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Spectroscopie de fluorescence et imagerie optique pour l'assistance à la résection de gliomes : conception et caractérisation de systèmes de mesure et modèles de traitement des données associées, sur fantômes et au bloc opératoire

Laure Alston 1, 2
2 RMN et optique : De la mesure au biomarqueur
CREATIS - Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé
Abstract : Gliomas are infiltrative tumors of the brain which are yet hardly curable, notably because of the difficulty to precisely delimitate their margins during surgery. Intraoperative 5-ALA induced protoporphyrin IX (PpIX) fluorescence microscopy has shown its relevance to assist neurosurgeons but lacks sensitivity. In this thesis, we perform a spectroscopic clinical trial on 10 patients with the assumption that collected fluorescence is a linear combination of the contribution of two states of PpIX which proportions vary with the density of tumor cells. This work starts with the development of the intraoperative, portable and real time fluorescence spectroscopic device that provides multi-wavelength excitation. Then, we show its use on PpIX phantoms with tissues mimicking properties. This first enables to obtain a reference emitted spectrum for each state apart and then permits the development of a fitting model to adjust any emitted spectrum as a linear combination of the references in the spectral band 608-637 nm. Next, we present the steps led to get approvals for the clinical trial, especially the risk analysis. In vivo data analysis is then presented, showing that we detect fluorescence where current microscopes cannot, which could exhibit a change in PpIX state from glioma center to its margins. Besides, the relevance of multi-wavelength excitation is highlighted as the correlation between the three measured spectra of a same sample decreases with the density of tumor cells. Finally, the complementary need to intraoperatively identify cerebral functional areas is tackled with optical measurements as a perspective and other properties of PpIX on phantoms are also raised
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Laure Alston. Spectroscopie de fluorescence et imagerie optique pour l'assistance à la résection de gliomes : conception et caractérisation de systèmes de mesure et modèles de traitement des données associées, sur fantômes et au bloc opératoire. Ingénierie biomédicale. Université de Lyon, 2017. Français. ⟨NNT : 2017LYSE1295⟩. ⟨tel-02076932⟩

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