Wide-field imaging of birefringent synovial fluid crystals using lens-free polarized microscopy for gout diagnosis

Ptychographic lens-less birefringence microscopy using a mask-modulated polarization image sensor

Birefringence, an inherent characteristic of optically anisotropic materials, is widely utilized in various imaging applications ranging from material characterizations to clinical diagnosis. Polarized light microscopy enables high-resolution, high-contrast imaging of optically anisotropic specimens, but it is associated with mechanical rotations of polarizer/analyzer and relatively complex optical designs. Here, we present a form of lens-less polarization-sensitive microscopy capable of complex and birefringence imaging of transparent objects without an optical lens and any moving parts. Our method exploits an optical mask-modulated polarization image sensor and single-input-state LED illumination design to obtain complex and birefringence images of the object via ptychographic phase retrieval. Using a camera with a pixel size of 3.45 μm, the method achieves birefringence imaging with a half-pitch resolution of 2.46 μm over a 59.74 mm2 field-of-view, which corresponds to a space-bandwidth product of 9.9 megapixels. We demonstrate the high-resolution, large-area, phase and birefringence imaging capability of our method by presenting the phase and birefringence images of various anisotropic objects, including a monosodium urate crystal, and excised mouse eye and heart tissues.

Polarization-sensitive intensity diffraction tomography

Optical anisotropy, which is an intrinsic property of many materials, originates from the structural arrangement of molecular structures, and to date, various polarization-sensitive imaging (PSI) methods have been developed to investigate the nature of anisotropic materials. In particular, the recently developed tomographic PSI technologies enable the investigation of anisotropic materials through volumetric mappings of the anisotropy distribution of these materials. However, these reported methods mostly operate on a single scattering model, and are thus not suitable for three-dimensional (3D) PSI imaging of multiple scattering samples. Here, we present a novel reference-free 3D polarization-sensitive computational imaging technique-polarization-sensitive intensity diffraction tomography (PS-IDT)-that enables the reconstruction of 3D anisotropy distribution of both weakly and multiple scattering specimens from multiple intensity-only measurements. A 3D anisotropic object is illuminated by circularly polarized plane waves at various illumination angles to encode the isotropic and anisotropic structural information into 2D intensity information. These information are then recorded separately through two orthogonal analyzer states, and a 3D Jones matrix is iteratively reconstructed based on the vectorial multi-slice beam propagation model and gradient descent method. We demonstrate the 3D anisotropy imaging capabilities of PS-IDT by presenting 3D anisotropy maps of various samples, including potato starch granules and tardigrade.

Improved polarized light microscopic detection of gouty crystals via dissolution with formalin and ethylenediamine tetraacetic acid

Conventional polarized light microscopy has been widely used to detect gouty crystals, but its limited sensitivity increases the risk of misidentification. In this study, a number of methods were investigated to improve the sensitivity of polarized light microscopy for the detection of monosodium urate monohydrate (MSUM) and calcium pyrophosphate dihydrate (CPPD) crystals. We found that coating glass slides with poly-L-lysine, a positively charged polymer, improved the attachment of crystals to the glass surface, resulting in clearer crystal images compared to non-coated slides. Additionally, the sensitivity of detection was further enhanced by selective dissolution, in which 40% v/v formalin phosphate buffer was employed to dissolve MSUM crystals but not CPPD while 10% ethylenediamine tetraacetic acid (EDTA) was employed to dissolved CPPD but not MSUM. The other possible interferences were dissolved in both EDTA and formalin solution. These methods were successfully applied to detect gouty crystals in biological milieu, including spiked porcine synovial fluid and inflamed rat subcutaneous air pouch tissues.

