Towards clinical photoacoustic and ultrasound imaging: Probe improvement and real-time graphical user interface

Photoacoustic imaging in prostate cancer: A new paradigm for diagnosis and management

The global health issue of prostate cancer (PCa) requires better diagnosis and treatment. Photoacoustic imaging (PAI) may change PCa management. This review examines PAI's principles, diagnostic role, and therapeutic guidance. PAI uses optical light excitation and ultrasonic detection for high-resolution functional and molecular imaging. PAI uses endogenous and exogenous contrast agents to distinguish cancerous and benign prostate tissues with greater sensitivity and specificity than PSA testing and TRUS-guided biopsy. In addition to diagnosing, PAI can guide and monitor PCa therapy. Its real-time imaging allows precise biopsies and brachytherapy seed placement. Photoacoustic temperature imaging allows non-invasive monitoring of thermal therapies like cryotherapy, improving treatment precision and success. Transurethral illumination probes, innovative contrast agents, integration with other imaging modalities, and machine learning analysis are being developed to overcome depth and data complexity restrictions. PAI could become an essential tool for PCa diagnosis and therapeutic guidance as the field advances.

Dual-modal Photoacoustic and Ultrasound Imaging: from preclinical to clinical applications

Photoacoustic imaging is a novel biomedical imaging modality that has emerged over the recent decades. Due to the conversion of optical energy into the acoustic wave, photoacoustic imaging offers high-resolution imaging in depth beyond the optical diffusion limit. Photoacoustic imaging is frequently used in conjunction with ultrasound as a hybrid modality. The combination enables the acquisition of both optical and acoustic contrasts of tissue, providing functional, structural, molecular, and vascular information within the same field of view. In this review, we first described the principles of various photoacoustic and ultrasound imaging techniques and then classified the dual-modal imaging systems based on their preclinical and clinical imaging applications. The advantages of dual-modal imaging were thoroughly analyzed. Finally, the review ends with a critical discussion of existing developments and a look toward the future.

Photoacoustic imaging for cutaneous melanoma assessment: a comprehensive review

Significance

Cutaneous melanoma (CM) has a high morbidity and mortality rate, but it can be cured if the primary lesion is detected and treated at an early stage. Imaging techniques such as photoacoustic (PA) imaging (PAI) have been studied and implemented to aid in the detection and diagnosis of CM.

Aim

Provide an overview of different PAI systems and applications for the study of CM, including the determination of tumor depth/thickness, cancer-related angiogenesis, metastases to lymph nodes, circulating tumor cells (CTCs), virtual histology, and studies using exogenous contrast agents.

Approach

A systematic review and classification of different PAI configurations was conducted based on their specific applications for melanoma detection. This review encompasses animal and preclinical studies, offering insights into the future potential of PAI in melanoma diagnosis in the clinic.

Results

PAI holds great clinical potential as a noninvasive technique for melanoma detection and disease management. PA microscopy has predominantly been used to image and study angiogenesis surrounding tumors and provide information on tumor characteristics. Additionally, PA tomography, with its increased penetration depth, has demonstrated its ability to assess melanoma thickness. Both modalities have shown promise in detecting metastases to lymph nodes and CTCs, and an all-optical implementation has been developed to perform virtual histology analyses. Animal and human studies have successfully shown the capability of PAI to detect, visualize, classify, and stage CM.

Conclusions

PAI is a promising technique for assessing the status of the skin without a surgical procedure. The capability of the modality to image microvasculature, visualize tumor boundaries, detect metastases in lymph nodes, perform fast and label-free histology, and identify CTCs could aid in the early diagnosis and classification of CM, including determination of metastatic status. In addition, it could be useful for monitoring treatment efficacy noninvasively.

Panoramic volumetric clinical handheld photoacoustic and ultrasound imaging

Photoacoustic (PA) imaging has gained much attention, providing structural and functional information in combination with clinical ultrasound (US) imaging systems. 2D PA and US imaging is easily implemented, but its heavy dependence on operator skills makes 3D imaging preferable. In this study, we propose a panoramic volumetric clinical PA and US imaging system equipping a handheld imaging scanner weighing 600 g and measuring 70 × 62 × 110 mm³. Multiple PA/US scans were performed to cover a large field-of-view (FOV), and the acquired PA/US volumes were mosaic-stitched after manually correcting the positions and rotations in a total of 6 degrees of freedom. PA and US maximum amplitude projection images were visualized online, while spectral unmixed data was quantified offline. The performance of the system was tested via tissue-mimicking phantom experiments. The system's potential was confirmed in vivo by panoramically imaging vascular networks in human arms and necks, with FOVs of 331 × 38 and 129 × 120 mm², respectively. Further, we quantified hemoglobin oxygen saturation levels in the radial artery, brachial artery, carotid artery, and jugular vein. We hope that this system can be applied for various clinical fields such as cardiovascular imaging, dermatology, vascular surgery, internal medicine, and oncology.

