Using noninvasive multispectral imaging to quantitatively assess tissue vasculature

Design and testing of an optical instrument for skin flap monitoring

Flap procedures are complex surgical tools widely used in reconstructive surgery. Flap ischemia is one of the most dangerous complications, both during the surgical procedure and during the patient's recovery, which can quickly lead to tissue necrosis (flap loss) with serious medical and psychological consequences. Today, bedside clinical assessment remains the gold standard for flap monitoring, but timely detection of flap ischemia is a difficult and challenging task, so auxiliary techniques are needed to support flap monitoring. Here we present a prototype of a new optical diagnostic tool, based on visible light absorption in diffuse reflectance spectroscopy, for non-invasive, continuous, real-time monitoring of flaps. The proposed approach is assessed by monitoring flap ischemic scenarios induced on pig animal models. The results obtained support that the proposed approach has great potential, not only for prompt detection of ischemia (in seconds), but also for clear differentiation between an arterial occlusion and venous occlusion.

Current and Future Tools for Diagnosis of Kaposi's Sarcoma

Simple Summary

Kaposi’s sarcoma, a rare opportunistic tumor, is observed in four epidemiological conditions (AIDS-related, iatrogenic, endemic or classic KS). Although in most cases KS is an indolent disease, it can be locally aggressive and/or it can invade other organs than the skin, resulting in more severe presentations, especially in patients with severe immunosuppression. There is no consensus on the imaging workup that is necessary for either the initial staging of the disease or the follow-up. Future perspectives include the use of certain non-invasive imaging tools that may help to evaluate the clinical response to treatment, as well as certain new histological markers that may help in guiding the treatment planning for this atypical neoplasm.

Abstract

Kaposi’s sarcoma (KS) is a rare, atypical malignancy associated with immunosuppression and can be qualified as an opportunistic tumor, which responds to immune modulation or restoration. Four different epidemiological forms have been individualized (AIDS-related, iatrogenic, endemic or classic KS). Although clinical examination is sufficient to diagnose cutaneous lesions of KS, additional explorations are necessary in order to detect lesions involving other organs. New histological markers have been developed in recent years concerning the detection of HHV-8 latent or lytic proteins in the lesions, helping to confirm the diagnosis when it is clinically doubtful. More recently, the evaluation of the local immune response has also been shown to provide some guidance in choosing the appropriate therapeutic option when necessary. We also review the indication and the results of conventional radiological imaging and of non-invasive imaging tools such as ¹⁸F-fluoro-deoxy-glucose positron emission tomography, thermography and laser Doppler imaging for the diagnosis of KS and for the follow-up of therapeutic response in patients requiring systemic treatment.

Beer-Lambert law for optical tissue diagnostics: current state of the art and the main limitations

SIGNIFICANCE

Beer-Lambert law (BLL) is a widely used tool for contact and remote determination of absorber concentration in various media, including living tissues. Originally proposed in the 18th century as a simple exponential expression, it has survived numerous modifications and updates. The basic assumptions of this law may not be fulfilled in real measurement conditions. This can lead to mistaken or misinterpreted results. In particular, the effects to be additionally taken into account in the tissue measurements include anisotropy, scattering, fluorescence, chemical equilibria, interference, dichroism, spectral bandwidth disagreements, stray radiation, and instrumental effects.

AIM

We review the current state of the art and the main limitations of remote tissue diagnostics using the BLL. Historical development of updating this law by taking into account specific additional factors such as light scattering and photon pathlengths in diffuse reflectance is described, along with highlighting the main risks to be considered by interpreting the measured data.

APPROACH

Literature data related to extension and modification of the BLL related to tissue assessment and concentration estimation of specific tissue molecules are collected and analyzed. The main emphasis here is put on the optical measurements of living tissue chromophore concentrations and estimation of physiological parameters, e.g., blood oxygen saturation.

RESULTS

Modified expressions of the BLL suitable for several specific cases of living tissue characterization are presented and discussed.

CONCLUSIONS

Applications of updated/modified Beer-Lambert law (MBLL) with respect to particular measurement conditions are helpful for obtaining more reliable data on the target tissue physiological state and biochemical content. MBLL accounting for the role of scattering in several ways appears to be a successful approach. Extended MBLL and BLL in the time domain form could provide more accurate results, but this requires more time resources to be spent.

Noncontact Physiological Measurement Using a Camera: A Technical Review and Future Directions

Using a camera as an optical sensor to monitor physiological parameters has garnered considerable research interest in biomedical engineering in recent decades. Researchers have explored the use of a camera for monitoring a variety of physiological waveforms, together with the vital signs carried by these waveforms. Most of the obtained waveforms are related to the human respiratory and cardiovascular systems, and in addition of being indicative of overall health, they can also detect early signs of certain diseases. While using a camera for noncontact physiological signal monitoring offers the advantages of low cost and operational ease, it also has the disadvantages such as vulnerability to motion and lack of burden-free calibration solutions in some use cases. This study presents an overview of the existing camera-based methods that have been reported in recent years. It introduces the physiological principles behind these methods, signal acquisition approaches, various types of acquired signals, data processing algorithms, and application scenarios of these methods. It also discusses the technological gaps between the camera-based methods and traditional medical techniques, which are mostly contact-based. Furthermore, we present the manner in which noncontact physiological signal monitoring use has been extended, particularly over the recent years, to more day-to-day aspects of individuals' lives, so as to go beyond the more conventional use case scenarios. We also report on the development of novel approaches that facilitate easier measurement of less often monitored and recorded physiological signals. These have the potential of ushering a host of new medical and lifestyle applications. We hope this study can provide useful information to the researchers in the noncontact physiological signal measurement community.

