Fig. 7.

ISX characterization of plasma-derived PpIX-positive EVs from patients with malignant glioma following 5-ALA administration for FGS with both avidly fluorescent and minimally fluorescent tumors. (a) Avidly fluorescent tumor: The T1-post-gadolinium-contrast axial MRI (left) shows the posterior left temporal tumor which demonstrated avid intraoperative fluorescence under the blue light of the microscope (right); ISX scatter plot of representative patient plasma before 5-ALA (left) and following 5-ALA (right). (b) Minimally fluorescent tumor: The T1-post-gadolinium-contrast axial MRI shows the left occipital tumor (left) which demonstrated minimal intraoperative fluorescence under the blue light of the microscope (right); ISX scatter plot of representative patient plasma before 5-ALA (left) and following 5-ALA (right). (c) Line-plot of pre-5-ALA and post-5-ALA levels for patients with avidly fluorescent tumors (red) and minimally fluorescent tumors (gray). The dotted line represents the threshold (t) of background fluorescent signal prior to 5-ALA dosing based on this population. (d) Bar graph indicating the fold change (post-5-ALA/pre-5-ALA levels) of PpIX-positive EV signal for patients with avidly fluorescent tumors (red) and patients with minimally fluorescent tumors (gray). (e) Pearson correlation of enhancing tumor volumes and fold change of PpIX-fluorescent EV signal from the 4 patients with avidly fluorescenct tumors (f) ISX scatter plots of Patient 2 plasma: pre-5-ALA, post-5-ALA (intraoperative, 3.5 h post-dosing), 2 weeks post-FGS, and 6 weeks post-FGS; wks = weeks. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)