Imaged guided surgery during arteriovenous malformation of gastrointestinal stromal tumor using hyperspectral and indocyanine green visualization techniques: A case report

Figure 1 Preoperative diagnostics contrast enhanced computed tomography and axial positron emission tomography. A: Coronal contrast enhanced computed tomography; B: Axial contrast enhanced computed tomography shows an exophytic mass of the jejunum (measuring 7 cm × 4 cm), heterogenous contrast enhancement and irregular margins, with partial necrosis; C: Contrast enhanced computed tomography and axial positron emission tomography.

Figure 2 Intraoperative exploration and detection of the arteriovenous malformation and complete resection of the tumour and the supplying mesenteric arcade. A: Impression of the tumour after exploration; B: Diaphanoscopy of the tumour and the supplying arteries and veins; C: Tumourmass after resection.

Figure 3 Intraoperative presentation and intraoperative calculation of the optical hyperspectral imaging parameters via TIVITA^® tissue. Circles represent the “region of interest” and the dotted line shows the selected resection margins before incision. A: Red–green–blue (RGB) image of the tumour; B: Tissue water index (TWI) of the tumour with the regions of interest (ROI) and planed resection margins; C: TWI of the tumour focused only on the resection margins; D: RGB of the tumour, focused on the antimesenteric side; E: Near-Infra-Red of the tumour with the ROI and planed resection margins, focused on the antimesenteric side; F: TWI of the tumour focused only on the resection margins, focused on the antimesenteric side.

Figure 4 Early and late onset image of the anterior side posterior side of the tumor mass after indocyanine green application and simultaneous observation of the arteriovenous malformations using fluorescence imaging device. A: Anterior side, early onset image of the tumor mass after indocyanine green application; B: Anterior side, late onset image of the tumor mass after indocyanine green application; C: Posterior side, early onset image of the tumor mass after indocyanine green application; D: Posterior side, onset image of the tumor mass after indocyanine green application.

Figure 5 Images acquired via TIVITA^® Tissue system (Diaspective Vision GmbH, Am Salzhaff, Germany). The software provides a red–green–blue image (RGB image) and four false-color images with an effective number of 640 × 480 pixels, which respectively represent tissue oxygenation, near-infrared perfusion index, tissue water index, and organ hemoglobin index[5]. A: Red–green–blue image; B: Oxygenation; C: Near infra-red perfusion index; D: Organ hemoglobin index; E: Tissue- water- index.

Figure 6 Comparison of the hyperspectral parameters of the macroscopic healthy, pathological transformed gut and the tumor mass/AV- fistula. HSI: Hyperspectral imaging; TWI: Tissue water index.