Photoacoustic breast tomography prototypes with reported human applications

Optimizing breast cancer diagnosis with photoacoustic imaging: An analysis of intratumoral and peritumoral radiomics

Background

The differentiation between benign and malignant breast tumors extends beyond morphological structures to encompass functional alterations within the nodules. The combination of photoacoustic (PA) imaging and radiomics unveils functional insights and intricate details that are imperceptible to the naked eye.

Purpose

This study aims to assess the efficacy of PA imaging in breast cancer radiomics, focusing on the impact of peritumoral region size on radiomic model accuracy.

Materials and methods

From January 2022 to November 2023, data were collected from 358 patients with breast nodules, diagnosed via PA/US examination and classified as BI-RADS 3-5. The study used the largest lesion dimension in PA images to define the region of interest, expanded by 2 mm, 5 mm, and 8 mm, for extracting radiomic features. Techniques from statistics and machine learning were applied for feature selection, and logistic regression classifiers were used to build radiomic models. These models integrated both intratumoral and peritumoral data, with logistic regressions identifying key predictive features.

Results

The developed nomogram, combining 5 mm peritumoral data with intratumoral and clinical features, showed superior diagnostic performance, achieving an AUC of 0.950 in the training cohort and 0.899 in validation. This model outperformed those based solely on clinical features or other radiomic methods, with the 5 mm peritumoral region proving most effective in identifying malignant nodules.

Conclusion

This research demonstrates the significant potential of PA imaging in breast cancer radiomics, especially the advantage of integrating 5 mm peritumoral with intratumoral features. This approach not only surpasses models based on clinical data but also underscores the importance of comprehensive radiomic analysis in accurately characterizing breast nodules.

Assessment of Oxygen Saturation in Breast Lesions Using Photoacoustic Imaging: Correlation With Benign and Malignant Disease

BACKGROUND

Hypoxia is a hallmark of breast cancer (BC). Photoacoustic (PA) imaging, based on the use of laser-generated ultrasound (US), can detect oxygen saturation (So2) in the tissues of breast lesion patients.

PURPOSE

To measure the oxygenation status of tissue in and on both sides of the lesion in breast lesion participants using a multimodal Photoacoustic/ultrasound (PA/US) imaging system and to determine the correlation between So2 measured by PA imaging and benign or malignant disease.

MATERIALS AND METHODS

Multimodal PA/US imaging and gray-scale US (GSUS) of breast lesion was performed in consecutive breast lesion participants imaged in the US Outpatient Clinic between 2022 and 2023. Dual-wavelength PA imaging was used to measure the So2 value inside the lesion and on both sides of the tissue, and to distinguish benign from malignant lesions based on the So2 value. The ability of So2 to distinguish benign from malignant breast lesions was evaluated by the receiver operating characteristic curve (ROC) and the De-Long test.

RESULTS

A total of 120 breast lesion participants (median age, 42.5 years) were included in the study. The malignant lesions exhibited lower So2 levels compared to benign lesions (malignant: 71.30%; benign: 83.81%; P < .01). Moreover, PA/US imaging demonstrates superior diagnostic results compared to GSUS, with an area under the curve (AUC) of 0.89 versus 0.70, sensitivity of 89.58% versus 85.42%, and specificity of 86.11% versus 55.56% at the So2 cut-off value of 78.85 (P < .001). The false positive rate in GSUS reduced by 30.75%, and the false negative rate diminished by 4.16% with PA /US diagnosis. Finally, the So2 on both sides tissues of malignant lesions are lower than that of benign lesions (P < .01).

CONCLUSION

PA imaging allows for the assessment of So2 within the lesions of breast lesion patients, thereby facilitating a superior distinction between benign and malignant lesions.

Current status of optoacoustic breast imaging and future trends in clinical application: is it ready for prime time?

Optoacoustic imaging (OAI) is an emerging field with increasing applications in patients and exploratory clinical trials for breast cancer. Optoacoustic imaging (or photoacoustic imaging) employs non-ionizing, laser light to create thermoelastic expansion in tissues and detect the resulting ultrasonic emission. By combining high optical contrast capabilities with the high spatial resolution and anatomic detail of grayscale ultrasound, OAI offers unique opportunities for visualizing biological function of tissues in vivo. Over the past decade, human breast applications of OAI, including benign/malignant mass differentiation, distinguishing cancer molecular subtype, and predicting metastatic potential, have significantly increased. We discuss the current state of optoacoustic breast imaging, as well as future opportunities and clinical application trends. CLINICAL RELEVANCE STATEMENT: Optoacoustic imaging is a novel breast imaging technique that enables the assessment of breast cancer lesions and tumor biology without the risk of ionizing radiation exposure, intravenous contrast, or radionuclide injection. KEY POINTS: • Optoacoustic imaging (OAI) is a safe, non-invasive imaging technique with thriving research and high potential clinical impact. • OAI has been considered a complementary tool to current standard breast imaging techniques. • OAI combines parametric maps of molecules that absorb light and scatter acoustic waves (like hemoglobin, melanin, lipids, and water) with anatomical images, facilitating scalable and real-time molecular evaluation of tissues.

