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Liu W, Qu A, Yuan J, Wang L, Chen J, Zhang X, Wang H, Han Z, Li Y. Colorectal cancer histopathology image analysis: A comparative study of prognostic values of automatically extracted morphometric nuclear features in multispectral and red-blue-green imagery. Histol Histopathol 2024; 39:1303-1316. [PMID: 38343355 DOI: 10.14670/hh-18-715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVES Multispectral imaging (MSI) has been utilized to predict the prognosis of colorectal cancer (CRC) patients, however, our understanding of the prognostic value of nuclear morphological parameters of bright-field MSI in CRC is still limited. This study was designed to compare the efficiency of MSI and standard red-green-blue (RGB) images in predicting the prognosis of CRC. METHODS We compared the efficiency of MS and conventional RGB images on the quantitative assessment of hematoxylin-eosin (HE) stained histopathology images. A pipeline was developed using a pixel-wise support vector machine (SVM) classifier for gland-stroma segmentation, and a marker-controlled watershed algorithm was used for nuclei segmentation. The correlation between extracted morphological parameters and the five-year disease-free survival (5-DFS) was analyzed. RESULTS Forty-seven nuclear morphological parameters were extracted in total. Based on Kaplan-Meier analysis, eight features derived from MS images and seven featured derived from RGB images were significantly associated with 5-DFS, respectively. Compared with RGB images, MSI showed higher accuracy, precision, and Dice index in nuclei segmentation. Multivariate analysis indicated that both integrated parameters 1 (factors negatively correlated with CRC prognosis including nuclear number, circularity, eccentricity, major axis length) and 2 (factors positively correlated with CRC prognosis including nuclear average area, area perimeter, total area/total perimeter ratio, average area/perimeter ratio) in MS images were independent prognostic factors of 5-DFS, in contrast with only integrated parameter 1 (P<0.001) in RGB images. More importantly, the quantification of HE-stained MS images displayed higher accuracy in predicting 5-DFS compared with RGB images (76.9% vs 70.9%). CONCLUSIONS Quantitative evaluation of HE-stained MS images could yield more information and better predictive performance for CRC prognosis than conventional RGB images, thereby contributing to precision oncology.
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Affiliation(s)
- Wenlou Liu
- Department of Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Aiping Qu
- School of Computer, University of South China, Hengyang, China
| | - Jingping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Linwei Wang
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiamei Chen
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiuli Zhang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hongmei Wang
- Department of Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhengxiang Han
- Department of Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
| | - Yan Li
- Department of Cancer Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
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Wang H, Singh KD, Poudel HP, Natarajan M, Ravichandran P, Eisenreich B. Forage Height and Above-Ground Biomass Estimation by Comparing UAV-Based Multispectral and RGB Imagery. SENSORS (BASEL, SWITZERLAND) 2024; 24:5794. [PMID: 39275705 PMCID: PMC11397825 DOI: 10.3390/s24175794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/23/2024] [Accepted: 08/31/2024] [Indexed: 09/16/2024]
Abstract
Crop height and biomass are the two important phenotyping traits to screen forage population types at local and regional scales. This study aims to compare the performances of multispectral and RGB sensors onboard drones for quantitative retrievals of forage crop height and biomass at very high resolution. We acquired the unmanned aerial vehicle (UAV) multispectral images (MSIs) at 1.67 cm spatial resolution and visible data (RGB) at 0.31 cm resolution and measured the forage height and above-ground biomass over the alfalfa (Medicago sativa L.) breeding trials in the Canadian Prairies. (1) For height estimation, the digital surface model (DSM) and digital terrain model (DTM) were extracted from MSI and RGB data, respectively. As the resolution of the DTM is five times less than that of the DSM, we applied an aggregation algorithm to the DSM to constrain the same spatial resolution between DSM and DTM. The difference between DSM and DTM was computed as the canopy height model (CHM), which was at 8.35 cm and 1.55 cm for MSI and RGB data, respectively. (2) For biomass estimation, the normalized difference vegetation index (NDVI) from MSI data and excess green (ExG) index from RGB data were analyzed and regressed in terms of ground measurements, leading to empirical models. The results indicate better performance of MSI for above-ground biomass (AGB) retrievals at 1.67 cm resolution and better performance of RGB data for canopy height retrievals at 1.55 cm. Although the retrieved height was well correlated with the ground measurements, a significant underestimation was observed. Thus, we developed a bias correction function to match the retrieval with the ground measurements. This study provides insight into the optimal selection of sensor for specific targeted vegetation growth traits in a forage crop.
