Microvascular anastomosis guidance and evaluation using real-time three-dimensional Fourier-domain Doppler optical coherence tomography

In vivo characterization of cerebrovascular impairment induced by amyloid β peptide overload in glymphatic clearance system using swept-source optical coherence tomography

SIGNIFICANCE

Antiamyloid β ( A β ) immunotherapy is a promising therapeutic strategy for Alzheimer's disease (AD) but generates large amounts of soluble A β peptides that could overwhelm the clearance pathway, leading to serious side effects. Direct implications of A β in glymphatic drainage transport for cerebral vasculature and tissue are not well known. Studies are needed to resolve this issue and pave the way to better monitoring abnormal vascular events that may occur in A β -modifying therapies for AD.

AIM

The objective is to characterize the modification of cerebral vasculature and tissue induced by soluble A β abundantly present in the glymphatic clearance system.

APPROACH

A β 1 - 42 peptide was injected intracerebroventricularly and swept-source optical coherence tomography (SS-OCT) was used to monitor the progression of changes in the brain microvascular network and tissue in vivo over 14 days. Parameters reflecting vascular morphology and structure as well as tissue status were quantified and compared before treatment.

RESULTS

Vascular perfusion density, vessel length, and branch density decreased sharply and persistently following peptide administration. In comparison, vascular average diameter and vascular tortuosity were moderately increased at the late stage of monitoring. Endpoint density gradually increased, and the global optical attenuation coefficient value decreased significantly over time.

CONCLUSIONS

A β burden in the glymphatic system directly contributes to cerebrovascular structural and morphological abnormalities and global brain tissue damage, suggesting severe deleterious properties of soluble cerebrospinal fluid- A β . We also show that OCT can be used as an effective tool to monitor cerebrovascular dynamics and tissue property changes in response to therapeutic treatments in drug discovery research.

Phase unwrapping based on a residual en-decoder network for phase images in Fourier domain Doppler optical coherence tomography

To solve the phase unwrapping problem for phase images in Fourier domain Doppler optical coherence tomography (DOCT), we propose a deep learning-based residual en-decoder network (REDN) method. In our approach, we reformulate the definition for obtaining the true phase as obtaining an integer multiple of 2π at each pixel by semantic segmentation. The proposed REDN architecture can provide recognition performance with pixel-level accuracy. To address the lack of phase images that are noise and wrapping free from DOCT systems for training, we used simulated images synthesized with DOCT phase image background noise features. An evaluation study on simulated images, DOCT phase images of phantom milk flowing in a plastic tube and a mouse artery, was performed. Meanwhile, a comparison study with recently proposed deep learning-based DeepLabV3+ and PhaseNet methods for signal phase unwrapping and traditional modified networking programming (MNP) method was also performed. Both visual inspection and quantitative metrical evaluation based on accuracy, specificity, sensitivity, root-mean-square-error, total-variation, and processing time demonstrate the robustness, effectiveness and superiority of our method. The proposed REDN method will benefit accurate and fast DOCT phase image-based diagnosis and evaluation when the detected phase is wrapped and will enrich the deep learning-based image processing platform for DOCT images.

In vivo monitoring of thrombosis in mice by optical coherence tomography

The objective of this study is to establish a novel method for continuously monitoring thrombus progression with various outcome measures and to assess the efficacy of antithrombotic drugs in murine thrombosis model in mice. In the study, thrombus was induced in the femoral vein of mice by FeCl₃ and monitored over time by spectral-domain optical coherence tomography (OCT). Three-dimensional images of thrombi with or without heparin as an antithrombotic agent were obtained from OCT angiography. In addition, several parameters of thrombi were analyzed and compared between control and anticoagulant groups. By using OCT, we were able to trace thrombus generation in the same mouse in real time. We found that in our model heparin reduced thrombus size by ~60% and thrombus cross-sectional area by 50%. OCT results also show that both time to thrombus size (>0.02mm³ ) and time to occlusion (>30%) were significantly reduced after heparin addition. This study demonstrates that OCT reliably monitors thrombus generation and progression from various aspects including thrombus size. This enables us to measure the kinetic of thrombosis more accurately, and effectively evaluate the efficacy and activities of antithrombotic drugs. This model may represent a useful tool in antithrombotic drug discoveries in preclinical studies.

