Human breast cancerin vitro: matching histo-pathology with small-angle x-ray scattering and diffraction enhanced x-ray imaging

Principles of Different X-ray Phase-Contrast Imaging: A Review

Numerous advances have been made in X-ray technology in recent years. X-ray imaging plays an important role in the nondestructive exploration of the internal structures of objects. However, the contrast of X-ray absorption images remains low, especially for materials with low atomic numbers, such as biological samples. X-ray phase-contrast images have an intrinsically higher contrast than absorption images. In this review, the principles, milestones, and recent progress of X-ray phase-contrast imaging methods are demonstrated. In addition, prospective applications are presented.

Assessment of the additional clinical potential of X-ray dark-field imaging for breast cancer in a preclinical setup

Background:

Mammography can identify calcifications up to 50–100 μm in size as a surrogate parameter for breast cancer or ductal carcinoma in situ (DCIS). Microcalcifications measuring <50 µm are also associated with breast cancer or DCIS and are frequently not detected on mammography, although they can be detected with dark-field imaging. This study examined whether additional breast examination using X-ray dark-field imaging can increase the detection rate of calcifications. Advances in knowledge:

 (1) evaluation of additional modality of breast imaging;

 (2) specific evaluation of breast calcifications.

Implications for patient care: the addition of X-ray dark-field imaging to conventional mammography could detect additional calcifications.

Methods:

Talbot–Lau X-ray phase–contrast imaging and X-ray dark-field imaging were used to acquire images of breast specimens. The radiation dosage with the technique is comparable with conventional mammography. Three X-ray gratings with periods of 5–10 µm between the X-ray tube and the flat-panel detector provide three different images in a single sequence: the conventional attenuation image, differential phase image, and dark-field image. The images were read by radiologists. Radiological findings were marked and examined pathologically. The results were described in a descriptive manner.

Results:

A total of 81 breast specimens were investigated with the two methods; 199 significant structures were processed pathologically, consisting of 123 benign and 76 malignant lesions (DCIS or invasive breast cancer). X-ray dark-field imaging identified 15 additional histologically confirmed carcinoma lesions that were visible but not declared suspicious on digital mammography alone. Another four malignant lesions that were not visible on mammography were exclusively detected with X-ray dark-field imaging.

Conclusions:

Adding X-ray dark-field imaging to digital mammography increases the detection rate for breast cancer and DCIS associated lesions with micrometer-sized calcifications.

The use of X-ray dark-field imaging may be able to provide more accurate and detailed radiological classification of suspicious breast lesions.

Adding X-ray dark-field imaging to mammography may be able to increase the detection rate and improve preoperative planning in deciding between mastectomy or breast-conserving therapy, particularly in patients with invasive lobular breast cancer.

Assessing lesion malignancy by scanning small-angle x-ray scattering of breast tissue with microcalcifications

Scanning small-angle x-ray scattering (SAXS) measurements were performed on 36 formalin-fixed breast tissue biopsies obtained from two patients. All samples contained microcalcifications of type II, i.e. formed by hydroxyapatite. We demonstrate the feasibility of classifying breast lesions by scanning SAXS of tissues containing microcalcifications with a resolution of 35 [Formula: see text]m [Formula: see text] 30 [Formula: see text]m. We report a characteristic Bragg peak found around q  =  1.725 nm^-1 that occurs primarily for malignant lesions. Such a clear SAXS fingerprint is potentially linked to structural changes of breast tissue and corresponds to dimensions of about 3.7 nm. This material property could be used as an early indicator of malignancy development, as it is readily assessed by SAXS. If this fingerprint is combined with other known SAXS features, which also indicate the level of malignancy, such as lipid spacing and collagen periodicity, it could complement traditional pathology-based analyses. To confirm the SAXS-based classification, a histopathological workup and a gold standard histopathological diagnosis were conducted to determine the malignancy level of the lesions. Our aim is to report this SAXS fingerprint, which is clearly related to malignant breast lesions. However, any further conclusion based on our dataset is limited by the low number of patients and samples. Running a broad study to increase the number of samples and patients is of great importance and relevance for the breast-imaging community.

Novel Detection Scheme for X-ray Small-Angle Scattering

X-ray imaging techniques, including x-ray radiography and computed tomography, have been in use for decades and proven effective and indispensable in diagnosis and therapy due to their fine resolution and fast acquisition speed. However, the innate disadvantage of x-ray is the poor soft tissue contrast. Small-angle scattering signals were shown to provide unique information about the abnormality of soft tissues that is complementary to the traditional attenuation image. Currently, there is no effective small-angle scattering detection system. In this paper, we propose a new "collimation" design dedicated to capture a small-angle scattering radiographic image directly, which carries critical pathological information for differentiation between normal and abnormal tissues. Our design consists of two interlaced gratings so that both the primary flux and Compton scattering photons are effectively blocked to leave the apertures mainly open to small-angle scattering photons. Theoretical analysis and Monte Carlo simulations demonstrate that small-angle scattering radiography is feasible with our proposed technology.

