Effect of bile absorption coefficients on the estimation of liver tissue optical properties and related implications in discriminating healthy and tumorous samples

Multimodal Optical Monitoring of Auto- and Allografts of Skin on a Burn Wound

The aim of the study was to investigate the dynamics of the state of allo- and autografts of skin on a wound using optical modalities: diffuse reflectance spectroscopy (DRS), optical coherence tomography (OCT), and laser Doppler flowmetry (LDF). A deep thermal burn was simulated in 24 rats covering 20% of the body surface. On day 3 after the injury, a fascial necrectomy of two 500 mm² areas on the left and right sides of the midline of the animal body were excised. Allografts and autografts were placed in the centers of these areas. Optical measurements of grafts were performed on the 0, 3rd, 6th, 10th, and 13th days after transplantation. The allografts demonstrated a pronounced decrease in oxygenation, blood content, and perfusion compared to autografts on the 6th day; in the following days of observation, these values returned to the average values of autografts. Water content gradually decreased from the beginning to the end of observation. In conclusion, optical diagnostics revealed changes in the morphological microstructure, the rate of restoration of blood circulation, and oxygen exchange in the early stages, specific for the allo- and autograft.

VIS-NIR Diffuse Reflectance Spectroscopy System with Self-Calibrating Fiber-Optic Probe: Study of Perturbation Resistance

We report on the comparative analysis of self-calibrating and single-slope diffuse reflectance spectroscopy in resistance to different measurement perturbations. We developed an experimental setup for diffuse reflectance spectroscopy (DRS) in a wide VIS-NIR range with a fiber-optic probe equipped with two source and two detection fibers capable of providing measurements employing both single- and dual-slope (self-calibrating) approaches. In order to fit the dynamic range of a spectrometer in the wavelength range of 460-1030 nm, different exposure times have been applied for short (2 mm) and long (4 mm) source-detector distances. The stability of the self-calibrating and traditional single-slope approaches to instrumental perturbations were compared in phantom and in vivo studies on human palm, including attenuations in individual channels, fiber curving, and introducing optical inhomogeneities in the probe-tissue interface. The self-calibrating approach demonstrated high resistance to instrumental perturbations introduced in the source and detection channels, while the single-slope approach showed resistance only to perturbations introduced into the source channels.

Insights into Biochemical Sources and Diffuse Reflectance Spectral Features for Colorectal Cancer Detection and Localization

Colorectal cancer (CRC) is the third most common and second most deadly type of cancer worldwide. Early detection not only reduces mortality but also improves patient prognosis by allowing the use of minimally invasive techniques to remove cancer while avoiding major surgery. Expanding the use of microsurgical techniques requires accurate diagnosis and delineation of the tumor margins in order to allow complete excision of cancer. We have used diffuse reflectance spectroscopy (DRS) to identify the main optical CRC biomarkers and to optimize parameters for the integration of such technologies into medical devices. A total number of 2889 diffuse reflectance spectra were collected in ex vivo specimens from 47 patients. Short source-detector distance (SDD) and long-SDD fiber-optic probes were employed to measure tissue layers from 0.5 to 1 mm and from 0.5 to 1.9 mm deep, respectively. The most important biomolecules contributing to differentiating DRS between tissue types were oxy- and deoxy-hemoglobin (Hb and HbO₂), followed by water and lipid. Accurate tissue classification and potential DRS device miniaturization using Hb, HbO₂, lipid and water data were achieved particularly well within the wavelength ranges 350-590 nm and 600-1230 nm for the short-SDD probe, and 380-400 nm, 420-610 nm, and 650-950 nm for the long-SDD probe.

Quantitative spatial mapping of tissue water and lipid content using spatial frequency domain imaging in the 900- to 1000-nm wavelength region

Significance

Water and lipid are key participants of many biological processes, but there are few label-free, non-contact optical methods that can spatially map these components in-vivo. Shortwave infrared meso-patterned imaging (SWIR-MPI) is an emerging technique that successfully addresses this need. However, it requires a dedicated SWIR camera to probe the 900- to 1300-nm wavelength region, which hinders practical translation of the technology.

Aim

Compared with SWIR-MPI, we aim to develop a new technique that can dramatically reduce the cost in detector while maintaining high accuracy for the quantification of tissue water and lipid content.

Approach

By utilizing water and lipid absorption features in the 900- to 1000-nm wavelength region as well as optimal wavelength and spatial frequency combinations, we develop a new imaging technique based on spatial frequency domain imaging to quantitatively map tissue water and lipid content using a regular silicon-based camera.

Results

The proposed method is validated with a phantom study, which shows average error of 0.9 ± 1.2 % for water content estimation, and -0.4 ± 0.7 % for lipid content estimation, respectively. The proposed method is also demonstrated for ex vivo porcine tissue lipid mapping as well as in-vivo longitudinal water content monitoring.

Conclusions

The proposed technique enables spatial mapping of tissue water and lipid content with the cost in detector reduced by two orders of magnitude compared with SWIR-MPI while maintaining high accuracy. The experimental results highlight the potential of this technique for substantial impact in both scientific and industrial applications.

Distinguishing tumor from healthy tissue in human liver ex vivo using machine learning and multivariate analysis of diffuse reflectance spectra

The aim of this work was to evaluate the capability of diffuse reflectance spectroscopy to distinguish malignant liver tissues from surrounding tissues and to determine whether an extended wavelength range (450-1550 nm) offers any advantages over using the conventional wavelength range. Furthermore, multivariate analysis combined with a machine learning algorithm, either linear discriminant analysis or the more advanced support vector machine, was used to discriminate between and classify freshly excised human liver specimens from 18 patients. Tumors were distinguished from surrounding liver tissues with a sensitivity of 99%, specificity of 100%, classification rate of 100% and a Matthews correlation coefficient of 100% using the extended wavelength range and a combination of principal component analysis and support vector techniques. The results indicate that this technology may be useful in clinical applications for real-time tissue diagnostics of tumor margins where rapid classification is important.