Optoacoustic Imaging With Decision Support for Differentiation of Benign and Malignant Breast Masses: A 15-Reader Retrospective Study

BACKGROUND. Overlap in ultrasound features of benign and malignant breast masses yields high rates of false-positive interpretations and benign biopsy results. Optoacoustic imaging is an ultrasound-based functional imaging technique that can increase specificity. OBJECTIVE. The purpose of this study was to compare specificity at fixed sensitivity of ultrasound images alone and of fused ultrasound and optoacoustic images evaluated with machine learning-based decision support tool (DST) assistance. METHODS. This retrospective Reader-02 study included 480 patients (mean age, 49.9 years) with 480 breast masses (180 malignant, 300 benign) that had been classified as BI-RADS category 3-5 on the basis of conventional gray-scale ultrasound findings. The patients were selected by stratified random sampling from the earlier prospective 16-site Pioneer-01 study. For that study, masses were further evaluated by ultrasound alone followed by fused ultrasound and optoacoustic imaging between December 2012 and September 2015. For the current study, 15 readers independently reviewed the previously acquired images after training in optoacoustic imaging interpretation. Readers first assigned probability of malignancy (POM) on the basis of clinical history, mammographic findings, and conventional ultrasound findings. Readers then evaluated fused ultrasound and optoacoustic images, assigned scores for ultrasound and optoacoustic imaging features, and viewed a POM prediction score derived by a machine learning-based DST before issuing final POM. Individual and mean specificities at fixed sensitivity of 98% and partial AUC (pAUC) (95-100% sensitivity) were calculated. RESULTS. Averaged across all readers, specificity at fixed sensitivity of 98% was significantly higher for fused ultrasound and optoacoustic imaging with DST assistance than for ultrasound alone (47.2% vs 38.2%; p = .03). Across all readers, pAUC was higher (p < .001) for fused ultrasound and optoacoustic imaging with DST assistance (0.024 [95% CI, 0.023-0.026]) than for ultrasound alone (0.021 [95% CI, 0.019-0.022]). Better performance using fused ultrasound and optoacoustic imaging with DST assistance than using ultrasound alone was observed for 14 of 15 readers for specificity at fixed sensitivity and for 15 of 15 readers for pAUC. CONCLUSION. Fused ultrasound and optoacoustic imaging with DST assistance had significantly higher specificity at fixed sensitivity than did conventional ultrasound alone. CLINICAL IMPACT. Optoacoustic imaging, integrated with reader training and DST assistance, may help reduce the frequency of biopsy of benign breast masses.

Three-dimensional non-invasive brain imaging of ischemic stroke by integrated photoacoustic, ultrasound and angiographic tomography (PAUSAT)

We present an ischemic stroke study using our newly-developed PAUSAT system that integrates photoacoustic computed tomography (PACT), high-frequency ultrasound imaging, and acoustic angiographic tomography. PAUSAT is capable of three-dimensional (3D) imaging of the brain morphology, blood perfusion, and blood oxygenation. Using PAUSAT, we studied the hemodynamic changes in the whole mouse brain induced by two common ischemic stroke models: the permanent middle cerebral artery occlusion (pMCAO) model and the photothrombotic (PT) model. We imaged the same mouse brains before and after stroke, and quantitatively compared the two stroke models. We observed clear hemodynamic changes after ischemic stroke, including reduced blood perfusion and oxygenation. Such changes were spatially heterogenous. We also quantified the tissue infarct volume in both stroke models. The PAUSAT measurements were validated by laser speckle imaging and histology. Our results have collectively demonstrated that PAUSAT can be a valuable tool for non-invasive longitudinal studies of neurological diseases at the whole-brain scale.

