ArticleActa neurochirurgica2020
Validating a new generation filter system for visualizing 5-ALA-induced PpIX fluorescence in malignant glioma surgery: a proof of principle study.
Article in Acta neurochirurgica, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Hyperspectral imaging for tumor resection guidance in surgery: a systematic review of preclinical and clinical studies.Journal of biomedical optics · 2025Pooled it
- Machine Learning-Based Fluorescence Assessment for Augmented Imaging and Decision Support in Glioblastoma Resections.Cancers · 2026Article
- Imaging lymphatic function and inflammation response through hypoxia via endogenous biomarker.Journal of biomedical optics · 2026Article
- Emerging uses of 5-aminolevulinic-acid-induced protoporphyrin IX in medicine: a review of multifaceted, ubiquitous, molecular diagnostic, therapeutic, and theranostic opportunities.Journal of biomedical optics · 2025Review
- Integrating mass spectrometry and hyperspectral imaging for protoporphyrin IX detection in malignant glioma tissue.Scientific reports · 2025Article
- Review
- The abscopal effects of sonodynamic therapy in cancer.British journal of cancer · 2025Review
- Predicting intraoperative 5-ALA-induced tumor fluorescence via MRI and deep learning in gliomas with radiographic lower-grade characteristics.Journal of neuro-oncology · 2025Article
- Review
- Towards machine learning-based quantitative hyperspectral image guidance for brain tumor resection.Communications medicine · 2024Article
- A Wearable Fluorescence Imaging Device for Intraoperative Identification of Human Brain Tumors.IEEE journal of translational engineering in health and medicine · 2024Article
- Second-Generation Wide-Field Visualization Devices for 5-ALA-Induced Fluorescence and Concepts for Validation in Neurosurgery-A Systematic Review.Neurosurgery practice · 2023Review
- Hyperspectral imaging benchmark based on machine learning for intraoperative brain tumour detection.NPJ precision oncology · 2023Article
- Comparison of minimal detectable protoporphyrin IX concentrations with a loupe device and conventional 5-ALA fluorescence microscopy: an experimental study.Journal of biomedical optics · 2023Article
- Assessment of open-field fluorescence guided surgery systems: implementing a standardized method for characterization and comparison.Journal of biomedical optics · 2023Article
- Intraoperative molecular imaging: 3rd biennial clinical trials update.Journal of biomedical optics · 2023Review
- 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy.Bioengineering (Basel, Switzerland) · 2023Review
- Challenges in, and recommendations for, hyperspectral imaging in ex vivo malignant glioma biopsy measurements.Scientific reports · 2023Article
- Unraveling the blue shift in porphyrin fluorescence in glioma: The 620 nm peak and its potential significance in tumor biology.Frontiers in neuroscience · 2023Article
- Suppression of angiotensin converting enzyme 2, a host receptor for SARS-CoV-2 infection, using 5-aminolevulinic acid in vitro.PloS one · 2023Article
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe BLUE 400 filter system (Carl Zeiss Meditec, Oberkochen, Germany) has provided visualization of 5-ALA-induced fluorescence-guided surgery for more than 20 years. Nevertheless, constraints, e.g., limited background discrimination during hemostasis, obstruct fluency of surgery. A novel filter with improved background visualization was developed, requiring validation regarding fluorescence discrimination. The aim of this article is to determine diagnostic accuracy and perception of protoporphyrin IX (PpIX) discrimination of a novel filter system with higher background illumination (BLUE 400 AR) compared with the gold standard, BLUE 400.
methodsA surgical microscope equipped with both BLUE 400 and BLUE 400 AR was used. Comparisons were performed on a biological basis and on the visual perception of margins. High-resolution images were compared during and after surgery by senior neurosurgeons. In a predefined biopsy algorithm, four biopsies per patient at tumor margins of PpIX fluorescence and adjacent brain were acquired using BLUE 400 AR only from regions intended for resection and assessed for cell count and density.
resultsThirty-two patients with malignant gliomas were included in this study. BLUE 400 AR markedly enhanced the brightness of the surgical field, allowing superior discrimination of brain anatomy. A total of 128 biopsies from fluorescence margins were collected. Positive predictive value (PPV) was 98.44% (95% CI, 90.06-99.77%) for malignant glioma. Residual median cell density in non-fluorescent tissue was 13% (IQR 13 to 31). Perception of the location of fluorescent margins on HD images was equivalent for both filter combinations.
conclusionsBLUE 400 AR demonstrated superior background compared with conventional BLUE 400 in malignant glioma surgery but comparable fluorescence margins and PPV. Therefore, BLUE 400 AR can be considered safe and effective in supporting malignant glioma surgery.
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