Beyond fluorescence intensity: a Minimum acquisition and reporting standard and emerging technologies for colorectal indocyanine green fluorescence angiography studies - Summary - MDSpire
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Beyond fluorescence intensity: a Minimum acquisition and reporting standard and emerging technologies for colorectal indocyanine green fluorescence angiography studies
To propose a standard for acquisition and reporting in colorectal indocyanine green fluorescence angiography (ICG-FA) to improve comparability and support multicenter validation.
Approach:
Background: ICG-FA is used to assess bowel perfusion during colorectal anastomosis, but current protocols and reporting are heterogeneous, which complicates the interpretation of results.
Main message: ICG-FA's effectiveness is influenced by various factors, including injection technique and camera geometry, and single fluorescence-intensity snapshots are not reliable for comparison due to substantial interobserver variability.
Proposal: A minimum acquisition and reporting standard is proposed, including consistent reporting of ICG administration, physiological status, imaging conditions, camera geometry, analysis methodology, measured outcomes, decision impact, and software/version details.
Key Findings:
Pooled randomized evidence supports the benefit of ICG-FA, particularly in left-sided and rectal surgeries.
Interobserver variability in visual interpretation of ICG-FA is substantial.
Time-intensity kinetics and spatial heterogeneity measures are more reproducible than single intensity measures.
Interpretation:
The focus should shift from whether ICG-FA is beneficial to how its signal is acquired, quantified, interpreted, and reported.
Limitations:
Current evidence on kinetic metrics is preliminary and requires multicenter validation.
Variability in acquisition protocols can obscure clinically meaningful associations.
Conclusion:
Standardization in ICG-FA practices is essential for improving comparability and supporting multicenter validation.
