Figure 8.

Illustrative case. A 47-year-old male with newly diagnosed glioblastoma multiforme (GBM) in the left temporal lobe. (A) Preoperative T1-weighted MR image with contrast showed a tumor in the left temporal lobe with ring-like enhancement (CE region). (B) Preoperative FLAIR image revealed severe peripheral edema (NCE region) surrounding the tumor mass. (C,D) Intraoperative images of the resected tumor under white light (C) and blue laser (D) observed through an optical filter (460 nm long pass). Bright red fluorescence was confirmed, particularly around the rim area that corresponded to the CE region. (E,F) Spectrum and hematoxylin and eosin stained section (original magnification ×200) obtained from the CE region. The sharp peak at 400 nm was from the excitation laser and the wider peak at 664 nm was from the TS fluorescence (E). Fluorescence intensity was calculated as the peak height (arrows) minus the baseline value at 600 nm (dotted line at the bottom). Abundant tumor cell invasion and endothelial proliferation was seen (F). (G,H) The same data obtained from the NCE region. Compared to the CE region, a lower fluorescence intensity (G) and reduced cellularity with normal brain tissue (H) were observed. a.u., arbitrary units; CE, contrast-enhanced; NCE, non-contrast-enhanced; TS, talaporfin sodium.