Point-of-care, multispectral, smartphone-based dermascopes for dermal lesion screening and erythema monitoring

SIGNIFICANCE

The rates of melanoma and nonmelanoma skin cancer are rising across the globe. Due to a shortage of board-certified dermatologists, the burden of dermal lesion screening and erythema monitoring has fallen to primary care physicians (PCPs). An adjunctive device for lesion screening and erythema monitoring would be beneficial because PCPs are not typically extensively trained in dermatological care.

AIM

We aim to examine the feasibility of using a smartphone-camera-based dermascope and a USB-camera-based dermascope utilizing polarized white-light imaging (PWLI) and polarized multispectral imaging (PMSI) to map dermal chromophores and erythema.

APPROACH

Two dermascopes integrating LED-based PWLI and PMSI with both a smartphone-based camera and a USB-connected camera were developed to capture images of dermal lesions and erythema. Image processing algorithms were implemented to provide chromophore concentrations and redness measures.

RESULTS

PWLI images were successfully converted to an alternate colorspace for erythema measures, and the spectral bandwidth of the PMSI LED illumination was sufficient for mapping of deoxyhemoglobin, oxyhemoglobin, and melanin chromophores. Both types of dermascopes were able to achieve similar relative concentration results.

CONCLUSION

Chromophore mapping and erythema monitoring are feasible with PWLI and PMSI using LED illumination and smartphone-based cameras. These systems can provide a simpler, more portable geometry and reduce device costs compared with interference-filter-based or spectrometer-based clinical-grade systems. Future research should include a rigorous clinical trial to collect longitudinal data and a large enough dataset to train and implement a machine learning-based image classifier.

Hyperspectral imaging in the spatial frequency domain with a supercontinuum source

We introduce a method for quantitative hyperspectral optical imaging in the spatial frequency domain (hs-SFDI) to image tissue absorption (μa) and reduced scattering (μs') parameters over a broad spectral range. The hs-SFDI utilizes principles of spatial scanning of the spectrally dispersed output of a supercontinuum laser that is sinusoidally projected onto the tissue using a digital micromirror device. A scientific complementary metal-oxide-semiconductor camera is used for capturing images that are demodulated and analyzed using SFDI computational models. The hs-SFDI performance is validated using tissue-simulating phantoms over a range of μa and μs' values. Quantitative hs-SFDI images are obtained from an ex-vivo beef sample to spatially resolve concentrations of oxy-, deoxy-, and met-hemoglobin, as well as water and fat fractions. Our results demonstrate that the hs-SFDI can quantitatively image tissue optical properties with 1000 spectral bins in the 580- to 950-nm range over a wide, scalable field of view. With an average accuracy of 6.7% and 12.3% in μa and μs', respectively, compared to conventional methods, hs-SFDI offers a promising approach for quantitative hyperspectral tissue optical imaging.

Optical Imaging Technology: A Useful Tool to Identify Remission in Cushing Disease After Surgery

We recently reported the use of optical imaging technology to quantify facial plethora in endogenous Cushing syndrome (CS). In the present study, we studied a larger cohort of patients with Cushing disease (CD) and examined water content fraction as well as blood volume fraction as bio-optic markers for determining the efficacy of this methodology as a predictor of lasting remission after surgery for CS. We imaged 49 patients before and after transsphenoidal surgery (TSS) for Cushing disease (CD); 22 patients were also seen at 3-6 months, and 13 patients 12 months post-operatively. On all patients, we used multi-spectral imaging (MSI) to evaluate hemodynamic distributions as well as water content at a specific area of the face. We found a decrease in blood volume fraction after vs. before surgical treatment in the tested facial area in 37 of the 40 patients, as determined with biochemical markers (p<0.001). All patients that were followed up for up to 12 months showed the same decrease from preoperative values and they remained in remission from CD. We conclude that MSI can be used for the evaluation of remission from CD, at least in the immediate post-operative period and up to one year after surgery. The use of this technology can supplement biochemical and other testing for the evaluation of the various treatment modalities available for patients with CD.

Validation of optical properties quantification with a dual-step technique for biological tissue analysis

To approach wide-field optical properties quantification in real heterogeneous biological tissue, we developed a Dual-Step setup that couples a punctual diffuse reflectance spectroscopy (DRS) technique with multispectral imaging (MSI). The setup achieves wide-field optical properties assessment through an initial estimation of scattering with DRS, which is used to estimate absorption with MSI. The absolute quantification of optical properties is based on the ACA-Pro algorithm that has been adapted both for DRS and for MSI. This paper validates the Dual-Step system not only on homogeneous Intralipid phantoms but also on a heterogeneous gelatine phantom with different scattering and absorbing properties.