Clinical photoacoustic/ultrasound dual-modal imaging: Current status and future trends

Photoacoustic tomography (PAT) is an emerging biomedical imaging modality that combines optical and ultrasonic imaging, providing overlapping fields of view. This hybrid approach allows for a natural integration of PAT and ultrasound (US) imaging in a single platform. Due to the similarities in signal acquisition and processing, the combination of PAT and US imaging creates a new hybrid imaging for novel clinical applications. Over the recent years, particular attention is paid to the development of PAT/US dual-modal systems highlighting mutual benefits in clinical cases, with an aim of substantially improving the specificity and sensitivity for diagnosis of diseases. The demonstrated feasibility and accuracy in these efforts open an avenue of translating PAT/US imaging to practical clinical applications. In this review, the current PAT/US dual-modal imaging systems are discussed in detail, and their promising clinical applications are presented and compared systematically. Finally, this review describes the potential impacts of these combined systems in the coming future.

Fast Correction of “Finite Aperture Effect” in Photoacoustic Tomography Based on Spatial Impulse Response

Photoacoustic computed tomography (PACT) is a fast-developing imaging technique, which can provide structural and functional information in biological tissues with high-resolution beyond the depth of the optical diffusion limit. However, the most current PACT reconstruction method generally employs a point detector assumption, whereas in most PAT systems with circular or spherical scanning modes, the transducer is mostly flat and with a finite size. This model mismatch leads to a notable deterioration in the lateral direction in regions far from the rotation center, which is known as the “finite aperture effect”. In this work, we propose to compensate a novel Back-projection (BP) method based on the transducer’s spatial impulse response (SIR) for fast correction of the “finite aperture effect”. The SIR accounts for the waveform change of the transducer for an arbitrary point source due to the geometry of the detection surface. Simulation results showed that the proposed SIR-BP method can effectively improve the lateral resolution and signal to noise ratio (SNR) in the off-center regions. For a target 4.5 mm far from the rotation center, this new method improved the lateral resolution about five times along with a 7 dB increase in the SNR. Experimental results also showed that this SIR-BP method can well restore the image angular blur to recover small structures, as demonstrated by the imaging of leaf veins. This new method offers a valuable alternative to the conventional BP method, and can guide the design of PAT systems based on circular/spherical scan.

Role of blood oxygenation saturation in ovarian cancer diagnosis using multi-spectral photoacoustic tomography

In photoacoustic tomography (PAT), a tunable laser typically illuminates the tissue at multiple wavelengths, and the received photoacoustic waves are used to form functional images of relative total haemoglobin (rHbT) and blood oxygenation saturation (%sO2 ). Due to measurement errors, the estimation of these parameters can be challenging, especially in clinical studies. In this study, we use a multi-pixel method to smooth the measurements before calculating rHbT and %sO2 . We first perform phantom studies using blood tubes of calibrated %sO2 to evaluate the accuracy of our %sO2 estimation. We conclude by presenting diagnostic results from PAT of 33 patients with 51 ovarian masses imaged by our co-registered PAT and ultrasound system. The ovarian masses were divided into malignant and benign/normal groups. Functional maps of rHbT and %sO2 and their histograms as well as spectral features were calculated using the PAT data from all ovaries in these two groups. Support vector machine models were trained on different combinations of the significant features. The area under ROC (AUC) of 0.93 (0.95%CI: 0.90-0.96) on the testing data set was achieved by combining mean %sO2 , a spectral feature, and the score of the study radiologist.

Sound Out the Deep Colors: Photoacoustic Molecular Imaging at New Depths

Photoacoustic tomography (PAT) has become increasingly popular for molecular imaging due to its unique optical absorption contrast, high spatial resolution, deep imaging depth, and high imaging speed. Yet, the strong optical attenuation of biological tissues has traditionally prevented PAT from penetrating more than a few centimeters and limited its application for studying deeply seated targets. A variety of PAT technologies have been developed to extend the imaging depth, including employing deep-penetrating microwaves and X-ray photons as excitation sources, delivering the light to the inside of the organ, reshaping the light wavefront to better focus into scattering medium, as well as improving the sensitivity of ultrasonic transducers. At the same time, novel optical fluence mapping algorithms and image reconstruction methods have been developed to improve the quantitative accuracy of PAT, which is crucial to recover weak molecular signals at larger depths. The development of highly-absorbing near-infrared PA molecular probes has also flourished to provide high sensitivity and specificity in studying cellular processes. This review aims to introduce the recent developments in deep PA molecular imaging, including novel imaging systems, image processing methods and molecular probes, as well as their representative biomedical applications. Existing challenges and future directions are also discussed.

