Multifunctional in vivo imaging for monitoring wound healing using swept-source polarization-sensitive optical coherence tomography

Visualization enhancement by PCA-based image fusion for skin burns assessment in polarization-sensitive OCT

Polarization-sensitive optical coherence tomography (PS-OCT) is a functional imaging tool for measuring tissue birefringence characteristics. It has been proposed as a potentially non-invasive technique for evaluating skin burns. However, the PS-OCT modality usually suffers from high system complexity and relatively low tissue-specific contrast, which makes assessing the extent of burns in skin tissue difficult. In this study, we employ an all-fiber-based PS-OCT system with single-state input, which is simple and efficient for skin burn assessment. Multiple parameters, such as phase retardation (PR), degree of polarization uniformity (DOPU), and optical axis orientation, are obtained to extract birefringent features, which are sensitive to subtle changes in structural arrangement and tissue composition. Experiments on ex vivo porcine skins burned at different temperatures were conducted for skin burn investigation. The burned depths estimated by PR and DOPU increase linearly with the burn temperature to a certain extent, which is helpful in classifying skin burn degrees. We also propose an algorithm of image fusion based on principal component analysis (PCA) to enhance tissue contrast for the multi-parameter data of PS-OCT imaging. The results show that the enhanced images generated by the PCA-based image fusion method have higher tissue contrast, compared to the en-face polarization images by traditional mean value projection. The proposed approaches in this study make it possible to assess skin burn severity and distinguish between burned and normal tissues.

Advanced Wound Diagnostics: Toward Transforming Wound Care into Precision Medicine

Significance: Nonhealing wounds are an ever-growing global pandemic, with mortality rates and management costs exceeding many common cancers. Although our understanding of the molecular and cellular factors driving wound healing continues to grow, standards for diagnosing and evaluating wounds remain largely subjective and experiential, whereas therapeutic strategies fail to consistently achieve closure and clinicians are challenged to deliver individualized care protocols. There is a need to apply precision medicine practices to wound care by developing evidence-based approaches, which are predictive, prescriptive, and personalized. Recent Advances: Recent developments in "advanced" wound diagnostics, namely biomarkers (proteases, acute phase reactants, volatile emissions, and more) and imaging systems (ultrasound, autofluorescence, spectral imaging, and optical coherence tomography), have begun to revolutionize our understanding of the molecular wound landscape and usher in a modern age of therapeutic strategies. Herein, biomarkers and imaging systems with the greatest evidence to support their potential clinical utility are reviewed. Critical Issues: Although many potential biomarkers have been identified and several imaging systems have been or are being developed, more high-quality randomized controlled trials are necessary to elucidate the currently questionable role that these tools are playing in altering healing dynamics or predicting wound closure within the clinical setting. Future Directions: The literature supports the need for the development of effective point-of-care wound assessment tools, such as a platform diagnostic array that is capable of measuring multiple biomarkers at once. These, along with advances in telemedicine, synthetic biology, and "smart" wearables, will pave the way for the transformation of wound care into a precision medicine. Clinical Trial Registration number: NCT03148977.

Deep-learning approach for automated thickness measurement of epithelial tissue and scab using optical coherence tomography

SIGNIFICANCE

In order to elucidate therapeutic treatment to accelerate wound healing, it is crucial to understand the process underlying skin wound healing, especially re-epithelialization. Epidermis and scab detection is of importance in the wound healing process as their thickness is a vital indicator to judge whether the re-epithelialization process is normal or not. Since optical coherence tomography (OCT) is a real-time and non-invasive imaging technique that can perform a cross-sectional evaluation of tissue microstructure, it is an ideal imaging modality to monitor the thickness change of epidermal and scab tissues during wound healing processes in micron-level resolution. Traditional segmentation on epidermal and scab regions was performed manually, which is time-consuming and impractical in real time.

AIM

We aim to develop a deep-learning-based skin layer segmentation method for automated quantitative assessment of the thickness of in vivo epidermis and scab tissues during a time course of healing within a rodent model.

APPROACH

Five convolution neural networks were trained using manually labeled epidermis and scab regions segmentation from 1000 OCT B-scan images (assisted by its corresponding angiographic information). The segmentation performance of five segmentation architectures was compared qualitatively and quantitatively for validation set.

RESULTS

Our results show higher accuracy and higher speed of the calculated thickness compared with human experts. The U-Net architecture represents a better performance than other deep neural network architectures with 0.894 at F1-score, 0.875 at mean intersection over union, 0.933 at Dice similarity coefficient, and 18.28  μm at an average symmetric surface distance. Furthermore, our algorithm is able to provide abundant quantitative parameters of the wound based on its corresponding thickness maps in different healing phases. Among them, normalized epidermal thickness is recommended as an essential hallmark to describe the re-epithelialization process of the rodent model.

