High-sensitivity intravascular photoacoustic imaging of lipid-laden plaque with a collinear catheter design

Evaluating acoustic and thermal properties of a plaque phantom

PURPOSE

The aim of this study is to evaluate the acoustic and thermal properties of a plaque phantom. This is very important for the effective implementation of ultrasound not only in diagnosis but especially in treatment for the future.

MATERIAL AND METHODS

An evaluation of acoustic and thermal properties of plaque phantoms to test their suitability mainly for ultrasound imaging and therapy was presented. The evaluation included measurements of the acoustic propagation speed using pulse-echo technique, ultrasonic attenuation coefficient using through transmission immersion technique, and absorption coefficient. Moreover, thermal properties (thermal conductivity, volumetric specific heat capacity and thermal diffusivity) were measured with the transient method using a needle probe.

RESULTS

It was shown that acoustic and thermal properties of atherosclerotic plaque phantoms fall well within the range of reported values for atherosclerotic plaque and slightly different for thermal diffusivity and volumetric specific heat capacity for soft tissues. The mean value of acoustic and thermal properties and their standard deviation of plaque phantoms were 1523 ± 23 m/s for acoustic speed, 0.50 ± 0.02 W/mK for thermal conductivity, 0.30 ± 0.21 db/cm-MHz for ultrasonic absorption coefficient and 1.63 ± 0.46 db/cm-MHz for ultrasonic attenuation coefficient.

CONCLUSIONS

This study demonstrated that acoustic and thermal properties of atherosclerotic plaque phantoms were within the range of reported values. Future studies should be focused on the optimum recipe of the atherosclerotic plaque phantoms that mimics the human atherosclerotic plaque (agar 4% w/v, gypsum 10% w/v and butter 10% w/v) and can be used for HIFU therapy.

A high-sensitivity high-resolution intravascular photoacoustic catheter through mode cleaning in a graded-index fiber

Intravascular photoacoustic imaging has been developed to evaluate the possibility of plaque rupture in atherosclerosis by high spatial resolution imaging of lipid. However, the detection sensitivity and spatial resolution are compromised by the poor focusing caused by a multimode fiber. In this work, we report an intravascular photoacoustic catheter with mode self-cleaning in a graded-index fiber to improve the beam quality and the sensitivity for lipid detection. Compared with the higher-order modes in a step-index multimode fiber, the lower-order modes generated by the self-cleaning effect in the graded-index fiber greatly enhanced the photoacoustic spatial resolution and detection sensitivity. The dominant ringing artifact caused by laser absorption of the ultrasound transducer was further reduced by using stripe suppression. A lipid plaque mimicking phantom was imaged for evaluation. Lipid particles with a small diameter of 75.7 µm were clearly observed.

Survival intravascular photoacoustic imaging of lipid-rich plaque in cholesterol fed rabbits

Intravascular photoacoustic (IVPA) imaging is a promising modality for quantitative assessment of lipid-laden atherosclerotic plaques. Yet, survival IVPA imaging of the same plaque in the same animal is not demonstrated. Here, using a sheathed IVUS/PA catheter of 0.9 mm in diameter, we demonstrate MRI-guided survival IVPA imaging of same plaque in an aorta of a well-established rabbit model mimicking atherosclerosis in human patients. The IVUS/PA results were confirmed by histology. These advances open the opportunity to evaluate the effectiveness of a therapy that aims to reduce the size of atherosclerotic plaques and demonstrates the potential of translating the IVPA catheter into clinic for detection of lipid-rich plaques that are at high risk for thrombosis.

Progress in Probe-Based Sensing Techniques for In Vivo Diagnosis

Advancements in robotic surgery help to improve the endoluminal diagnosis and treatment with minimally invasive or non-invasive intervention in a precise and safe manner. Miniaturized probe-based sensors can be used to obtain information about endoluminal anatomy, and they can be integrated with medical robots to augment the convenience of robotic operations. The tremendous benefit of having this physiological information during the intervention has led to the development of a variety of in vivo sensing technologies over the past decades. In this paper, we review the probe-based sensing techniques for the in vivo physical and biochemical sensing in China in recent years, especially on in vivo force sensing, temperature sensing, optical coherence tomography/photoacoustic/ultrasound imaging, chemical sensing, and biomarker sensing.

Investigating atherosclerotic plaque phantoms for ultrasound therapy

PURPOSE

The aim of the proposed study was to conduct a feasibility study using a flat rectangular (2 × 10 mm2) transducer operating at 4.0 MHz for creating thermal lesions in an arterial atherosclerotic plaque phantom. The proposed method can be used in the future for treating atherosclerotic plaques in human arteries.

MATERIALS AND METHODS

The flat rectangular transducer was firstly assessed in agar/silica evaporated milk phantom, polyacrylamide phantom and freshly excised turkeytissue phantom. Then, the same transducer was assessed in an arterial atherosclerotic plaque phantom which was created in the laboratory with a very low cost. The recipe of the atherosclerotic plaque phantom was 4% w/v agar, 1% w/v gypsum, 2% w/v butter and 93% water. The amount of plaque removal was evaluated visually and using an X-Ray system.

RESULTS

It was shown that the flat rectangular transducer can create thermal lesions on the agar/silica evaporated milk phantom, polyacrylamide phantom and in excised tissue. The size of the lesions matches the geometry of the transducer. Moreover, this transducer destroyed 27.1% of the atherosclerotic plaque phantom with 8 W acoustical power and 30 s duration.

CONCLUSIONS

This feasibility study demonstrated that atherosclerotic plaque can be destroyed using a very small flat rectangular (2 × 10 mm2) transducer in a very small time interval of 30 s. In future clinical trials the transducer will be incorporated in a catheter which will be inserted intravascular (1-3 mm) wide and can be used to treat atherosclerotic plaques in the coronary arteries.

High-resolution label-free mapping of murine kidney vasculature by raster-scanning optoacoustic mesoscopy: an ex vivo study

BACKGROUND

Chronic kidney disease (CKD) is a global burden affecting both children and adults. Novel imaging modalities hold great promise to visualize and quantify structural, functional, and molecular organ damage. The aim of the study was to visualize and quantify murine renal vasculature using label-free raster scanning optoacoustic mesoscopy (RSOM) in explanted organs from mice with renal injury.