Development of Multispectral Optoacoustic Tomography as a Clinically Translatable Modality for Cancer Imaging

The use of optoacoustic imaging takes advantage of the photoacoustic effect to generate high-contrast, high-resolution medical images at penetration depths of up to 5 cm. Multispectral optoacoustic tomography (MSOT) is a type of optoacoustic imaging system that has seen promising preclinical success with a recent emergence into the clinic. Multiwavelength illumination of tissue allows for the mapping of multiple chromophores, which are generated endogenously or exogenously. However, translation of MSOT to the clinic is still in its preliminary stages. For successful translation, MSOT requires refinement of probes and data-acquisition systems to tailor to the human body, along with more intuitive, real-time visualization settings. The possibilities of optoacoustic imaging, namely MSOT, in the clinic are reviewed here. ©RSNA, 2020.

Photoacoustic Imaging for Management of Breast Cancer: A Literature Review and Future Perspectives

In this review article, a detailed chronological account of the research related to photoacoustic imaging for the management of breast cancer is presented. Performing a detailed analysis of the breast cancer detection related photoacoustic imaging studies undertaken by different research groups, this review attempts to present the clinical evidence in support of using photoacoustic imaging for breast cancer detection. Based on the experimental evidence obtained from the clinical studies conducted so far, the performance of photoacoustic imaging is compared with that of conventional breast imaging modalities. While we find that there is enough experimental evidence to support the use of photoacoustic imaging for breast cancer detection, additional clinical studies are required to be performed to evaluate the diagnostic potential of photoacoustic imaging for identifying different types of breast cancer. To establish the utility of photoacoustic imaging for breast cancer screening, clinical studies with high-risk asymptomatic patients need to be done.

In vivo photoacoustic imaging dynamically monitors the structural and functional changes of ischemic stroke at a very early stage

Ischemic stroke (IS) is one of the leading causes of death and accounts for 85% of stroke cases. Since the symptoms are not obvious, diagnosis of IS, particularly at an early stage, is a great challenge. Photoacoustic imaging combines high sensitivity of optical imaging and fine resolution of ultrasonography to non-invasively provide structural and functional information of IS.

Methods: We adopted three rapid photoacoustic imaging systems with varying characteristics, including a portable handheld photoacoustic system, high-sensitivity bowl-shaped array photoacoustic computed tomography (PACT), and high-resolution photoacoustic microscopy (PAM) to assess the stereoscopic and comprehensive pathophysiological status of IS at an early stage. Two representative models of IS, referring to photothrombosis and middle cerebral artery occlusion (MCAO) models, were established to verify the feasibility of photoacoustic imaging detection.

Results: Non-invasive, rapid PACT of the IS model in mouse provided structural information of the brain lesion, achieving early disease identification (5 min after the onset of disease). Moreover, it was able to dynamically reflect disease progression. Quantitative high-resolution PAM allowed observation of pathological changes in the microvascular system of mouse brain. In terms of functional imaging, significant differences in oxygen saturation (sO₂) levels between infarcted and normal areas could be observed by PACT, permitting effective functional parameters for the diagnosis of IS.

Conclusions: We used PACT to perform full-view structural imaging and functional imaging of sO₂ in IS at the macroscopic level, and then observed the microvascular changes in the infarcted area at the microscopic level by using PAM. This work may provide new tools for the early diagnosis of IS and its subsequent complications as well as assessment of disease progression.

Current and future trends in photoacoustic breast imaging

Non-invasive detection of breast cancer has been regarded as the holy grail of applications for photoacoustic (optoacoustic) imaging right from the early days of re-discovery of the method. Two-and-a-half decades later we report on the state-of-the-art in photoacoustic breast imaging technology and clinical studies. Even within the single application of breast imaging, we find imagers with various measurement geometries, ultrasound detection characteristics, illumination schemes, and image reconstruction strategies. We first analyze the implications on performance of a few of these design choices in a generic imaging system, before going into detailed descriptions of the imagers. Per imaging system we present highlights of patient studies, which barring a couple are mostly in the nature of technology demonstrations and proof-of-principle studies. We close this work with a discussion on several aspects that may turn out to be crucial for the future clinical translation of the method.

