Quantitative nontumorous and tumorous human brain tissue assessment using microstructural co- and cross-polarized optical coherence tomography

Konstantin S Yashin,Lidia B Timofeeva,Grigory V Gelikonov,Alexander A Moiseev,Elena B Kiseleva,Elena V Zagaynova,Sergey S Kuznetsov,Natalia D Gladkova,Igor А Medyanik,Leonid Ya Kravets,Nadezhda P Pavlova

doi:10.1038/s41598-019-38493-y

Konstantin S Yashin, Lidia B Timofeeva + Show 9 more

Open Access

https://doi.org/10.1038/s41598-019-38493-y

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Abstract

Optical coherence tomography (OCT) is a promising method for detecting cancer margins during tumor resection. This study focused on differentiating tumorous from nontumorous tissues in human brain tissues using cross-polarization OCT (CP OCT). The study was performed on fresh ex vivo human brain tissues from 30 patients with high- and low-grade gliomas. Different tissue types that neurosurgeons should clearly distinguish during surgery, such as the cortex, white matter, necrosis and tumorous tissue, were separately analyzed. Based on volumetric CP OCT data, tumorous and normal brain tissue were differentiated using two optical coefficients — attenuation and forward cross-scattering. Compared with white matter, tumorous tissue without necrotic areas had significantly lower optical attenuation and forward cross-scattering values. The presence of particular morphological patterns, such as necrosis and injured myelinated fibers, can lead to dramatic changes in coefficient values and create some difficulties in differentiating between tissues. Color-coded CP OCT maps based on optical coefficients provided a visual assessment of the tissue. This study demonstrated the high translational potential of CP OCT in differentiating tumorous tissue from white matter. The clinical use of CP OCT during surgery in patients with gliomas could increase the extent of tumor resection and improve overall and progression-free survival.

Highlights

In the adult population, gliomas are the most common central nervous system tumors (34%)[1,2]
The tissue types that should be identified during tumor resection are not limited by the terms “tumorous” and “nontumorous” tissues and comprise gray matter, white matter, tumor tissue, and necrosis
Active application of optical coherence tomography (OCT) to clinical practice is determined by the clear benefits of this method, such as using near infrared light sources with no risk of tissue damage, high resolution (~10 micron), no need for contrast agents, imaging depths of more than 1 mm, and imaging at a distance, enabling integration into a surgical microscope or endoscope[17]

Summary

Introduction

Gliomas are the most common central nervous system tumors (34%)[1,2]. Due to infiltrative growth into surrounding brain tissue, differentiating tumorous and nontumorous tissue to achieve total tumor resection is difficult[6,7,11]. Intraoperative imaging technologies such as 5-ALA-guided resection and intraoperative MRI may be beneficial in maximizing the extent of resection[12,13,14,15], but these methods have some limitations (for example, the necessity of using contrast agents). Tumorous and nontumorous tissues can be differentiated by OCT using qualitative[23,27] or quantitative assessment[22,23,28,29] of OCT images. The potential and limitations of the tissue differentiation method remain unclear

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