Smartphone-based hand-held polarized light microscope for on-site pharmaceutical crystallinity characterization

Polarized light microscopy (PLM) is a common but critical method for pharmaceutical crystallinity characterization, which has been widely introduced for research purposes or drug testing and is recommended by many pharmacopeias around the world. To date, crystallinity characterization of pharmaceutical solids is restricted to laboratories due to the relatively bulky design of the conventional PLM system, while little attention has been paid to on-site, portable, and low-cost applications. Herein, we developed a smartphone-based polarized microscope with an ultra-miniaturization design ("hand-held" scale) for these purposes. The compact system consists of an optical lens, two polarizers, and a tailor-made platform to hold the smartphone. Analytical performance parameters including resolution, imaging quality of interference color, and imaging reproducibility were measured. In a first approach, we illustrated the suitability of the device for pharmaceutical crystallinity characterization and obtained high-quality birefringence images comparable to a conventional PLM system, and we also showed the great promise of the device for on-site characterization with high flexibility. In a second approach, we employed the device as a proof of concept for a wider application ranging from liquid crystal to environmental pollutants or tissues from plants. As such, this smartphone-based hand-held polarized light microscope shows great potential in helping pharmacists both for research purposes and on-site drug testing, not to mention its broad application prospects in many other fields.

Multi-Illumination Single-Holographic-Exposure Lensless Fresnel (MISHELF) Microscopy: Principles and Biomedical Applications

Lensless holographic microscopy (LHM) comes out as a promising label-free technique since it supplies high-quality imaging and adaptive magnification in a lens-free, compact and cost-effective way. Compact sizes and reduced prices of LHMs make them a perfect instrument for point-of-care diagnosis and increase their usability in limited-resource laboratories, remote areas, and poor countries. LHM can provide excellent intensity and phase imaging when the twin image is removed. In that sense, multi-illumination single-holographic-exposure lensless Fresnel (MISHELF) microscopy appears as a single-shot and phase-retrieved imaging technique employing multiple illumination/detection channels and a fast-iterative phase-retrieval algorithm. In this contribution, we review MISHELF microscopy through the description of the principles, the analysis of the performance, the presentation of the microscope prototypes and the inclusion of the main biomedical applications reported so far.

Polarization multiplexed diffractive computing: all-optical implementation of a group of linear transformations through a polarization-encoded diffractive network

Research on optical computing has recently attracted significant attention due to the transformative advances in machine learning. Among different approaches, diffractive optical networks composed of spatially-engineered transmissive surfaces have been demonstrated for all-optical statistical inference and performing arbitrary linear transformations using passive, free-space optical layers. Here, we introduce a polarization-multiplexed diffractive processor to all-optically perform multiple, arbitrarily-selected linear transformations through a single diffractive network trained using deep learning. In this framework, an array of pre-selected linear polarizers is positioned between trainable transmissive diffractive materials that are isotropic, and different target linear transformations (complex-valued) are uniquely assigned to different combinations of input/output polarization states. The transmission layers of this polarization-multiplexed diffractive network are trained and optimized via deep learning and error-backpropagation by using thousands of examples of the input/output fields corresponding to each one of the complex-valued linear transformations assigned to different input/output polarization combinations. Our results and analysis reveal that a single diffractive network can successfully approximate and all-optically implement a group of arbitrarily-selected target transformations with a negligible error when the number of trainable diffractive features/neurons (N) approaches [Formula: see text], where N_i and N_o represent the number of pixels at the input and output fields-of-view, respectively, and N_p refers to the number of unique linear transformations assigned to different input/output polarization combinations. This polarization-multiplexed all-optical diffractive processor can find various applications in optical computing and polarization-based machine vision tasks.

Linear diattenuation imaging of biological samples with digital lensless holographic microscopy

A digital lensless holographic microscope (DLHM) sensitive to the linear diattenuation produced by biological samples is reported. The insertion of a linear polarization-states generator and a linear polarization-states analyzer in a typical DLHM setup allows the proper linear diattenuation imaging of microscopic samples. The proposal has been validated for simulated and experimental biological samples containing calcium oxalate crystals extracted from agave leaves and potato starch grains. The performance of the proposed method is similar to that of a traditional polarimetric microscope to obtain linear diattenuation images of microscopic samples but with the advantages of DLHM, such as numerical refocusing, cost effectiveness, and the possibility of field-portable implementation.