CONCLUSIONS

The automatic segmentation and thickness measurements within different phases of wound healing data demonstrates that our pipeline provides a robust, quantitative, and accurate method for serving as a standard model for further research into effect of external pharmacological and physical factors.

Orthogonal-polarization-gating optical coherence tomography for human sweat ducts in vivo

We propose an orthogonal-polarization-gating optical coherence tomography (OPG-OCT) for human sweat ducts in vivo. OPG-OCT is composed of the orthogonal linearly polarized light of a sample arm individually interfering with orthogonal linearly polarized lights of the reference arms, where OPG-OCT induces two images, one reflecting the projection intensity and the other the horizontal linear diattenuation (HLD). The results demonstrate that OPG-OCT projection intensity could improve the image quality of sweat ducts. HLD also clearly illustrates the spiral shape of the sweat ducts. Finally, sweat ducts in intensity image are segmented by employing convolutional neural networks (CNN). The proportions of left-handed and right-handed ducts are extracted to characterize the sweat ducts based on HLD. Therefore, the OPG-OCT technique employing CNN for the human sweat glands has the potential to automatically identify the human sweat ducts in vivo.

Attenuation corrected-optical coherence tomography for quantitative assessment of skin wound healing and scar morphology

Imaging the structural modifications of underlying tissues is vital to monitor wound healing. Optical coherence tomography (OCT) images high-resolution sub-surface information, but suffers a loss of intensity with depth, limiting quantification. Hence correcting the attenuation loss is important. We performed swept source-OCT of full-thickness excision wounds for 300 days in mice skin. We used single-scatter attenuation models to determine and correct the attenuation loss in the images. The phantom studies established the correspondence of corrected-OCT intensity (reflectivity) with matrix density and hydration. We histologically validated the corrected-OCT and measured the wound healing rate. We noted two distinct phases of healing-rapid and steady-state. We also detected two compartments in normal scars using corrected OCT that otherwise were not visible in the OCT scans. The OCT reflectivity in the scar compartments corresponded to distinct cell populations, mechanical properties and composition. OCT reflectivity has potential applications in evaluating the therapeutic efficacy of healing and characterizing scars.

Polarization state tracing method to map local birefringent properties in samples using polarization sensitive optical coherence tomography

We propose a method that utilizes the trajectory of output polarization states on the Poincaré sphere to derive depth-resolved birefringent information within samples using a fiber-based polarization sensitive optical coherence tomography. The apparent (or intermediate) optic axis and the local phase retardation are first obtained by fitting a plane to the adjacent output polarization states along depths in the Poincare sphere. A sequence of 3D rotation operation determined by the local birefringent property of the upper layers is then applied to the apparent axis to finally determine the local optic axis. This method requires only one input polarization state and is compatible with both free-space and fiber-based PSOCT systems, simplifying the imaging system setup. The theoretical framework is presented to derive the local phase retardation and optic axis from the output polarization states and then demonstrated by mapping local birefringent information of the mouse thigh tissue in vitro.

Polarization sensitive optical coherence tomography for imaging microvascular information within living tissue without polarization-induced artifacts

When imaging birefringent samples using optical coherence tomography angiography (OCTA), the phase retardation may appear opposite to the phase change due to the blood flow in the orthogonal signals, for which a cancellation effect can occur when deriving OCTA signals. This effect can diminish the ability of OCTA to detect vascular information, leading to an erroneous interpretation of the final OCTA images. To mitigate this issue, we demonstrate polarization-sensitive optical coherence tomography (PS-OCT) to image microvascular information within a living sample without polarization induced artifacts. The system is furnished with a swept source OCT (SS-OCT) that incorporates two imaging modes: OCTA imaging and polarization-sensitive imaging. PS-OCT is used to provide birefringent contrast where the color-encoded Stokes parameters are used to obtain high contrast polarization-state images. OCTA is used to acquire high-resolution images of functional microvascular networks permeating the scanned tissue volume. Taking the advantages of the dual-channel PS-OCT configuration, the polarization induced artifacts are eliminated from OCTA vascular imaging. The proposed PS-OCTA system is employed to visualize the birefringent components and the vascular networks of the human skin in vivo. It is expected that the proposed system setup would have useful and practical applications in the investigations of the vasculature in the birefringent tissue samples both pre-clinically and clinically.