Review on ultrasound-guided photoacoustic imaging for complementary analyses of biological systems in vivo

Photoacoustic imaging has been developed as a new biomedical molecular imaging modality. Due to its similarity to conventional ultrasound imaging in terms of signal detection and image generation, dual-modal photoacoustic and ultrasound imaging has been applied to visualize physiological and morphological information in biological systems in vivo. By complementing each other, dual-modal photoacoustic and ultrasound imaging showed synergistic advances in photoacoustic imaging with the guidance of ultrasound images. In this review, we introduce our recent progresses in dual-modal photoacoustic and ultrasound imaging systems at various scales of study, from preclinical small animals to clinical humans. A summary of the works reveals various strategies for combining the structural information of ultrasound images with the molecular information of photoacoustic images.

Recent Advances in Photoacoustic Agents for Theranostic Applications

Photoacoustic agents are widely used in various theranostic applications. By evaluating the biodistribution obtained from photoacoustic images, the effectiveness of theranostic agents in terms of their delivery efficiency and treatment responses can be analyzed. Through this study, we evaluate and summarize the recent advances in photoacoustic-guided phototherapy, particularly in photothermal and photodynamic therapy. This overview can guide the future directions for theranostic development. Because of the recent applications of photoacoustic imaging in clinical trials, theranostic agents with photoacoustic monitoring have the potential to be translated into the clinical world.

Photoacoustic signal enhancement in dual-contrast gastrin-releasing peptide receptor-targeted nanobubbles

Translatable imaging agents are a crucial element of successful molecular imaging. Photoacoustic molecular imaging relies on optical absorbing materials to generate a sufficient signal. However, few materials approved for human use can generate adequate photoacoustic responses. Here we report a new nanoengineering approach to further improve photoacoustic response from biocompatible materials. Our study shows that when optical absorbers are incorporated into the shell of a gaseous nanobubble, their photoacoustic signal can be significantly enhanced compared to the original form. As an example, we constructed nanobubbles using biocompatible indocyanine green (ICG) and biodegradable poly(lactic-co-glycolic acid) (PLGA). We demonstrated that these ICG nanobubbles generate a strong ultrasound signal and almost four-fold photoacoustic signal compared to the same concentration of ICG solution; our theoretical calculations corroborate this effect and elucidate the origin of the photoacoustic enhancement. To demonstrate their molecular imaging performance, we conjugated gastrin-releasing peptide receptor (GRPR) targeting ligands with the ICG nanobubbles. Our dual photoacoustic/ultrasound molecular imaging shows a more than three-fold enhancement in targeting specificity of the GRPR-targeted ICG nanobubbles, compared to untargeted nanobubbles or prostate cancer cells not expressing GRPR, in a prostate cancer xenograft mouse model in vivo.

Recent Advances in Contrast-Enhanced Photoacoustic Imaging: Overcoming the Physical and Practical Challenges

For decades now, photoacoustic imaging (PAI) has been investigated to realize its potential as a niche biomedical imaging modality. Despite its highly desirable optical contrast and ultrasonic spatiotemporal resolution, PAI is challenged by such physical limitations as a low signal-to-noise ratio (SNR), diminished image contrast due to strong optical attenuation, and a lower-bound on spatial resolution in deep tissue. In addition, contrast-enhanced PAI has faced practical limitations such as insufficient cell-specific targeting due to low delivery efficiency and difficulties in developing clinically translatable agents. Identifying these limitations is essential to the continuing expansion of the field, and substantial advances in developing contrast-enhancing agents, complemented by high-performance image acquisition systems, have synergistically dealt with the challenges of conventional PAI. This review covers the past four years of research on pushing the physical and practical challenges of PAI in terms of SNR/contrast, spatial resolution, targeted delivery, and clinical application. Promising strategies for dealing with each challenge are reviewed in detail, and future research directions for next generation contrast-enhanced PAI are discussed.

Wide-field three-dimensional photoacoustic/ultrasound scanner using a two-dimensional matrix transducer array

Two-dimensional matrix transducer arrays are the most appropriate imaging probes for acquiring dual-modal 3D photoacoustic (PA)/ultrasound (US) images. However, they have small footprints which limit the field-of-view (FOV) to less than 10 mm × 10 mm and degrade the spatial resolution. In this study, we demonstrate a dual-modal PA and US imaging system (using a 2D matrix transducer array and a motorized 2D scanning system) to enlarge the FOV of volumetric images. Multiple PA volumes were merged to form a wide-field image of approximately 45 mm × 45 mm. In vivo imaging was demonstrated using rat sentinel lymph nodes (SLNs) and bladders stained with methylene blue. We believe that this volumetric PA/US imaging technique with a 2D matrix transducer array can be a useful tool for narrow-field real-time monitoring and wide-field imaging of various preclinical and clinical studies.