Model-free classification of X-ray scattering signals applied to image segmentation

This article describes a modeling framework to relate the molecular orientation of nanostructures to polarized resonant soft X-ray scattering measurements using the Born approximation and a full tensor treatment.

In most cases, the analysis of small-angle and wide-angle X-ray scattering (SAXS and WAXS, respectively) requires a theoretical model to describe the sample’s scattering, complicating the interpretation of the scattering resulting from complex heterogeneous samples. This is the reason why, in general, the analysis of a large number of scattering patterns, such as are generated by time-resolved and scanning methods, remains challenging. Here, a model-free classification method to separate SAXS/WAXS signals on the basis of their inflection points is introduced and demonstrated. This article focuses on the segmentation of scanning SAXS/WAXS maps for which each pixel corresponds to an azimuthally integrated scattering curve. In such a way, the sample composition distribution can be segmented through signal classification without applying a model or previous sample knowledge. Dimensionality reduction and clustering algorithms are employed to classify SAXS/WAXS signals according to their similarity. The number of clusters, i.e. the main sample regions detected by SAXS/WAXS signal similarity, is automatically estimated. From each cluster, a main representative SAXS/WAXS signal is extracted to uncover the spatial distribution of the mixtures of phases that form the sample. As examples of applications, a mudrock sample and two breast tissue lesions are segmented.

Small-angle scatter tomography with a photon-counting detector array

Small-angle x-ray scatter imaging has a high intrinsic contrast in cancer research and other applications, and provides information on molecular composition and micro-structure of the tissue. In general, the implementations of small-angle coherent scatter imaging can be divided into two main categories: direct tomography and angular dispersive computerized tomography. Based on the recent development of energy-discriminative photon-counting detector array, here we propose a computerized tomography setup based on energy-dispersive measurement with a photon-counting detector array. To show merits of the energy-dispersive approach, we have performed numerical tests with a phantom containing various tissue types, in comparison with the existing imaging approaches. The results show that with an energy resolution of ~6 keV, the energy dispersive tomography system with a broadband tabletop x-ray would outperform the angular dispersive system, which makes the x-ray small-angle scatter tomography promising for high-specificity tissue imaging.

Model predictions for the wide-angle x-ray scatter signals of healthy and malignant breast duct biopsies

Wide-angle x-ray scatter (WAXS) could potentially be used to diagnose ductal carcinoma in situ (DCIS) in breast biopsies. The regions of interest were assumed to consist of fibroglandular tissue and epithelial cells and the model assumed that biopsies with DCIS would have a higher concentration of the latter. The scattered number of photons from a 2-mm diameter column of tissue was simulated using a 110-kV beam and selectively added in terms of momentum transfer. For a 1-min exposure, specificities and sensitivities of unity were obtained for biopsies 2- to 20-mm thick. The impact of sample and tumor cell layer thicknesses was studied. For example, a biopsy erroneously estimated to be 8 mm would be correctly diagnosed if its actual thickness was between 7.3 and 8.7 mm. An 8-mm thick malignant biopsy can be correctly diagnosed provided the malignant cell layer thickness is [Formula: see text]. WAXS methods could become a diagnostic tool for DCIS within breast biopsies.

Signs analysis and clinical assessment: phase-contrast computed tomography of human breast tumours

Purpose

To analyse the diagnostic signs present in slices of human breast tumour specimens using synchrotron radiation phase-contrast imaging computed tomography (PCI-CT) for the first time and assess the feasibility of this technique for clinical applications.

Materials and Methods

The ethics committee of our university and relevant clinical hospital approved this prospective study, and written informed consent was obtained from all patients. PCI-CT of human breast tumour specimens with synchrotron radiation was performed at the Shanghai Synchrotron Radiation Facility (SSRF). A total of 14 specimens of early-stage carcinomas and 8 specimens of adenomas were enrolled. Based on raw data reconstruction, the diagnostic signs present in the slices were analysed and correlated with histopathology. We proposed a criterion for clinical diagnosis according to the evaluated signs and the Breast Imaging Reporting and Data System (BI-RADS) for reference. The criterion was then assessed by clinicians in a double-blind method. Finally, descriptive statistics were evaluated, depending on the assessment results.

Results

The 14 carcinoma specimens and 8 adenoma specimens were diagnosed as malignant and benign tumours, respectively. The total coincidence rate was 100%.

Conclusion

Our study results demonstrate that the X-ray diagnostic signs observed in the specimen slices and the criterion used for clinical diagnosis were accurate and reliable. The criterion based on signs analysis can be used to differentiate early-stage benign or malignant tumours. As a promising imaging method, PCI-CT can serve as a possible and feasible supplement to BI-RADS in the future.