Quantum imaging of a polarisation sensitive phase pattern with hyper-entangled photons

A transparent polarisation sensitive phase pattern makes a polarisation dependent transformation of quantum state of photons without absorbing them. Such an invisible pattern can be imaged with quantum entangled photons by making joint quantum measurements on photons. This paper shows a long path experiment to quantum image a transparent polarisation sensitive phase pattern with hyper-entangled photon pairs involving momentum and polarisation degrees of freedom. In the imaging configuration, a single photon interacts with the pattern while the other photon, which has never interacted with the pattern, is measured jointly in a chosen polarisation basis and in a quantum superposition basis of its position which is equivalent to measure its momentum. Individual photons of each hyper-entangled pair cannot provide a complete image information. The image is constructed by measuring the polarisation state and position of the interacting photon corresponding to a measurement outcome of the non-interacting photon. This paper presents a detailed concept, theory and free space long path experiments on quantum imaging of polarisation sensitive phase patterns.

Isotropically resolved label-free tomographic imaging based on tomographic moulds for optical trapping

A major challenge in three-dimensional (3D) microscopy is to obtain accurate spatial information while simultaneously keeping the microscopic samples in their native states. In conventional 3D microscopy, axial resolution is inferior to spatial resolution due to the inaccessibility to side scattering signals. In this study, we demonstrate the isotropic microtomography of free-floating samples by optically rotating a sample. Contrary to previous approaches using optical tweezers with multiple foci which are only applicable to simple shapes, we exploited 3D structured light traps that can stably rotate freestanding complex-shaped microscopic specimens, and side scattering information is measured at various sample orientations to achieve isotropic resolution. The proposed method yields an isotropic resolution of 230 nm and captures structural details of colloidal multimers and live red blood cells, which are inaccessible using conventional tomographic microscopy. We envision that the proposed approach can be deployed for solving diverse imaging problems that are beyond the examples shown here.

Polarization-sensitive differential phase-contrast microscopy

We present a novel, to the best of our knowledge, form of polarization microscopy capable of producing quantitative optic-axis and phase retardation maps of transparent and anisotropic materials. The proposed method operates on differential phase-contrast (DPC) microscopy that produces a phase image of a thin specimen using multi-axis intensity measurements. For polarization-sensitive imaging, patterned illumination light is circularly polarized to illuminate a specimen. The light transmitted through a specimen is split into two orthogonal polarization states and measured by an image sensor. Subsequent DPC computation based on the illumination patterns, acquired images, and the imaging model enables the retrieval of polarization-dependent quantitative phase images, which are utilized to reconstruct the orientation and retardation of the specimen. We demonstrate the validity of the proposed method by measuring the optic-axis and phase retardation maps of calibrated and various anisotropic samples.

Deep Learning-Based Holographic Polarization Microscopy

Polarized light microscopy provides high contrast to birefringent specimen and is widely used as a diagnostic tool in pathology. However, polarization microscopy systems typically operate by analyzing images collected from two or more light paths in different states of polarization, which lead to relatively complex optical designs, high system costs, or experienced technicians being required. Here, we present a deep learning-based holographic polarization microscope that is capable of obtaining quantitative birefringence retardance and orientation information of specimen from a phase-recovered hologram, while only requiring the addition of one polarizer/analyzer pair to an inline lensfree holographic imaging system. Using a deep neural network, the reconstructed holographic images from a single state of polarization can be transformed into images equivalent to those captured using a single-shot computational polarized light microscope (SCPLM). Our analysis shows that a trained deep neural network can extract the birefringence information using both the sample specific morphological features as well as the holographic amplitude and phase distribution. To demonstrate the efficacy of this method, we tested it by imaging various birefringent samples including, for example, monosodium urate and triamcinolone acetonide crystals. Our method achieves similar results to SCPLM both qualitatively and quantitatively, and due to its simpler optical design and significantly larger field-of-view this method has the potential to expand the access to polarization microscopy and its use for medical diagnosis in resource limited settings.

