths (Fig. 4(B)), an increased redox ratio (Fig. 4(F)), both attributed to metabolic changes in tissue, and a decrease in intensity at 400-420 nm, attributed to changes in tissue extracellular matrix (ECM) and morphology (Fig. 4(A))
This study demonstrates in a live rat model the ability of Time-resolved fluorescence spectroscopy (TRFS) to differentiate radiation-induced brain necrosis from normal brain based on the tissue’s intrinsic molecular contrast
Summary
Radiation-induced brain necrosis is a complication of radiation therapy (RT) which presents as an irreversible, progressive necrotic lesion within a few weeks after initial treatment, or can appear years after the initial treatment [1]. Delineation of radiation-induced necrosis in the brain has been attempted with a variety of preoperative imaging modalities, but with limited success. Magnetic resonance imaging (MRI) has produced varied results in identifying radiation-induced necrosis and recurrent tumor margins [3, 4]. Single-photon emission computed tomography (SPECT) has good specificity for diagnosis, but suffers from poor resolution [6]. Positron emission tomography has improved resolution but less specificity compared to SPECT [7]. While these imaging modalities show promise, pathological assessment of biopsied tissue obtained during invasive and time-intensive surgery or stereotaxic biopsy is still the clinical gold standard [8]
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