[Phase contrast imaging of the breast. Basic principles and steps towards clinical implementation]

CLINICAL/METHODICAL ISSUE

Breast cancer is the most common cancer and the leading cause of cancer deaths in women worldwide.

STANDARD RADIOLOGICAL METHODS

Mammography is the only imaging technique approved for nationwide breast cancer screening. Digital full field mammography has improved mammographic image quality. Nevertheless, mammography has a low positive predictive value and a low sensitivity especially in mammographically dense breasts. One of the major limitations is the inherently low contrast between healthy breast parenchyma and breast cancer.

METHODICAL INNOVATIONS

Phase contrast imaging is based on the phase shift that occurs when X-rays encounter a change in refractive index between different materials.

PERFORMANCE

The improved soft tissue contrast makes the technology particularly promising for breast diagnostics.

ACHIEVEMENTS

The studies presented here suggest that phase contrast imaging provides additional diagnostic information both using phase contrast mammography and phase contrast computed tomography (CT).

PRACTICAL RECOMMENDATIONS

This paper provides an overview of the basic principles of the phase contrast imaging and describes recent developments towards in vivo and ex vivo phase contrast imaging of the breast.

Phase-based x-ray scattering--a possible method to detect cancer cells in a very early stage

PURPOSE

This theoretical work contains a detailed investigation of the potential and sensitivity of phase-based x-ray scattering for cancer detection in biopsies if cancer is in a very early stage of development.

METHODS

Cancer cells in their early stage of development differ from healthy ones mainly due to their faster growing cell nuclei and the enlargement of their densities. This growth is accompanied by an altered nucleus-plasma relation for the benefit of the cell nuclei, that changes the physical properties especially the index of refraction of the cell and the one of the cell nuclei. Interaction of radiation with matter is known to be highly sensitive to small changes of the index of refraction of matter; therefore a detection of such changes of volume and density of cell nuclei by means of high angular resolved phase-based scattering of x rays might provide a technique to distinguish malignant cells from healthy ones if the cell-cell nucleus system is considered as a coherent phase shifting object. Then one can observe from a thin biopsy which represents a monolayer of cells (no multiple scattering) that phase-based x-ray scattering curves from healthy cells differ from those of cancer cells in their early stage of development.

RESULTS

Detailed calculations of x-ray scattering patterns from healthy and cancer cell nuclei yield graphs and numbers with which one can distinguish healthy cells from cancer ones, taking into account that both kinds of cells occur in a tissue within a range of size and density. One important result is the role and the influence of the (lateral) coherence width of the radiation on the scattering curves and the sensitivity of phase-based scattering for cancer detection. A major result is that a larger coherence width yields a larger sensitivity for cancer detection. Further import results are calculated limits for critical sizes and densities of cell nuclei in order to attribute the investigated tissue to be healthy or diseased.

CONCLUSIONS

With this proposed method it should be in principle possible to detect cancer cells in apparently healthy tissues in biopsies and/or in samples of the far border region of abscised or excised tissues. Thus this method could support established methods in diagnostics of cancer-suspicious samples.

X-ray phase-contrast imaging of the breast--advances towards clinical implementation

Breast cancer constitutes about one-quarter of all cancers and is the leading cause of cancer death in women. To reduce breast cancer mortality, mammographic screening programmes have been implemented in many Western countries. However, these programmes remain controversial because of the associated radiation exposure and the need for improvement in terms of diagnostic accuracy. Phase-contrast imaging is a new X-ray-based technology that has been shown to provide enhanced soft-tissue contrast and improved visualization of cancerous structures. Furthermore, there is some indication that these improvements of image quality can be maintained at reduced radiation doses. Thus, X-ray phase-contrast mammography may significantly contribute to advancements in early breast cancer diagnosis. Feasibility studies of X-ray phase-contrast breast CT have provided images that allow resolution of the fine structure of tissue that can otherwise only be obtained by histology. This implies that X-ray phase-contrast imaging may also lead to the development of entirely new (micro-) radiological applications. This review provides a brief overview of the physical characteristics of this new technology and describes recent developments towards clinical implementation of X-ray phase-contrast imaging of the breast.

Lung tumors on multimodal radiographs derived from grating-based X-ray imaging--a feasibility study

PURPOSE

The purpose of this study was to assess whether grating-based X-ray imaging may have a role in imaging of pulmonary nodules on radiographs.

MATERIALS AND METHODS

A mouse lung containing multiple lung tumors was imaged using a small-animal scanner with a conventional X-ray source and a grating interferometer for phase-contrast imaging. We qualitatively compared the signal characteristics of lung nodules on transmission, dark-field and phase-contrast images. Furthermore, we quantitatively compared signal characteristics of lung tumors and the adjacent lung tissue and calculated the corresponding contrast-to-noise ratios.