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Affiliation(s)
- Hongquan Wang
- Lethbridge Research and Development Centre, Agriculture and Agri-Food Canada (AAFC), 5403 1st Avenue South, Lethbridge, AB T1J 4B1, Canada
| | - Keshav D Singh
- Lethbridge Research and Development Centre, Agriculture and Agri-Food Canada (AAFC), 5403 1st Avenue South, Lethbridge, AB T1J 4B1, Canada
| | - Hari P Poudel
- Lethbridge Research and Development Centre, Agriculture and Agri-Food Canada (AAFC), 5403 1st Avenue South, Lethbridge, AB T1J 4B1, Canada
| | - Manoj Natarajan
- Lethbridge Research and Development Centre, Agriculture and Agri-Food Canada (AAFC), 5403 1st Avenue South, Lethbridge, AB T1J 4B1, Canada
| | - Prabahar Ravichandran
- Lethbridge Research and Development Centre, Agriculture and Agri-Food Canada (AAFC), 5403 1st Avenue South, Lethbridge, AB T1J 4B1, Canada
| | - Brandon Eisenreich
- Lethbridge Research and Development Centre, Agriculture and Agri-Food Canada (AAFC), 5403 1st Avenue South, Lethbridge, AB T1J 4B1, Canada
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Stergar J, Hren R, Milanič M. Design and Validation of a Custom-Made Hyperspectral Microscope Imaging System for Biomedical Applications. SENSORS (BASEL, SWITZERLAND) 2023; 23:2374. [PMID: 36904578 PMCID: PMC10007032 DOI: 10.3390/s23052374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/10/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Hyperspectral microscope imaging (HMI) is an emerging modality that integrates spatial information collected by standard laboratory microscopy and the spectral-based contrast obtained by hyperspectral imaging and may be instrumental in establishing novel quantitative diagnostic methodologies, particularly in histopathology. Further expansion of HMI capabilities hinges upon the modularity and versatility of systems and their proper standardization. In this report, we describe the design, calibration, characterization, and validation of the custom-made laboratory HMI system based on a Zeiss Axiotron fully motorized microscope and a custom-developed Czerny-Turner-type monochromator. For these important steps, we rely on a previously designed calibration protocol. Validation of the system demonstrates a performance comparable to classic spectrometry laboratory systems. We further demonstrate validation against a laboratory hyperspectral imaging system for macroscopic samples, enabling future comparison of spectral imaging results across length scales. An example of the utility of our custom-made HMI system on a standard hematoxylin and eosin-stained histology slide is also shown.
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Affiliation(s)
- Jošt Stergar
- Jožef Stefan Institute, Jamova Cesta 39, SI-1000 Ljubljana, Slovenia
- Faculty of Mathematics and Physics, University of Ljubljana, Jadranska ulica 19, SI-1000 Ljubljana, Slovenia
| | - Rok Hren
- Faculty of Mathematics and Physics, University of Ljubljana, Jadranska ulica 19, SI-1000 Ljubljana, Slovenia
| | - Matija Milanič
- Jožef Stefan Institute, Jamova Cesta 39, SI-1000 Ljubljana, Slovenia
- Faculty of Mathematics and Physics, University of Ljubljana, Jadranska ulica 19, SI-1000 Ljubljana, Slovenia
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Acuña-Rodriguez JP, Mena-Vega JP, Argüello-Miranda O. Live-cell fluorescence spectral imaging as a data science challenge. Biophys Rev 2022; 14:579-597. [PMID: 35528031 PMCID: PMC9043069 DOI: 10.1007/s12551-022-00941-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/09/2022] [Indexed: 12/13/2022] Open
Abstract
Live-cell fluorescence spectral imaging is an evolving modality of microscopy that uses specific properties of fluorophores, such as excitation or emission spectra, to detect multiple molecules and structures in intact cells. The main challenge of analyzing live-cell fluorescence spectral imaging data is the precise quantification of fluorescent molecules despite the weak signals and high noise found when imaging living cells under non-phototoxic conditions. Beyond the optimization of fluorophores and microscopy setups, quantifying multiple fluorophores requires algorithms that separate or unmix the contributions of the numerous fluorescent signals recorded at the single pixel level. This review aims to provide both the experimental scientist and the data analyst with a straightforward description of the evolution of spectral unmixing algorithms for fluorescence live-cell imaging. We show how the initial systems of linear equations used to determine the concentration of fluorophores in a pixel progressively evolved into matrix factorization, clustering, and deep learning approaches. We outline potential future trends on combining fluorescence spectral imaging with label-free detection methods, fluorescence lifetime imaging, and deep learning image analysis.
