Multimodal photoacoustic imaging as a tool for sentinel lymph node identification and biopsy guidance

A new fluorescenttargeting tracer contrasts dual tracers in sentinel lymph node biopsy of breast cancer

Purpose: To explore the clinical application value of indocyanine green (ICG)-rituximab in sentinel lymph node biopsy. Methods: This study included 156 patients with primary breast cancer: 50 patients were enrolled in dose-climbing test, and 106 patients were enrolled in verification test. This was to compare the consistency of ICG-rituximab and combined method in the detected lymph nodes. Results: According to the verification test, the imaging rate of ICG-rituximab was 97.3%. Compared with the combined method, the concordance rate of fluorescence method was 0.991 (28 + 78/107; p < 0.001). Conclusion: For ICG-rituximab as a fluorescent targeting tracer, the optimal imaging dose of ICG 93.75 μg/rituximab 375 μg can significantly reduce the imaging of secondary lymph nodes. Compared with the combined method, it has a higher concordance rate.

Precision Surgery Guided by Intraoperative Molecular Imaging

Intraoperative molecular imaging (IMI) has recently emerged as an important tool in the armamentarium of surgical oncologists. IMI allows real-time assessment of oncologic resection quality, margin assessment, and occult disease detection during real-time surgery. Numerous tracers have now been developed for use in IMI-guided tissue sampling. Fluorochromes localize to the tumor by taking advantage of their disorganized capillary milieu, overexpressed receptors, or upregulated enzymes. Although fluorescent tracers can suffer from issues of autofluorescence and lack of depth penetration, these challenges are being addressed through hybrid radioactive/fluorescent tracers and new tracers that fluoresce in the near-infrared (NIR-II [wavelength > 1,000 nm]) range. IMI is already being used to treat numerous cancers, with demonstrated improvement in cancer recurrence and patient outcomes without incurring significant burden on either clinicians or patients. In this comprehensive review, we discuss history, mechanism, current oncologic applications, and future directions of IMI-guided optical biopsy.

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.

Sentinel lymph node detection by combining nonradioactive techniques with contrast agents: State of the art and prospects

The status of sentinel lymph nodes (SLNs) has a substantial prognostic value because these nodes are the first place where cancer cells accumulate along their spreading route. Routine SLN biopsy ("gold standard") involves peritumoral injections of radiopharmaceuticals, such as technetium-99m, which has obvious disadvantages. This review examines the methods used as "gold standard" analogs to diagnose SLNs. Nonradioactive preoperative and intraoperative methods of SLN detection are analyzed. Promising photonic tools for SLNs detection are reviewed, including NIR-I/NIR-II fluorescence imaging, photoswitching dyes for SLN detection, in vivo photoacoustic detection, imaging and biopsy of SLNs. Also are discussed methods of SLN detection by magnetic resonance imaging, ultrasonic imaging systems including as combined with photoacoustic imaging, and methods based on the magnetometer-aided detection of superparamagnetic nanoparticles. The advantages and disadvantages of nonradioactive SLN-detection methods are shown. The review concludes with prospects for the use of conservative diagnostic methods in combination with photonic tools.

Indocyanine green dye based bimodal contrast agent tested by photoacoustic/fluorescence tomography setup

Multimodal imaging systems are in high demand for preclinical research, experimental medicine, and clinical practice. Combinations of photoacoustic technology with other modalities including fluorescence, ultrasound, MRI, OCT have been already applied in feasibility studies. Nevertheless, only the combination of photoacoustics with ultrasound in a single setup is commercially available now. A combination of photoacoustics and fluorescence is another compelling approach because those two modalities naturally complement each other. Here, we presented a bimodal contrast agent based on the indocyanine green dye (ICG) as a single signalling compound embedded in the biocompatible and biodegradable polymer shell. We demonstrate its remarkable characteristics by imaging using a commercial photoacoustic/fluorescence tomography system (TriTom, PhotoSound Technologies). It was shown that photoacoustic signal of the particles depends on the amount of dye loaded into the shell, while fluorescence signal depends on the total amount of dye per particle. For the first time to our knowledge, a commercial bimodal photoacoustic/fluorescence setup was used for characterization of ICG doped polymer particles. Additionally, we conducted cell toxicity studies for these particles as well as studied biodistribution over time in vivo and ex vivo using fluorescent imaging. The obtained results suggest a potential for the application of biocompatible and biodegradable bimodal contrast agents as well as the integrated photoacoustic/fluorescence imaging system for preclinical and clinical studies.