RESULTS

Of the 5 tumors visualized on the transmission image, 3/5 tumors were clearly visualized and 1 tumor was faintly visualized in the dark-field image as areas of decreased small angle scattering. In the phase-contrast images, 3/5 tumors were clearly visualized, while the remaining 2 tumors were faintly visualized by the phase-shift occurring at their edges. No additional tumors were visualized in either the dark-field or phase-contrast images. Compared to the adjacent lung tissue, lung tumors were characterized by a significant decrease in transmission signal (median 0.86 vs. 0.91, p = 0.04) and increase in dark-field signal (median 0.71 vs. 0.65, p = 0.04). Median contrast-to-noise ratios for the visualization of lung nodules were 4.4 for transmission images and 1.7 for dark-field images (p = 0.04).

CONCLUSION

Lung nodules can be visualized on all three radiograph modalities derived from grating-based X-ray imaging. However, our initial data suggest that grating-based multimodal X-ray imaging does not increase the sensitivity of chest radiographs for the detection of lung nodules.

X-ray phase-contrast imaging: from pre-clinical applications towards clinics

Phase-contrast x-ray imaging (PCI) is an innovative method that is sensitive to the refraction of the x-rays in matter. PCI is particularly adapted to visualize weakly absorbing details like those often encountered in biology and medicine. In past years, PCI has become one of the most used imaging methods in laboratory and preclinical studies: its unique characteristics allow high contrast 3D visualization of thick and complex samples even at high spatial resolution. Applications have covered a wide range of pathologies and organs, and are more and more often performed in vivo. Several techniques are now available to exploit and visualize the phase-contrast: propagation- and analyzer-based, crystal and grating interferometry and non-interferometric methods like the coded aperture. In this review, covering the last five years, we will give an overview of the main theoretical and experimental developments and of the important steps performed towards the clinical implementation of PCI.

Assessment of grating-based X-ray phase-contrast CT for differentiation of invasive ductal carcinoma and ductal carcinoma in situ in an experimental ex vivo set-up

OBJECTIVE

Limited contrast between healthy and tumour tissue is a limiting factor in mammography and CT of the breast. Phase-contrast computed tomography (PC-CT) provides improved soft-tissue contrast compared with absorption-based techniques. In this study, we assessed the technical feasibility of grating-based PC-CT imaging of the breast for characterisation of ductal carcinoma in situ (DCIS).

METHODS

Grating-based PC-CT was performed on one breast specimen containing an invasive ductal carcinoma and DCIS using monochromatic radiation of 23 keV. Phase-contrast and absorption-based images were compared qualitatively and quantitatively with histopathology in a blinded fashion.

RESULTS

Grating-based PC-CT showed improved differentiation of soft-tissue components. Circular structures of high phase-shift contrast corresponding to the walls of the dilated ductuli of the DCIS were visualised with a contrast-to-noise ratio (CNR) of 9.6 using PC-CT but were not detectable on absorption-based images (CNR = 0.27). The high phase-shift structures of the dilated ductuli were identifiable in the PC-CT volume data set allowing for 3D characterisation of DCIS.

CONCLUSIONS

Our results indicate that unlike conventional CT, grating-based PC-CT may allow the differentiation between invasive carcinoma and intraductal carcinoma and healthy breast tissue and provide 3D visualisation of DCIS.

Comparison of in vitro breast cancer visibility in analyser-based computed tomography with histopathology, mammography, computed tomography and magnetic resonance imaging

High-resolution analyser-based X-ray imaging computed tomography (HR ABI-CT) findings on in vitro human breast cancer are compared with histopathology, mammography, computed tomography (CT) and magnetic resonance imaging. The HR ABI-CT images provided significantly better low-contrast visibility compared with the standard radiological images. Fine cancer structures indistinguishable and superimposed in mammograms were seen, and could be matched with the histopathological results. The mean glandular dose was less than 1 mGy in mammography and 12-13 mGy in CT and ABI-CT. The excellent visibility of in vitro breast cancer suggests that HR ABI-CT may have a valuable role in the future as an adjunct or even alternative to current breast diagnostics, when radiation dose is further decreased, and compact synchrotron radiation sources become available.

