PMC6000743_01
Representative image of the ICG-PDE system during operation in case 1, which showed fluorescence of the main HCC (A; thick arrow) and portal vein tumor thrombus in the right portal vein (B; thin arrow). The portal vein was taped; RPV, right portal vein, LPV, left portal vein. C; The preoperative MRI showed main tumor (thick arrow) and tip of thrombus (thin arrow). D; Resected specimen showed main tumor (thick arrow) and tip of thrombus (thin arrow).
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These could be compared to preoperative images and specimen as Fig. 2C and D.
PMC6000743_02
A; The resected adrenal gland was strongly fluorescent and was diagnosed as a metastatic gland by histological examination. The preoperative CT and resected specimen showed metastasis of HCC in adrenal gland (B and C; double-headed arrow).
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By confirming the fluorescent spot in the right adrenal gland (Fig. 3A), the adrenal gland was also resected and histological examination revealed metastasis of HCC. The comparative preoperative CT image and resected specimen of metastatic adrenal gland tumor (Fig. 3B and C).
PMC6000743_03
The fluorescent tissue was locally resected and was diagnosed as a metastatic lymph node of HCC by histological examination cted adrenal gland was srescent lesion could be seen in the vena cava wall (B; thick arrow) and the tumor thrombus in the vena cava could be resected (C). The preoperative CT and resected metastatic TT of HCC in vena cava (D and E; thick arrow).
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TT in the vena cava could not be observed by the outline appearance because of postoperative adhesive connective tissue; however, the fluorescent metastatic node lesion and the venous wall were visualized by ICG-PDE (Fig. 4A and B). Thus, the TT could be completely resected, which was also confirmed by ICG-PDE (Fig. 4C). The comparative preoperative CT image and resected specimen of TT attached wall of vena cava (Fig. 4D and E). The specimen showed a mild chronic hepatitis.