Fluorescent probes for biomolecule detection under environmental stress

The use of fluorescent probes in visible detection has been developed over the last several decades. Biomolecules are essential in the biological processes of organisms, and their distribution and concentration are largely influenced by environmental factors. Significant advances have occurred in the applications of fluorescent probes for the detection of the dynamic localization and quantity of biomolecules during various environmental stress-induced physiological and pathological processes. Herein, we summarize representative examples of small molecule-based fluorescent probes that provide bimolecular information when the organism is under environmental stress. The discussion includes strategies for the design of smart small-molecule fluorescent probes, in addition to their applications in biomolecule imaging under environmental stresses, such as hypoxia, ischemia-reperfusion, hyperthermia/hypothermia, organic/inorganic chemical exposure, oxidative/reductive stress, high glucose stimulation, and drug treatment-induced toxicity. We believe that comprehensive insight into the beneficial applications of fluorescent probes in biomolecule detection under environmental stress should enable the further development and effective application of fluorescent probes in the biochemical and biomedical fields.

Quantifying tissue optical properties of human heads in vivo using continuous-wave near-infrared spectroscopy and subject-specific three-dimensional Monte Carlo models

SIGNIFICANCE

Quantifying subject-specific optical properties (OPs) including absorption and transport scattering coefficients of tissues in the human head could improve the modeling of photon propagation for the analysis of functional near-infrared spectroscopy (fNIRS) data and dosage quantification in therapeutic applications. Current methods employ diffuse approximation, which excludes a low-scattering cerebrospinal fluid compartment and causes errors.

AIM

This work aims to quantify OPs of the scalp, skull, and gray matter in vivo based on accurate Monte Carlo (MC) modeling.

APPROACH

Iterative curve fitting was applied to quantify tissue OPs from multidistance continuous-wave NIR reflectance spectra. An artificial neural network (ANN) was trained using MC-simulated reflectance values based on subject-specific voxel-based tissue models to replace MC simulations as the forward model in curve fitting. To efficiently generate sufficient data for training the ANN, the efficiency of MC simulations was greatly improved by white MC simulations, increasing the detectors' acceptance angle, and building a lookup table for interpolation.

RESULTS

The trained ANN was six orders of magnitude faster than the original MC simulations. OPs of the three tissue compartments were quantified from NIR reflectance spectra measured at the forehead of five healthy subjects and their uncertainties were estimated.

CONCLUSIONS

This work demonstrated an MC-based iterative curve fitting method to quantify subject-specific tissue OPs in-vivo, with all OPs except for scattering coefficients of scalp within the ranges reported in the literature, which could aid the modeling of photon propagation in human heads.

Tissue-mimicking phantom materials with tunable optical properties suitable for assessment of diffuse reflectance spectroscopy during electrosurgery

Emerging intraoperative tumor margin assessment techniques require the development of more complex and reliable organ phantoms to assess the performance of the technique before its translation into the clinic. In this work, electrically conductive tissue-mimicking materials (TMMs) based on fat, water and agar/gelatin were produced with tunable optical properties. The composition of the phantoms allowed for the assessment of tumor margins using diffuse reflectance spectroscopy, as the fat/water ratio served as a discriminating factor between the healthy and malignant tissue. Moreover, the possibility of using polyvinyl alcohol (PVA) or transglutaminase in combination with fat, water and gelatin for developing TMMs was studied. The diffuse spectral response of the developed phantom materials had a good match with the spectral response of porcine muscle and adipose tissue, as well as in vitro human breast tissue. Using the developed recipe, anatomically relevant heterogeneous breast phantoms representing the optical properties of different layers of the human breast were fabricated using 3D-printed molds. These TMMs can be used for further development of phantoms applicable for simulating the realistic breast conserving surgery workflow in order to evaluate the intraoperative optical-based tumor margin assessment techniques during electrosurgery.

Optical characterization of the liver tissue affected by fibrolamellar hepatocellular carcinoma based on internal filters of laser-induced fluorescence

Laser-induced fluorescence (LIF) spectroscopy has recently gained regards for diagnosis of the cancer in various tissues of the human body. This method in its conventional form, when used for assay of highly scattering media, encounters a lot of noise due to multiple scattering and inner filter effects which overshadows the sensitivity and specificity of the method. Here, angular dependence of the LIF spectral shift due to the reabsorption events have been investigated for characterization of the bio-tissues. The aim was to determine the tissue morphological changeovers due to the cancer progression. The assessment of a rare type of the liver cancer i. e. fibrolamellar hepatocellular carcinoma revealed the significant difference in optical anisotropy of the parenchyma and liver tumor. As a result, utilizing LIF spectroscopy as a fast, highly sensitive and easy-to-use method one can evaluate the optical anisotropy for diagnosing tissues during the cancer progression.

Smart Blood Vessel Detection System for Laparoscopic Surgery

Objective: Compared with traditional surgery, laparoscopic surgery offers the advantages of smaller scars and rapid recovery and has gradually become popular. However, laparoscopic surgery has the limitation of low visibility and a lack of touch sense. As such, a physician may unexpectedly damage blood vessels, causing massive bleeding. In clinical settings, Doppler ultrasound is commonly used to detect vascular locations, but this approach is affected by the measuring angle and bone shadow and has poor ability to distinguish arteries from veins. To tackle these problems, a smart blood vessel detection system for laparoscopic surgery is proposed. Methods: Based on the principle of near-infrared spectroscopy, the proposed instrument can access hemoglobin (HbT) parameters at several depths simultaneously and recognize human tissue type by using a neural network. Results: Using the differences in HbT and StO₂ between different tissues, vascular and avascular locations can be recognized. Moreover, a mechanically rotatable stick enables the physician to easily operate in body cavities. Phantom and animal experiments were performed to validate the system’s performance. Conclusion: The proposed system has high ability to distinguish vascular from avascular locations at various depths.