MATERIAL AND METHODS

For the experiments, freshly bisected kidneys of alpha 8 integrin knock-out (KO) and wildtype mice (WT) were used. A total of n=7 female (n=4 KO, n=3 WT) and n=6 male animals (n=2 KO, n=4 WT) aged 6 weeks were examined with RSOM optoacoustic imaging systems (RSOM Explorer P50 at SWL 532nm and/or ms-P50 imaging system at 532 nm, 555 nm, 579 nm, and 606 nm). Images were reconstructed using a dedicated software, analyzed for size and vascular area and compared to standard histologic sections.

RESULTS

RSOM enabled mapping of murine kidney size and vascular area, revealing differences between kidney sizes of male (m) and female (f) mice (merged frequencies (MF) f vs. m: 52.42±6.24 mm² vs. 69.18±15.96 mm², p=0.0156) and absolute vascular area (MF f vs. m: 35.67±4.22 mm² vs. 49.07±13.48 mm², p=0.0036). Without respect to sex, the absolute kidney area was found to be smaller in knock-out (KO) than in wildtype (WT) mice (WT vs. KO: MF: p=0.0255) and showed a similar trend for the relative vessel area (WT vs. KO: MF p=0.0031). Also the absolute vessel areas of KO compared to WT were found significantly different (MF p=0.0089). A significant decrease in absolute vessel area was found in KO compared to WT male mice (MF WT vs. KO: 54.37±9.35 mm² vs. 34.93±13.82 mm², p=0.0232). In addition, multispectral RSOM allowed visualization of oxygenated and deoxygenated parenchymal regions by spectral unmixing.

CONCLUSION

This study demonstrates the capability of RSOM for label-free visualization of differences in vascular morphology in ex vivo murine renal tissue at high resolution. Due to its scalability optoacoustic imaging provides an emerging modality with potential for further preclinical and clinical imaging applications.

Intra-instrument channel workable, optical-resolution photoacoustic and ultrasonic mini-probe system for gastrointestinal endoscopy

There has been a long-standing expectation that the optical-resolution embodiment of photoacoustic tomography could have a substantial impact on gastrointestinal endoscopy by enabling microscopic visualization of the vasculature based on the endogenous contrast mechanism. Although multiple studies have demonstrated the in vivo imaging capability of a developed imaging device over the last decade, the implementation of such an endoscopic system that can be applied immediately when necessary via the instrument channel of a video endoscope has been a challenge. In this study, we developed a 3.38-mm diameter catheter-based, integrated optical-resolution photoacoustic and ultrasonic mini-probe system and successfully demonstrated its intra-instrument channel workability for the standard 3.7-mm diameter instrument channel of a clinical video endoscope based on a swine model. Through the instrument channel, we acquired the first in vivo dual-mode photoacoustic and ultrasonic endoscopic images from the esophagogastric junction of a swine. Further, in a rat colorectum in vivo imaging experiment, we visualized hierarchically developed mesh-like capillary networks with a hole size as small as ~50 µm, which suggests the potential level of image details that could be photoacoustically provided in clinical settings in the future.

Current research and future prospects of IVOCT imaging-based detection of the vascular lumen and vulnerable plaque

Intravascular optical coherence tomography (IVOCT) is an imaging method that has developed rapidly in recent years and is useful in coronary atherosclerosis diagnosis. It is widely used in the assessment of vulnerable plaque. This review summarizes the main research methods used in recent years for blood vessel lumen boundary detection and segmentation and vulnerable plaque segmentation and classification. This article aims to comprehensively and systematically introduce the research progress on internal tissues of blood vessels based on IVOCT images. The characteristics and advantages of various methods have been summarized to provide theoretical ideas and methods for the reference of relevant researchers and scholars.

Advances in Endoscopic Photoacoustic Imaging

Photoacoustic (PA) imaging is able to provide extremely high molecular contrast while maintaining the superior imaging depth of ultrasound (US) imaging. Conventional microscopic PA imaging has limited access to deeper tissue due to strong light scattering and attenuation. Endoscopic PA technology enables direct delivery of excitation light into the interior of a hollow organ or cavity of the body for functional and molecular PA imaging of target tissue. Various endoscopic PA probes have been developed for different applications, including the intravascular imaging of lipids in atherosclerotic plaque and endoscopic imaging of colon cancer. In this paper, the authors review representative probe configurations and corresponding preclinical applications. In addition, the potential challenges and future directions of endoscopic PA imaging are discussed.

Advanced Ultrasound and Photoacoustic Imaging in Cardiology

Cardiovascular diseases (CVDs) remain the leading cause of death worldwide. An effective management and treatment of CVDs highly relies on accurate diagnosis of the disease. As the most common imaging technique for clinical diagnosis of the CVDs, US imaging has been intensively explored. Especially with the introduction of deep learning (DL) techniques, US imaging has advanced tremendously in recent years. Photoacoustic imaging (PAI) is one of the most promising new imaging methods in addition to the existing clinical imaging methods. It can characterize different tissue compositions based on optical absorption contrast and thus can assess the functionality of the tissue. This paper reviews some major technological developments in both US (combined with deep learning techniques) and PA imaging in the application of diagnosis of CVDs.

Knockdown of circular RNA hsa_circ_0003204 inhibits oxidative stress and apoptosis through the miR-330-5p/Nod2 axis to ameliorate endothelial cell injury induced by low-density lipoprotein

Introduction

Atherosclerosis (AS) is the leading cause of cardiovascular disease. Circular RNA hsa_circ_0003204 (hsa_circ_0003204) was elevated in oxidized low-density lipoprotein (ox-LDL)-induced human umbilical vein endothelial cells. However, the role and molecular mechanism of hsa_circ_0003204 in the AS process have not been studied.

Material and methods

Human primary aortic endothelial cells (HAECs) were treated with low-density lipoprotein (ox-LDL) to establish the AS model. The viability of ox-LDL-induced HAECs was assessed by counting kit-8 (CCK8) assay. Reactive oxygen species (ROS), malondialdehyde (MDA) and superoxide dismutase (SOD) levels in ox-LDL-induced HAECs supernatant were evaluated with the relevant kits. The apoptosis of ox-LDL-induced HAECs was determined via flow cytometry assay. The expression of hsa_circ_0003204, miR-330-5p, and nucleotide-binding oligomerization domain 2 (Nod2) was analyzed through quantitative real-time polymerase chain reaction (qRT-PCR). The relationship between hsa_circ_0003204 or Nod2 and miR-330-5p was verified by dual-luciferase reporter assay. Protein level of Nod2 was detected using western blot analysis.

