Metabolic Dysfunction-Associated Fatty Liver Disease Impairs Intraoperative Indocyanine Green Fluorescence Cholangiography Quality: Development and Validation of a Predictive Model

Zhujiang Hospital150 enrolled

Overview

Near-infrared fluorescence cholangiography has been shown to improve the clinical outcomes of laparoscopic cholecystectomy (LC). However, it remains unclear whether hepatic steatosis in patients with metabolic dysfunction-associated fatty liver disease (MAFLD) influences the quality of indocyanine green fluorescence imaging (ICG-FI), and whether the quality can be predicted preoperatively. This study aimed to evaluate the impact of MAFLD on intraoperative fluorescence quality and to develop a multiple linear regression model for predicting intraoperative ICG-FI.

Study Type

OBSERVATIONAL

Enrollment

150

Conditions

MAFLD Cholecystitis Gallbladder Polyps Cholelithiasis

Interventions

Retrospective observational study without intervention measures

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age 18-75 years, any sex; 2. Definite surgical indication for cholecystectomy; 3. Underwent LC; 4. No severe contraindications such as significant cardiac, pulmonary, renal, or cerebral dysfunction. Exclusion Criteria: 1. Known allergy to ICG or iodinated contrast agents; 2. Use of medications affecting biliary excretion within 2 weeks prior to surgery; (3) LC without ICG-FI; (4) Incomplete clinical data.

Outcomes

Primary Outcomes

Common bile duct FI / Liver background FI (C/L)

The common bile duct-to-liver background fluorescence intensity ratio (C/L) \[Unit: Dimensionless number\] \[Time Frame: Perioperative period\] \[Measurement steps: Three photographs per case were obtained with the following requirements: Calot's triangle centred in the image, liver background positioned superiorly, and the CBD inferiorly, ensuring all measurement sites were visible and unobstructed. Each image was converted to greyscale, and regions of interest (ROI) of \>3000 pixels were selected for each critical structure to calculate FI. The mean FI from the three images was recorded as the final value for each structure.\]

Time frame: Perioperative period

Secondary Outcomes

Qualitative assessment of fluorescence visualization

Qualitative assessment of fluorescence visualization. \[Time Frame: Perioperative period\] \[Unit: Dimensionless number\] \[Measurement steps: It was performed by three senior surgeonsScores were averaged and graded on a five-point scale adapted from previous studies (1=completely invisible, impairs visualization; 2=poor, faint fluorescence, no added value; 3= visible but blurred, some added value; 4=good, clear visualization with significant added value; 5= excellent, very clear visualization with typical added value)\]