Stable fiber-based polarization-sensitive optical coherence tomography using polarization maintaining common-path interferometer

SIGNIFICANCE

Our work advances the development of fiber-based polarization-sensitive optical coherence tomography (PS-OCT) by stabilizing the output polarization state of the light beam when the system is under environmental disturbance. While the fiber-based PS-OCT has been demonstrated previously, it remains a challenge for the traditional fiber-based PS-OCT to obtain a stable measurement when the optic fibers are disturbed by the environment. This important issue is addressed, paving the path for clinical translation of PS-OCT, which can provide a unique perspective of the biological samples.

AIM

Polarization maintaining common-path (CP) interferometer is fabricated with the goal of providing a stable fiber-based PS-OCT imaging system that is only responsive to the polarization changes generated by the sample, immune to environmental conditions.

APPROACH

The system is implemented by incorporating a CP interferometer together with polarization maintaining (PM) fibers. The PM fibers are used to preserve the two orthogonal linearly polarized components of the light during propagation. By sharing the CP in the sample and reference arms, any variations in phase retardation can be eliminated between the two channels in the PM fibers. The combination of the PM fiber and the CP interferometer ensures the stability of the output polarization state.

RESULTS

The stability of the proposed PS-OCT system is tested when a periodically stressed disturbance is applied to the fibers within the system. Stable in vivo PS-OCT images of the mouse thigh are demonstrated.

CONCLUSIONS

We have demonstrated a stable fiber-based PS-OCT system that combined the PM fiber and the CP configuration together. We have shown that the output polarization states and the system sensitivity can keep stable over time under the environmental disturbances to the system.

Synthetic Polymeric Antibacterial Hydrogel for Methicillin-Resistant Staphylococcus aureus-Infected Wound Healing: Nanoantimicrobial Self-Assembly, Drug- and Cytokine-Free Strategy

Antibacterial hydrogels are attracting extensive attention in soft tissue repair and regeneration, including bacteria-infected-wound healing. The abuse of antibiotics leads to drug resistance. Recent developments have demonstrated that the delivery of inorganic bactericidal agents in hydrogels can drive the wound healing process; however, this approach is complicated by external light stimuli, cytotoxicity, nondegradability, and sophisticated fabrication. Herein, an inherent antibacterial, bioresorbable hydrogel was developed by the spontaneous self-aggregation of amphiphilic, oxadiazole-group-decorated quaternary ammonium salts (QAS)-conjugated poly(ε-caprolactone)-poly(ethylene glycol)-poly(ε-caprolactone) (PCEC-QAS) micellar nanoantimicrobials for methicillin-resistant Staphylococcus aureus (MRSA)-infected cutaneous wound healing. The PCEC-QAS hydrogel showed a stable gel state within the temperature range of 5-50 °C and antibacterial efficacy against both Gram-negative and -positive bacteria in vitro and in vivo. Additionally, the PCEC-QAS hydrogel facilitated the cell spreading, proliferation, and migration without cytotoxicity. An in vivo degradation and skin defect healing study suggested the PCEC-QAS hydrogel was totally absorbed without local or systemic toxicity and could promote wound repair in the absence of drugs, cytokines, or cells. Significantly, this hydrogel accelerated the regeneration of a MRSA-infected full-thickness impaired skin wound by successfully reconstructing an intact and thick epidermis similar to normal mouse skin. Collectively, a self-assembling PCEC-QAS antibacterial hydrogel is a promising dressing material to promote skin regeneration and prevent bacterial infection without additional drugs, cells, light irradiation, or delivery systems, providing a simple but effective strategy for treating dermal wounds.

Buffered polarization diverse detection for single-camera polarization-sensitive optical coherence tomography

Herein we propose a method to mitigate a position mismatch problem for a spectral-domain polarization-sensitive optical coherence tomography (SD-PS-OCT) system that uses a single line-scan detection scheme. A single detector-based PS-OCT detects two orthogonal polarization components as two adjacent A-scan signals in turns. Thus, two adjacent A-scan signals are not scattered at a fixed point in time (position mismatch problem), resulting in uncorrelated signals between them. To achieve sequential detection of simultaneously scattered light, a buffering single-mode fiber was connected to one of the two ports coming out of the optical switch, provided a proper time delay. A single-mode optical fiber of 2.69 km in length was used to buffer, and its length was determined by a frame rate of the spectrometer used as a detector. With the proposed SD-PS-OCT scheme, the PS-OCT system with a simple configuration, and the minimized position mismatch problem between two polarization components can be set.