Automatic Liver Viability Scoring with Deep Learning and Hyperspectral Imaging

Hyperspectral imaging (HSI) is a non-invasive imaging modality already applied to evaluate hepatic oxygenation and to discriminate different models of hepatic ischemia. Nevertheless, the ability of HSI to detect and predict the reperfusion damage intraoperatively was not yet assessed. Hypoxia caused by hepatic artery occlusion (HAO) in the liver brings about dreadful vascular complications known as ischemia-reperfusion injury (IRI). Here, we show the evaluation of liver viability in an HAO model with an artificial intelligence-based analysis of HSI. We have combined the potential of HSI to extract quantitative optical tissue properties with a deep learning-based model using convolutional neural networks. The artificial intelligence (AI) score of liver viability showed a significant correlation with capillary lactate from the liver surface (r = −0.78, p = 0.0320) and Suzuki’s score (r = −0.96, p = 0.0012). CD31 immunostaining confirmed the microvascular damage accordingly with the AI score. Our results ultimately show the potential of an HSI-AI-based analysis to predict liver viability, thereby prompting for intraoperative tool development to explore its application in a clinical setting.

Explainable liver tumor delineation in surgical specimens using hyperspectral imaging and deep learning

Surgical removal is the primary treatment for liver cancer, but frequent recurrence caused by residual malignant tissue remains an important challenge, as recurrence leads to high mortality. It is unreliable to distinguish tumors from normal tissues merely under visual inspection. Hyperspectral imaging (HSI) has been proved to be a promising technology for intra-operative use by capturing the spatial and spectral information of tissue in a fast, non-contact and label-free manner. In this work, we investigated the feasibility of HSI for liver tumor delineation on surgical specimens using a multi-task U-Net framework. Measurements are performed on 19 patients and a dataset of 36 specimens was collected with corresponding pathological results serving as the ground truth. The developed framework can achieve an overall sensitivity of 94.48% and a specificity of 87.22%, outperforming the baseline SVM method by a large margin. In particular, we propose to add explanations on the well-trained model from the spatial and spectral dimensions to show the contribution of pixels and spectral channels explicitly. On that basis, a novel saliency-weighted channel selection method is further proposed to select a small subset of 5 spectral channels which provide essentially as much information as using all 224 channels. According to the dominant channels, the absorption difference of hemoglobin and bile content in the normal and malignant tissues seems to be promising markers that could be further exploited.

Evaluation of wavelength ranges and tissue depth probed by diffuse reflectance spectroscopy for colorectal cancer detection

Colorectal cancer (CRC) is the third most common type of cancer worldwide and the second most deadly. Recent research efforts have focused on developing non-invasive techniques for CRC detection. In this study, we evaluated the diagnostic capabilities of diffuse reflectance spectroscopy (DRS) for CRC detection by building 6 classification models based on support vector machines (SVMs). Our dataset consists of 2889 diffuse reflectance spectra collected from freshly excised ex vivo tissues of 47 patients over wavelengths ranging from 350 and 1919 nm with source-detector distances of 630-µm and 2500-µm to probe different depths. Quadratic SVMs were used and performance was evaluated using twofold cross-validation on 10 iterations of randomized training and test sets. We achieved (93.5 ± 2.4)% sensitivity, (94.0 ± 1.7)% specificity AUC by probing the superficial colorectal tissue and (96.1 ± 1.8)% sensitivity, (95.7 ± 0.6)% specificity AUC by sampling deeper tissue layers. To the best of our knowledge, this is the first DRS study to investigate the potential of probing deeper tissue layers using larger SDD probes for CRC detection in the luminal wall. The data analysis showed that using a broader spectrum and longer near-infrared wavelengths can improve the diagnostic accuracy of CRC as well as probing deeper tissue layers.

Multispectral tissue mapping: developing a concept for the optical evaluation of liver disease

Purpose: Alterations in the optical absorption behavior of liver tissue secondary to pathological processes can be evaluated by multispectral analysis, which is increasingly being explored as an imaging adjunct for use in liver surgery. Current methods are either invasive or have a limited wavelength spectrum, which restricts utility. This proof of concept study describes the development of a multispectral imaging (MSI) method called multispectral tissue mapping (MTM) that addresses these issues. Approach: The imaging system consists of a tunable excitation light source and a near-infrared camera. Following the development stage, proof of concept experiments are carried out where absorption spectra from colorectal cancer liver metastasis (CRLM), hepatocellular carcinoma (HCC), and liver steatosis specimen are acquired and compared to controls. Absorption spectra are compared to histopathology examination as the current gold standard for tissue assessment. Generalized linear mixed modeling is employed to compare absorption characteristics of individual pixels and to select wavelengths for false color image processing with the aim of visually enhancing cancer tissue. Results: Analysis of individual pixels revealed distinct absorption spectra therefore suggesting that MTM is possible. A prominent absorption peak at 1210 nm was found in lipid-rich animal tissues and steatotic liver specimen. Liver cancer tissue had a heterogeneous appearance on MSI. Subsequent statistical analysis suggests that measuring changes in absorption behavior may be a feasible method to estimate the pixel-based probability of cancer being present. In CRLM, this was observed throughout 1100 to 1700 nm, whereas in HCC it was concentrated around 1140 and 1430 nm. False color image processing visibly enhances contrast between cancer and normal liver tissues. Conclusions: The system's ability to enable no-touch MSI at 1100 to 1700 nm was demonstrated. Preliminary data suggest that MTM warrants further exploration as a potential imaging tool for the detection of liver cancer during surgery.