Three-dimensional multispectral optoacoustic mesoscopy reveals melanin and blood oxygenation in human skin in vivo

Optical imaging plays a major role in disease detection in dermatology. However, current optical methods are limited by lack of three-dimensional detection of pathophysiological parameters within skin. It was recently shown that single-wavelength optoacoustic (photoacoustic) mesoscopy resolves skin morphology, i.e. melanin and blood vessels within epidermis and dermis. In this work we employed illumination at multiple wavelengths for enabling three-dimensional multispectral optoacoustic mesoscopy (MSOM) of natural chromophores in human skin in vivo operating at 15-125 MHz. We employ a per-pulse tunable laser to inherently co-register spectral datasets, and reveal previously undisclosed insights of melanin, and blood oxygenation in human skin. We further reveal broadband absorption spectra of specific skin compartments. We discuss the potential of MSOM for label-free visualization of physiological biomarkers in skin in vivo.

Facial Plethora: Modern Technology for Quantifying an Ancient Clinical Sign and Its Use in Cushing Syndrome

CONTEXT

Facial plethora is a clinical sign described since ancient times for a variety of diseases. In the 19th century, it was linked to increased blood volume or flow, but this has never been proven. Facial plethora is also one of the earliest described clinical features of Cushing's syndrome (CS).

OBJECTIVE

This study aimed to quantify facial plethora changes in CS as an early assessment of cure after surgery using noninvasive near-infrared multispectral imaging (MSI).

DESIGN

The longitudinal cohort study was initiated in August 2012 and completed in August 2014.

SETTING

Clinical research hospital, National Institutes of Health.

PATIENTS

Thirty-four of the 38 patients who received surgical treatment for CS under protocol 97CH0076 during this period were included.

INTERVENTION(S)

MSI was performed on the right cheek of patients before surgery and 4.9 ± 3.1 days afterward.

MAIN OUTCOME MEASURE(S)

Average blood volume fraction as measured by MSI and serum cortisol.

RESULTS

All but four of the 28 patients (86%) who were assessed as cured by postoperative plasma cortisol measurements of < 3 μg/dL showed a decrease in blood volume fraction (17.7 ± 0.03 vs 15.8 ± 0.03%; P = .0019), whereas an increase was seen in patients with persistent CS (18.5 ± 0.03 vs 21.4 ± 0.04%; P = .0017). Change in blood volume fraction before and after surgery was correlated with postoperative cortisol (rs = 0.58; P = .0003).

CONCLUSIONS

Clinical data obtained from 34 patients indicate that a decrease in facial plethora after surgery, as evidenced by a decrease in blood volume fraction, is correlated with CS outcome. This novel technology for the first time identified a physiological mechanism associated with an ancient clinical sign. Furthermore, as a proof of principle, MSI is a promising early marker of cure in patients with CS that complements biochemical and clinical data.

Quantified ultrasound elastography in the assessment of cutaneous carcinoma

OBJECTIVE

To evaluate the feasibility of high-frequency ultrasound and ultrasound elastography (USE) in discriminating benign from malignant skin lesions in a prospective cohort study and to introduce the use of a "strain ratio" for evaluation of skin lesions.

METHODS

A commercial ultrasound system with a 14-MHz transducer was used to visualize skin lesions requiring biopsy on clinical evaluation. Anatomic ultrasound and USE imaging of the skin lesions was performed using 2- to 4-mm gel stand-off pads. A region of interest was manually selected over the area of each lesion with the lowest strain. The concept of a strain ratio of the compressibility of the normal skin at the corresponding layer to that of the least compressible region of a lesion in question was created and applied. This ratio was subsequently correlated with blind histopathological evaluation for malignancy.

RESULTS

55 patients were included in the study with a total of 67 lesions evaluated. 29 lesions were malignant and 38 benign. All malignant lesions had strain ratios ≥3.9. All benign lesions had strain ratios ≤3.0. A diagnostic value between 3.0 and 3.9 would result in 100% sensitivity and specificity in the characterization of these lesions as malignant.

CONCLUSION

This pilot study demonstrated that USE plus strain ratio appears to be a promising modality in providing diagnostic determination between cancerous and benign primary solitary skin lesions prior to biopsy.

ADVANCES IN KNOWLEDGE

This is the first reported study applying an original mathematical elastographic ratio, or strain ratio, to evaluate primary solitary skin lesions.

Illumination Compensation and Normalization Using Low-Rank Decomposition of Multispectral Images in Dermatology

When attempting to recover the surface color from an image, modelling the illumination contribution per-pixel is essential. In this work we present a novel approach for illumination compensation using multispectral image data. This is done by means of a low-rank decomposition of representative spectral bands with prior knowledge of the reflectance spectra of the imaged surface. Experimental results on synthetic data, as well as on images of real lesions acquired at the university clinic, show that the proposed method significantly improves the contrast between the lesion and the background.