Optical diagnostic imaging and therapy for thyroid cancer

Thyroid cancer, as one of the most common endocrine cancers, has seen a surge in incidence in recent years. This is most likely due to the lack of specificity and accuracy of its traditional diagnostic modalities, leading to the overdiagnosis of thyroid nodules. Although there are several treatment options available, they are limited to surgery and 131I radiation therapy that come with significant side effects and hence cannot meet the treatment needs of anaplastic thyroid carcinoma with very high malignancy. Optical imaging that utilizes optical absorption, refraction and scattering properties, not only observes the structure and function of cells, tissues, organs, or even the whole organism to assist in diagnosis, but can also be used to perform optical therapy to achieve targeted non-invasive and precise treatment of thyroid cancer. These applications of screening, diagnosis, and treatment, lend to optical imaging's promising potential within the realm of thyroid cancer surgical navigation. Over the past decade, research on optical imaging in the diagnosis and treatment of thyroid cancer has been growing year by year, but no comprehensive review on this topic has been published. Here, we review key advances in the application of optical imaging in the diagnosis and treatment of thyroid cancer and discuss the challenges and potential for clinical translation of this technology.

Motion Compensation for 3D Multispectral Handheld Photoacoustic Imaging

Three-dimensional (3D) handheld photoacoustic (PA) and ultrasound (US) imaging performed using mechanical scanning are more useful than conventional 2D PA/US imaging for obtaining local volumetric information and reducing operator dependence. In particular, 3D multispectral PA imaging can capture vital functional information, such as hemoglobin concentrations and hemoglobin oxygen saturation (sO₂), of epidermal, hemorrhagic, ischemic, and cancerous diseases. However, the accuracy of PA morphology and physiological parameters is hampered by motion artifacts during image acquisition. The aim of this paper is to apply appropriate correction to remove the effect of such motion artifacts. We propose a new motion compensation method that corrects PA images in both axial and lateral directions based on structural US information. 3D PA/US imaging experiments are performed on a tissue-mimicking phantom and a human wrist to verify the effects of the proposed motion compensation mechanism and the consequent spectral unmixing results. The structural motions and sO₂ values are confirmed to be successfully corrected by comparing the motion-compensated images with the original images. The proposed method is expected to be useful in various clinical PA imaging applications (e.g., breast cancer, thyroid cancer, and carotid artery disease) that are susceptible to motion contamination during multispectral PA image analysis.

Clinical photoacoustic/ultrasound dual-modal imaging: Current status and future trends

Photoacoustic tomography (PAT) is an emerging biomedical imaging modality that combines optical and ultrasonic imaging, providing overlapping fields of view. This hybrid approach allows for a natural integration of PAT and ultrasound (US) imaging in a single platform. Due to the similarities in signal acquisition and processing, the combination of PAT and US imaging creates a new hybrid imaging for novel clinical applications. Over the recent years, particular attention is paid to the development of PAT/US dual-modal systems highlighting mutual benefits in clinical cases, with an aim of substantially improving the specificity and sensitivity for diagnosis of diseases. The demonstrated feasibility and accuracy in these efforts open an avenue of translating PAT/US imaging to practical clinical applications. In this review, the current PAT/US dual-modal imaging systems are discussed in detail, and their promising clinical applications are presented and compared systematically. Finally, this review describes the potential impacts of these combined systems in the coming future.

Whole-Body Photoacoustic Imaging Techniques for Preclinical Small Animal Studies

Photoacoustic imaging is a hybrid imaging technique that has received considerable attention in biomedical studies. In contrast to pure optical imaging techniques, photoacoustic imaging enables the visualization of optical absorption properties at deeper imaging depths. In preclinical small animal studies, photoacoustic imaging is widely used to visualize biodistribution at the molecular level. Monitoring the whole-body distribution of chromophores in small animals is a key method used in preclinical research, including drug-delivery monitoring, treatment assessment, contrast-enhanced tumor imaging, and gastrointestinal tracking. In this review, photoacoustic systems for the whole-body imaging of small animals are explored and summarized. The configurations of the systems vary with the scanning methods and geometries of the ultrasound transducers. The future direction of research is also discussed with regard to achieving a deeper imaging depth and faster imaging speed, which are the main factors that an imaging system should realize to broaden its application in biomedical studies.

State of the Art in Carbon Nanomaterials for Photoacoustic Imaging

Photoacoustic imaging using energy conversion from light to ultrasound waves has been developed as a powerful tool to investigate in vivo phenomena due to their complex characteristics. In photoacoustic imaging, endogenous chromophores such as oxygenated hemoglobin, deoxygenated hemoglobin, melanin, and lipid provide useful biomedical information at the molecular level. However, these intrinsic absorbers show strong absorbance only in visible or infrared optical windows and have limited light transmission, making them difficult to apply for clinical translation. Therefore, the development of novel exogenous contrast agents capable of increasing imaging depth while ensuring strong light absorption is required. We report here the application of carbon nanomaterials that exhibit unique physical, mechanical, and electrochemical properties as imaging probes in photoacoustic imaging. Classified into specific structures, carbon nanomaterials are synthesized with different substances according to the imaging purposes to modulate the absorption spectra and highly enhance photoacoustic signals. In addition, functional drugs can be loaded into the carbon nanomaterials composite, and effective in vivo monitoring and photothermal therapy can be performed with cell-specific targeting. Diverse applied cases suggest the high potential of carbon nanomaterial-based photoacoustic imaging in in vivo monitoring for clinical research.