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Affiliation(s)
- Jessy Pamela Acuña-Rodriguez
- Center for Geophysical Research (CIGEFI), University of Costa Rica, San Pedro, San José Costa Rica
- School of Physics, University of Costa Rica, 2060 San Pedro, San José Costa Rica
| | - Jean Paul Mena-Vega
- School of Physics, University of Costa Rica, 2060 San Pedro, San José Costa Rica
| | - Orlando Argüello-Miranda
- Department of Plant and Microbial Biology, North Carolina State University, 112 DERIEUX PLACE, Raleigh, NC 27695-7612 USA
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Crouzet C, Jeong G, Chae RH, LoPresti KT, Dunn CE, Xie DF, Agu C, Fang C, Nunes ACF, Lau WL, Kim S, Cribbs DH, Fisher M, Choi B. Spectroscopic and deep learning-based approaches to identify and quantify cerebral microhemorrhages. Sci Rep 2021; 11:10725. [PMID: 34021170 PMCID: PMC8140127 DOI: 10.1038/s41598-021-88236-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/25/2021] [Indexed: 02/04/2023] Open
Abstract
Cerebral microhemorrhages (CMHs) are associated with cerebrovascular disease, cognitive impairment, and normal aging. One method to study CMHs is to analyze histological sections (5-40 μm) stained with Prussian blue. Currently, users manually and subjectively identify and quantify Prussian blue-stained regions of interest, which is prone to inter-individual variability and can lead to significant delays in data analysis. To improve this labor-intensive process, we developed and compared three digital pathology approaches to identify and quantify CMHs from Prussian blue-stained brain sections: (1) ratiometric analysis of RGB pixel values, (2) phasor analysis of RGB images, and (3) deep learning using a mask region-based convolutional neural network. We applied these approaches to a preclinical mouse model of inflammation-induced CMHs. One-hundred CMHs were imaged using a 20 × objective and RGB color camera. To determine the ground truth, four users independently annotated Prussian blue-labeled CMHs. The deep learning and ratiometric approaches performed better than the phasor analysis approach compared to the ground truth. The deep learning approach had the most precision of the three methods. The ratiometric approach has the most versatility and maintained accuracy, albeit with less precision. Our data suggest that implementing these methods to analyze CMH images can drastically increase the processing speed while maintaining precision and accuracy.