Remote diffuse reflectance spectroscopy sensor for tissue engineering monitoring based on blind signal separation

In this study the first results on evaluation and assessment of grafted bioengineered skin substitutes using an optical Diffuse Reflectance Spectroscopy (DRS) system with a remote optical probe are shown. The proposed system is able to detect early vascularization of skin substitutes expressing the Vascular Endothelial Growth Factor (VEGF) protein compared to normal grafts, even though devitalized skin is used to protect the grafts. Given the particularities of the biological problem, data analysis is performed using two Blind Signal Separation (BSS) methods: Principal Component Analysis (PCA) and Independent Component Analysis (ICA). These preliminary results are the first step towards point-of-care diagnostics for skin implants early assessment.

Bolus tracking with nanofilter-based multispectral videography for capturing microvasculature hemodynamics

Multispectral imaging is a highly desirable modality for material-based analysis in diverse areas such as food production and processing, satellite-based reconnaissance, and biomedical imaging. Here, we present nanofilter-based multispectral videography (nMSV) in the 700 to 950 nm range made possible by the tunable extraordinary-optical-transmission properties of 3D metallic nanostructures. Measurements made with nMSV during a bolus injection of an intravascular tracer in the ear of a piglet resulted in spectral videos of the microvasculature. Analysis of the multispectral videos generated contrast measurements representative of arterial pulsation, the distribution of microvascular transit times, as well as a separation of the venous and arterial signals arising from within the tissue. Therefore, nMSV is capable of acquiring serial multispectral images relevant to tissue hemodynamics, which may have application to the detection and identification of skin cancer.

A novel pilot study using spatial frequency domain imaging to assess oxygenation of perforator flaps during reconstructive breast surgery

INTRODUCTION

Although various methods exist for monitoring flaps during reconstructive surgery, surgeons primarily rely on assessment of clinical judgment. Early detection of vascular complications improves rate of flap salvage. Spatial frequency domain imaging (SFDI) is a promising new technology that provides oxygenation images over a large field of view. The goal of this clinical pilot study is to use SFDI in perforator flap breast reconstruction.

METHODS

Three women undergoing unilateral breast reconstruction after mastectomy were enrolled for our study. The SFDI system was deployed in the operating room, and images acquired over the course of the operation. Time points included images of each hemiabdominal skin flap before elevation, the selected flap after perforator dissection, and after microsurgical transfer.

RESULTS

Spatial frequency domain imaging was able to measure tissue oxyhemoglobin concentration (ctO2Hb), tissue deoxyhemoglobin concentration, and tissue oxygen saturation (stO2). Images were created for each metric to monitor flap status and the results quantified throughout the various time points of the procedure. For 2 of 3 patients, the chosen flap had a higher ctO2Hb and stO2. For 1 patient, the chosen flap had lower ctO2Hb and stO2. There were no perfusion deficits observed based on SFDI and clinical follow-up.

CONCLUSIONS

The results of our initial human pilot study suggest that SFDI has the potential to provide intraoperative oxygenation images in real-time during surgery. With the use of this technology, surgeons can obtain tissue oxygenation and hemoglobin concentration maps to assist in intraoperative planning; this can potentially prevent complications and improve clinical outcome.

Evaluation of non-invasive multispectral imaging as a tool for measuring the effect of systemic therapy in Kaposi sarcoma

Diffuse multi-spectral imaging has been evaluated as a potential non-invasive marker of tumor response. Multi-spectral images of Kaposi sarcoma skin lesions were taken over the course of treatment, and blood volume and oxygenation concentration maps were obtained through principal component analysis (PCA) of the data. These images were compared with clinical and pathological responses determined by conventional means. We demonstrate that cutaneous lesions have increased blood volume concentration and that changes in this parameter are a reliable indicator of treatment efficacy, differentiating responders and non-responders. Blood volume decreased by at least 20% in all lesions that responded by clinical criteria and increased in the two lesions that did not respond clinically. Responses as assessed by multi-spectral imaging also generally correlated with overall patient clinical response assessment, were often detectable earlier in the course of therapy, and are less subject to observer variability than conventional clinical assessment. Tissue oxygenation was more variable, with lesions often showing decreased oxygenation in the center surrounded by a zone of increased oxygenation. This technique could potentially be a clinically useful supplement to existing response assessment in KS, providing an early, quantitative, and non-invasive marker of treatment effect.

Multispectral imaging in the extended near-infrared window based on endogenous chromophores

To minimize the problem with scattering in deep tissues while increasing the penetration depth, we explored the feasibility of imaging in the relatively unexplored extended near infrared (exNIR) spectral region at 900 to 1400 nm with endogenous chromophores. This region, also known as the second NIR window, is weakly dominated by absorption from water and lipids and is free from other endogenous chromophores with virtually no autofluorescence. To demonstrate the applicability of the exNIR for bioimaging, we analyzed the optical properties of individual components and biological tissues using an InGaAs spectrophotometer and a multispectral InGaAs scanning imager featuring transmission geometry. Based on the differences in spectral properties of tissues, we utilized ratiometric approaches to extract spectral characteristics from the acquired three-dimensional "datacube". The obtained images of an exNIR transmission through a mouse head revealed sufficient details consistent with anatomical structures.