Listening to drug delivery and responses via photoacoustic imaging

Administrating pharmaceutic agents efficiently to achieve the therapeutic effect is the aim of all drug delivery techniques. Recent drug delivery systems aim to deliver high doses of drugs to disease sites accurately while maximizing therapeutic effects and minimizing potential side effects. Key approaches apply image guidance techniques for the quantification of drug biodistribution and pharmacokinetic parameters during drug delivery. This review highlights recent research on image-guided drug delivery systems based on photoacoustic imaging, which has been attracting attention for its non-invasiveness, non-ionizing radiation, and real-time imaging functions. Photoacoustic imaging based on the photothermal conversion efficiency of agents can be easily combined with various phototherapeutics, making them highly suitable for drug delivery therapy platforms. Here, we summarize and compare the characteristics of various types of photoacoustic imaging systems, focus on contrast-enhanced photoacoustic imaging and controlled release of therapeutics in drug delivery systems for synergistic therapies.

Review on Multispectral Photoacoustic Analysis of Cancer: Thyroid and Breast

In recent decades, photoacoustic imaging has been used widely in biomedical research, providing molecular and functional information from biological tissues in vivo. In addition to being used for research in small animals, photoacoustic imaging has also been utilized for in vivo human studies, achieving a multispectral photoacoustic response in deep tissue. There have been several clinical trials for screening cancer patients by analyzing multispectral responses, which in turn provide metabolomic information about the underlying biological tissues. This review summarizes the methods and results of clinical photoacoustic trials available in the literature to date to classify cancerous tissues, specifically of the thyroid and breast. From the review, we can conclude that a great potential exists for photoacoustic imaging to be used as a complementary modality to improve diagnostic accuracy for suspicious tumors, thus significantly benefitting patients’ healthcare.

Optical fiber-based handheld polarized photoacoustic computed tomography for detecting anisotropy of tissues

BACKGROUND

Photoacoustic computed tomography (PACT) is a fast-developing biomedical imaging modality and has immense potential for clinical translation. It utilizes laser excitation and acoustic detection to achieve high spatial resolution and considerable imaging depth in biological tissues. Current PACT primarily treats the absorption coefficient of tissues as a scalar variable while reconstructing the image, which limits its use for anisotropic evaluation of the tissues. Thus, by incorporating polarized imaging methods to evaluate anisotropy, applications of PACT can be further enhanced. So far, dichroism-sensitive PACT has been suggested for polarization detection of biological tissues. However, this approach is unsuitable for intraoperative imaging, since high-power spatial light is needed for excitation, which is dangerous and inconvenient to operate. Thus, there is a need to develop a polarized PACT system suitable for clinical use.

METHODS

Herein, we have proposed a specially designed handheld polarized PACT (HP-PACT) system, which was designed to promote intraoperative anisotropy detection of biological tissues. Excitation light was delivered by an optical fiber and reshaped by a compact set of lenses at the output end of the optical fiber. A polarizer was applied to generate linearly polarized light, and the polarization direction was adjusted by simply rotating the half-wave plate. Photoacoustic imaging (PAI) using excitation with several different polarization directions was carried out. Optical axes and the structure of the anisotropic objects were obtained using the principle of polarization detection with the PAI.

RESULTS

We experimentally demonstrated the performance of HP-PACT by imaging both the polarized and unpolarized plastic films. The results showed that HP-PACT can successfully detect the direction of the optical axes of polarized plastic films and has the ability to image at different depths. When linearly polarized light with different polarization directions was used as excitation, PAI studies on a highly anisotropic bovine tendon and relatively low anisotropic mouse leg showed the structural differences between the 2 tissues. The quantified degrees of anisotropy of the bovine tendon and mouse legs were 0.6 and 0.3, respectively.

CONCLUSIONS

The proposed HP-PACT is able to determine the anisotropic substances' optical axes and distinguish anisotropic substances from isotropic ones. Thus, HP-PACT has the potential for intraoperative diagnosis and treatment of anisotropic tissues, including nerves and tendons.

Photoacoustic imaging systems based on clinical ultrasound platform

Photoacoustic imaging has drawn a significant amount of attention due to its unique capacity for functional, metabolic, and molecular imaging, which is achieved by the combination of optical excitation and acoustic detection. With both strengths of light and ultrasound, photoacoustic images can provide strong optical contrast at high ultrasound resolution in deep tissue. As photoacoustic imaging can be used to visualize complementary information to ultrasound imaging using the same data acquisition process, several studies have been conducted on combining photoacoustic imaging with existing clinical ultrasound systems. This review highlights our development of a photoacoustic/ultrasound dual-modal imaging system, various features and functionalities implemented for clinical translation, and preclinical/clinical studies performed by using the systems.

