Fluorescence of non-neoplastic, magnetic resonance imaging-enhancing tissue by 5-aminolevulinic acid: case report.

Abstract

It has been established that fluorescence-guided resection using 5-aminolevulinic acid is useful in glioma surgery. In this study, we describe three cases in which even perinecrotic tissue could be recognized as fluorescence positive. Three cases of central nervous system disease, showing gadolinium enhancement on magnetic resonance imaging scans, were operated on with the aid of fluorescence derived from 5-aminolevulinic acid. Two of these were diagnosed as radiation necrosis and the other as a neurodegenerative demyelinating disease. In all cases, at least some parts of the gadolinium-enhanced area could be labeled as fluorescence positive, whereas centers of necrotic tissue were negative for fluorescence. Histologically, cell infiltration was marked in each case that showed fluorescence activity. Both malignant tumors and the perinecrotic area in radiation necrosis or neurodegenerative disease can be labeled as fluorescence positive using 5-aminolevulinic acid.