Direct tomography with chemical-bond contrast

Three-dimensional (3D) X-ray imaging methods have advanced tremendously during recent years. Traditional tomography uses absorption as the contrast mechanism, but for many purposes its sensitivity is limited. The introduction of diffraction, small-angle scattering, refraction, and phase contrasts has increased the sensitivity, especially in materials composed of light elements (for example, carbon and oxygen). X-ray spectroscopy, in principle, offers information on element composition and chemical environment. However, its application in 3D imaging over macroscopic length scales has not been possible for light elements. Here we introduce a new hard-X-ray spectroscopic tomography with a unique sensitivity to light elements. In this method, dark-field section images are obtained directly without any reconstruction algorithms. We apply the method to acquire the 3D structure and map the chemical bonding in selected samples relevant to materials science. The novel aspects make this technique a powerful new imaging tool, with an inherent access to the molecular-level chemical environment.

Molecular X-ray computed tomography of myelin in a rat brain

In this work we demonstrate the feasibility of applying small-angle X-ray scattering computed tomography (SAXS-CT) for non-invasive molecular imaging of myelin sheaths in a rat brain. Our results show that the approach yields information on several quantities, including the relative myelin concentration, its periodicity, the total thickness of the myelin sheaths, and the relative concentration of cytoskeletal neurofilaments. For example the periodicity of the myelin sheaths varied in the range from 17.0 to 18.2 nm around an average of 17.6 (±0.3) nm. We believe that imaging, i.e., spatially resolved measuring these quantities could provide general means for understanding the relation to a number of neurodegenerative diseases.

Brain tumor imaging using small-angle x-ray scattering tomography

We demonstrate high-resolution small-angle x-ray scattering computed tomography (SAXS-CT) of soft matter and soft tissue samples. Complete SAXS patterns over extended ranges of momentum transfer are reconstructed spatially resolved from volumes inside an extended sample. Several SAXS standard samples are used to quantitatively validate the method and demonstrate its performance. Further results on biomedical tissue samples (rat brains) are presented that demonstrate the advantages of the method compared to existing biomedical x-ray imaging approaches. Functional areas of the brains as well as tumor morphology are imaged. By providing insights into the structural organization at the nano-level, SAXS-CT complements and extends results obtainable with standard methods such as x-ray absorption tomography and histology.

Effect of breast compression on lesion characteristic visibility with diffraction-enhanced imaging

RATIONALE AND OBJECTIVES

Conventional mammography can not distinguish between transmitted, scattered, or refracted x-rays, thus requiring breast compression to decrease tissue depth and separate overlapping structures. Diffraction-enhanced imaging (DEI) uses monochromatic x-rays and perfect crystal diffraction to generate images with contrast based on absorption, refraction, or scatter. Because DEI possesses inherently superior contrast mechanisms, the current study assesses the effect of breast compression on lesion characteristic visibility with DEI imaging of breast specimens.

MATERIALS AND METHODS

Eleven breast tissue specimens, containing a total of 21 regions of interest, were imaged by DEI uncompressed, half-compressed, or fully compressed. A fully compressed DEI image was displayed on a soft-copy mammography review workstation, next to a DEI image acquired with reduced compression, maintaining all other imaging parameters. Five breast imaging radiologists scored image quality metrics considering known lesion pathology, ranking their findings on a 7-point Likert scale.

RESULTS

When fully compressed DEI images were compared to those acquired with approximately a 25% difference in tissue thickness, there was no difference in scoring of lesion feature visibility. For fully compressed DEI images compared to those acquired with approximately a 50% difference in tissue thickness, across the five readers, there was a difference in scoring of lesion feature visibility. The scores for this difference in tissue thickness were significantly different at one rocking curve position and for benign lesion characterizations. These results should be verified in a larger study because when evaluating the radiologist scores overall, we detected a significant difference between the scores reported by the five radiologists.

CONCLUSIONS

Reducing the need for breast compression might increase patient comfort during mammography. Our results suggest that DEI may allow a reduction in compression without substantially compromising clinical image quality.

Varying collimation for dark-field extraction

Although x-ray imaging is widely used in biomedical applications, biological soft tissues have small density changes, leading to low contrast resolution for attenuation-based x-ray imaging. Over the past years, x-ray small-angle scattering was studied as a new contrast mechanism to enhance subtle structural variation within the soft tissue. In this paper, we present a detection method to extract this type of x-ray scattering data, which are also referred to as dark-field signals. The key idea is to acquire an x-ray projection multiple times with varying collimation before an x-ray detector array. The projection data acquired with a collimator of a sufficiently high collimation aspect ratio contain mainly the primary beam with little scattering, while the data acquired with an appropriately reduced collimation aspect ratio include both the primary beam and small-angle scattering signals. Then, analysis of these corresponding datasets will produce desirable dark-field signals; for example, via digitally subtraction. In the numerical experiments, the feasibility of our dark-field detection technology is demonstrated in Monte Carlo simulation. The results show that the acquired dark field signals can clearly reveal the structural information of tissues in terms of Rayleigh scattering characteristics.

