Multimodal imaging in radioguided surgery

Radioguided surgery (RGS) utilizes radiolabeled tracers that accumulate in the lesion of interest following local or systemic administration. RGS is an expanding surgical guidance technology, but unfortunately most currently available radiotracers are unable to provide intraoperative optical information regarding the location of the lesion. In 2011, a new hybrid tracer (both radioactive and fluorescent) was introduced for sentinel lymph node detection. This hybrid tracer (indocyanine green-99mTc-nanocolloid) has helped to generate a new hybrid surgical guidance concept, thereby expanding the traditional RGS-based approach. Based on its radioactive signature a hybrid tracer is able to preserve the “traditional” role for RGS. Furthermore, as an additional tool in the operating room, a hybrid tracer provides optical information via fluorescence guidance. This review discusses the most common RGS approaches. Different clinically used radioactive tracers and their potential hybrid derivatives are also discussed. Furthermore, the various imaging devices designed for radioactivity-based detection are reviewed in the context of generating hybrid-imaging modalities.