Analysis and evaluation of BC-mode OCT image visualization for microsurgery guidance

Optical coherence tomography (OCT) has been gaining acceptance in image-guided microsurgery as a noninvasive imaging technique. However, when using B-mode OCT imaging, it is difficult to continuously keep the surgical tool in the imaging field, and the image of the tissue beneath the tool is corrupted by shadow effects. The alternative using C-mode OCT imaging is either too slow in imaging speed when operating in a high-resolution mode, or provides a poor image resolution in a high-speed mode, with the sweep rate less than one million hertz. Moreover, the 3-dimensional rendering of C-mode OCT image makes it difficult to visualize the tissue structure and track the surgical tool beneath the tissue surface. To solve these problems, we propose a BC-mode OCT image visualization method. This method uses a sparse C-scanning scheme, which provides a set of high-resolution B-mode OCT images at sparsely spaced cross sections. The final BC-mode OCT image is obtained by averaging the image set, with inter frame variance processing to enhance the signal of the surgical tool and tissue layers. The performance of BC-mode OCT images, such as image resolution, signal to noise ratio (SNR), imaging speed, and surgical tool tracking accuracy, is analyzed theoretically and verified experimentally. The feasibility of the proposed method is evaluated by guiding the insertion of a 30-gauge needle into the cornea of an ex-vivo human eye freehand. The results show that this provides better visualization of both the surgical tool and the tissue structure than the conventional B- or C- mode OCT image.

Cooperative Three-View Imaging Optical Coherence Tomography for Intraoperative Vascular Evaluation

Real-time intraoperative optical coherence tomography (OCT) imaging of blood vessels after anastomosis operation can provide important information the vessel, such as patency, flow speed, and thrombosis morphology. Due to the strong scattering and absorption effect of blood, normal OCT imaging suffers from the problem of incomplete cross-sectional view of the vessel under investigation when the diameter is large. In this work, we present a novel cooperative three-view imaging spectral domain optical coherence tomography system for intraoperative exposed vascular imaging. Two more side views (left view and right view) were realized through a customized sample arm optical design and corresponding mechanical design and fabrication, which could generate cross-sectional images from three circumferential view directions to achieve a larger synthetic field of view (FOV). For each view, the imaging depth was 6.7 mm (in air) and the lateral scanning range was designed to be 3 mm. Therefore, a shared synthetic rectangle FOV of 3 mm × 3 mm was achieved through cooperative three view scanning. This multi-view imaging method can meet the circumferential imaging demands of vessels with an outer diameter less than 3 mm. Both phantom tube and rat vessel imaging confirmed the increased system FOV performance. We believe the intraoperative application of this cooperative three-imaging optical coherence tomography for objective vascular anastomosis evaluation can benefit patient outcomes in the future.

Robust phase unwrapping for phase images in Fourier domain Doppler optical coherence tomography

To solve the 2 ? phase ambiguity for phase-resolved Doppler images in Doppler optical coherence tomography, we present a modified network programming technique for the first time to the best of our knowledge. The proposed method assumes that error of the discrete derivatives between unwrapped phase image and wrapped phase image can be arbitrary values instead of integer-multiple of 2 ? , which makes the real-phase restoration accurate and robust against noise. We compared our proposed method with the network programming method. Parameters including root-mean-square-error and noise amplification degree were adopted for comparison. The experimental study on simulated images, phantom, and real-vessel OCT images were performed. The proposed method consistently achieves optimal results.

Review of intraoperative optical coherence tomography: technology and applications [Invited]

During microsurgery, en face imaging of the surgical field through the operating microscope limits the surgeon's depth perception and visualization of instruments and sub-surface anatomy. Surgical procedures outside microsurgery, such as breast tumor resections, may also benefit from visualization of the sub-surface tissue structures. The widespread clinical adoption of optical coherence tomography (OCT) in ophthalmology and its growing prominence in other fields, such as cancer imaging, has motivated the development of intraoperative OCT for real-time tomographic visualization of surgical interventions. This article reviews key technological developments in intraoperative OCT and their applications in human surgery. We focus on handheld OCT probes, microscope-integrated OCT systems, and OCT-guided laser treatment platforms designed for intraoperative use. Moreover, we discuss intraoperative OCT adjuncts and processing techniques currently under development to optimize the surgical feedback derivable from OCT data. Lastly, we survey salient clinical studies of intraoperative OCT for human surgery.

High-speed OCT light sources and systems [Invited]

Imaging speed is one of the most important parameters that define the performance of optical coherence tomography (OCT) systems. During the last two decades, OCT speed has increased by over three orders of magnitude. New developments in wavelength-swept lasers have repeatedly been crucial for this development. In this review, we discuss the historical evolution and current state of the art of high-speed OCT systems, with focus on wavelength swept light sources and swept source OCT systems.

JP. A multiphase transitioning peptide hydrogel for suturing ultrasmall vessels

Many surgeries are complicated by the need to anastomose, or reconnect, micrometre-scale vessels. Although suturing remains the gold standard for anastomosing vessels, it is difficult to place sutures correctly through collapsed lumen, making the procedure prone to failure. Here, we report a multiphase transitioning peptide hydrogel that can be injected into the lumen of vessels to facilitate suturing. The peptide, which contains a photocaged glutamic acid, forms a solid-like gel in a syringe and can be shear-thin delivered to the lumen of collapsed vessels (where it distends the vessel) and the space between two vessels (where it is used to approximate the vessel ends). Suturing is performed directly through the gel. Light is used to initiate the final gel-sol phase transition that disrupts the hydrogel network, allowing the gel to be removed and blood flow to resume. This gel adds a new tool to the armamentarium for micro- and supermicrosurgical procedures.