Results

Hsa_circ_0003204 and Nod2 were upregulated while miR-330-5p was decreased in ox-LDL-induced HAECs. Hsa_circ_0003204 depletion restrained the oxidative stress and apoptosis of ox-LDL-induced HAECs. Notably, hsa_circ_0003204 regulated Nod2 expression via sponging miR-330-5p in HAECs. Moreover, miR-330-5p inhibition restored the constraint of the oxidative stress and apoptosis of ox-LDL-induced HAECs caused by hsa_circ_0003204 silencing. Additionally, miR-330-5p targeted Nod2 and Nod2 enhancement abolished the repressive effects of miR-330-5p overexpression on the oxidative stress and apoptosis of ox-LDL-induced HAECs.

Conclusions

Hsa_circ_0003204 exhaustion mitigated endothelial cell injury through suppressing the oxidative stress and apoptosis in ox-LDL-induced HAECs via the miR-330-5p/Nod2 axis.

Multifocus Thermal Strain Imaging Using a Curved Linear Array Transducer for Identification of Lipids in Deep Tissue

Thermal strain imaging (TSI) is an ultrasound-based imaging technique intended primarily for diseases in which lipid accumulation is the main biomarker. The goal of the research described here was to successfully implement TSI on a single, commercially available curved linear array transducer for heating and imaging of organs at a deeper depth. For an effective temperature rise of the tissue over a large area, which is key to TSI performance, an innovative multifocus beamforming approach was applied. This yielded a heating area from 32 to 96 mm in the axial direction and -7 to +7 mm in the lateral direction. The pressure fields generated from simulation were in agreement with pressure fields measured with the hydrophone. TSI with safe acoustic power identified with high contrast a rubber inclusion and liposuction fat tissue embedded in a gelatin block.

Recent Advances in Transducers for Intravascular Ultrasound (IVUS) Imaging

As a well-known medical imaging methodology, intravascular ultrasound (IVUS) imaging plays a critical role in diagnosis, treatment guidance and post-treatment assessment of coronary artery diseases. By cannulating a miniature ultrasound transducer mounted catheter into an artery, the vessel lumen opening, vessel wall morphology and other associated blood and vessel properties can be precisely assessed in IVUS imaging. Ultrasound transducer, as the key component of an IVUS system, is critical in determining the IVUS imaging performance. In recent years, a wide range of achievements in ultrasound transducers have been reported for IVUS imaging applications. Herein, a comprehensive review is given on recent advances in ultrasound transducers for IVUS imaging. Firstly, a fundamental understanding of IVUS imaging principle, evaluation parameters and IVUS catheter are summarized. Secondly, three different types of ultrasound transducers (piezoelectric ultrasound transducer, piezoelectric micromachined ultrasound transducer and capacitive micromachined ultrasound transducer) for IVUS imaging are presented. Particularly, the recent advances in piezoelectric ultrasound transducer for IVUS imaging are extensively examined according to their different working mechanisms, configurations and materials adopted. Thirdly, IVUS-based multimodality intravascular imaging of atherosclerotic plaque is discussed. Finally, summary and perspectives on the future studies are highlighted for IVUS imaging applications.

Optoacoustic Imaging in Inflammation

Optoacoustic or photoacoustic imaging (OAI/PAI) is a technology which enables non-invasive visualization of laser-illuminated tissue by the detection of acoustic signals. The combination of "light in" and "sound out" offers unprecedented scalability with a high penetration depth and resolution. The wide range of biomedical applications makes this technology a versatile tool for preclinical and clinical research. Particularly when imaging inflammation, the technology offers advantages over current clinical methods to diagnose, stage, and monitor physiological and pathophysiological processes. This review discusses the clinical perspective of using OAI in the context of imaging inflammation as well as in current and emerging translational applications.

3D acoustic resolution-based photoacoustic endoscopy with dynamic focusing

Background

Acoustic resolution-based photoacoustic endoscopy (ARPAE) is a non-invasive potential tool for imaging gastrointestinal and urogenital tracts. However, current ARPAE systems usually only provide 2D sectorial B-mode images, and have the limitation of the image quality significantly deteriorating out-of-focus regions due to transducers with fixed focus in these systems. To overcome these limitations, we put forward a modified back-projection method that can provide 3D images with dynamic focusing in ARPAE.

Methods

A graphics processing unit (GPU)-based parallel computation technique was adopted for efficient computation. Both simulated and phantom/ex-vivo experiments were conducted to validate our method.

Results

The findings indicated that our proposed method can effectively improve the lateral resolution and signal-to-noise ratio (SNR) in the out-of-focus regions. For a target 3 mm from the transducer focus, the new method can improve 11 times in the lateral resolution, along with an improvement of up to 37 dB in the SNR.

Conclusions

3D ARPAE provides high-quality imaging in both focus and out-of-focus regions.

Photoacoustic Tomography Opening New Paradigms in Biomedical Imaging

After the emergence of the ultrasound, X-ray CT, PET, and MRI, photoacoustic tomography (PAT) is now in the phase of its exponential growth, with its expected full maturation being another form of mainstream clinical imaging modality. By combining the high contrast benefit of optical imaging and the high-resolution deep imaging capability of ultrasound, PAT can provide unprecedented anatomical image contrasts at clinically relevant depths as well as enable the use of a variety of functional and molecular imaging information, which is not possible with conventional imaging modalities. With these strengths, PAT has achieved numerous breakthroughs in various biomedical applications and also provided new technical platforms that may be able to resolve unmet issues in clinics. In this chapter, we provide an overview of the development of PAT technology for several major biomedical applications and provide an approximate projection of the future of PAT.