Real-time Jones phase microscopy for studying transparent and birefringent specimens

Tissue birefringence is an intrinsic marker of potential value for cancer diagnosis. Traditionally, birefringence properties have been studied by using intensity-based formalisms, through the Mueller matrix algebra. On the other hand, the Jones matrix description allows for a direct assessment of the sample's anisotropic response. However, because Jones algebra is based on complex fields, requiring measurements of both phase and amplitude, it is less commonly used. Here we propose a real-time imaging method for measuring Jones matrices by quantitative phase imaging. We combine a broadband phase imaging system with a polarization-sensitive detector to obtain Jones matrices at each point in a megapixel scale image, with near video rate capture speeds. To validate the utility of our approach, we measured standard targets, partially birefringent samples, dynamic specimens, and thinly sliced histopathological tissue.

Lensless imaging of plant samples using the cross-polarized light

Lensless imaging has recently become an alternative and cost-effective choice for many macro and micro applications, like wave-front sensing, fluorescence imaging, holographic microscopy, and so on. However, the polarized imaging, especially the cross-polarized light, has rarely been explored and integrated in lensless imaging methods. In this paper, we introduce the cross-polarized illumination into the lensless system for high-contrast and background-free imaging of plant samples. We capture a snapshot measurement and apply the blind deconvolution for reconstruction, obtaining the depolarized imaging of plant samples. Experiments exhibit the specific and sparse structures of the root system and vessel distribution of samples. We also build a corresponding lens-based system for performance comparison. This proposed lensless system is believed to have the potential in studies on the root development and water transport mechanism of plants in the future.

Laboratory testing of extravascular body fluids: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Part II - Synovial fluid

Joint diseases are conditions with an often progressive and generally painful nature affecting the patient's quality of life and, in some cases, requiring a prompt diagnosis in order to start the treatment urgently. Synovial fluid (SF) laboratory testing is an important part of a diagnostic evaluation of patients with joint diseases. Laboratory testing of SF can provide valuable information in establishing the diagnosis, be a part of a patient's follow-up and treatment with the purpose of improving the patient's health and quality of life. Synovial fluid laboratory testing is rarely performed in Croatian medical biochemistry laboratories. Consequently, procedures for SF laboratory testing are poorly harmonized. This document is the second in the series of recommendations prepared by the members of the Working group for extravascular body fluid samples of the Croatian Society of Medical Biochemistry and Laboratory Medicine. It addresses preanalytical, analytical, and postanalytical issues and the clinical significance of tests used in SF laboratory testing with the aim of improving the value of SF laboratory testing in the diagnosis of joint diseases and assisting in the achievement of national harmonization. It is intended for laboratory professionals and all medical personnel involved in synovial fluid collection and testing.

Single-pixel, single-input-state polarization-sensitive wavefront imaging

In this Letter, we describe a single-pixel polarization-sensitive imaging technique, capable of generating the birefringence map of a thin specimen by using single-pixel detectors. Spatially modulated light is circularly polarized to illuminate the specimen. The transmitted light through the specimen is then focused via a lens and measured by position-sensitive detectors in two orthogonal polarization channels. The measurement of the irradiance and centroid position of the optical focus and subsequent computations enable the production of polarization-dependent wavefront maps, which can then be utilized to reconstruct sample birefringence information. We demonstrate the feasibility of our method by measuring distribution of optic-axis orientation and phase retardation of various birefringent samples.

Magnetically responsive layer-by-layer microcapsules can be retained in cells and under flow conditions to promote local drug release without triggering ROS production

Nanoengineered vehicles have the potential to deliver cargo drugs directly to disease sites, but can potentially be cleared by immune system cells or lymphatic drainage. In this study we explore the use of magnetism to hold responsive particles at a delivery site, by incorporation of superparamagnetic iron oxide nanoparticles (SPIONs) into layer-by-layer (LbL) microcapsules. Microcapsules with SPIONs were rapidly phagocytosed by cells but did not trigger cellular ROS synthesis within 24 hours of delivery nor affect cell viability. In a non-directional cell migration assay, SPION containing microcapsules significantly inhibited movement of phagocytosing cells when placed in a magnetic field. Similarly, under flow conditions, a magnetic field retained SPION containing microcapsules at a physiologic wall shear stress of 0.751 dyne cm^-2. Even when the SPION content was reduced to 20%, the majority of microcapsules were still retained. Dexamethasone microcrystals were synthesised by solvent evaporation and underwent LbL encapsulation with inclusion of a SPION layer. Despite a lower iron to volume content of these structures compared to microcapsules, they were also retained under shear stress conditions and displayed prolonged release of active drug, beyond 30 hours, measured using a glucocorticoid sensitive reporter cell line generated in this study. Our observations suggest use of SPIONs for magnetic retention of LbL structures is both feasible and biocompatible and has potential application for improved local drug delivery.