Three-dimensional Multistructural Quantitative Photoacoustic and US Imaging of Human Feet in Vivo

Background Monitoring the microcirculation in human feet is crucial in assessing peripheral vascular diseases, such as diabetic foot. However, conventional imaging modalities are more focused on diagnosis in major arteries, and there are limited methods to provide microvascular information in early stages of the disease. Purpose To investigate a three-dimensional (3D) noncontrast bimodal photoacoustic (PA)/US imaging system that visualizes the human foot morphologically and also reliably quantifies podiatric vascular parameters noninvasively. Materials and Methods A clinically relevant PA/US imaging system was combined with a foot scanner to obtain 3D PA and US images of the human foot in vivo. Healthy participants were recruited from September 2020 to June 2021. The collected 3D PA and US images were postprocessed to present structural information about the foot. The quantitative reliability was evaluated in five repeated scans of 10 healthy feet by calculating the intraclass correlation coefficient and minimal detectable change, and the detectability of microvascular changes was tested by imaging 10 healthy feet intentionally occluded with use of a pressure cuff (160 mm Hg). Statistically significant difference is indicated with P values. Results Ten feet from six healthy male volunteers (mean age ± standard deviation, 27 years ± 3) were included. The foot images clearly visualized the structure of the vasculature, bones, and skin and provided such functional information as the total hemoglobin concentration (HbT), hemoglobin oxygen saturation (SO₂), vessel density, and vessel depth. Functional information from five independent measurements of 10 healthy feet was moderately reliable (intraclass correlation coefficient, 0.51-0.74). Significant improvements in HbT (P = .006) and vessel density (P = .046) as well as the retention of SO₂ were observed, which accurately described the microvascular change due to venous occlusion. Conclusion Three-dimensional photoacoustic and US imaging was able to visualize morphologic and physiologic features of the human foot, including the peripheral microvasculature, in healthy volunteers. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Mezrich in this issue.

Review on Optical Imaging Techniques for Multispectral Analysis of Nanomaterials

Biomedical imaging is an essential tool for investigating biological responses in vivo. Among the several imaging techniques, optical imaging systems with multispectral analysis of nanoparticles have been widely investigated due to their ability to distinguish the substances in biological tissues in vivo. This review article focus on multispectral optical imaging techniques that can provide molecular functional information. We summarize the basic principle of the spectral unmixing technique that enables the delineation of optical chromophores. Then, we explore the principle, typical system configuration, and biomedical applications of the representative optical imaging techniques, which are fluorescence imaging, two-photon microscopy, and photoacoustic imaging. The results in the recent studies show the great potential of the multispectral analysis techniques for monitoring responses of biological systems in vivo.

Copper-Catalyzed Covalent Dimerization of Near-Infrared Fluorescent Cyanine Dyes: Synergistic Enhancement of Photoacoustic Signals for Molecular Imaging of Tumors

Photoacoustic (PA) imaging relies on the absorption of light by chromophores to generate acoustic waves used to delineate tissue structures and physiology. Here, we demonstrate that Cu(II) efficiently catalyzes the dimerization of diverse near-infrared (NIR) cyanine molecules, including a peptide conjugate. NMR spectroscopy revealed a C-C covalent bond along the heptamethine chains, creating stable molecules under conditions such as a wide range of solvents and pH mediums. Dimerization achieved >90% fluorescence quenching, enhanced photostability, and increased PA signals by a factor of about 4 at equimolar concentrations compared to the monomers. In vivo study with a mouse cancer model revealed that dimerization enhanced tumor retention and PA signal, allowing cancer detection at doses where the monomers are less effective. While the dye dimers highlighted peritumoral blood vessels, the PA signal for dimeric tumor-targeting dye-peptide conjugate, LS301, was diffuse throughout the entire tumor mass. A combination of the ease of synthesis, diversity of molecules that are amenable to Cu(II)-catalyzed dimerization, and the high acoustic wave amplification by these stable dimeric small molecules ushers a new strategy to develop clinically translatable PA molecular amplifiers for the emerging field of molecular photoacoustic imaging.

A Deep Learning-Based Model That Reduces Speed of Sound Aberrations for Improved In Vivo Photoacoustic Imaging

Photoacoustic imaging (PAI) has attracted great attention as a medical imaging method. Typically, photoacoustic (PA) images are reconstructed via beamforming, but many factors still hinder the beamforming techniques in reconstructing optimal images in terms of image resolution, imaging depth, or processing speed. Here, we demonstrate a novel deep learning PAI that uses multiple speed of sound (SoS) inputs. With this novel method, we achieved SoS aberration mitigation, streak artifact removal, and temporal resolution improvement all at once in structural and functional in vivo PA images of healthy human limbs and melanoma patients. The presented method produces high-contrast PA images in vivo with reduced distortion, even in adverse conditions where the medium is heterogeneous and/or the data sampling is sparse. Thus, we believe that this new method can achieve high image quality with fast data acquisition and can contribute to the advance of clinical PAI.

iRGD Peptide-Mediated Liposomal Nanoparticles with Photoacoustic/Ultrasound Dual-Modality Imaging for Precision Theranostics Against Hepatocellular Carcinoma

Purpose

Prepare a multifunctional ultrasound molecular probe, cell-penetrating peptide-modified 10-hydroxycamptothecin-loaded phase-transformation lipid nanoparticles (iRGD-ICG-10-HCPT-PFP-NPs), and to combine iRGD-ICG-10-HCPT-PFP -NPs with low-intensity focused ultrasound (LIFU) for precision theranostics against hepatocellular carcinoma (HCC).