Modern breast cancer detection: a technological review

Breast cancer is a serious threat worldwide and is the number two killer of women in the United States. The key to successful management is screening and early detection. What follows is a description of the state of the art in screening and detection for breast cancer as well as a discussion of new and emerging technologies. This paper aims to serve as a starting point for those who are not acquainted with this growing field.

Radiologist evaluation of an X-ray tube-based diffraction-enhanced imaging prototype using full-thickness breast specimens

RATIONALE AND OBJECTIVES

Conventional mammographic image contrast is derived from x-ray absorption, resulting in breast structure visualization due to density gradients that attenuate radiation without distinction between transmitted, scattered, or refracted x-rays. Diffraction-enhanced imaging (DEI) allows for increased contrast with decreased radiation dose compared to conventional mammographic imaging because of monochromatic x-rays, its unique refraction-based contrast mechanism, and excellent scatter rejection. However, a lingering drawback to the clinical translation of DEI has been the requirement for synchrotron radiation.

MATERIALS AND METHODS

The authors' laboratory developed a DEI prototype (DEI-PR) using a readily available tungsten x-ray tube source and traditional DEI crystal optics, providing soft tissue images at 60 keV. Images of full-thickness human breast tissue specimens were acquired on synchrotron-based DEI (DEI-SR), DEI-PR, and digital mammographic systems. A panel of expert radiologists evaluated lesion feature visibility and correlation with pathology after receiving training on the interpretation of refraction contrast mammographic images.

RESULTS

For mammographic features (mass, calcification), no significant differences were detected between the DEI-SR and DEI-PR systems. Benign lesions were perceived as better seen by radiologists using the DEI-SR system than the DEI-PR system at the [111] reflectivity, with generalizations limited by small sample size. No significant differences between DEI-SR and DEI-PR were detected for any other lesion type (atypical, cancer) at either crystal reflectivity.

CONCLUSIONS

Thus, except for benign lesion characterizations, the DEI-PR system's performance was roughly equivalent to that of the traditional DEI system, demonstrating a significant step toward clinical translation of this modality for breast cancer applications.

Analysis of breast cancer by small angle X-ray scattering (SAXS)

Small angle X-ray scattering (SAXS) images of normal breast tissue and benign and malignant breast tumour tissues, fixed in formalin, were measured at the momentum transfer range of 0.063 nm(-1) < or = q (= 4pisin(theta/2)/lambda) < or = 2.720 nm(-1). Four intrinsic parameters were extracted from the scattering profiles (1D SAXS image reduced) and, from the combination of these parameters, another three parameters were also created. All parameters, intrinsic and derived, were subject to discriminant analysis, and it was verified that parameters such as the area of diffuse scatter at the momentum transfer range 0.50 < or = q < or = 0.56 nm(-1), the ratio between areas of fifth-order axial and third-order lateral peaks and third-order axial spacing provide the most significant information for diagnosis (p < 0.001). Thus, in this work it was verified that by combining these three parameters it was possible to classify human breast tissues as normal, benign lesion or malignant lesion with a sensitivity of 83% and a specificity of 100%.

Characterization of diffraction-enhanced imaging contrast in breast cancer

Diffraction-enhanced imaging (DEI) is a new x-ray imaging modality that has been shown to enhance contrast between normal and cancerous breast tissues. In this study, diffraction-enhanced imaging in computed tomography (DEI-CT) mode was used to quantitatively characterize the refraction contrasts of the organized structures associated with invasive human breast cancer. Using a high-sensitivity Si (3 3 3) reflection, the individual features of breast cancer, including masses, calcifications and spiculations, were observed. DEI-CT yields 14, 5 and 7 times higher CT numbers and 10, 9 and 6 times higher signal-to-noise ratios (SNR) for masses, calcifications and spiculations, respectively, as compared to conventional CT of the same specimen performed using the same detector, x-ray energy and dose. Furthermore, DEI-CT at ten times lower dose yields better SNR than conventional CT. In light of the recent development of a compact DEI prototype using an x-ray tube as its source, these results, acquired at a clinically relevant x-ray energy for which a pre-clinical DEI prototype currently exists, suggest the potential of clinical implementation of mammography with DEI-CT to provide high-contrast, high-resolution images of breast cancer (Parham 2006 PhD Dissertation University of North Carolina at Chapel Hill).

Fourier X-ray scattering radiography yields bone structural information

PURPOSE

To characterize certain aspects of the microscopic structures of cortical and trabecular bone by using Fourier x-ray scattering imaging.

MATERIALS AND METHODS

Protocols approved by the National Institutes of Health Animal Care and Use Committee were used to examine ex vivo the hind limb of a rat and the toe of a pig. The Fourier x-ray scattering imaging technique involves the use of a grid mask to modulate the cone beam and Fourier spectral filters to isolate the harmonic images. The technique yields attenuation, scattering, and phase-contrast (PC) images from a single exposure. In the rat tibia cortical bone, the scattering signals from two orthogonal grid orientations were compared by using Wilcoxon signed rank tests. In the pig toe, the heterogeneity of scattering and PC signals was compared between trabecular and compact bone regions of uniform attenuation by using F tests.