Skin parameter map retrieval from a dedicated multispectral imaging system applied to dermatology/cosmetology

In vivo quantitative assessment of skin lesions is an important step in the evaluation of skin condition. An objective measurement device can help as a valuable tool for skin analysis. We propose an explorative new multispectral camera specifically developed for dermatology/cosmetology applications. The multispectral imaging system provides images of skin reflectance at different wavebands covering visible and near-infrared domain. It is coupled with a neural network-based algorithm for the reconstruction of reflectance cube of cutaneous data. This cube contains only skin optical reflectance spectrum in each pixel of the bidimensional spatial information. The reflectance cube is analyzed by an algorithm based on a Kubelka-Munk model combined with evolutionary algorithm. The technique allows quantitative measure of cutaneous tissue and retrieves five skin parameter maps: melanin concentration, epidermis/dermis thickness, haemoglobin concentration, and the oxygenated hemoglobin. The results retrieved on healthy participants by the algorithm are in good accordance with the data from the literature. The usefulness of the developed technique was proved during two experiments: a clinical study based on vitiligo and melasma skin lesions and a skin oxygenation experiment (induced ischemia) with healthy participant where normal tissues are recorded at normal state and when temporary ischemia is induced.

An introduction to primary skin imaging

Dermatology is a field in which clinical examination is heavily relied upon for diagnosis. When required, a tissue biopsy may also be performed to confirm the diagnosis. Recent advances in imaging techniques have been applied to cutaneous lesions to improve diagnostic accuracy without the need for biopsy. These new imaging techniques are reviewed for their developing role in dermatology.

Development of a Novel Embedded Relay Lens Microscopic Hyperspectral Imaging System for Cancer Diagnosis: Use of the Mice with Oral Cancer to Be the Example

This paper develops a novel embedded relay lens microscopic hyperspectral imaging system (ERL-MHSI) with high spectral resolution (nominal spectral resolution of 2.8 nm) and spatial resolution (30 μm × 10 μm) for cancer diagnosis. The ERL-MHSI system has transmittance and fluorescence mode. The transmittance can provide the morphological information for pathological diagnosis, and the fluorescence of cells or tissue can provide the characteristic signature for identification of normal and abnormal. In this work, the development of the ERL-MHSI system is discussed and the capability of the system is demonstrated by diagnosing early stage oral cancer of twenty mice in vitro. The best sensitivity for identifying normal cells and squamous cell carcinoma (SCC) was 100%. The best specificity for identifying normal cells and SCC was 99%. The best sensitivity for identifying normal cells and dysplasia was 99%. The best specificity for identifying normal cells and dysplasia was 97%. This work also utilizes fractal dimension to analyze the morphological information and find the significant different values between normal and SCC.

Three-dimensional phantoms for curvature correction in spatial frequency domain imaging

The sensitivity to surface profile of non-contact optical imaging, such as spatial frequency domain imaging, may lead to incorrect measurements of optical properties and consequently erroneous extrapolation of physiological parameters of interest. Previous correction methods have focused on calibration-based, model-based, and computation-based approached. We propose an experimental method to correct the effect of surface profile on spectral images. Three-dimensional (3D) phantoms were built with acrylonitrile butadiene styrene (ABS) plastic using an accurate 3D imaging and an emergent 3D printing technique. In this study, our method was utilized for the correction of optical properties (absorption coefficient μ(a) and reduced scattering coefficient μ(s)') of objects obtained with a spatial frequency domain imaging system. The correction method was verified on three objects with simple to complex shapes. Incorrect optical properties due to surface with minimum 4 mm variation in height and 80 degree in slope were detected and improved, particularly for the absorption coefficients. The 3D phantom-based correction method is applicable for a wide range of purposes. The advantages and drawbacks of the 3D phantom-based correction methods are discussed in details.

First-in-human pilot study of a spatial frequency domain oxygenation imaging system

Oxygenation measurements are widely used in patient care. However, most clinically available instruments currently consist of contact probes that only provide global monitoring of the patient (e.g., pulse oximetry probes) or local monitoring of small areas (e.g., spectroscopy-based probes). Visualization of oxygenation over large areas of tissue, without a priori knowledge of the location of defects, has the potential to improve patient management in many surgical and critical care applications. In this study, we present a clinically compatible multispectral spatial frequency domain imaging (SFDI) system optimized for surgical oxygenation imaging. This system was used to image tissue oxygenation over a large area (16×12 cm) and was validated during preclinical studies by comparing results obtained with an FDA-approved clinical oxygenation probe. Skin flap, bowel, and liver vascular occlusion experiments were performed on Yorkshire pigs and demonstrated that over the course of the experiment, relative changes in oxygen saturation measured using SFDI had an accuracy within 10% of those made using the FDA-approved device. Finally, the new SFDI system was translated to the clinic in a first-in-human pilot study that imaged skin flap oxygenation during reconstructive breast surgery. Overall, this study lays the foundation for clinical translation of endogenous contrast imaging using SFDI.