Hyperspectral evaluation of hepatic oxygenation in a model of total vs. arterial liver ischaemia

Liver ischaemia reperfusion injury (IRI) is a dreaded pathophysiological complication which may lead to an impaired liver function. The level of oxygen hypoperfusion affects the level of cellular damage during the reperfusion phase. Consequently, intraoperative localisation and quantification of oxygen impairment would help in the early detection of liver ischaemia. To date, there is no real-time, non-invasive, and intraoperative tool which can compute an organ oxygenation map, quantify and discriminate different types of vascular occlusions intraoperatively. Hyperspectral imaging (HSI) is a non-invasive optical methodology which can quantify tissue oxygenation and which has recently been applied to the medical field. A hyperspectral camera detects the relative reflectance of a tissue in the range of 500 to 1000 nm, allowing the quantification of organic compounds such as oxygenated and deoxygenated haemoglobin at different depths. Here, we show the first comparative study of liver oxygenation by means of HSI quantification in a model of total vascular inflow occlusion (VIO) vs. hepatic artery occlusion (HAO), correlating optical properties with capillary lactate and histopathological evaluation. We found that liver HSI could discriminate between VIO and HAO. These results were confirmed via cross-validation of HSI which detected and quantified intestinal congestion in VIO. A significant correlation between the near-infrared spectra and capillary lactate was found (r = − 0.8645, p = 0.0003 VIO, r = − 0.7113, p = 0.0120 HAO). Finally, a statistically significant negative correlation was found between the histology score and the near-infrared parameter index (NIR) (r = − 0.88, p = 0.004). We infer that HSI, by predicting capillary lactates and the histopathological score, would be a suitable non-invasive tool for intraoperative liver perfusion assessment.

Comparison of spectral characteristics in human and pig biliary system with hyperspectral imaging (HSI)

Injuries to the biliary tree during surgical, endoscopic or invasive radiological diagnostic or therapeutic procedures involving the pancreas, liver or organs of the upper gastrointestinal tract give rise to the need to develop a method for clear discrimination of biliary anatomy from surrounding tissue. Hyperspectral imaging (HSI) is an emerging optical technique in disease diagnosis and image-guided surgery with inherent advantages of being a non-contact, non-invasive, and non-ionizing technique. HSI can produce quantitative diagnostic information about tissue pathology, morphology, and chemical composition. HSI was applied in human liver transplantation and compared to porcine model operations to assess the capability of discriminating biliary anatomy from surrounding biological tissue. Absorbance spectra measured from bile ducts, gall bladder, and liver show a dependence on tissue composition and bile concentration, with agreement between human and porcine datasets. The bile pigment biliverdin and structural proteins collagen and elastin were identified as contributors to the bile duct and gall bladder absorbance spectra.

Improving Endo-Myocardial Biopsy by Real-Time Spectral Tissue Sensing: A Feasibility Study

Objective: The aim of this research is to integrate spectral tissue sensing technology inside a cardiac bioptome for real-time measurements of tissue characteristics. Methods: Bioptome tip and handle components were designed and manufactured to house and guide optical fibers. The designed components were assembled on a cardiac bioptome together with optical fibers. A technical feasibility test was carried out to study the functionality of the instrument and the effect of the optical technology on the biopsy performance. Biopsy samples were taken from five different tissue types in a porcine heart and the resulting optical spectra were compared. Results: Spectral tissue sensing fibers were successfully integrated inside a conventional cardiac bioptome. The integrated instrument allowed differentiation between ventricular tissue, blood, and cardiac fat tissue based on blood and fat percentage and amount of scattering. Moreover, differences between scarred and non-scarred tissue were clearly visible. Conclusion: A first step has been made in the use of spectral tissue sensing for the detection of different tissue structures for endo-myocardial biopsy. The instrument was able to differentiate between various tissues, as well as between healthy and diseased cardiac tissues. Future research should focus on measurements of naturally diseased cardiac tissue, repeated measurements with statistical value, and improvements to the instrument design. Significance: Having the ability to measure tissue characteristics prior to acquiring a biopsy sample will not only allow easier positioning of the bioptome at the correct location, but can also prevent sampling undesired tissue or scar tissue from previous biopsies.

Optical percutaneous needle biopsy of the liver: a pilot animal and clinical study

This paper presents the results of the experiments which were performed using the optical biopsy system specially developed for in vivo tissue classification during the percutaneous needle biopsy (PNB) of the liver. The proposed system includes an optical probe of small diameter acceptable for use in the PNB of the liver. The results of the feasibility studies and actual tests on laboratory mice with inoculated hepatocellular carcinoma and in clinical conditions on patients with liver tumors are presented and discussed. Monte Carlo simulations were carried out to assess the diagnostic volume and to trace the sensing depth. Fluorescence and diffuse reflectance spectroscopy measurements were used to monitor metabolic and morphological changes in tissues. The tissue oxygen saturation was evaluated using a recently developed approach to neural network fitting of diffuse reflectance spectra. The Support Vector Machine Classification was applied to identify intact liver and tumor tissues. Analysis of the obtained results shows the high sensitivity and specificity of the proposed multimodal method. This approach allows to obtain information before the tissue sample is taken, which makes it possible to significantly reduce the number of false-negative biopsies.

Ultrasound-modulated optical glucose sensing using a 1645 nm laser

Regular and frequent blood glucose monitoring is vital in managing diabetes treatment plans and preventing severe complications. Because current invasive techniques impede patient compliance and are not infection-free, many noninvasive methods have been proposed. Among them, optical methods have drawn much attention for their rich optical contrast, but their resolution is degraded in deep tissue. Here, we present an ultrasound-modulated optical sensing (UOS) technique to noninvasively monitor glucose that uses an infrared laser (1645 nm) and a single-element focused ultrasound transducer. Focused ultrasound waves can acoustically localize diffused photons in scattering media, and thus optical contrast can be represented with much enhanced spatial resolution. To maximize the signal-to-noise ratio, we compared the modulation depths of UOS signals in both continuous and burst ultrasound transmission modes. Finally, UOS measurements of various glucose concentrations are presented and compared with those acquired in phantoms with a conventional diffuse optical sensing method. The UOS measurements in a 20 mm thick tissue-mimicking phantom show 26.6% accuracy in terms of mean absolute relative difference (MARD), which indicates the great potential of the proposed technique as a noninvasive glucose sensor.