Photoacoustic imaging with fiber optic technology: A review

Photoacoustic imaging (PAI) has achieved remarkable growth in the past few decades since it takes advantage of both optical and ultrasound (US) imaging. In order to better promote the wide clinical applications of PAI, many miniaturized and portable PAI systems have recently been proposed. Most of these systems utilize fiber optic technologies. Here, we overview the fiber optic technologies used in PAI. This paper discusses three different fiber optic technologies: fiber optic light transmission, fiber optic US transmission, and fiber optic US detection. These fiber optic technologies are analyzed in different PAI modalities including photoacoustic microscopy (PAM), photoacoustic computed tomography (PACT), and minimally invasive photoacoustic imaging (MIPAI).

Shortwave-infrared meso-patterned imaging enables label-free mapping of tissue water and lipid content

Water and lipids are key participants in many biological processes, but there are few non-invasive methods that provide quantification of these components in vivo, and none that can isolate and quantify lipids in the blood. Here we develop a new imaging modality termed shortwave infrared meso-patterned imaging (SWIR-MPI) to provide label-free, non-contact, spatial mapping of water and lipid concentrations in tissue. The method utilizes patterned hyperspectral illumination to target chromophore absorption bands in the 900-1,300 nm wavelength range. We use SWIR-MPI to monitor clinically important physiological processes including edema, inflammation, and tumor lipid heterogeneity in preclinical models. We also show that SWIR-MPI can spatially map blood-lipids in humans, representing an example of non-invasive and contact-free measurements of in vivo blood lipids. Together, these results highlight the potential of SWIR-MPI to enable new capabilities in fundamental studies and clinical monitoring of major conditions including obesity, cancer, and cardiovascular disease.

Highly sensitive lipid detection and localization in atherosclerotic plaque with a dual-frequency intravascular photoacoustic/ultrasound catheter

Intravascular photoacoustic/ultrasound (IVPA/US) is an emerging hybrid imaging modality that provides specific lipid detection and localization, while maintaining co-registered artery morphology, for diagnosis of vulnerable plaque in cardiovascular disease. However, current IVPA/US approaches based on a single-element transducer exhibit compromised performance for lipid detection due to the relatively low contrast of lipid absorption and conflicting detection bands for photoacoustic and ultrasound signals. Here, we present a dual-frequency IVPA/US catheter for highly sensitive detection and precision localization of lipids. The low frequency transducer provides enhanced photoacoustic sensitivity, while the high frequency transducer maintains state-of-the-art spatial resolution for ultrasound imaging. The boosted capability of IVPA/US imaging enables a multi-scale analysis of lipid distribution in swine with coronary atherosclerosis. The dual-frequency IVPA/US catheter has a diameter of 1 mm and flexibility to easily adapt to current catheterization procedures and is a significant step toward clinical diagnosis of vulnerable plaque.

High-robustness intravascular photoacoustic endoscope with a hermetically sealed opto-sono capsule

The prevailing open-structure intravascular photoacoustic (IVPA) endoscope emits a gradually deformed laser beam with exposed optical or acoustical components bearing pollution and damage in arterial lumen. Deformed laser beam scanning, which causes a low excitation efficiency and serious deterioration of the transverse resolution, is a current big obstacle to the application of photoacoustic endoscopy in intravascular imaging. Hence, the stable and reliable IVPA endoscope is indispensable. In this letter, we designed a high-robustness intravascular photoacoustic (HR-IVPA) endoscope with a hermetically sealed opto-sono capsule. The distal end of the opto-sono capsule was integrated with miniaturized optics, including a customized C-Lens and a customized total-reflection prism (TRP). The TRP was first applied to a side-viewing IVPA endoscope, featuring a high-throughput energy coupling efficiency of 90% and a cut-off free damage threshold. The optical path structure of the endoscope, optimized using optical simulation tools, overcame the ambiguous focus shift caused by chromatic dispersion and achieved a waist size of 20 µm as well as a focus depth of 4 mm in water at the wavelength of 1200 nm. The mass phantom experiments demonstrated that the HR-IVPA endoscope afforded repeatable IVPA images with a relatively constant signal-to-noise ratio (SNR) of about ∼41.8 dB and a transverse resolution of about ∼23 µm. The imaging experiments of the stent and lipid further demonstrated the robustness and validated the imaging ability of the HR-IVPA endoscope, which opens a new avenue for improving the endoscopic imaging capability, strengthening the credible detection of atherosclerotic cardiovascular disease.

Electrothermal-MEMS-induced nonlinear distortion correction in photoacoustic laparoscopy

Micro-electro-mechanical systems (MEMS) scanner has significant advantages of miniature size, fast response and high stability, which is particularly applicable to photoacoustic laparoscopy (PAL). However, tilt angle-voltage curve of electrothermal MEMS shows a nonlinear character, which leads to inevitable nonlinear distortion in photoacoustic imaging. To overcome this problem, a nonlinear distortion correction was developed for the high-resolution forward-scanning electrothermal-MEMS-based PAL. The adaptive resampling method (ARM) was introduced to adaptively calibrate the projection of non-uniform scanning region to match the uniform scanning region. The correction performed low time complexity and high portability owing to the adaptive capacity of distortion decomposition in the reconstruction of physical models. Compared with the sample structure, phantom experiments demonstrated that the distortion was calibrated in all directions and the corrected image provided up to 96.82% high structural similarity in local subset. Furthermore, ARM was applied to imaging the abdominal cavity of rat and the vascular morphology was corrected in real-time display within a delay less than 2 seconds. All these results demonstrated that the nonlinear distortion correction possessed timely and effective correction in PAL, which suggested that it had the potential to employ to any other electrothermal-MEMS-based photoacoustic imaging systems for accurate and quantitative functional imaging.