Pathological crystal imaging with single-shot computational polarized light microscopy

Pathological crystal identification is routinely practiced in rheumatology for diagnosing arthritis disease such as gout, and relies on polarized light microscopy as the gold standard method used by medical professionals. Here, we present a single-shot computational polarized light microscopy method that reconstructs the transmittance, retardance and slow-axis orientation of a birefringent sample using a single image captured with a pixelated-polarizer camera. This method is fast, simple-to-operate and compatible with all the existing standard microscopes without extensive or costly modifications. We demonstrated the success of our method by imaging three different types of crystals found in synovial fluid and reconstructed the birefringence information of these samples using a single image, without being affected by the orientation of individual crystals within the sample field-of-view. We believe this technique will provide improved sensitivity, specificity and speed, all at low cost, for clinical diagnosis of crystals found in synovial fluid and other bodily fluids.

Computational cytometer based on magnetically modulated coherent imaging and deep learning

Detecting rare cells within blood has numerous applications in disease diagnostics. Existing rare cell detection techniques are typically hindered by their high cost and low throughput. Here, we present a computational cytometer based on magnetically modulated lensless speckle imaging, which introduces oscillatory motion to the magnetic-bead-conjugated rare cells of interest through a periodic magnetic force and uses lensless time-resolved holographic speckle imaging to rapidly detect the target cells in three dimensions (3D). In addition to using cell-specific antibodies to magnetically label target cells, detection specificity is further enhanced through a deep-learning-based classifier that is based on a densely connected pseudo-3D convolutional neural network (P3D CNN), which automatically detects rare cells of interest based on their spatio-temporal features under a controlled magnetic force. To demonstrate the performance of this technique, we built a high-throughput, compact and cost-effective prototype for detecting MCF7 cancer cells spiked in whole blood samples. Through serial dilution experiments, we quantified the limit of detection (LoD) as 10 cells per millilitre of whole blood, which could be further improved through multiplexing parallel imaging channels within the same instrument. This compact, cost-effective and high-throughput computational cytometer can potentially be used for rare cell detection and quantification in bodily fluids for a variety of biomedical applications.

Accurate color imaging of pathology slides using holography and absorbance spectrum estimation of histochemical stains

Holographic microscopy presents challenges for color reproduction due to the usage of narrow-band illumination sources, which especially impacts the imaging of stained pathology slides for clinical diagnoses. Here, an accurate color holographic microscopy framework using absorbance spectrum estimation is presented. This method uses multispectral holographic images acquired and reconstructed at a small number (e.g., three to six) of wavelengths, estimates the absorbance spectrum of the sample, and projects it onto a color tristimulus. Using this method, the wavelength selection is optimized to holographically image 25 pathology slide samples with different tissue and stain combinations to significantly reduce color errors in the final reconstructed images. The results can be used as a practical guide for various imaging applications and, in particular, to correct color distortions in holographic imaging of pathology samples spanning different dyes and tissue types.

Diagnostic advances in synovial fluid analysis and radiographic identification for crystalline arthritis

PURPOSE OF REVIEW

The present review addresses diagnostic methods for crystalline arthritis including synovial fluid analysis, ultrasound, and dual energy CT scan (DECT).

RECENT FINDINGS

There are new technologies on the horizon to improve the ease, sensitivity, and specificity of synovial fluid analysis. Raman spectroscopy uses the spectral signature that results from a material's unique energy absorption and scatter for crystal identification. Lens-free microscopy directly images synovial fluid aspirate on to a complementary metal-oxide semiconductor chip, providing a high-resolution, wide field of view (∼20 mm) image. Raman spectroscopy and lens-free microscopy may provide additional benefit over compensated polarized light microscopy synovial fluid analysis by quantifying crystal density in synovial fluid samples. Ultrasound and DECT have good sensitivity and specificity for the identification of monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals. However, both have limitations in patients with recent onset gout and low urate burdens.