Development of simple diffuse optical metabolic spectroscopy for tissue metabolism measurement

In the field of biomedicine, there are optical systems that provide the tissue metabolic rate of oxygen consumption (tMRO₂) by the simultaneous measurement of blood flow and oxygenation level. However, current optical systems are costly and require complex optical alignments, which are inconvenient for clinical applications. Therefore, in this study, we developed a simple diffuse optical metabolic spectroscopy system by combining a broadband light source and a laser and by sharing a spectrometer as a detector for both diffuse optical spectroscopy and diffuse speckle contrast analysis. This system simultaneously measures blood flow, volume, and oxygenation in a simple and cost-effective manner. The system response to flow is demonstrated through the flow phantom experiments. The results of the experiments show that flow response is in the range 0~0.9 ml/min, with a resolution better than 0.1 ml/min. During the blood phantom study, the blood volume fraction increased linearly with blood accumulation. Further, the change in oxygenation was monitored with the modulation of the oxygen level in the gas supply. Finally, tMRO₂ changes were measured during ischemia, induced by the upper arm cuff and the results showed a decrease and a recovery of tMRO₂ with cuff inflation and deflation, respectively. This simple diffuse optical metabolic spectroscopic system can easily be applied in medical environments by providing a simple and convenient solution for measuring tMRO₂.

Evaluation of endoscopic visible light spectroscopy: comparison with microvascular oxygen tension measurements in a porcine model

BACKGROUND

Visible light spectroscopy (VLS) is a technique used to measure the mucosal oxygen saturation during upper gastrointestinal endoscopy to evaluate mucosal ischemia, however in vivo validation is lacking. We aimed to compare VLS measurements with a validated quantitative microvascular oxygen tension (μPO₂) measurement technique.

METHODS

Simultaneous VLS measurements and μPO₂ measurements were performed on the small intestine of five pigs. First, simultaneous measurements were performed at different FiO₂ values (18%-100%). Thereafter, the influence of bile was assessed by comparing VLS measurements in the presence of bile and without bile. Finally, simultaneous VLS and μPO₂ measurements were performed from the moment a lethal dose potassium chloride intravenously was injected.

RESULTS

In contrast to μPO₂ values that increased with increasing FiO₂, VLS values decreased. Both measurements correlated poorly with R² = 0.39, intercept 18.5, slope 0.41 and a bias of - 16%. Furthermore, the presence of bile influenced VLS values significantly (median (IQR)) before bile application 57.5% (54.8-59.0%) versus median with bile mixture of the stomach 73.5% (66.8-85.8), p = < 2.2 * 10^-16; median with bile mixture of small bowel 47.6% (41.8-50.8) versus median after bile removal 57.0% (54.7-58.6%), p = < 2.2 * 10^-16). Finally, the VLS mucosal oxygen saturation values did not decrease towards a value of 0 in the first 25 min of asystole in contrast to the μPO₂ values.

CONCLUSIONS

These results suggest that VLS measures the mixed venous oxygen saturation rather than mucosal capillary hemoglobin oxygen saturation. Further research is needed to establish if the mixed venous compartment is optimal to assess gastrointestinal ischemia.

Intraoperative liver steatosis characterization using diffuse reflectance spectroscopy

BACKGROUND

Liver steatosis is associated with poor outcome after liver transplantation and liver resection. There is a need for an accurate and reliable intraoperative tool to identify and quantify steatosis. This study aimed to investigate whether surface diffuse reflectance spectroscopy (DRS) measurements could detect liver steatosis on humans during liver surgery.

METHODS

The DRS instrumentation setup consists of a computer, a high-power tungsten halogen light source and two spectrometers, connected through a trifurcated optical fiber to a hand-held probe. Patients scheduled for open resection for liver tumors were considered for inclusion. Multiple DRS measurements were performed on the liver surface after mobilization.

RESULTS

In total, 1210 DRS spectra originated from 38 patients, were analyzed. When applying the data to an analytical model the volumetric absorption ratio factor of fat and water specified an explicit distinction between mild to moderate, and moderate to severe steatosis (p < 0.001). There were significant differences between none-to-mild and moderate-to-severe steatosis grade for the following parameters: reduced scattering coefficient (p < 0.001), Mie to total scattering fraction (p < 0.001), Mie slope (p = 0.003), lipid/(lipid + water) (p < 0.001), blood volume (p = 0.044) and bile volume (p < 0.001).

CONCLUSION

This study shows that it is possible to evaluate steatosis grades with hepatic surface diffuse reflectance spectroscopy measurements.

Diffuse reflectance spectroscopy accurately discriminates early and advanced grades of fatty liver in mice

Nonalcoholic fatty liver disease (NAFLD) ranges from steatosis to nonalcoholic steatohepatitis and cirrhosis. Liver biopsy, considered the gold standard to diagnose NAFLD, shows significantly high rates of interobserver variability. Thus there is a need to develop tools that accurately categorize mild and advanced grades of steatosis in order to identify patients at higher risk of developing chronic liver disease. Diffuse reflectance spectroscopy (DRS) has proved to be useful in grading liver fibrosis and cirrhosis, without having been implemented for steatosis. We aim to categorize early and advanced stages of liver steatosis in a methionine-choline deficient (MCD) mouse model. C57bl/6 mice are fed either methionine-choline control or MCD diet during 2 or 8 weeks to induce mild and advanced steatosis. Liver samples are obtained and steatosis is evaluated by oil red O staining. Diffuse reflectance spectra are directly measured on ex vivo liver specimens, in a wavelength range of 400 to 800 nm. DRS is able to discriminate between early or advanced steatosis and healthy hepatic tissue with negligible error while showing high average sensitivity and specificity (0.94 and 0.95, respectively). Our results suggest that liver steatosis can be accurately evaluated by DRS, highlighting the importance of applied spectroscopic methods in assessing NAFLD.