Materials and Methods

The morphology of nanoparticles (NPs) and iRGD-ICG-10-HCPT-PFP-NPs was detected. In vitro, we examined targeting ability by flow cytometry and confocal laser scanning microscopy (CLSM), assessed penetration ability into hepatoma cells, and assessed killing ability. In vivo, we examined the targeting ability of the NPs with a photoacoustic (PA) imager and fluorometer (FL), while LIFU irradiation was used to trigger the release of chemotherapeutic drugs, which had a therapeutic effect on tumors.

Results

The particle size of iRGD-ICG-10-HCPT-PFP-NPs was 298.4 ± 10.42 nm. In vitro, iRGD-ICG-10-HCPT-PFP-NPs bound more to SK-Hep1 cells than ICG-10-HCPT-PFP-NPs. iRGD-ICG-10-HCPT-PFP-NPs could achieve PA/ultrasound imaging. The percentage of antiproliferative and apoptotic cells in the iRGD-ICG-10-HCPT-PFP-NPs+LIFU group was significantly higher. In vivo, iRGD-ICG-10-HCPT-PFP-NPs can target tumor sites and achieve PA/ultrasound imaging. The tumor volume in the iRGD-ICG-10-HCPT-PFP-NPs+LIFU group was significantly smaller, and the antiproliferative and proapoptotic effects were higher.

Conclusion

We successfully prepared a novel molecular probe that has good targeting, can perform ultrasound/PA dual-modality imaging, and can penetrate deep into tumors to achieve better therapeutic tumor effects, providing a new idea and method for theranostics of HCC.

Point-of-Care Ultrasound as a Tool to Assess Wound Size and Tissue Regeneration after Skin Grafting

Chronic wounds can be difficult to heal and are often accompanied by pain and discomfort. Multiple skin substitutes or cellularized/tissue-based skin products have been used in an attempt to facilitate closure of complex wounds. Allografts from cadaveric sources have been a viable option in achieving such closure. However, early assessment of graft incorporation has been difficult clinically, often with delayed evidence of failure. Visual cues to assess graft integrity have been limited and remain largely superficial at the skin surface. Furthermore, currently used optical imaging techniques can penetrate only a few millimeters deep into tissue. Ultrasound (US) imaging offers a potential solution to address this limitation. This work evaluates the use of US to monitor wound healing and allograft integration. We used a commercially available dual-mode (US and photoacoustic) scanner operating only in US mode. We compared the reported wound size from the clinic with the size measured using US in 45 patients. Two patients from this cohort received an allogenic skin graft and underwent multiple US scans over a 110-d period. All data were processed by two independent analysts; one of them was blinded to the study. We measured change in US intensity and wound contraction as a function of time. Our results revealed a strong correlation (R² = 0.81, p < 0.0001) between clinically and US-measured wound sizes. Wound contraction >91% was seen in both patients after skin grafting. An inverse relationship between wound size and US intensity (R² = 0.77, p < 0 .0001) indicated that the echogenicity of the wound bed increases as healthy cells infiltrate the allograft matrix, regenerating and leading to healthy tissue and re-epithelization. This work indicates that US can be used to measure wound size and visualize tissue regeneration during the healing process.

Seeing through the Skin: Photoacoustic Tomography of Skin Vasculature and Beyond

Skin diseases are the most common human diseases and manifest in distinct structural and functional changes to skin tissue components such as basal cells, vasculature, and pigmentation. Although biopsy is the standard practice for skin disease diagnosis, it is not sufficient to provide in vivo status of the skin and highly depends on the timing of diagnosis. Noninvasive imaging technologies that can provide structural and functional tissue information in real time would be invaluable for skin disease diagnosis and treatment evaluation. Among the modern medical imaging technologies, photoacoustic (PA) tomography (PAT) shows great promise as an emerging optical imaging modality with high spatial resolution, high imaging speed, deep penetration depth, rich contrast, and inherent sensitivity to functional and molecular information. Over the last decade, PAT has undergone an explosion in technical development and biomedical applications. Particularly, PAT has attracted increasing attention in skin disease diagnosis, providing structural, functional, metabolic, molecular, and histological information. In this concise review, we introduce the principles and imaging capability of various PA skin imaging technologies. We highlight the representative applications in the past decade with a focus on imaging skin vasculature and melanoma. We also envision the critical technical developments necessary to further accelerate the translation of PAT technologies to fundamental skin research and clinical impacts.