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Affiliation(s)
- Christian Crouzet
- grid.266093.80000 0001 0668 7243Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Biomedical Engineering, University of California-Irvine, Irvine, CA USA
| | - Gwangjin Jeong
- grid.411982.70000 0001 0705 4288Department of Biomedical Engineering, Beckman Laser Institute Korea, Dankook University, Cheonan, 31116 Republic of Korea
| | - Rachel H. Chae
- grid.116068.80000 0001 2341 2786Massachusetts Institute of Technology, Cambridge, MA USA
| | - Krystal T. LoPresti
- grid.266093.80000 0001 0668 7243Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Biomedical Engineering, University of California-Irvine, Irvine, CA USA
| | - Cody E. Dunn
- grid.266093.80000 0001 0668 7243Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Biomedical Engineering, University of California-Irvine, Irvine, CA USA
| | - Danny F. Xie
- grid.266093.80000 0001 0668 7243Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Biomedical Engineering, University of California-Irvine, Irvine, CA USA
| | - Chiagoziem Agu
- grid.251990.60000 0000 9562 8554Albany State University, Albany, GA USA
| | - Chuo Fang
- grid.266093.80000 0001 0668 7243Neurology and Pathology and Laboratory Medicine, University of California-Irvine, Irvine, CA USA
| | - Ane C. F. Nunes
- grid.266093.80000 0001 0668 7243Department of Medicine, Division of Nephrology, University of California-Irvine, Irvine, CA USA
| | - Wei Ling Lau
- grid.266093.80000 0001 0668 7243Department of Medicine, Division of Nephrology, University of California-Irvine, Irvine, CA USA
| | - Sehwan Kim
- grid.411982.70000 0001 0705 4288Department of Biomedical Engineering, Beckman Laser Institute Korea, Dankook University, Cheonan, 31116 Republic of Korea
| | - David H. Cribbs
- grid.266093.80000 0001 0668 7243Institute for Memory Impairments and Neurological Disorders, University of California-Irvine, Irvine, CA USA
| | - Mark Fisher
- grid.266093.80000 0001 0668 7243Neurology and Pathology and Laboratory Medicine, University of California-Irvine, Irvine, CA USA
| | - Bernard Choi
- grid.266093.80000 0001 0668 7243Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Biomedical Engineering, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Surgery, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California-Irvine, Irvin, CA USA
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Asgharnejad H, Sarrafzadeh MH, Abhar-Shegofteh O, Khorshidi Nazloo E, Oh HM. Biomass quantification and 3-D topography reconstruction of microalgal biofilms using digital image processing. ALGAL RES 2021. [DOI: 10.1016/j.algal.2021.102243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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7
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Farris AB, Vizcarra J, Amgad M, Cooper LAD, Gutman D, Hogan J. Artificial intelligence and algorithmic computational pathology: an introduction with renal allograft examples. Histopathology 2021; 78:791-804. [PMID: 33211332 DOI: 10.1111/his.14304] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Whole slide imaging, which is an important technique in the field of digital pathology, has recently been the subject of increased interest and avenues for utilisation, and with more widespread whole slide image (WSI) utilisation, there will also be increased interest in and implementation of image analysis (IA) techniques. IA includes artificial intelligence (AI) and targeted or hypothesis-driven algorithms. In the overall pathology field, the number of citations related to these topics has increased in recent years. Renal pathology is one anatomical pathology subspecialty that has utilised WSIs and IA algorithms; it can be argued that renal transplant pathology could be particularly suited for whole slide imaging and IA, as renal transplant pathology is frequently classified by use of the semiquantitative Banff classification of renal allograft pathology. Hypothesis-driven/targeted algorithms have been used in the past for the assessment of a variety of features in the kidney (e.g. interstitial fibrosis, tubular atrophy, inflammation); in recent years, the amount of research has particularly increased in the area of AI/machine learning for the identification of glomeruli, for histological segmentation, and for other applications. Deep learning is the form of machine learning that is most often used for such AI approaches to the 'big data' of pathology WSIs, and deep learning methods such as artificial neural networks (ANNs)/convolutional neural networks (CNNs) are utilised. Unsupervised and supervised AI algorithms can be employed to accomplish image or semantic classification. In this review, AI and other IA algorithms applied to WSIs are discussed, and examples from renal pathology are covered, with an emphasis on renal transplant pathology.