Diffuse reflectance spectroscopy of human liver tumor specimens - towards a tissue differentiating optical biopsy needle using light emitting diodes

Significant numbers of liver biopsies fail to yield representative tissue samples. This study was conducted to evaluate the ability of LED-based diffuse reflectance spectroscopy to discriminate tumors from liver parenchyma. Ex vivo spectra were acquired from malignant lesions and liver parenchyma of 32 patients who underwent liver resection using a white light source and several LEDs. Integrated spectra of two combined LEDs with emission peaks at 470 nm and 515 nm were classified with 98.4% sensitivity and 99.2% specificity. The promising results could yield to a simple handheld and cost-efficient tool for real-time tissue differentiation implemented in a biopsy needle.

Determination of optical properties of turbid medium from relative interstitial CW radiance measurements using the incomplete P3 approximation

Interstitial determination of the tissue optical properties is important in biomedicine, especially for interstitial laser therapies. Continuous wave (CW) radiance techniques which examine light from multiple directions have been proposed as minimally invasive methods for determining the optical properties under an interstitial probe arrangement. However, both the fitting algorithm based on the P3 approximation and the analytical method based on the diffusion approximation (DA), which are currently used recovery algorithms, cannot extract the optical properties of tissue with low transport albedos accurately from radiance measurements. In this paper, we proposed an incomplete P3 approximation for the radiance, the P3_in for short, which is the asymptotic part of the solution for the P3 approximation. The relative differences between the P3_in and the P3 were within 0.48% over a wide range of clinically relevant optical properties for measurements at source detector separations (SDS) from 5 mm to 10 mm and angles from 0° to 160°. Based on the P3_in, we developed an analytical method for extracting the optical properties directly using simple expressions constructed from the radiance measurements at only two SDSs and four angles. The developed recovery algorithm was verified by simulated and experimental radiance data. The results show that both the absorption and reduced scattering coefficients were recovered accurately with relative errors within 5.28% and 3.86%, respectively, from the simulated data and with relative errors within 10.82% and 10.67%, respectively, from the experimental data over a wide range of albedos from 0.5 to 0.99. Since the developed P3_in-based radiance technique can obtain the optical properties rapidly from the measurements at only two SDSs and four angles, it is expected to be used for in vivo and in situ determination of the optical properties in online treatment planning during laser therapies.

Development and Testing of an LED-Based Near-Infrared Sensor for Human Kidney Tumor Diagnostics

Optical spectroscopy is increasingly used for cancer diagnostics. Tumor detection feasibility in human kidney samples using mid- and near-infrared (NIR) spectroscopy, fluorescence spectroscopy, and Raman spectroscopy has been reported (Artyushenko et al., Spectral fiber sensors for cancer diagnostics in vitro. In Proceedings of the European Conference on Biomedical Optics, Munich, Germany, 21–25 June 2015). In the present work, a simplification of the NIR spectroscopic analysis for cancer diagnostics was studied. The conventional high-resolution NIR spectroscopic method of kidney tumor diagnostics was replaced by a compact optical sensing device constructively represented by a set of four light-emitting diodes (LEDs) at selected wavelengths and one detecting photodiode. Two sensor prototypes were tested using 14 in vitro clinical samples of 7 different patients. Statistical data evaluation using principal component analysis (PCA) and partial least-squares discriminant analysis (PLS-DA) confirmed the general applicability of the LED-based sensing approach to kidney tumor detection. An additional validation of the results was performed by means of sample permutation.

The tooth as a monitor of cholestatic liver disease in rats

OBJECTIVE

Measure, noninvasively, the deposition of bilirubin in the tooth by using DIAGNOdent and correlate it to liver dysfunction.

STUDY DESIGN

After confirming the capacity of DIAGNOdent to measure varying bile concentrations in plaster blocks, a cholestatic liver disease model was studied to detect increasing bilirubin impregnation in the teeth of rats. Wistar-EPM rats (n = 50) were divided into three groups: (1) BDL: rats submitted to bile duct ligation (BDL); (2) Naïve: rats without procedure; and (3) Sham: rats submitted to laparotomy without BDL (n = 10/period/group). The rats' teeth were monitored with the use of DIAGNOdent before the procedure and at days 10 and 50 following surgery. Serum bilirubin was also monitored.

RESULTS

Tests in vitro showed that DIAGNOdent detected bile in plaster blocks according to its concentration. BDL promoted progressive liver dysfunction, with death occurring approximately 50 days later. DIAGNOdent values obtained on teeth showed correlation with the progression of serum hyperbilirubinemia.

CONCLUSIONS

The tooth was found to be a good tissue for noninvasively monitoring the progression of bilirubinemia in cholestatic liver disease in rats by using DIAGNOdent.

Review: in vivo optical spectral tissue sensing-how to go from research to routine clinical application?

Innovations in optical spectroscopy have helped the technology reach a point where performance previously seen only in laboratory settings can be translated and tested in real-world applications. In the field of oncology, spectral tissue sensing (STS) by means of optical spectroscopy is considered to have major potential for improving diagnostics and optimizing treatment outcome. The concept has been investigated for more than two decades and yet spectral tissue sensing is not commonly employed in routine medical practice. It is therefore important to understand what is needed to translate technological advances and insights generated through basic scientific research in this field into clinical practice. The aim of the discussion presented here is not to provide a comprehensive review of all work published over the last decades but rather to highlight some of the challenges found in literature and encountered by our group in the quest to translate optical technologies into useful clinical tools. Furthermore, an outlook is proposed on how translational researchers could proceed to eventually have STS incorporated in the process of clinical decision-making.