New contrast agents for photoacoustic imaging and theranostics: Recent 5-year overview on phthalocyanine/naphthalocyanine-based nanoparticles

The phthalocyanine (Pc) and naphthalocyanine (Nc) nanoagents have drawn much attention as contrast agents for photoacoustic (PA) imaging due to their large extinction coefficients and long absorption wavelengths in the near-infrared region. Many investigations have been conducted to enhance Pc/Ncs' photophysical properties and address their poor solubility in an aqueous solution. Many diverse strategies have been adopted, including centric metal chelation, structure modification, and peripheral substitution. This review highlights recent advances on Pc/Nc-based PA agents and their extended use for multiplexed biomedical imaging, multimodal diagnostic imaging, and image-guided phototherapy.

Multiparametric Photoacoustic Analysis of Human Thyroid Cancers In Vivo

Thyroid cancer is one of the most common cancers, with a global increase in incidence rate for both genders. Ultrasound-guided fine-needle aspiration is the current gold standard to diagnose thyroid cancers, but the results are inaccurate, leading to repeated biopsies and unnecessary surgeries. To reduce the number of unnecessary biopsies, we explored the use of multiparametric photoacoustic (PA) analysis in combination with the American Thyroid Association (ATA) Guideline (ATAP). In this study, we performed in vivo multispectral PA imaging on thyroid nodules from 52 patients, comprising 23 papillary thyroid cancer (PTC) and 29 benign cases. From the multispectral PA data, we calculated hemoglobin oxygen saturation level in the nodule area, then classified the PTC and benign nodules with multiparametric analysis. Statistical analyses showed that this multiparametric analysis of multispectral PA responses could classify PTC nodules. Combining the photoacoustically indicated probability of PTC and the ATAP led to a new scoring method that achieved a sensitivity of 83% and a specificity of 93%. This study is the first multiparametric analysis of multispectral PA data of thyroid nodules with statistical significance. As a proof of concept, the results show that the proposed new ATAP scoring can help physicians examine thyroid nodules for fine-needle aspiration biopsy, thus reducing unnecessary biopsies.

Perspective on fast-evolving photoacoustic tomography

SIGNIFICANCE

Acoustically detecting the rich optical absorption contrast in biological tissues, photoacoustic tomography (PAT) seamlessly bridges the functional and molecular sensitivity of optical excitation with the deep penetration and high scalability of ultrasound detection. As a result of continuous technological innovations and commercial development, PAT has been playing an increasingly important role in life sciences and patient care, including functional brain imaging, smart drug delivery, early cancer diagnosis, and interventional therapy guidance.

AIM

Built on our 2016 tutorial article that focused on the principles and implementations of PAT, this perspective aims to provide an update on the exciting technical advances in PAT.

APPROACH

This perspective focuses on the recent PAT innovations in volumetric deep-tissue imaging, high-speed wide-field microscopic imaging, high-sensitivity optical ultrasound detection, and machine-learning enhanced image reconstruction and data processing. Representative applications are introduced to demonstrate these enabling technical breakthroughs in biomedical research.

CONCLUSIONS

We conclude the perspective by discussing the future development of PAT technologies.

Simultaneous Dual-Modal Multispectral Photoacoustic and Ultrasound Macroscopy for Three-Dimensional Whole-Body Imaging of Small Animals

Photoacoustic imaging is a promising medical imaging technique that provides excellent function imaging of an underlying biological tissue or organ. However, it is limited in providing structural information compared to other imaging modalities, such as ultrasound imaging. Thus, to offer complete morphological details of biological tissues, photoacoustic imaging is typically integrated with ultrasound imaging. This dual-modal imaging technique is already implemented on commercial clinical ultrasound imaging platforms. However, commercial platforms suffer from limited elevation resolution compared to the lateral and axial resolution. We have successfully developed a dual-modal photoacoustic and ultrasound imaging to address these limitations, specifically targeting animal studies. The system can acquire whole-body images of mice in vivo and provide complementary structural and functional information of biological tissue information simultaneously. The color-coded depth information can be readily obtained in photoacoustic images using complementary information from ultrasound images. The system can be used for several biomedical applications, including drug delivery, biodistribution assessment, and agent testing.

Nonlinear pth root spectral magnitude scaling beamforming for clinical photoacoustic and ultrasound imaging

A recently introduced nonlinear pth root delay-and-sum (NL-p-DAS) beamforming (BF) technique for ultrasound (US) and photoacoustic (PA) imaging, achieving better spatial and contrast resolution compared to a conventional delay and sum (DAS) technique. While the method is advantageous for better resolution, it suffers from grainy speckles and dark areas in the image mainly due to the interference of non-sinusoidal functions. In this Letter, we introduce a modified NL-p-DAS technique called nonlinear pth root spectral magnitude scaling (NL-p-SMS), which performs the pth root on the spectral magnitude instead of the temporal amplitude. We evaluated the US and PA images of NL-p-SMS against those of NL-p-DAS by comparing the axial and lateral line profiles, contrasts, and contrast-to-noise ratios (CNRs) in both phantom and in vivo imaging studies with various p values. As a result, we found that the NL-p-SMS has better axial resolution and CNR than the NL-p-DAS, and reduces the grainy speckles and dark area artifacts. We believe that, with this enhanced performance, our proposed approach could be an advancement compared to the existing nonlinear BF algorithms.