Photoacoustic Imaging in Tissue Engineering and Regenerative Medicine

Several imaging modalities are available for investigation of the morphological, functional, and molecular features of engineered tissues in small animal models. While research in tissue engineering and regenerative medicine (TERM) would benefit from a comprehensive longitudinal analysis of new strategies, researchers have not always applied the most advanced methods. Photoacoustic imaging (PAI) is a rapidly emerging modality that has received significant attention due to its ability to exploit the strong endogenous contrast of optical methods with the high spatial resolution of ultrasound methods. Exogenous contrast agents can also be used in PAI for targeted imaging. Applications of PAI relevant to TERM include stem cell tracking, longitudinal monitoring of scaffolds in vivo, and evaluation of vascularization. In addition, the emerging capabilities of PAI applied to the detection and monitoring of cancer and other inflammatory diseases could be exploited by tissue engineers. This article provides an overview of the operating principles of PAI and its broad potential for application in TERM. Impact statement Photoacoustic imaging, a new hybrid imaging technique, has demonstrated high potential in the clinical diagnostic applications. The optical and acoustic aspect of the photoacoustic imaging system works in harmony to provide better resolution at greater tissue depth. Label-free imaging of vasculature with this imaging can be used to track and monitor disease, as well as the therapeutic progression of treatment. Photoacoustic imaging has been utilized in tissue engineering to some extent; however, the full benefit of this technique is yet to be explored. The increasing availability of commercial photoacoustic systems will make application as an imaging tool for tissue engineering application more feasible. This review first provides a brief description of photoacoustic imaging and summarizes its current and potential application in tissue engineering.

Multimodal intravascular imaging technology for characterization of atherosclerosis

Early detection of vulnerable plaques is the critical step in the prevention of acute coronary events. Morphology, composition, and mechanical property of a coronary artery have been demonstrated to be the key characteristics for the identification of vulnerable plaques. Several intravascular multimodal imaging technologies providing co-registered simultaneous images have been developed and applied in clinical studies to improve the characterization of atherosclerosis. In this paper, the authors review the present system and probe designs of representative intravascular multimodal techniques. In addition, the scientific innovations, potential limitations, and future directions of these technologies are also discussed.

Minimally invasive photoacoustic imaging: Current status and future perspectives

Photoacoustic imaging (PAI) is an emerging biomedical imaging modality that is based on optical absorption contrast, capable of revealing distinct spectroscopic signatures of tissue at high spatial resolution and large imaging depths. However, clinical applications of conventional non-invasive PAI systems have been restricted to examinations of tissues at depths less than a few cm due to strong light attenuation. Minimally invasive photoacoustic imaging (miPAI) has greatly extended the landscape of PAI by delivering excitation light within tissue through miniature fibre-optic probes. In the past decade, various miPAI systems have been developed with demonstrated applicability in several clinical fields. In this article, we present an overview of the current status of miPAI and our thoughts on future perspectives.

PMN-PT/Epoxy 1-3 composite based ultrasonic transducer for dual-modality photoacoustic and ultrasound endoscopy

Endoscopic dual-modality photoacoustic (PA) and ultrasound (US) imaging has the capability of providing morphology and molecular information simultaneously. An ultrasonic transducer was applied for detecting PA signals and performing US imaging which determines the sensitivity and performance of a dual-modality PA/US system. In our study, a miniature single element 32-MHz lead magnesium niobate-lead titanate (PMN-PT) epoxy 1-3 composite based ultrasonic transducer was developed. A miniature endoscopic probe based on this transducer has been fabricated. Using the dual modality PA/US system with a PMN-PT/epoxy 1-3 composite based ultrasonic transducer, phantom and in vivo animal studies have been conducted to evaluate the performance. The preliminary results show enhanced bandwidths of the new ultrasonic transducer and improved signal-to-noise ratio of PA and US images of rat colorectal wall compared with PMN-PT and lead zirconate titanate (PZT) composite based ultrasonic transducers.

Photoacoustic imaging for guidance of interventions in cardiovascular medicine

Imaging guidance is paramount to procedural success in minimally invasive interventions. Catheter-based therapies are the standard of care in the treatment of many cardiac disorders, including coronary artery disease, structural heart disease and electrophysiological conditions. Many of these diseases are caused by, or effect, a change in vasculature or cardiac tissue composition, which can potentially be detected by photoacoustic imaging. This review summarizes the state of the art in photoacoustic imaging approaches that have been proposed for intervention guidance in cardiovascular care. All of these techniques are currently in the preclinical phase. We will conclude with an outlook towards clinical applications.

Laser threshold and cell damage mechanism for intravascular photoacoustic imaging

OBJECTIVES

Intravascular photoacoustic (IVPA) imaging is being developed to image atherosclerotic plaques, a leading cause of morbidity and mortality in the United States. However, the safety of this imaging modality, which requires repeated irradiation with short laser pulses, has not yet been investigated. This study has two objectives. First, determine in vitro the limit of cumulative fluence that can be applied to cells before death at IVPA relevant wavelengths. Second, evaluate if high single pulse fluences are a potential cause of cell death during IVPA imaging.

MATERIALS AND METHODS

Experiments were conducted using endothelial cells, macrophages, and smooth muscle cells. The cumulative fluence experiments were conducted at 1064 and 1197 nm, using a high pulse repetition frequency laser. Cells were irradiated with a wide range of cumulative fluences and evaluated for cell death. The thresholds for death were compared to the maximum expected clinical cumulative fluence. To evaluate the effect of single pulse fluences, cells were irradiated at 1064, 1210, and 1720 nm. Light was delivered at a range of pulse energies to emulate the fluences that cells would be exposed to during clinical IVPA imaging.

RESULTS

At 1064 nm, all three cell types remained viable at cumulative fluences above the maximum expected clinical cumulative fluence, which is calculated based on common IVPA imaging protocols. At 1197 nm, cells were viable near or just below the maximum expected clinical cumulative fluence, with some cell type to cell type variation. All three cell types remained viable after irradiation with high single pulse fluences at all three wavelengths.

CONCLUSION

The cumulative fluence experiments indicate that safety considerations are likely to put constraints on the amount of irradiation that can be used in IVPA imaging protocols. However, this study also indicates that it will be possible to use IVPA imaging safely, since cumulative fluences could be reduced by as much as two orders of magnitude below the maximum expected clinical cumulative fluence by varying the imaging protocol, albeit at the expense of image quality. The single pulse fluence experiments indicate that cell death from single pulse fluence is not likely during IVPA imaging. Thus, future studies should focus on heat accumulation as the likely mechanism of tissue damage. Lasers Surg. Med. 51:466-474, 2019. © 2018 Wiley Periodicals, Inc.