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Affiliation(s)
- Alton B Farris
- Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Juan Vizcarra
- Department of Bioinformatics, Emory University, Atlanta, GA, USA
| | - Mohamed Amgad
- Department of Pathology and Center for Computational Imaging and Signal Analytics, Northwestern University, Chicago, IL, USA
| | - Lee A D Cooper
- Department of Pathology and Center for Computational Imaging and Signal Analytics, Northwestern University, Chicago, IL, USA
| | - David Gutman
- Department of Bioinformatics, Emory University, Atlanta, GA, USA
| | - Julien Hogan
- Department of Surgery, Emory University, Atlanta, GA, USA
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Farris AB, Moghe I, Wu S, Hogan J, Cornell LD, Alexander MP, Kers J, Demetris AJ, Levenson RM, Tomaszewski J, Barisoni L, Yagi Y, Solez K. Banff Digital Pathology Working Group: Going digital in transplant pathology. Am J Transplant 2020; 20:2392-2399. [PMID: 32185875 PMCID: PMC7496838 DOI: 10.1111/ajt.15850] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 01/25/2023]
Abstract
The Banff Digital Pathology Working Group (DPWG) was formed in the time leading up to and during the joint American Society for Histocompatibility and Immunogenetics/Banff Meeting, September 23-27, 2019, held in Pittsburgh, Pennsylvania. At the meeting, the 14th Banff Conference, presentations directly and peripherally related to the topic of "digital pathology" were presented; and discussions before, during, and after the meeting have resulted in a list of issues to address for the DPWG. Included are practice standardization, integrative approaches for study classification, scoring of histologic parameters (eg, interstitial fibrosis and tubular atrophy and inflammation), algorithm classification, and precision diagnosis (eg, molecular pathways and therapeutics). Since the meeting, a survey with international participation of mostly pathologists (81%) was conducted, showing that whole slide imaging is available at the majority of centers (71%) but that artificial intelligence (AI)/machine learning was only used in ≈12% of centers, with a wide variety of programs/algorithms employed. Digitalization is not just an end in itself. It also is a necessary precondition for AI and other approaches. Discussions at the meeting and the survey highlight the unmet need for a Banff DPWG and point the way toward future contributions that can be made.
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Affiliation(s)
| | | | - Simon Wu
- University of AlbertaEdmontonCanada
| | | | | | | | - Jesper Kers
- Amsterdam University Medical CentersAmsterdamthe Netherlands,Leiden University Medical CenterLeidenthe Netherlands
| | | | | | - John Tomaszewski
- University at BuffaloState University of New YorkBuffaloNew York
| | | | - Yukako Yagi
- Memorial Sloan Kettering Cancer CenterNew YorkNew York
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Fereidouni F, Todd A, Li Y, Chang CW, Luong K, Rosenberg A, Lee YJ, Chan JW, Borowsky A, Matsukuma K, Jen KY, Levenson R. Dual-mode emission and transmission microscopy for virtual histochemistry using hematoxylin- and eosin-stained tissue sections. BIOMEDICAL OPTICS EXPRESS 2019; 10:6516-6530. [PMID: 31853414 PMCID: PMC6913420 DOI: 10.1364/boe.10.006516] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 05/23/2023]
Abstract
In the clinical practice of pathology, trichrome stains are commonly used to highlight collagen and to help evaluate fibrosis. Such stains do delineate collagen deposits but are not molecularly specific and can suffer from staining inconsistencies. Moreover, performing histochemical stain evaluation requires the preparation of additional sections beyond the original hematoxylin- and eosin-stained slides, as well as additional staining steps, which together add cost, time, and workflow complications. We have developed a new microscopy approach, termed DUET (DUal-mode Emission and Transmission) that can be used to extract signals that would typically require special stains or advanced optical methods. Our preliminary analysis demonstrates the potential of using the resulting signals to generate virtual histochemical images that resemble trichrome-stained slides and can support clinical evaluation. We demonstrate advantages of this approach over images acquired from conventional trichrome-stained slides and compare them with images created using second harmonic generation microscopy.
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Affiliation(s)
- Farzad Fereidouni
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Austin Todd
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Yuheng Li
- Department of Computer Science, UC Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Che-Wei Chang
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Keith Luong
- Department of Electrical and Computer Engineering, UC Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Avi Rosenberg
- Renal Pathology, Department of Pathology, Johns Hopkins University and Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Yong-Jae Lee
- Department of Computer Science, UC Davis, One Shields Avenue, Davis, CA 95616, USA
| | - James W. Chan
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Alexander Borowsky
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Karen Matsukuma
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Kuang-Yu Jen
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Richard Levenson
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
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