Noninvasive imaging of human skin hemodynamics using a digital red-green-blue camera

In order to visualize human skin hemodynamics, we investigated a method that is specifically developed for the visualization of concentrations of oxygenated blood, deoxygenated blood, and melanin in skin tissue from digital RGB color images. Images of total blood concentration and oxygen saturation can also be reconstructed from the results of oxygenated and deoxygenated blood. Experiments using tissue-like agar gel phantoms demonstrated the ability of the developed method to quantitatively visualize the transition from an oxygenated blood to a deoxygenated blood in dermis. In vivo imaging of the chromophore concentrations and tissue oxygen saturation in the skin of the human hand are performed for 14 subjects during upper limb occlusion at 50 and 250 mm Hg. The response of the total blood concentration in the skin acquired by this method and forearm volume changes obtained from the conventional strain-gauge plethysmograph were comparable during the upper arm occlusion at pressures of both 50 and 250 mm Hg. The results presented in the present paper indicate the possibility of visualizing the hemodynamics of subsurface skin tissue.

Quantitative principal component model for skin chromophore mapping using multi-spectral images and spatial priors

We describe a novel reconstruction algorithm based on Principal Component Analysis (PCA) applied to multi-spectral imaging data. Using numerical phantoms, based on a two layered skin model developed previously, we found analytical expressions, which convert qualitative PCA results into quantitative blood volume and oxygenation values, assuming the epidermal thickness to be known. We also evaluate the limits of accuracy of this method when the value of the epidermal thickness is not known. We show that blood volume can reliably be extracted (less than 6% error) even if the assumed thickness deviates 0.04mm from the actual value, whereas the error in blood oxygenation can be as large as 25% for the same deviation in thickness. This PCA based reconstruction was found to extract blood volume and blood oxygenation with less than 8% error, if the underlying structure is known. We then apply the method to in vivo multi-spectral images from a healthy volunteer's lower forearm, complemented by images of the same area using Optical Coherence Tomography (OCT) for measuring the epidermal thickness. Reconstruction of the imaging results using a two layered analytical skin model was compared to PCA based reconstruction results. A point wise correlation was found, showing the proof of principle of using PCA based reconstruction for blood volume and oxygenation extraction.

Hyperspectral imaging of atherosclerotic plaques in vitro

Vulnerable plaques constitute a risk for serious heart problems, and are difficult to identify using existing methods. Hyperspectral imaging combines spectral- and spatial information, providing new possibilities for precise optical characterization of atherosclerotic lesions. Hyperspectral data were collected from excised aorta samples (n = 11) using both white-light and ultraviolet illumination. Single lesions (n = 42) were chosen for further investigation, and classified according to histological findings. The corresponding hyperspectral images were characterized using statistical image analysis tools (minimum noise fraction, K-means clustering, principal component analysis) and evaluation of reflectance/fluorescence spectra. Image analysis combined with histology revealed the complexity and heterogeneity of aortic plaques. Plaque features such as lipids and calcifications could be identified from the hyperspectral images. Most of the advanced lesions had a central region surrounded by an outer rim or shoulder-region of the plaque, which is considered a weak spot in vulnerable lesions. These features could be identified in both the white-light and fluorescence data. Hyperspectral imaging was shown to be a promising tool for detection and characterization of advanced atherosclerotic plaques in vitro. Hyperspectral imaging provides more diagnostic information about the heterogeneity of the lesions than conventional single point spectroscopic measurements.

The effect of zirconia and titanium implant abutments on light reflection of the supporting soft tissues

OBJECTIVES

To determine the difference in light reflection of oral mucosa covering titanium (Ti) or zirconia (ZrO(2)) abutments as it relates to the thickness of the covering mucosa.

MATERIAL AND METHODS

Fifteen anterior implants (Astra Osseo speed(®)) in 11 patients were fitted with a Ti or a ZrO(2) abutment (cross-over, within-subject comparison). Hyper-spectral images were taken with a camera fitted on a surgical microscope. High-resolution images with 70 nm interval between 440 and 720 nm were obtained within 30 s (1392 × 1024 pixels). Black- and white-point reference was used for spatial and spectral normalization as well as correction for motion during exposure. Reflection spectra were extracted from the image on a line mid-buccal of the implant, starting 1 mm above the soft tissue continuing up to 3 mm apically.

RESULTS

Median soft tissue height is 2.3 mm (min: 1.2 mm and max: 3.1 mm). The buccal mucosa rapidly increases in the thickness, when moving apically. At 2.2 mm, thickness is 3 mm. No perceivable difference between the Ti and ZrO(2) abutment can be observed when the thickness of the mucosa is 2±0.1 mm (95% confidence interval) or more.

CONCLUSION

It is expected that the difference in light reflection of soft tissue covering Ti or ZrO(2) abutments is no longer noticeable for the human eye when the mucosa thickness exceeds 2 mm. Haemoglobin peaks in the reflection spectrum can be observed and make hyper-spectral imaging a practical and useful tool for measuring soft tissue health.