Photoacoustic Tomography with a Ring Ultrasound Transducer: A Comparison of Different Illumination Strategies

Photoacoustic (PA) imaging is a methodology that uses the absorption of short laser pulses by endogenous or exogenous chromophores within human tissue, and the subsequent generation of acoustic waves acquired by an ultrasound (US) transducer, to form an image that can provide functional and molecular information. Amongst the various types of PA imaging, PA tomography (PAT) has been proposed for imaging pathologies such as breast cancer. However, the main challenge for PAT imaging is the deliverance of sufficient light energy horizontally through an imaging cross-section as well as vertically. In this study, three different illumination methods are compared for a full-ring ultrasound (US) PAT system. The three distinct illumination setups are full-ring, diffused-beam, and point source illumination. The full-ring system utilizes a cone mirror and parabolic reflector to create the ringed-shaped beam for PAT, while the diffuse scheme uses a light diffuser to expand the beam, which illuminates tissue-mimicking phantoms. The results indicate that the full-ring illumination is capable of providing a more uniform fluence irrespective of the vertical depth of the imaged cross-section, while the point source and diffused illumination methods provide a higher fluence at regions closer to the point of entry, which diminishes with depth. In addition, a set of experiments was conducted to determine the optimum position of ring-illumination with respect to the position of the acoustic detectors to achieve the highest signal-to-noise ratio.

Affibody-Indocyanine Green Based Contrast Agent for Photoacoustic and Fluorescence Molecular Imaging of B7-H3 Expression in Breast Cancer

Spectroscopic photoacoustic (sPA) molecular imaging has high potential for identification of exogenous contrast agents targeted to specific markers. Antibody-dye conjugates have recently been used extensively for preclinical sPA and other optical imaging modalities for highly specific molecular imaging of breast cancer. However, antibody-based agents suffer from long circulation times that limit image specificity. Here, the efficacy of a small protein scaffold, the affibody (ABY), conjugated to indocyanine green (ICG), a near-infrared fluorescence dye, as a targeted molecular imaging probe is demonstrated. In particular, B7-H3 (CD276), a cellular receptor expressed in breast cancer, was imaged via sPA and fluorescence molecular imaging to differentiate invasive tumors from normal glands in mice. Administration of ICG conjugated to an ABY specific to B7-H3 (ABYB7-H3-ICG) showed significantly higher signal in mammary tumors compared to normal glands of mice. ABYB7-H3-ICG is a compelling scaffold for molecular sPA imaging for breast cancer detection.

All-reflective ring illumination system for photoacoustic tomography

Given that breast cancer is the second leading cause of cancer-related deaths among women in the United States, it is necessary to continue improving the sensitivity and specificity of breast imaging systems that diagnose breast lesions. Photoacoustic (PA) imaging can provide functional information during in vivo studies and can augment the structural information provided by ultrasound (US) imaging. A full-ring, all-reflective, illumination system for photoacoustic tomography (PAT) coupled to a full-ring US receiver is developed and tested. The US/PA tomography system utilizes a cone mirror and conical reflectors to optimize light delivery for PAT imaging and has the potential to image objects that are placed within the ring US transducer. The conical reflector used in this system distributes the laser energy over a circular cross-sectional area, thereby reducing the overall fluence. This, in turn, allows the operator to increase the laser energy achieving better cross-sectional penetration depth. A proof-of-concept design utilizing a single cone mirror and a parabolic reflector is used for imaging cylindrical phantoms with light-absorbing objects. For the given phantoms, it has been shown that there was no restriction in imaging a given targeted cross-sectional area irrespective of vertical depth, demonstrating the potential of mirror-based, ring-illuminated PAT system. In addition, the all-reflective ring illumination method shows a uniform PA signal across the scanned cross-sectional area.

Optoacoustic Breast Imaging: Imaging-Pathology Correlation of Optoacoustic Features in Benign and Malignant Breast Masses

OBJECTIVE

Optoacoustic ultrasound breast imaging is a fused anatomic and functional modality that shows morphologic features, as well as hemoglobin amount and relative oxygenation within and around breast masses. The purpose of this study is to investigate the positive predictive value (PPV) of optoacoustic ultrasound features in benign and malignant masses.

SUBJECTS AND METHODS

In this study, 92 masses assessed as BI-RADS category 3, 4, or 5 in 94 subjects were imaged with optoacoustic ultrasound. Each mass was scored by seven blinded independent readers according to three internal features in the tumor interior and two external features in its boundary zone and periphery. Mean and median optoacoustic ultrasound scores were compared with histologic findings for biopsied masses and nonbiopsied BI-RADS category 3 masses, which were considered benign if they were stable at 12-month follow-up. Statistical significance was analyzed using a two-sided Wilcoxon rank sum test with a 0.05 significance level.