Cardiovascular optoacoustics: From mice to men - A review

Imaging has become an indispensable tool in the research and clinical management of cardiovascular disease (CVD). An array of imaging technologies is considered for CVD diagnostics and therapeutic assessment, ranging from ultrasonography, X-ray computed tomography and magnetic resonance imaging to nuclear and optical imaging methods. Each method has different operational characteristics and assesses different aspects of CVD pathophysiology; nevertheless, more information is desirable for achieving a comprehensive view of the disease. Optoacoustic (photoacoustic) imaging is an emerging modality promising to offer novel information on CVD parameters by allowing high-resolution imaging of optical contrast several centimeters deep inside tissue. Implemented with illumination at several wavelengths, multi-spectral optoacoustic tomography (MSOT) in particular, is sensitive to oxygenated and deoxygenated hemoglobin, water and lipids allowing imaging of the vasculature, tissue oxygen saturation and metabolic or inflammatory parameters. Progress with fast-tuning lasers, parallel detection and advanced image reconstruction and data-processing algorithms have recently transformed optoacoustics from a laboratory tool to a promising modality for small animal and clinical imaging. We review progress with optoacoustic CVD imaging, highlight the research and diagnostic potential and current applications and discuss the advantages, limitations and possibilities for integration into clinical routine.

Comparative Quantification of Arterial Lipid by Intravascular Photoacoustic-Ultrasound Imaging and Near-Infrared Spectroscopy-Intravascular Ultrasound

Intravascular photoacoustic-ultrasound (IVPA-US) imaging and near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) are two hybrid modalities that detect arterial lipid, with comparison necessary to understand the relative advantages of each. We performed in vivo and ex vivo IVPA-US imaging of the iliac arteries of Ossabaw swine with metabolic syndrome (MetS) and lean swine to investigate sensitivity for early-stage atherosclerosis. We repeated imaging ex vivo with NIRS-IVUS for comparison to IVPA-US and histology. Both modalities showed significantly greater lipid in MetS vs. lean swine, but only IVPA-US localized the lipid as perivascular. To investigate late-stage atherosclerosis, we performed ex vivo IVPA-US imaging of a human coronary artery with comparison to NIRS-IVUS and histology. Two advanced fibroatheromas were identified, with agreement between IVPA-measured lipid area and NIRS-derived lipid content. As confirmed histologically, IVPA-US has sensitivity to detect lipid content similar to NIRS-IVUS and provides additional depth resolution, enabling quantification and localization of lipid cores within plaques.

Functional endoscopy techniques for tracking stem cell fate

Tracking and monitoring implanted stem cells are essential to maximize benefits and to minimize the side effects of stem cell therapy for personalized or "precision" medicine. Previously, we proposed a comprehensive biological Global Positioning System (bGPS) to track and monitor stem cells in vivo. Magnetic resonance imaging (MRI), positron emission tomography (PET), bioluminescent imaging, fluorescence imaging, and single-photon emission computerized tomography (SPECT) have been utilized to track labeled or genetically-modified cells in vivo in rats and humans. A large amount of research has been dedicated to the design of reporter genes and molecular probes for imaging and the visualization of the biodistribution of the implanted cells in high resolution. On the other hand, optical-based functional imaging, such as photoacoustic imaging (PAI), optical coherence tomography (OCT), and multiphoton microscopy (MPM), has been implemented into small endoscopes to image cells inside the body. The optical fiber allows miniaturization of the imaging probe while maintaining high resolution due to light-based imaging. Upon summarizing the recent progress in the design and application of functional endoscopy techniques for stem cell monitoring, we offer perspectives for the future development of endoscopic molecular imaging tools for in vivo tracking of spatiotemporal changes in subclonal evolution at the single cell level.

Tapered fiber-based intravascular photoacoustic endoscopy for high-resolution and deep-penetration imaging of lipid-rich plaque

High-resolution intravascular photoacoustic (IVPA) imaging can potentially improve the identification of atherosclerosis plaque. However, the absorption of water and the low coupled laser energy resulted in insufficient excitation energy provided by the single-mode fiber-based IVPA endoscope to achieve high-resolution and deep-penetration plaque imaging. In this paper, we developed a 1 mm diameter IVPA endoscope assembled with a Ø25-Ø9 μm tapered fiber. Owing to high coupling efficiency and the small output facula of tapered fiber, the IVPA endoscope has an optimal lateral resolution of 18 μm and a large imaging-depth covering from the intima to the peri-adventitial adipose, as confirmed by imaging results respectively. Furthermore, IVPA imaging in the blood has confirmed that the tapered fiber-based endoscope can display the distribution and the relative concentration of lipid in ex vivo plaque precisely. By the obtained histology-like images, IVPA imaging shows great potential for accurately imaging atherosclerosis plaque.

All-Optical Rotational Ultrasound Imaging

Miniaturised high-resolution imaging devices are valuable for guiding minimally invasive procedures such as vascular stent placements. Here, we present all-optical rotational B-mode pulse-echo ultrasound imaging. With this device, ultrasound transmission and reception are performed with light. The all-optical transducer in the probe comprised an optical fibre that delivered pulsed excitation light to an optical head at the distal end with a multi-walled carbon nanotube and polydimethylsiloxane composite coating. This coating was photoacoustically excited to generate a highly directional ultrasound beam perpendicular to the optical fibre axis. A concave Fabry-Pérot cavity at the distal end of an optical fibre, which was interrogated with a tuneable continuous-wave laser, served as an omnidirectional ultrasound receiver. The transmitted ultrasound had a -6 dB bandwidth of 31.3 MHz and a peak-to-peak pressure of 1.87 MPa, as measured at 1.5 mm from the probe. The receiver had a noise equivalent pressure <100 Pa over a 20 MHz bandwidth. With a maximum outer probe diameter of 1.25 mm, the probe provided imaging with an axial resolution better than 50 µm, and a real-time imaging rate of 5 frames per second. To investigate the capabilities of the probe, intraluminal imaging was performed in healthy swine carotid arteries. The results demonstrate that the all-optical probe is viable for clinical rotational ultrasound imaging.

Cylindrical illumination with angular coupling for whole-prostate photoacoustic tomography

Current diagnosis of prostate cancer relies on histological analysis of tissue samples acquired by biopsy, which could benefit from real-time identification of suspicious lesions. Photoacoustic tomography has the potential to provide real-time targets for prostate biopsy guidance with chemical selectivity, but light delivered from the rectal cavity has been unable to penetrate to the anterior prostate. To overcome this barrier, a urethral device with cylindrical illumination is developed for whole-prostate imaging, and its performance as a function of angular light coupling is evaluated with a prostate-mimicking phantom.