RESULTS

In cortical bone, the scattering signal was significantly higher (P < 10(-15)) when the grid was parallel to the periosteal surface. Trabecular bone, as compared with cortical bone, appeared highly heterogeneous on the scattering (P < 10(-34)) and PC (P < 10(-27)) images.

CONCLUSION

The ordered alignment of the mineralized collagen fibrils in compact bone was reflected in the anisotropic scattering signal in this bone. In trabecular bone, the porosity of the mineralized matrix accounted for the granular pattern seen on the scattering and PC images.

X-ray scattering for classifying tissue types associated with breast disease

Collagen types I and III can be characterized at the molecular level (at the tens to hundreds of nanometers scale) using small angle x-ray scattering (SAXS). Although collagen fibril structural parameters at this length scale have shown differences between diseased and nondiseased breast tissues, a comprehensive analysis involving a multitude of features with a large (>50) patient cohort has not previously been investigated. Breast tissue samples were excised from 80 patients presenting with either a breast lump or reduction mammoplasty. From these, invasive carcinoma, benign tissue, and normal parenchyma were analyzed. Parameters related to collagen structure, including longitudinal (axial) and lateral (equatorial) features, polar angle features, total scattering intensity, and tissue heterogeneity effects, were extracted from the SAXS patterns and examined. The amplitude of the third-order axial peak and the total scattering intensity (amorphous scatter) showed the most separation between tissue groups and a classification model using these two parameters demonstrated an accuracy of over 95% between invasive carcinoma and mammoplasty patients. Normal tissue taken from disease-free patients (mammoplasty) and normal tissue taken from patients with presence of disease showed significant differences, suggesting that SAXS may provide different diagnostic information from that of conventional histopathology.

Structural characterization of the human cerebral myelin sheath by small angle x-ray scattering

Myelin is a multi-lamellar membrane surrounding neuronal axons and increasing their conduction velocity. When investigated by small-angle x-ray scattering (SAXS), the lamellar quasi-periodical arrangement of the myelin sheath gives rise to distinct peaks, which allow the determination of its molecular organization and the dimensions of its substructures. In this study we report on the myelin sheath structural determination carried out on a set of human brain tissue samples coming from surgical biopsies of two patients: a man around 60 and a woman nearly 90 years old. The samples were extracted either from white or grey cerebral matter and did not undergo any manipulation or chemical-physical treatment, which could possibly have altered their structure, except dipping them into a formalin solution for their conservation. Analysis of the scattered intensity from white matter of intact human cerebral tissue allowed the evaluation not only of the myelin sheath periodicity but also of its electronic charge density profile. In particular, the thicknesses of the cytoplasm and extracellular regions were established, as well as those of the hydrophilic polar heads and hydrophobic tails of the lipid bilayer. SAXS patterns were measured at several locations on each sample in order to establish the statistical variations of the structural parameters within a single sample and among different samples. This work demonstrates that a detailed structural analysis of the myelin sheath can also be carried out in randomly oriented samples of intact human white matter, which is of importance for studying the aetiology and evolution of the central nervous system pathologies inducing myelin degeneration.

Hard-X-ray dark-field imaging using a grating interferometer

Imaging with visible light today uses numerous contrast mechanisms, including bright- and dark-field contrast, phase-contrast schemes and confocal and fluorescence-based methods. X-ray imaging, on the other hand, has only recently seen the development of an analogous variety of contrast modalities. Although X-ray phase-contrast imaging could successfully be implemented at a relatively early stage with several techniques, dark-field imaging, or more generally scattering-based imaging, with hard X-rays and good signal-to-noise ratio, in practice still remains a challenging task even at highly brilliant synchrotron sources. In this letter, we report a new approach on the basis of a grating interferometer that can efficiently yield dark-field scatter images of high quality, even with conventional X-ray tube sources. Because the image contrast is formed through the mechanism of small-angle scattering, it provides complementary and otherwise inaccessible structural information about the specimen at the micrometre and submicrometre length scale. Our approach is fully compatible with conventional transmission radiography and a recently developed hard-X-ray phase-contrast imaging scheme. Applications to X-ray medical imaging, industrial non-destructive testing and security screening are discussed.

Breast cancer cells exhibit selective modulation induced by different collagen substrates

During the invasive phase of malignant tumors, neoplastic cells break into the basal lamina and enter in contact with the underlying connective tissue, which concurrently undergoes extensive modifications. The aim of our present minireview is to focus the changes in the collagenous matrix occurring during breast cancer progression and to explore the possible effects of different collagen substrates on breast cancer cell behavior and proteomic modulation.