RESULTS

Mean and median optoacoustic ultrasound scores for all individual internal and external features, as well as summed scores, were higher for malignant masses than for benign masses (p < 0.0001). High external scores, indicating increased hemoglobin and deoxygenation and abnormal vessel morphologic features in the tumor boundary zone and periphery, better distinguished benign from malignant masses than did high internal scores reflecting increased hemoglobin and deoxygenation within the tumor interior.

CONCLUSION

High optoacoustic ultrasound scores, particularly those based on external features in the boundary zone and periphery of breast masses, have high PPVs for malignancy and, conversely, low optoacoustic ultrasound scores have low PPV for malignancy. The functional component of optoacoustic ultrasound may help to overcome some of the limitations of morphologic overlap in the distinction of benign and malignant masses.

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

BACKGROUND

Optoacoustic tomography (OT) of breast tumour oxygenation is a promising new technique, currently in clinical trials, which may help to determine disease stage and therapeutic response. However, the ability of OT to distinguish breast tumours displaying different vascular characteristics has yet to be established. The aim of the study is to prove OT as a sensitive technique for differentiating breast tumour models with manifestly different vasculatures.

METHODS

Multispectral OT (MSOT) was performed in oestrogen-dependent (MCF-7) and oestrogen-independent (MDA-MB-231) orthotopic breast cancer xenografts. Total haemoglobin (THb) and oxygen saturation (SO2MSOT) were calculated. Pathological and biochemical evaluation of the tumour vascular phenotype was performed for validation.

RESULTS

MCF-7 tumours show SO2MSOT similar to healthy tissue in both rim and core, despite significantly lower THb in the core. MDA-MB-231 tumours show markedly lower SO2MSOT with a significant rim-core disparity. Ex vivo analysis revealed that MCF-7 tumours contain fewer blood vessels (CD31+) that are more mature (CD31+/aSMA+) than MDA-MB-231. MCF-7 presented higher levels of stromal VEGF and iNOS, with increased NO serum levels. The vasculogenic process observed in MCF-7 was consistent with angiogenesis, while MDA-MB-231 appeared to rely more on vascular mimicry.

CONCLUSIONS

OT is sensitive to differences in the vascular phenotypes of our breast cancer models.

Emerging Breast Imaging Technologies on the Horizon

Early detection of breast cancers by mammography in conjunction with adjuvant therapy has contributed to reduction in breast cancer mortality. Mammography remains the "gold-standard" for breast cancer screening but is limited by tissue superposition. Digital breast tomosynthesis and more recently, dedicated breast computed tomography have been developed to alleviate the tissue superposition problem. However, all of these modalities rely upon x-ray attenuation contrast to provide anatomical images, and there are ongoing efforts to develop and clinically translate alternative modalities. These emerging modalities could provide for new contrast mechanisms and may potentially improve lesion detection and diagnosis. In this article, several of these emerging modalities are discussed with a focus on technologies that have advanced to the stage of in vivo clinical evaluation.

Hemispherical photoacoustic imaging of myocardial infarction: in vivo detection and monitoring

OBJECTIVES

This study aimed to demonstrate the capacity for noninvasive localisation and characterisation of myocardial infarction (MI) in vivo using a hemispherical photoacoustic imaging (PAI) system. MI remains a leading cause of morbidity and mortality worldwide. To enable optimal treatment of patients, timely and accurate diagnosis and longitudinal monitoring is critical.

METHODS

Ischaemia was induced in Balb/c mice by ligation of the left anterior descending artery. The hemispherical PAI system, equipped with 128 ultrasonic transducers spirally distributed on the surface, along with parallel data acquisition, was applied for imaging of the mouse heart.

RESULTS

Our study showed that hemispherical PAI can delineate thoracic vessels and the morphology of the entire heart. Longitudinal PAI images revealed gradual expansion of the infarcted area along with necrosis and fibrosis, which were quantitatively validated by triphenyltetrazolium chloride staining. After MI modelling, the photoacoustic (PA) signal intensity decreased by 399.1 ± 56.3 (p < 0.001), a ~2.5-fold reduction compared to that of healthy cardiac tissue. The calculated size of the enlarged heart, 10.4 ± 6.0 mm² (p < 0.001), represents an increase of ~18% versus that of a healthy heart.

CONCLUSIONS

PAI enables MI diagnosis and injury localisation with its capabilities for both deep organ imaging and lesion region differentiation.

KEY POINTS

• Photoacoustic imaging (PAI), combining optical absorption and ultrasonic resolution, can delineate cardiac anatomy. • PAI can diagnose myocardial infarction lesions with 10 mm imaging depth in vivo. • Quantified results are in excellent agreement with enzyme and histological examinations. • PAI can serve as a complementary modality to SPECT and ultrasound imaging. • This study will encourage further PAI development for clinical use.