Optimal wavelengths for optoacoustic measurements of blood oxygen saturation in biological tissues

The non-invasive measurement of blood oxygen saturation in blood vessels is a promising clinical application of optoacoustic imaging. Nevertheless, precise optoacoustic measurements of blood oxygen saturation are limited because of the complexities of calculating the spatial distribution of the optical fluence. In the paper error in the determination of blood oxygen saturation, associated with the use of approximate methods of optical fluence evaluation within the blood vessel, was investigated for optoacoustic measurements at two wavelengths. The method takes into account both acoustic pressure noise and the error in determined values of the optical scattering and absorption coefficients used for the calculation of the fluence. It is shown that, in conditions of an unknown (or partially known) spatial distribution of fluence at depths of 2 to 8 mm, minimal error in the determination of blood oxygen saturation is achieved at wavelengths of 658 ± 40 nm and 1069 ± 40 nm.

Diffuse Reflectance Spectroscopy for Surface Measurement of Liver Pathology

BACKGROUND

Liver parenchymal injuries such as steatosis, steatohepatitis, fibrosis, and sinusoidal obstruction syndrome can lead to increased morbidity and liver failure after liver resection. Diffuse reflectance spectroscopy (DRS) is an optical measuring method that is fast, convenient, and established. DRS has previously been used on the liver with an invasive technique consisting of a needle that is inserted into the parenchyma. We developed a DRS system with a hand-held probe that is applied to the liver surface. In this study, we investigated the impact of the liver capsule on DRS measurements and whether liver surface measurements are representative of the whole liver. We also wanted to confirm that we could discriminate between tumor and liver parenchyma by DRS.

MATERIALS AND METHODS

The instrumentation setup consisted of a light source, a fiber-optic contact probe, and two spectrometers connected to a computer. Patients scheduled for liver resection due to hepatic malignancy were included, and DRS measurements were performed on the excised liver part with and without the liver capsule and alongside a newly cut surface. To estimate the scattering parameters and tissue chromophore volume fractions, including blood, bile, and fat, the measured diffuse reflectance spectra were applied to an analytical model.

RESULTS

In total, 960 DRS spectra from the excised liver tissue of 18 patients were analyzed. All factors analyzed regarding tumor versus liver tissue were significantly different. When measuring through the capsule, the blood volume fraction was found to be 8.4 ± 3.5%, the lipid volume fraction was 9.9 ± 4.7%, and the bile volume fraction was 8.2 ± 4.6%. No differences could be found between surface measurements and cross-sectional measurements. In measurements with/without the liver capsule, the differences in volume fraction were 1.63% (0.75-2.77), -0.54% (-2.97 to 0.32), and -0.15% (-1.06 to 1.24) for blood, lipid, and bile, respectively.

CONCLUSION

This study shows that it is possible to manage DRS measurements through the liver capsule and that surface DRS measurements are representative of the whole liver. The results are consistent with data published earlier on the combination of liver chromophores. The results encourage us to proceed with in vivo measurements for further quantification of the liver's composition and assessment of parenchymal damage such as steatosis and fibrosis grade.

In vivo tumor identification of colorectal liver metastases with diffuse reflectance and fluorescence spectroscopy

BACKGROUND AND OBJECTIVE

Over the last decade, an increasing effort has been put towards the implementation of optical guidance techniques to aid surgeons during cancer surgery. Diffuse reflectance spectroscopy (DRS) and fluorescence spectroscopy (FS) are two of these new techniques. The objective of this study is to investigate whether in vivo optical spectroscopy is able to accurately discriminate colorectal liver metastases (CRLM) from normal liver tissue in vivo.

MATERIALS AND METHODS

DRS and FS were incorporated at the tip of a needle and were used for in vivo tissue differentiation during resection of CRLM. Measurements were taken in and around the tumor lesions and measurement sites were marked and correlated to histology (i.e., normal liver tissue or tumor tissue). Patients with and without neoadjuvant systemic chemotherapy were included into the study.

RESULTS

Four hundred and eighty-four measurements were taken in and near 19 liver lesions prior to resection. Overall sensitivity and specificity for DRS was 95% and 92%, respectively. Bile was the most discriminative parameter. The addition of FS did not improve the overall accuracy. Sensitivity and specificity was not hampered by neo-adjuvant chemotherapy; sensitivity and specificity after neo-adjuvant chemotherapy were 92% and 100%, respectively.

CONCLUSION

We have successfully integrated spectroscopy technology into a disposable 15 Gauge optical needle and we have shown that DRS and FS can accurately discriminate CRLM from normal liver tissue in the in vivo setting regardless of whether the patient was pre-treated with systemic therapy. This technique makes in vivo guidance accessible for common surgical practice. Lasers Surg. Med. 48:820-827, 2016. © 2016 Wiley Periodicals, Inc.

In vivo characterization of colorectal metastases in human liver using diffuse reflectance spectroscopy: toward guidance in oncological procedures

There is a strong need to develop clinical instruments that can perform rapid tissue assessment at the tip of smart clinical instruments for a variety of oncological applications. This study presents the first in vivo real-time tissue characterization during 24 liver biopsy procedures using diffuse reflectance (DR) spectroscopy at the tip of a core biopsy needle with integrated optical fibers. DR measurements were performed along each needle path, followed by biopsy of the target lesion using the same needle. Interventional imaging was coregistered with the DR spectra. Pathology results were compared with the DR spectroscopy data at the final measurement position. Bile was the primary discriminator between normal liver tissue and tumor tissue. Relative differences in bile content matched with the tissue diagnosis based on histopathological analysis in all 24 clinical cases. Continuous DR measurements during needle insertion in three patients showed that the method can also be applied for biopsy guidance or tumor recognition during surgery. This study provides an important validation step for DR spectroscopy-based tissue characterization in the liver. Given the feasibility of the outlined approach, it is also conceivable to make integrated fiber-optic tools for other clinical procedures that rely on accurate instrument positioning.