Exogenous imaging contrast and therapeutic agents for intravascular photoacoustic imaging and image-guided therapy

Intravascular photoacoustic (IVPA) imaging has been developed in recent years as a viable imaging modality for the assessment of atherosclerotic plaques. Exogenous imaging contrast and therapeutic agents further enhance this imaging modality and provide significant benefits. Imaging contrast agents can significantly increase photoacoustic signal, resulting in enhanced plaque detection and characterization. The ability to use these particles to molecularly target markers of disease progression makes it possible to determine patient-specific levels of risk and plan treatments accordingly. With improved diagnosis, clinicians will be able to use therapeutic agents that are synergistic with IVPA imaging to treat atherosclerotic patients. Pre-clinical and clinical studies with relevance to IVPA imaging have shown promise in the area of diagnosis and therapeutics. In this review, we present a variety of imaging contrast agents that are either designed for or are compatible with IVPA imaging, cover uses of therapeutic agents that compliment this imaging modality, and discuss future directions of research in the field.

High-speed Intraoperative Assessment of Breast Tumor Margins by Multimodal Ultrasound and Photoacoustic Tomography

Conventional methods for breast tumor margins assessment need a long turnaround time, which may lead to re-operation for patients undergoing lumpectomy surgeries. Photoacoustic tomography (PAT) has been shown to visualize adipose tissue in small animals and human breast. Here, we demonstrate a customized multimodal ultrasound and PAT system for intraoperative breast tumor margins assessment using fresh lumpectomy specimens from 66 patients. The system provides the margin status of the entire excised tissue within 10 minutes. By subjective reading of three researchers, the results show 85.7% [95% confidence interval (CI), 42.0% - 99.2%] sensitivity and 84.6% (95% CI, 53.7% - 97.3%) specificity, 71.4% (95% CI, 30.3% - 94.9%) sensitivity and 92.3% (95% CI, 62.1% - 99.6%) specificity, and 100% (95% CI, 56.1% - 100%) sensitivity and 53.9% (95% CI, 26.1% - 79.6%) specificity respectively when cross-correlated with post-operational histology. Furthermore, a machine learning-based algorithm is deployed for margin assessment in the challenging ductal carcinoma in situ tissues, and achieved 85.5% (95% CI, 75.2% - 92.2%) sensitivity and 90% (95% CI, 79.9% - 95.5%) specificity. Such results present the potential of using mutlimodal ultrasound and PAT as a high-speed and accurate method for intraoperative breast tumor margins evaluation.

Intravascular Photothermal Strain Imaging for Lipid Detection

Cardiovascular disease (CVD) is one of the major threats to humanity, accounting for one-third of the world's deaths. For patients with high-risk CVD, plaque rupture can lead to critical condition. It is therefore important to determine the stability of the plaque and classify the patient's risk level. Lipid content is an important determinant of plaque stability. However, conventional intravascular imaging methods have limitations in finding lipids. Therefore, new intravascular imaging techniques for plaque risk assessment are urgently needed. In this study, a novel photothermal strain imaging (pTSI) was applied to an intravascular imaging system for detecting lipids in plaques. As a combination of thermal strain imaging and laser-induced heating, pTSI differentiates lipids from other tissues based on changes in ultrasound (US) velocity with temperature change. We designed an optical pathway to an intravascular ultrasound catheter to deliver 1210-nm laser and US simultaneously. To establish the feasibility of the intravascular pTSI system, we experimented with a tissue-mimicking phantom made of fat and gelatin. Due to the difference in the strain during laser heating, we can clearly distinguish fat and gelatin in the phantom. The result demonstrates that pTSI could be used with conventional intravascular imaging methods to detect the plaque lipid.

Optoacoustic sensing of hematocrit to improve the accuracy of hybrid fluorescence-ultrasound intravascular imaging

Hybrid intravascular fluorescence-ultrasound imaging is emerging for reading anatomical and biological information in vivo. By operating through blood, intravascular near-infrared fluorescence (NIRF) detection is affected by hemoglobin attenuation. Improved quantification has been demonstrated with methods that correct for the attenuation of the optical signal as it propagates through blood. These methods assume an attenuation coefficient for blood and measure the distance between detector and the vessel wall by observing the intravascular ultrasound images. Assumptions behind the attenuation employed in correction models may reduce the accuracy of these methods. Herein, we explore a novel approach to dynamically estimate optical absorption by using optoacoustic (photoacoustic) measurements. Adaptive correction is based on a trimodal intravascular catheter that integrates fluorescence, ultrasound and optoacoustic measurements. Using the novel catheter, we show how optoacoustic measurements can determine variations of blood absorption, leading to accurate quantification of the detected NIRF signals at different hematocrit values.

All-optical dual photoacoustic and optical coherence tomography intravascular probe

Intravascular imaging in percutaneous coronary interventions can be an invaluable tool in the treatment of coronary artery disease. It is of significant interest to provide molecular imaging contrast that is complementary to structural contrast provided by optical coherence tomography (OCT) and intravascular ultrasound imaging (IVUS). In this study, we developed a dual-modality intravascular imaging probe comprising a commercial OCT catheter and a high sensitivity fiber optic ultrasound sensor, to provide both photoacoustic (PA) and OCT imaging. With PA imaging, the lateral resolution varied from 18 μm to 40 μm; the axial resolution was consistently in the vicinity of 45 μm. We demonstrated the clinical potential of the probe with 2-D circumferential PA and OCT imaging, and with multispectral PA imaging.

Label-free assessment of carotid artery biochemical composition using fiber-based fluorescence lifetime imaging

Novel diagnostic tools with the ability to monitor variations in biochemical composition and provide benchmark indicators of vascular tissue maturation are needed to create functional tissue replacements. We investigated the ability of fiber-based, label-free multispectral fluorescent lifetime imaging (FLIm) to quantify the anatomical variations in biochemical composition of native carotid arteries and validated these results against biochemical assays. FLIm-derived parameters in spectral band 415-455 nm correlated with tissue collagen content (R² = 0.64) and cell number (R² = 0.61) and in spectral band 465-553 nm strongly correlated with elastin content (R² = 0.89). These results suggest that FLIm holds great potential for assessing vascular tissue maturation and functional properties based on tissue autofluorescence.