White-light Sagnac interferometer for snapshot multispectral imaging

The theoretical and experimental demonstration of a multispectral Sagnac interferometer (MSI) is presented. The MSI was created by including two multiple-order blazed diffraction gratings in both arms of a standard polarization Sagnac interferometer (PSI). By introducing these high-order diffractive structures, unique spectral passbands can be amplitude modulated onto coincident carrier frequencies. Extraction of the modulated multispectral images, corresponding to each passband, is accomplished within the Fourier domain. This yields a unique multispectral sensor capable of imaging all the passbands in a single snapshot. First, the theoretical operating principles of a PSI are discussed to provide a context for the MSI. This is followed by the theoretical and experimental development of the MSI, which is an extension of a dispersion-compensated PSI. Indoor and outdoor testing and validation of the MSI are performed by observing vegetation, demonstrating the ability of our experimental setup to detect four distinct spectral passbands.

Direct curvature correction for noncontact imaging modalities applied to multispectral imaging

Noncontact optical imaging of curved objects can result in strong artifacts due to the object's shape, leading to curvature biased intensity distributions. This artifact can mask variations due to the object's optical properties, and makes reconstruction of optical/physiological properties difficult. In this work we demonstrate a curvature correction method that removes this artifact and recovers the underlying data, without the necessity of measuring the object's shape. This method is applicable to many optical imaging modalities that suffer from shape-based intensity biases. By separating the spatially varying data (e.g., physiological changes) from the background signal (dc component), we show that the curvature can be extracted by either averaging or fitting the rows and columns of the images. Numerical simulations show that our method is equivalent to directly removing the curvature, when the object's shape is known, and accurately recovers the underlying data. Experiments on phantoms validate the numerical results and show that for a given image with 16.5% error due to curvature, the method reduces that error to 1.2%. Finally, diffuse multispectral images are acquired on forearms in vivo. We demonstrate the enhancement in image quality on intensity images, and consequently on reconstruction results of blood volume and oxygenation distributions.

Principal component model of multispectral data for near real-time skin chromophore mapping

Multispectral images of skin contain information on the spatial distribution of biological chromophores, such as blood and melanin. From this, parameters such as blood volume and blood oxygenation can be retrieved using reconstruction algorithms. Most such approaches use some form of pixelwise or volumetric reconstruction code. We explore the use of principal component analysis (PCA) of multispectral images to access blood volume and blood oxygenation in near real time. We present data from healthy volunteers under arterial occlusion of the forearm, experiencing ischemia and reactive hyperemia. Using a two-layered analytical skin model, we show reconstruction results of blood volume and oxygenation and compare it to the results obtained from our new spectral analysis based on PCA. We demonstrate that PCA applied to multispectral images gives near equivalent results for skin chromophore mapping and quantification with the advantage of being three orders of magnitude faster than the reconstruction algorithm.

Rapid and accurate estimation of blood saturation, melanin content, and epidermis thickness from spectral diffuse reflectance

We present a method to determine chromophore concentrations, blood saturation, and epidermal thickness of human skin from diffuse reflectance spectra. Human skin was approximated as a plane-parallel slab of variable thickness supported by a semi-infinite layer corresponding to the epidermis and dermis, respectively. The absorption coefficient was modeled as a function of melanin content for the epidermis and blood content and oxygen saturation for the dermis. The scattering coefficient and refractive index of each layer were found in the literature. Diffuse reflectance spectra between 490 and 620 nm were generated using Monte Carlo simulations for a wide range of melanosome volume fraction, epidermal thickness, blood volume, and oxygen saturation. Then, an inverse method was developed to retrieve these physiologically meaningful parameters from the simulated diffuse reflectance spectra of skin. A previously developed accurate and efficient semiempirical model for diffuse reflectance of two layered media was used instead of time-consuming Monte Carlo simulations. All parameters could be estimated with relative root-mean-squared error of less than 5% for (i) melanosome volume fraction ranging from 1% to 8%, (ii) epidermal thickness from 20 to 150 mum, (iii) oxygen saturation from 25% to 100%, (iv) blood volume from 1.2% to 10%, and (v) tissue scattering coefficient typical of human skin in the visible part of the spectrum. A similar approach could be extended to other two-layer absorbing and scattering systems.

2-D mapping of skin chromophores in the spectral range 500 - 700 nm

The multi-spectral imaging technique has been used for distant mapping of in-vivo skin chromophores by analyzing spectral data at each reflected image pixel and constructing 2-D maps of the relative concentrations of oxy-/deoxy-haemoglobin and melanin. Instead of using a broad visible-NIR spectral range, this study focuses on narrowed spectral band 500-700 nm, speeding-up the signal processing procedure. Regression analysis confirmed that superposition of three Gaussians is optimal analytic approximation for the oxy-haemoglobin absorption tabular spectrum in this spectral band, while superposition of two Gaussians fits well for deoxy-haemoglobin absorption and exponential function - for melanin absorption. The proposed approach was clinically tested for three types of in-vivo skin provocations: ultraviolet irradiance, chemical reaction with vinegar essence and finger arterial occlusion. Spectral range 500-700 nm provided better sensitivity to oxy-haemoglobin changes and higher response stability to melanin than two reduced ranges 500-600 nm and 530-620 nm.