In Vivo Dual-Modal Photoacoustic and Ultrasound Imaging of Sentinel Lymph Nodes Using a Solid-State Dye Laser System

Photoacoustic imaging (PAI) is being actively investigated as a non-invasive and non-radioactive imaging technique for sentinel lymph node (SLN) biopsy. By taking advantage of optical and ultrasound imaging, PAI probes SLNs non-invasively with methylene blue (MB) in both live animals and breast cancer patients. However, these PAI systems have limitations for widespread use in clinics and commercial marketplaces because the lasers used by the PAI systems, e.g., tunable liquid dye laser systems and optical parametric oscillator (OPO) lasers, are bulky in size, not economical, and use risky flammable and toxic liquid dyes. To overcome these limitations, we are proposing a novel dual-modal photoacoustic and ultrasound imaging system based on a solid-state dye laser (SD-PAUSI), which is compact, convenient, and carries far less risk of flammability and toxicity. Using a solid-state dye handpiece that generates 650-nm wavelength, we successfully imaged the MB tube positioned deeply (~3.9 cm) in chicken breast tissue. The SLNs were also photoacoustically detected in the in vivo rats beneath a 2.2-cm-thick layer of chicken breast, which is deeper than the typical depth of SLNs in humans (1.2 ± 0.5 cm). Furthermore, we showed the multispectral capability of the PAI by switching the dye handpiece, in which the MB-dyed SLN was selectively highlighted from the surrounding vasculature. These results demonstrated the great potential of the SD-PAUSI as an easy but effective modality for SLN detection.

GPU implementation of photoacoustic short-lag spatial coherence imaging for improved image-guided interventions

SIGNIFICANCE

Photoacoustic-based visual servoing is a promising technique for surgical tool tip tracking and automated visualization of photoacoustic targets during interventional procedures. However, one outstanding challenge has been the reliability of obtaining segmentations using low-energy light sources that operate within existing laser safety limits.

AIM

We developed the first known graphical processing unit (GPU)-based real-time implementation of short-lag spatial coherence (SLSC) beamforming for photoacoustic imaging and applied this real-time algorithm to improve signal segmentation during photoacoustic-based visual servoing with low-energy lasers.

APPROACH

A 1-mm-core-diameter optical fiber was inserted into ex vivo bovine tissue. Photoacoustic-based visual servoing was implemented as the fiber was manually displaced by a translation stage, which provided ground truth measurements of the fiber displacement. GPU-SLSC results were compared with a central processing unit (CPU)-SLSC approach and an amplitude-based delay-and-sum (DAS) beamforming approach. Performance was additionally evaluated with in vivo cardiac data.

RESULTS

The GPU-SLSC implementation achieved frame rates up to 41.2 Hz, representing a factor of 348 speedup when compared with offline CPU-SLSC. In addition, GPU-SLSC successfully recovered low-energy signals (i.e., ≤268  μJ) with mean ± standard deviation of signal-to-noise ratios of 11.2  ±  2.4 (compared with 3.5  ±  0.8 with conventional DAS beamforming). When energies were lower than the safety limit for skin (i.e., 394.6  μJ for 900-nm wavelength laser light), the median and interquartile range (IQR) of visual servoing tracking errors obtained with GPU-SLSC were 0.64 and 0.52 mm, respectively (which were lower than the median and IQR obtained with DAS by 1.39 and 8.45 mm, respectively). GPU-SLSC additionally reduced the percentage of failed segmentations when applied to in vivo cardiac data.

CONCLUSIONS

Results are promising for the use of low-energy, miniaturized lasers to perform GPU-SLSC photoacoustic-based visual servoing in the operating room with laser pulse repetition frequencies as high as 41.2 Hz.

Three-dimensional clinical handheld photoacoustic/ultrasound scanner

Clinical 2D photoacoustic (PA) imaging can be easily implemented in a traditional ultrasound (US) system. However, 3D PA imaging is still preferable because 2D B-mode PA/US imaging suffers from low reproducibility and high-operator dependency. Here, we demonstrate a compact clinical handheld 3D PA/US scanner using an 1D linear array US transducer combined with a mechanical scanning stage working via a Scotch yoke mechanism. The entire scanner measures just 100 × 80 × 100 mm3 and weighs only 950 g, so it can easily be operated by hand. Blood vessels and hemoglobin oxygen saturation images of different parts of the human body (e.g., neck, wrist, thigh, and instep) have been successfully acquired. The system can potentially be used for clinical applications in fields such as oncology, dermatology, nephrology, and internal medicine.