Elimination of Nontargeted Photoacoustic Signals for Combined Photoacoustic and Ultrasound Imaging

As a molecular imaging modality, photoacoustic (PA) imaging has been in the spotlight because it can provide an optical contrast image of physiological information and a relatively deep imaging depth. However, its sensitivity is limited despite the use of exogenous contrast agents due to the background PA signals generated from nontargeted absorbers, such as blood and boundaries between different biological tissues. In addition, clutter artifacts generated in both in-plane and out-of-plane imaging region degrade the sensitivity of PA imaging. We propose a method to eliminate the nontargeted PA signals. For this study, we used a dual-modal ultrasound (US)-PA contrast agent that is capable of generating both the backscattered US and PA signals in response to the transmitted US and irradiated light, respectively. The US images of the contrast agents are used to construct a masking image that contains the location information about the target site and is applied to the PA image acquired after contrast agent injection. In vitro and in vivo experimental results demonstrated that the masking image constructed using the US images makes it possible to completely remove nontargeted PA signals. The proposed method can be used to enhance the clear visualization of the target area in PA images.

Photoacoustic Signal Simulation Using Discrete Particle Approach and its Application in Tomography

A theoretical framework for photoacoustic (PA) signal simulation using a discrete particle approach is discussed, and the tomographic image reconstruction using such signals is reported. Various numerical phantoms in two dimensions were constructed by inserting monodisperse/polydisperse solid circles/disks of uniform strength occupying regular or random locations within the imaging region. In particular, a blood vessel network phantom was simulated by positioning solid circles mimicking red blood cells randomly within the vessel using a Monte Carlo method. The PA signal from a single disk was obtained by numerically evaluating the analytical formula, and then, such signals from many disks were summed up linearly to generate the resultant signals at detector locations. Classical backprojection and time-reversal algorithms were employed to form reconstructed images. Two model-based approaches, namely impulse response-based (IRB) and interpolation-based (IPB) methods, were also deployed for image reconstruction. Some standard parameters were calculated to assess the performance of these reconstruction algorithms. The simulation results demonstrate that the Monte Carlo method can be applied in practice for the fast simulation of tissue realization keeping microscopic details intact, and accordingly, PA signals can be calculated for photoacoustic tomography (PAT) imaging. Furthermore, the IRB technique produces images with superior quality and outperforms other algorithms.

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.

In Vivo Dual-Modal Photoacoustic and Ultrasound Imaging of Sentinel Lymph Nodes Using a Solid-State Dye Laser System

Photoacoustic imaging (PAI) is being actively investigated as a non-invasive and non-radioactive imaging technique for sentinel lymph node (SLN) biopsy. By taking advantage of optical and ultrasound imaging, PAI probes SLNs non-invasively with methylene blue (MB) in both live animals and breast cancer patients. However, these PAI systems have limitations for widespread use in clinics and commercial marketplaces because the lasers used by the PAI systems, e.g., tunable liquid dye laser systems and optical parametric oscillator (OPO) lasers, are bulky in size, not economical, and use risky flammable and toxic liquid dyes. To overcome these limitations, we are proposing a novel dual-modal photoacoustic and ultrasound imaging system based on a solid-state dye laser (SD-PAUSI), which is compact, convenient, and carries far less risk of flammability and toxicity. Using a solid-state dye handpiece that generates 650-nm wavelength, we successfully imaged the MB tube positioned deeply (~3.9 cm) in chicken breast tissue. The SLNs were also photoacoustically detected in the in vivo rats beneath a 2.2-cm-thick layer of chicken breast, which is deeper than the typical depth of SLNs in humans (1.2 ± 0.5 cm). Furthermore, we showed the multispectral capability of the PAI by switching the dye handpiece, in which the MB-dyed SLN was selectively highlighted from the surrounding vasculature. These results demonstrated the great potential of the SD-PAUSI as an easy but effective modality for SLN detection.