Hyperspectral and physiological analyses of coral-algal interactions

Space limitation leads to competition between benthic, sessile organisms on coral reefs. As a primary example, reef-building corals are in direct contact with each other and many different species and functional groups of algae. Here we characterize interactions between three coral genera and three algal functional groups using a combination of hyperspectral imaging and oxygen microprofiling. We also performed in situ interaction transects to quantify the relative occurrence of these interaction on coral reefs. These studies were conducted in the Southern Line Islands, home to some of the most remote and near-pristine reefs in the world. Our goal was to determine if different types of coral-coral and coral-algal interactions were characterized by unique fine-scale physiological signatures. This is the first report using hyperspectral imaging for characterization of marine benthic organisms at the micron scale and proved to be a valuable tool for discriminating among different photosynthetic organisms. Consistent patterns emerged in physiology across different types of competitive interactions. In cases where corals were in direct contact with turf or macroalgae, there was a zone of hypoxia and altered pigmentation on the coral. In contrast, interaction zones between corals and crustose coralline algae (CCA) were not hypoxic and the coral tissue was consistent across the colony. Our results suggest that at least two main characteristic coral interaction phenotypes exist: 1) hypoxia and coral tissue disruption, seen with interactions between corals and fleshy turf and/or some species of macroalgae, and 2) no hypoxia or tissue disruption, seen with interactions between corals and some species of CCA. Hyperspectral imaging in combination with oxygen profiling provided useful information on competitive interactions between benthic reef organisms, and demonstrated that some turf and fleshy macroalgae can be a constant source of stress for corals, while CCA are not.

Near infrared planar tumor imaging and quantification using nanosized Alexa 750-labeled phospholipid micelles

A novel highly biocompatible near infrared nanosized contrast agent was developed and used for rapid tumor detection and quantification using planar optical imaging and analysis. With this in mind, the near infrared fluorescent dye Alexa 750 was covalently attached to polyethylene glycol-phosphatidylethanolamine (PEG-PE) conjugate, and double labeled (with Alexa and rhodamine) PEG-PE micelles were injected into mice and observed using planar optical imaging. Pixel intensity data from the tumor site were normalized versus the autofluorescence of the animal at the same time point and normalized as signal to noise over the scattered light from the various tissues of the mice. The detected signal from the tumor was higher than the background noise allowing for rapid detection of the tumor. The tumor was clearly visible within one hour. Some signal was also detected from the abdomen of the mice. As determined by microscopy analysis, other organs of accumulation were the liver and kidney, which corresponded well to the data from the whole body imaging animal studies.

Image reconstruction method for a two-layer tissue structure accounts for chest-wall effects in breast imaging

We develop a new tomographic imaging reconstruction algorithm for a two-layer tissue structure. Simulations and phantom experiments show more accurate reconstruction of target optical properties compared with those results obtained from a semi-infinite tissue model for layered structures. This improvement is mainly attributed to the more accurate estimation of background optical properties and more accurate estimation of weight matrix for imaging reconstruction by considering the light propagation effect in the second layer. Clinical results of breast lesions are also presented to demonstrate the utility of this new imaging algorithm.

Imaging techniques for Kaposi's sarcoma

Kaposi[']s sarcoma (KS) is a multicentric tumour that most frequently involves the skin but can involve other tissues as well. Clinicians treating patients with KS or conducting clinical trials in this disease can benefit from imaging studies to document the extent of disease, to document changes with therapy, and to assess the extent of visceral and lymphatic involvement. A number of conventional techniques can be of use in meeting these needs, such as conventional light photography to assess skin or mucosal lesions, computed tomography of the chest to assess pulmonary disease, and magnetic resonance imaging. In addition, a number of techniques are being developed with the goals of providing improved differentiation of KS from other diseases or providing information about the degree of angiogenesis in the lesions and other physiological factors. We present here an overview of both established and experimental modalities of imaging in KS.

Detection limits of multi-spectral optical imaging under the skin surface

The present work shows that the optical/biological information contained in a typical spectral image mainly reflects the properties of a small (conic like) volume of tissue situated vertically under each individual pixel. The objects appearing on a spectral image reasonably reproduce the correct geometrical shape and size (like a non-deformed shadow) of underlying inclusions of pathological tissue. The information contained in a spectral image comes from a depth that does not exceed approximately 2-3 mm. The number of photons that visit a given tissue voxel situated at a depth larger than approximately 2 mm represents less than the 1% of the total number of photons reaching the corresponding detection pixel (forming the image). A pathological inclusion (e.g. a pool of blood or vascular tumor) situated at a depth of approximately 0.5 mm with a thickness of 0.5 mm produces an image intensity contrast of approximately 5% (for images taken at wavelengths in the 600-1000 nm range) when compared to the normal skin background. The same inclusion at a depth of 20 microm provides a contrast decreasing from 55 to 20% with respect to an increase in wavelength. The dermis/hypodermis interface behaves as a partial barrier for the photons, limiting their access to deeper skin regions. The image contrast depends on the depth and the type of chromophore contained in the inclusion. An increase in the concentration of a given molecule may produce different contrast, independently of the depth, depending on the characteristics of the skin layer where this change occurs.