Optical Ultrasound Generation and Detection for Intravascular Imaging: A Review

Combined ultrasound and photoacoustic imaging has attracted significant interests for intravascular imaging such as atheromatous plaque detection, with ultrasound imaging providing spatial location and morphology and photoacoustic imaging highlighting molecular composition of the plaque. Conventional ultrasound imaging systems utilize piezoelectric ultrasound transducers, which suffer from limited frequency bandwidths and reduced sensitivity with miniature transducer elements. Recent advances on optical methods for both ultrasound generation and detection have shown great promise, as they provide efficient and ultrabroadband ultrasound generation and sensitive and ultrabroadband ultrasound detection. As such, all-optical ultrasound imaging has a great potential to become a next generation ultrasound imaging method. In this paper, we review recent developments on optical ultrasound transmitters, detectors, and all-optical ultrasound imaging systems, with a particular focus on fiber-based probes for intravascular imaging. We further discuss our thoughts on future directions on developing combined all-optical photoacoustic and ultrasound imaging systems for intravascular imaging.

Multimodal Intravascular Photoacoustic and Ultrasound Imaging

The rupture of atherosclerotic plaques is the leading cause of death in developed countries. Early identification of vulnerable plaque is the essential step in preventing acute coronary events. Intravascular photoacoustic (IVPA) technology is able to visualize chemical composition of atherosclerotic plaque with high specificity and sensitivity. Integrated with intravascular ultrasound (IVUS) imaging, this multimodal intravascular IVPA/IVUS imaging technology is able to provide both structural and chemical compositions of arterial walls for detecting and characterizing atherosclerotic plaques. In this paper, we present representative multimodal IVPA/IVUS imaging systems and discuss current scientific innovations, potential limitations, and prospective improvements for characterization of coronary atherosclerosis.

Investigation on the Effect of Spatial Compounding on Photoacoustic Images of Carotid Plaques in the In Vivo Available Rotational Range

Photoacoustic imaging (PAI) is a promising imaging modality due to its high optical specificity. However, the low signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of in vivo PA images are major challenges that prevent PAI from finding its place in clinics. This paper investigates the merit of spatial compounding of PA images in arterial phantoms and the achievable improvements of SNR, when in vivo conditions are mimicked. The analysis of the compounding technique was performed on a polyvinyl alcohol vessel phantom with black threads embedded in its wall. The in vivo conditions were mimicked by limiting the rotation range in ±30°, adding turbid surrounding medium, and filling the lumen with porcine blood. Finally, the performance of the technique was evaluated in ex vivo human carotid plaque samples. Results showed that spatial compounding elevates the SNR by 5-10 dB and CNR by 1-5 dB, depending on the location of the absorbers. This paper elucidates prospective in vivo PA characterization of carotid plaques by proposing a method to enhance PA image quality.

Fast assessment of lipid content in arteries in vivo by intravascular photoacoustic tomography

Intravascular photoacoustic tomography is an emerging technology for mapping lipid deposition within an arterial wall for the investigation of the vulnerability of atherosclerotic plaques to rupture. By converting localized laser absorption in lipid-rich biological tissue into ultrasonic waves through thermoelastic expansion, intravascular photoacoustic tomography is uniquely capable of imaging the entire arterial wall with chemical selectivity and depth resolution. However, technical challenges, including an imaging catheter with sufficient sensitivity and depth and a functional sheath material without significant signal attenuation and artifact generation for both photoacoustics and ultrasound, have prevented in vivo application of intravascular photoacoustic imaging for clinical translation. Here, we present a highly sensitive quasi-collinear dual-mode photoacoustic/ultrasound catheter with elaborately selected sheath material, and demonstrated the performance of our intravascular photoacoustic tomography system by in vivo imaging of lipid distribution in rabbit aortas under clinically relevant conditions at imaging speeds up to 16 frames per second. Ex vivo evaluation of fresh human coronary arteries further confirmed the performance of our imaging system for accurate lipid localization and quantification of the entire arterial wall, indicating its clinical significance and translational capability.

Photoacoustic-based approach to surgical guidance performed with and without a da Vinci robot

Death and paralysis are significant risks of modern surgeries, caused by injury to blood vessels and nerves hidden by bone and other tissue. We propose an approach to surgical guidance that relies on photoacoustic (PA) imaging to determine the separation between these critical anatomical features and to assess the extent of safety zones during surgical procedures. Images were acquired as an optical fiber was swept across vessel-mimicking targets, in the absence and presence of teleoperation with a research da Vinci Surgical System. Vessel separation distances were measured directly from PA images. Vessel positions were additionally recorded based on the fiber position (calculated from the da Vinci robot kinematics) that corresponded to an observed PA signal, and these recordings were used to indirectly measure vessel separation distances. Amplitude- and coherence-based beamforming were used to estimate vessel separations, resulting in 0.52- to 0.56-mm mean absolute errors, 0.66- to 0.71-mm root-mean-square errors, and 65% to 68% more accuracy compared to fiber position measurements obtained through the da Vinci robot kinematics. Similar accuracy was achieved in the presence of up to 4.5-mm-thick ex vivo tissue. Results indicate that PA image-based measurements of the separation among anatomical landmarks could be a viable method for real-time path planning in multiple interventional PA applications.

Spectral analysis assisted photoacoustic imaging for lipid composition differentiation

Recent advances in atherosclerotic plaque detection have shown that not only does lipid core size and depth play important roles in plaque rupture and thrombi formation, but lipid composition, especially cholesterol deposition, is equally important in determining lesion vulnerability. Here, we demonstrate a spectral analysis assisted photoacoustic imaging approach to differentiate and map lipid compositions within an artery wall. The approach is based on the classification of spectral curves obtained from the sliding windows along time-of-flight photoacoustic signals via a numerical k-means clustering method. The evaluation result on a vessel-mimicking phantom containing cholesterol and olive oil shows accuracy and efficiency of this method, suggesting the potential to apply this approach in assessment of atherosclerotic plaques.