SUMMARY

New technologies promise improved methods for detection of MSU and CPP crystals. At this time, limitations of these technologies do not replace the need for synovial fluid aspiration for confirmation of crystal detection. None of these technologies address the often concomitant indication to rule out infectious arthritis.

Optical refractometry using lensless holography and autofocusing

Conventional optical refractometry methods are often limited by a narrow measurement range, complex hardware, or relatively high cost. Here, we present a novel refractometry method to measure the bulk refractive index (RI) of materials (including solids and liquids) using lensless holographic on-chip imaging and autofocusing, which is simple, cost-effective, and has a large RI measurement range. As a proof of concept, two compact prototypes were built to measure the RIs of solid materials and liquids, respectively, and they were tested by measuring the RIs of a ZnSe plate and a microscopy immersion oil. Experimental results show that our devices have an average accuracy of ~3 × 10^-4 RI unit (RIU) with an estimated precision of ~3 × 10^-3 RIU for solids; and an average accuracy of ~1 × 10^-4 RIU with an estimated precision of ~3 × 10^-4 RIU for liquids. We believe that this cost-effective and portable RI measurement platform holds promise to be used in laboratory and industrial settings.

Review: Unmet Needs and the Path Forward in Joint Disease Associated With Calcium Pyrophosphate Crystal Deposition

Calcium pyrophosphate (CPP) crystal deposition (CPPD) is prevalent and can be associated with synovitis and joint damage. The population of elderly persons predominantly affected by CPPD is growing rapidly. Since shortfalls exist in many aspects of CPPD, we conducted an anonymous survey of CPPD unmet needs, prioritized by experts from the Gout, Hyperuricemia and Crystal-Associated Disease Network. We provide our perspectives on the survey results, and we propose several CPPD basic and clinical translational research pathways. Chondrocyte and cartilage culture systems for generating CPP crystals in vitro and transgenic small animal CPPD models are needed to better define CPPD mechanism paradigms and help guide new therapies. CPPD recognition, clinical research, and care would be improved by international consensus on CPPD nomenclature and disease phenotype classification, better exploitation of advanced imaging, and pragmatic new point-of-care crystal analytic approaches for detecting CPP crystals. Clinical impacts of CPP crystals in osteoarthritis and in asymptomatic joints in elderly persons remain major unanswered questions that are rendered more difficult by current inability to therapeutically limit or dissolve the crystal deposits and assess the consequent clinical outcome. Going forward, CPPD clinical research studies should define clinical settings in which articular CPPD does substantial harm and should include analyses of diverse clinical phenotypes and populations. Clinical trials should identify the best therapeutic targets to limit CPP crystal deposition and associated inflammation and should include assessment of intraarticular agents. Our perspective is that such advances in basic and clinical science in CPPD are now within reach and can lead to better treatments for this disorder.

Measurements of polarization-dependent angle-resolved light scattering from individual microscopic samples using Fourier transform light scattering

We present a method to measure the vector-field light scattering of individual microscopic objects. The polarization-dependent optical field images are measured with quantitative phase imaging at the sample plane, and then numerically propagated to the far-field plane. This approach allows the two-dimensional polarization-dependent angle-resolved light scattered patterns from individual object to be obtained with high precision and sensitivity. Using this method, we present the measurements of the polarization-dependent light scattering of a liquid crystal droplet and individual silver nanowires over scattering angles of 50°. In addition, the spectroscopic extension of the polarization-dependent angle-resolved light scattering is demonstrated using wavelength-scanning illumination.