A Pivotal Study of Optoacoustic Imaging to Diagnose Benign and Malignant Breast Masses: A New Evaluation Tool for Radiologists

Purpose To compare the diagnostic utility of an investigational optoacoustic imaging device that fuses laser optical imaging (OA) with grayscale ultrasonography (US) to grayscale US alone in differentiating benign and malignant breast masses. Materials and Methods This prospective, 16-site study of 2105 women (study period: 12/21/2012 to 9/9/2015) compared Breast Imaging Reporting and Data System (BI-RADS) categories assigned by seven blinded independent readers to benign and malignant breast masses using OA/US versus US alone. BI-RADS 3, 4, or 5 masses assessed at diagnostic US with biopsy-proven histologic findings and BI-RADS 3 masses stable at 12 months were eligible. Independent readers reviewed US images obtained with the OA/US device, assigned a probability of malignancy (POM) and BI-RADS category, and locked results. The same independent readers then reviewed OA/US images, scored OA features, and assigned OA/US POM and a BI-RADS category. Specificity and sensitivity were calculated for US and OA/US. Benign and malignant mass upgrade and downgrade rates, positive and negative predictive values, and positive and negative likelihood ratios were compared. Results Of 2105 consented subjects with 2191 masses, 100 subjects (103 masses) were analyzed separately as a training population and excluded. An additional 202 subjects (210 masses) were excluded due to technical failures or incomplete imaging, 72 subjects (78 masses) due to protocol deviations, and 41 subjects (43 masses) due to high-risk histologic results. Of 1690 subjects with 1757 masses (1079 [61.4%] benign and 678 [38.6%] malignant masses), OA/US downgraded 40.8% (3078/7535) of benign mass reads, with a specificity of 43.0% (3242/7538, 99% confidence interval [CI]: 40.4%, 45.7%) for OA/US versus 28.1% (2120/7543, 99% CI: 25.8%, 30.5%) for the internal US of the OA/US device. OA/US exceeded US in specificity by 14.9% (P < .0001; 99% CI: 12.9, 16.9%). Sensitivity for biopsied malignant masses was 96.0% (4553/4745, 99% CI: 94.5%, 97.0%) for OA/US and 98.6% (4680/4746, 99% CI: 97.8%, 99.1%) for US (P < .0001). The negative likelihood ratio of 0.094 for OA/US indicates a negative examination can reduce a maximum US-assigned pretest probability of 17.8% (low BI-RADS 4B) to a posttest probability of 2% (BI-RADS 3). Conclusion OA/US increases the specificity of breast mass assessment compared with the device internal grayscale US alone. Online supplemental material is available for this article. ^© RSNA, 2017.

Predictor of Hand Radiological Progression in Patients With Rheumatoid Arthritis Receiving TNF Antagonist Therapy by Change in Grayscale Synovitis-A Preliminary Study

Objectives

This prospective study aimed to compare synovial ultrasound scores to conventional measures (DAS28, CRP levels) in predicting radiographic progression in patients with rheumatoid arthritis under TNF antagonist therapy.

Methods

Patients with RA who received TNF antagonist therapy were enrolled, all of whom underwent clinical, laboratory, and ultrasonographic assessments with grayscale and power Doppler assessments of bilateral elbows (anterior and posterior recess), wrists (dorsal, palmar, and ulnar aspects), second and third MCP joints (dorsal and palmar recess), and PIP II and III (dorsal and palmar) at baseline and at 1, 3 months. Hand radiographic damage was evaluated using van der Heijde modified Total Sharp Score (TSS) at baseline and 12 months.

Results

Thirty-two patients (384 joints, 832 synovial sites) continued the same treatment regimen for 12 months and completed the study, 41.6% of whom showed radiographic progression during the study period. Baseline DAS28 (P = 0.123), CRP level (P = 0.177), grayscale synovitis (P = 0.092), and power Doppler synovitis (P = 0.120) could not predict radiological damage in the TNF antagonist therapy group. However, ΔTSS was significantly related to changes in grayscale synovitis between baseline and 1 month (P = 0.011), but not at 3 months (P = 0.591), and was not related to changes in the power Doppler score at 1 (P = 0.634) and 3 months (P = 0.298).

Conclusions

Our data confirm that delayed improvement in grayscale synovitis between baseline and 1 month more accurately reflects 1-year radiological damage than conventional measures such as DAS28 score and CRP level. Therefore, we recommend serial ultrasound follow-up of patients with RA receiving TNF antagonist therapy.