High-resolution CT by diffraction-enhanced x-ray imaging: mapping of breast tissue samples and comparison with their histo-pathology

The aim of this study was to introduce high-resolution computed tomography (CT) of breast tumours using the diffraction-enhanced x-ray imaging (DEI) technique and to compare results with radiological and histo-pathological examinations. X-ray CT images of tumour-bearing breast tissue samples were acquired by monochromatic synchrotron radiation (SR). Due to the narrow beam and a large sample-to-detector distance scattering is rejected in the absorption contrast images (SR-CT). Large contrast enhancement is achieved by the use of the DEI-CT method, where the effects of refraction and scatter rejection are analysed by crystal optics. Clinical mammograms and CT images were recorded as reference material for a radiological examination. Three malignant and benign samples were studied in detail. Their radiographs were compared with optical images of stained histological sections. The DEI-CT images map accurately the morphology of the samples, including collagen strands and micro-calcifications of dimensions less than 0.1 mm. Histo-pathological examination and reading of the radiographs were done independently, and the conclusions were in general agreement. High-resolution DEI-CT images show strong contrast and permit visualization of details invisible in clinical radiographs. The radiation dose may be reduced by an order of magnitude without compromising image quality, which would make possible clinical in vivo DEI-CT with future compact SR sources.

Refraction-angle resolution of diffraction enhanced imaging

As a new method, x-ray diffraction enhanced imaging (DEI) has extremely high sensitivity for weakly absorbing low-Z samples in medical and biological fields. Conventional performance parameters, such as spatial resolution and low-contrast resolution, are not enough to describe the characteristics of a DEI system. This paper focuses on refraction-angle resolution which describes the ability of a DEI system to differentiate the x-rays refracted by the sample. The analysis of refraction-angle resolution is composed of two parts: the analysis of the single DEI image measured in a certain position of the rocking curve and the analysis of the refraction-angle image calculated by extraction methods. A 2D computer simulation experiment is performed to prove the results of the analyses. The limitations and conclusions of refraction-angle resolution are described in the end.

A semianalytic model to extract differential linear scattering coefficients of breast tissue from energy dispersive x-ray diffraction measurements

The goal of this work is to develop a technique to measure the x-ray diffraction signals of breast biopsy specimens. A biomedical x-ray diffraction technology capable of measuring such signals may prove to be of diagnostic use to the medical field. Energy dispersive x-ray diffraction measurements coupled with a semianalytical model were used to extract the differential linear scattering coefficients [mus(x)] of breast tissues on absolute scales. The coefficients describe the probabilities of scatter events occuring per unit length of tissue per unit solid angle of detection. They are a function of the momentum transfer argument, x=sin(theta/2)/X, where theta=scatter angle and lambda=incident wavelength. The technique was validated by using a 3 mm diameter 50 kV polychromatic x-ray beam incident on a 5 mm diameter 5 mm thick sample of water. Water was used because good x-ray diffraction data are available in the literature. The scatter profiles from 6 degrees to 15 degrees in increments of 1 degrees were measured with a 3 mm x 3 mm x 2 mm thick cadmium zinc telluride detector. A 2 mm diameter Pb aperture was placed on top of the detector. The target to detector distance was 29 cm and the duration of each measurement was 10 min. Ensemble averages of the results compare well with the gold standard data of A. H. Narten ["X-ray diffraction data on liquid water in the temperature range 4 degrees C-200 degrees C," ORNL Report No. 4578 (1970)]. An average 7.68% difference for which most of the discrepancies can be attributed to the background noise at low angles was obtained. The preliminary measurements of breast tissue are also encouraging.

Simulation of small-angle x-ray scattering from collagen fibrils and comparison with experimental patterns

Simulation of small-angle x-ray scattering from collagen in healthy and cancerous breast tissue may reveal detailed information on the structural changes in collagen. Collagen fibril is modelled as a cylinder with axially periodic step-function electron density, and packing is approximated by placing the cylinders in small hexagonal bundles. The intensity from a bundle is calculated by summing analytical scattering amplitudes from the cylinders, and intensities from several bundles with varying lattice constants are averaged. Comparisons with more complex models are made to estimate the robustness of the model. The oscillations in the equatorial direction are not significantly affected by added complexity. The relative intensities of the Bragg peaks in the meridional direction can be tuned by modifying the axial electron density distribution. Tests with different fibril radius distributions show that the average radius can be determined with an accuracy of +/-0.5 nm but that the shape of the radius distribution cannot be accurately determined from the scattering patterns. The effect of multiple scattering and the detector point-spread function (PSF) is considered, and the PSF may make a significant contribution to the final slope of the scattering pattern. Comparisons with observed scattering indicate that the model is basically correct at the supra-molecular level.