Optically Transparent Focused Transducers for Combined Photoacoustic and Ultrasound Microscopy

Purpose

Photoacoustic (PA) microscopy has emerged as a useful tool in biomedical imaging applications such as visualization of microvasculature and hemoglobin oxygen saturation, single-cell, and label-free imaging of organs including cancer. Since the ultrasound transducers used for PA signal detection are not optically transparent, the integration of optical and acoustic modules for coaxial alignment of laser and acoustic beam fields in PA microscopy is complex and costly.

Methods

Here, we report a recently developed optically transparent focused transducer for combined PA and ultrasound (US) microscopy. All the acoustic layers including the acoustic lens are optically transparent, enabling simple integration of optical and acoustic modules for both imaging modalities.

Results

The mean light transmittance of the transducer’s backing layer and acoustic lens and of the transducer itself were measured at 92%, 83%, and 66%, respectively. Results from in vitro and in vivo experiments demonstrated the transducer to be suitable for both US and PA imaging.

Conclusions

The results of this study represent a step toward efficient construction of probes for combined PA and US microscopy.

Deep tissue photoacoustic imaging of nickel(II) dithiolene-containing polymeric nanoparticles in the second near-infrared window

Photoacoustic imaging is gaining great attention in the medical world due to its significant potential for clinical translation. Light excitation in the second near-infrared (NIR-II) window (1000-1350 nm) has resolution and penetration depth suitable for several clinical applications. However, the significant challenge exists for clinical translation because of the absence of notable intrinsic chromophores in this clinically significant optical range to generate diagnostic images. Methods: We present newly developed a biocompatible nickel dithiolene-based polymeric nanoparticle (NiPNP), which have a strong and sharp absorption peak at 1064 nm, as a photoacoustic contrast agent to boost specific absorbance in the NIR-II window for in vivo deep tissue imaging. Results: We confirm the enhanced PA signal by NiPNP's strong light absorption in the NIR-II window (287% higher than that of NIR-I) and deep tissue imaging capability (~5.1 cm) through in vitro experiment. We have successfully acquired diagnostic-quality in vivo photoacoustic images in deep tissue (~3.4 cm) of sentinel lymph nodes, gastrointestinal tracts, and bladders of live rats by using clinically viable imaging system. Conclusions: Our results prove that with strong absorption in the NIR-II window and with deeper imaging depth, the clinical translation of photoacoustic imaging with NiPNP is feasible for preclinical studies and thus would facilitate further clinical investigations.

Portable and Rapid <i>In Vivo</i> Imaging of Tissue Oxygenation Changes Induced by Skin Perfusion Pressure

Current imaging systems available in the study of tissue hemodynamics and vascular reactivity are typically complex and bulky, hence limiting their applications to laboratory use. The aim of this study is to present the dynamics of skin oxygen level with changes in the microcirculatory perfusion monitored using a developed field portable, handheld tri-wavelength imaging system. The skin oxygen saturation level (StO2) was measured in-vivo in a span of 12 minutes in the ventral forearm of seven healthy humans at rest, before and after supra-diastolic and supra-systolic pressure inflations. The findings of this work showed statistical significance in the difference between the mean StO2 values in baseline and that following ischemic episodes with ρ ≤ 0.03. The values returned to baseline, although of different magnitude for each individual, within 2 min (ρ =0.217) during reperfusion could suggest the time required for the resume of normal autoregulation mechanisms and vasomotion reactivities in the recruits. This study concluded that the developed imaging system could find potential application in self-healthcare management and may help to improve patient care in remote or rural locations.

Impact of sensor apodization on the tangential resolution in photoacoustic tomography

Photoacoustic tomographic (PAT) image reconstruction with apodized sensors is discussed. A Gaussian function was used to model axisymmetric apodization of sensors, and its full width at half-maximum (FWHM) was varied to investigate the role of apodization on the PAT image reconstruction. The well-known conventional delay-and-sum (CDAS) algorithm and recently developed modified delay-and-sum (MDAS) algorithm were implemented to generate reconstructed images. The performances of these algorithms were examined by comparing simulated images formed by these methods and that of ideal point detectors. Simulations in two dimensions were conducted using the k-Wave toolbox for three different phantoms. The results produced by the CDAS method are very close to that of ideal point detectors when the FWHM of the Gaussian function is small. The MDAS algorithm for flat sensors provides excellent results (comparable to that of point detectors) when the FWHM of the Gaussian profile is large. This study elucidates how sensor apodization affects PAT image reconstruction.