Multispectral tissue characterization for intestinal anastomosis optimization

Intestinal anastomosis is a surgical procedure that restores bowel continuity after surgical resection to treat intestinal malignancy, inflammation, or obstruction. Despite the routine nature of intestinal anastomosis procedures, the rate of complications is high. Standard visual inspection cannot distinguish the tissue subsurface and small changes in spectral characteristics of the tissue, so existing tissue anastomosis techniques that rely on human vision to guide suturing could lead to problems such as bleeding and leakage from suturing sites. We present a proof-of-concept study using a portable multispectral imaging (MSI) platform for tissue characterization and preoperative surgical planning in intestinal anastomosis. The platform is composed of a fiber ring light-guided MSI system coupled with polarizers and image analysis software. The system is tested on ex vivo porcine intestine tissue, and we demonstrate the feasibility of identifying optimal regions for suture placement.

Evaluation of microvascular anastomosis using real-time, ultra-high-resolution, Fourier domain Doppler optical coherence tomography

BACKGROUND

Evolution in microsurgical techniques and tools has paved the way for supermicrosurgical anastomoses, with vessel diameters often approaching below 0.8 mm in the clinical realm and even smaller (0.2 to 0.3 mm) in murine models. Several imaging and monitoring devices have been introduced for postoperative monitoring, but intraoperative guidance, assessment, and predictability have remained limited to binocular optical microscopy and the surgeon's experience. The authors present a high-resolution, real-time, three-dimensional imaging modality for intraoperative evaluation of luminal narrowing, thrombus formation, and flow alterations.

METHODS

An imaging modality that provides immediate, in-depth, high-resolution, three-dimensional structure view and flow information of the anastomosed site, called phase-resolved Doppler optical coherence tomography, was developed. Twenty-two mouse femoral artery anastomoses and 17 mouse venous anastomoses were performed and evaluated. Flow status, vessel inner lumen three-dimensional structure, and early thrombus detection were analyzed based on imaging results. Predictions formed correlated with actual long-term surgical outcomes. Eventually, four cases of mouse orthotopic limb transplantation were carried out, and predicted long-term patency based on imaging results was confirmed by actual results.

RESULTS

The assessments based on high-resolution three-dimensional visualization of the vessel flow status and inner lumen provided by phase-resolved Doppler optical coherence tomography show 92 percent sensitivity and 90 percent specificity for arterial anastomoses and 90 percent sensitivity and 86 percent specificity for venous anastomoses.

CONCLUSIONS

Phase-resolved Doppler optical coherence tomography is an effective evaluation tool for microvascular anastomosis. It can predict the long-term vessel patency with high sensitivity and specificity.

MEMS-based handheld fourier domain Doppler optical coherence tomography for intraoperative microvascular anastomosis imaging

Purpose

To demonstrate the feasibility of a miniature handheld optical coherence tomography (OCT) imager for real time intraoperative vascular patency evaluation in the setting of super-microsurgical vessel anastomosis.

Methods

A novel handheld imager Fourier domain Doppler optical coherence tomography based on a 1.3-µm central wavelength swept source for extravascular imaging was developed. The imager was minimized through the adoption of a 2.4-mm diameter microelectromechanical systems (MEMS) scanning mirror, additionally a 12.7-mm diameter lens system was designed and combined with the MEMS mirror to achieve a small form factor that optimize functionality as a handheld extravascular OCT imager. To evaluate in-vivo applicability, super-microsurgical vessel anastomosis was performed in a mouse femoral vessel cut and repair model employing conventional interrupted suture technique as well as a novel non-suture cuff technique. Vascular anastomosis patency after clinically successful repair was evaluated using the novel handheld OCT imager.

Results

With an adjustable lateral image field of view up to 1.5 mm by 1.5 mm, high-resolution simultaneous structural and flow imaging of the blood vessels were successfully acquired for BALB/C mouse after orthotopic hind limb transplantation using a non-suture cuff technique and BALB/C mouse after femoral artery anastomosis using a suture technique. We experimentally quantify the axial and lateral resolution of the OCT to be 12.6 µm in air and 17.5 µm respectively. The OCT has a sensitivity of 84 dB and sensitivity roll-off of 5.7 dB/mm over an imaging range of 5 mm. Imaging with a frame rate of 36 Hz for an image size of 1000(lateral)×512(axial) pixels using a 50,000 A-lines per second swept source was achieved. Quantitative vessel lumen patency, lumen narrowing and thrombosis analysis were performed based on acquired structure and Doppler images.

Conclusions

A miniature handheld OCT imager that can be used for intraoperative evaluation of microvascular anastomosis was successfully demonstrated.