Multispectral Optoacoustic Tomography (MSOT) of Human Breast Cancer

Purpose: In a pilot study, we introduce fast handheld multispectral optoacoustic tomography (MSOT) of the breast at 28 wavelengths, aiming to identify high-resolution optoacoustic (photoacoustic) patterns of breast cancer and noncancerous breast tissue.Experimental Design: We imaged 10 female patients ages 48-81 years with malignant nonspecific breast cancer or invasive lobular carcinoma. Three healthy volunteers ages 31-36 years were also imaged. Fast-MSOT was based on unique single-frame-per-pulse (SFPP) image acquisition employed to improve the accuracy of spectral differentiation over using a small number of wavelengths. Breast tissue was illuminated at the 700-970 nm spectral range over 0.56 seconds total scan time. MSOT data were guided by ultrasonography and X-ray mammography or MRI.Results: The extended spectral range allowed the computation of oxygenated hemoglobin (HBO₂), deoxygenated hemoglobin (HB), total blood volume (TBV), lipid, and water contributions, allowing first insights into in vivo high-resolution breast tissue MSOT cancer patterns. TBV and Hb/HBO₂ images resolved marked differences between cancer and control tissue, manifested as a vessel-rich tumor periphery with highly heterogeneous spatial appearance compared with healthy tissue. We observe significant TBV variations between different tumors and between tumors over healthy tissues. Water and fat lipid layers appear disrupted in cancer versus healthy tissue; however, offer weaker contrast compared with TBV images.Conclusions: In contrast to optical methods, MSOT resolves physiologic cancer features with high resolution and revealed patterns not offered by other radiologic modalities. The new features relate to personalized and precision medicine potential. Clin Cancer Res; 23(22); 6912-22. ©2017 AACR.

From Detection to Resection: Photoacoustic Tomography and Surgery Guidance with Indocyanine Green Loaded Gold Nanorod@liposome Core-Shell Nanoparticles in Liver Cancer

Conventional imaging methods encounter challenges in diagnosing liver cancer that is less than 10 mm or without typical hypervascular features. With deep penetration and high spatial resolution imaging capability, the emerging photoacoustic tomography may offer better diagnostic efficacy for noninvasive liver cancer detection. Moreover, near-infrared fluorescence imaging-guided hepatectomy was proven to be able to identify nodules at the millimeter level. Thus, suitable photoacoustic and fluorescence dual-modality imaging probe may benefit patients in early diagnosis and complete resection. In this study, we fabricated indocyanine green loaded gold nanorod@liposome core-shell nanoparticles (Au@liposome-ICG) to integrate both imaging strategies. These nanoparticles exhibit superior biocompatibility, high stability, and enhanced dual-model imaging signals. Next, we explored their effectiveness of tumor detection and surgery guidance in orthotopic liver cancer mouse models. Histological analysis confirmed the accuracy of the probe in liver cancer detection and resection. This novel dual-modality nanoprobe holds promise for early diagnosis and better surgical outcome of liver cancer and has great potential for clinical translation.

Water Soluble Melanin Derivatives for Dynamic Contrast Enhanced Photoacoustic Imaging of Tumor Vasculature and Response to Antiangiogenic Therapy

A dynamic contrast enhanced (DCE) approach for tumor photoacoustic (PA) imaging is described. Novel water soluble melanin-based derivatives are synthesized that exhibit good PA properties, stability, safety and accumulation in tumor bearing mice. This melanin derivative is capable to characterize tumor vasculature and to monitor vessel permeability changes upon antiangiogenic treatment. DCE-PA imaging can assess functional response to cancer treatments.

Photoacoustic Molecular Imaging: From Multiscale Biomedical Applications Towards Early-Stage Theranostics

Photoacoustic imaging (PAI) has ushered in a new era of observational biotechnology and has facilitated the exploration of fundamental biological mechanisms and clinical translational applications, which has attracted tremendous attention in recent years. By converting laser into ultrasound emission, PAI combines rich optical contrast, high ultrasonic spatial resolution, and deep penetration depth in a single modality. This evolutional technique enables multiscale and multicontrast visualization from cells to organs, anatomy to function, and molecules to metabolism with high sensitivity and specificity. The state-of-the-art developments and applications of PAI are described in this review. Future prospects for clinical use are also highlighted. Collectively, PAI holds great promise to drive biomedical applications towards early-stage theranostics.