Point-of-care testing: applications of 3D printing

Point-of-care testing (POCT) devices fulfil a critical need in the modern healthcare ecosystem, enabling the decentralized delivery of imperative clinical strategies in both developed and developing worlds. To achieve diagnostic utility and clinical impact, POCT technologies are immensely dependent on effective translation from academic laboratories out to real-world deployment. However, the current research and development pipeline is highly bottlenecked owing to multiple restraints in material, cost, and complexity of conventionally available fabrication techniques. Recently, 3D printing technology has emerged as a revolutionary, industry-compatible method enabling cost-effective, facile, and rapid manufacturing of objects. This has allowed iterative design-build-test cycles of various things, from microfluidic chips to smartphone interfaces, that are geared towards point-of-care applications. In this review, we focus on highlighting recent works that exploit 3D printing in developing POCT devices, underscoring its utility in all analytical steps. Moreover, we also discuss key advantages of adopting 3D printing in the device development pipeline and identify promising opportunities in 3D printing technology that can benefit global health applications.

3D imaging of optically cleared tissue using a simplified CLARITY method and on-chip microscopy

High-throughput sectioning and optical imaging of tissue samples using traditional immunohistochemical techniques can be costly and inaccessible in resource-limited areas. We demonstrate three-dimensional (3D) imaging and phenotyping in optically transparent tissue using lens-free holographic on-chip microscopy as a low-cost, simple, and high-throughput alternative to conventional approaches. The tissue sample is passively cleared using a simplified CLARITY method and stained using 3,3'-diaminobenzidine to target cells of interest, enabling bright-field optical imaging and 3D sectioning of thick samples. The lens-free computational microscope uses pixel super-resolution and multi-height phase recovery algorithms to digitally refocus throughout the cleared tissue and obtain a 3D stack of complex-valued images of the sample, containing both phase and amplitude information. We optimized the tissue-clearing and imaging system by finding the optimal illumination wavelength, tissue thickness, sample preparation parameters, and the number of heights of the lens-free image acquisition and implemented a sparsity-based denoising algorithm to maximize the imaging volume and minimize the amount of the acquired data while also preserving the contrast-to-noise ratio of the reconstructed images. As a proof of concept, we achieved 3D imaging of neurons in a 200-μm-thick cleared mouse brain tissue over a wide field of view of 20.5 mm2. The lens-free microscope also achieved more than an order-of-magnitude reduction in raw data compared to a conventional scanning optical microscope imaging the same sample volume. Being low cost, simple, high-throughput, and data-efficient, we believe that this CLARITY-enabled computational tissue imaging technique could find numerous applications in biomedical diagnosis and research in low-resource settings.

Systematic review and quality analysis of emerging diagnostic measures for calcium pyrophosphate crystal deposition disease

OBJECTIVES

Calcium pyrophosphate crystal deposition disease (CPPD) is common, yet prevalence and overall clinical impact remain unclear. Sensitivity and specificity of CPPD reference standards (conventional crystal analysis (CCA) and radiography (CR)) were meta-analysed by EULAR (published 2011). Since then, new diagnostic modalities are emerging. Hence, we updated 2009-2016 literature findings by systematic review and evidence grading, and assessed unmet needs.

METHODS

We performed systematic search of full papers (PubMed, Scopus/EMBASE, Cochrane 2009-2016 databases). Search terms included CPPD, chondrocalcinosis, pseudogout, ultrasound, MRI, dual energy CT (DECT). Paper selection, data abstraction, EULAR evidence level, and Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 bias and applicability grading were performed independently by 3 authors.

RESULTS

We included 26 of 111 eligible papers, which showed emergence in CPPD diagnosis of ultrasound (U/S), and to lesser degree, DECT and Raman spectroscopy. U/S detected CPPD crystals in peripheral joints with sensitivity >80%, superior to CR. However, most study designs, though analytical, yielded low EULAR evidence level. DECT was marginally explored for CPPD, compared with 35 published DECT studies in gout. QUADAS-2 grading indicated strong applicability of U/S, DECT and Raman spectroscopy, but high study bias risk (in ∼30% of papers) due to non-controlled designs, and non-randomised subject selection.

CONCLUSIONS

Though CCA and CR remain reference standards for CPPD diagnosis, U/S, DECT and Raman spectroscopy are emerging U/S sensitivity appears to be superior to CR. We identified major unmet needs, including for randomised, blinded, controlled studies of CPPD diagnostic performance and rigorous analyses of 4 T MRI and other emerging modalities.