Bond-selective photoacoustic imaging by converting molecular vibration into acoustic waves

The quantized vibration of chemical bonds provides a way of detecting specific molecules in a complex tissue environment. Unlike pure optical methods, for which imaging depth is limited to a few hundred micrometers by significant optical scattering, photoacoustic detection of vibrational absorption breaks through the optical diffusion limit by taking advantage of diffused photons and weak acoustic scattering. Key features of this method include both high scalability of imaging depth from a few millimeters to a few centimeters and chemical bond selectivity as a novel contrast mechanism for photoacoustic imaging. Its biomedical applications spans detection of white matter loss and regeneration, assessment of breast tumor margins, and diagnosis of vulnerable atherosclerotic plaques. This review provides an overview of the recent advances made in vibration-based photoacoustic imaging and various biomedical applications enabled by this new technology.

Real-Time In Vivo Characterization of Primary Liver Tumors With Diffuse Optical Spectroscopy During Percutaneous Needle Interventions: Feasibility Study in Woodchucks

OBJECTIVE

This study presents the first in vivo real-time optical tissue characterization during image-guided percutaneous intervention using near-infrared diffuse optical spectroscopy sensing at the tip of a needle. The goal of this study was to indicate transition boundaries from healthy tissue to tumors, namely, hepatic carcinoma, based on the real-time feedback derived from the optical measurements.

MATERIALS AND METHODS

Five woodchucks with hepatic carcinoma were used for this study. The woodchucks were imaged with contrast-enhanced cone beam computed tomography with a flat panel detector C-arm system to visualize the carcinoma in the liver. In each animal, 3 insertions were performed, starting from the skin surface toward the hepatic carcinoma under image guidance. In 2 woodchucks, each end point of the insertion was confirmed with pathologic examination of a biopsy sample. While advancing the needle in the animals under image guidance such as fluoroscopy overlaid with cone beam computed tomography slice and ultrasound, optical spectra were acquired at the distal end of the needles. Optical tissue characterization was determined by translating the acquired optical spectra into clinical parameters such as blood, water, lipid, and bile fractions; tissue oxygenation levels; and scattering amplitude related to tissue density. The Kruskal-Wallis test was used to study the difference in the derived clinical parameters from the measurements performed within the healthy tissue and the hepatic carcinoma. Kurtoses were calculated to assess the dispersion of these parameters within the healthy and carcinoma tissues.

RESULTS

Blood and lipid volume fractions as well as tissue oxygenation and reduced scattering amplitude showed to be significantly different between the healthy part of the liver and the hepatic carcinoma (P < 0.05) being higher in normal liver tissue. A decrease in blood and lipid volume fractions and tissue oxygenation as well as an increase in scattering amplitude were observed when the tip of the needle crossed the margin from the healthy liver tissue to the carcinoma. The kurtosis for each derived clinical parameter was high in the hepatic tumor as compared with that in the healthy liver indicating intracarcinoma variability.

CONCLUSIONS

Tissue blood content, oxygenation level, lipid content, and tissue density all showed significant differences when the needle tip was guided from the healthy tissue to the carcinoma and can therefore be used to identify tissue boundaries during percutaneous image-guided interventions.

Portable handheld diffuse reflectance spectroscopy system for clinical evaluation of skin: a pilot study in psoriasis patients

Diffuse reflectance spectroscopy (DRS) has been utilized to study biological tissues for a variety of applications. However, many DRS systems are not designed for handheld use and/or relatively expensive which limit the extensive clinical use of this technique. In this paper, we report a handheld, low-cost DRS system consisting of a light source, optical switch, and a spectrometer, that can precisely quantify the optical properties of tissue samples in the clinical setting. The handheld DRS system was employed to determine the skin chromophore concentrations, absorption and scattering properties of 11 patients with psoriasis. The measurement results were compared to the clinical severity of psoriasis as evaluated by dermatologist using PASI (Psoriasis Area and Severity Index) scores. Our statistical analyses indicated that the handheld DRS system could be a useful non-invasive tool for objective evaluation of the severity of psoriasis. It is expected that the handheld system can be used for the objective evaluation and monitoring of various skin diseases such as keloid and psoriasis.

Utilizing confocal laser endomicroscopy for evaluating the adequacy of laparoscopic liver ablation

Background

Laparoscopic liver ablation therapy can be used for the treatment of primary and secondary liver malignancy. The increased incidence of cancer recurrence associated with this approach, has been attributed to the inability of monitoring the extent of ablated liver tissue.

Methods

The feasibility of assessing liver ablation with probe‐based confocal laser endomicroscopy (CLE) was studied in a porcine model of laparoscopic microwave liver ablation. Following the intravenous injection of the fluorophores fluorescein and indocyanine green, CLE images were recorded at 488 nm and 660 nm wavelength and compared to liver histology. Statistical analysis was performed to assess if fluorescence intensity change can predict the presence of ablated liver tissue.

Results

CLE imaging of fluorescein at 488 nm provided good visualization of the hepatic microvasculature; whereas, CLE imaging of indocyanine green at 660 nm enabled detailed visualization of hepatic sinusoid architecture and interlobular septations. Fluorescence intensity as measured in relative fluorescence units was found to be 75–100% lower in ablated compared to healthy liver regions. General linear mixed modeling and ROC analysis found the decrease in fluorescence to be statistically significant.

Conclusion

Laparoscopic, dual wavelength CLE imaging using two different fluorophores enables clinically useful visualization of multiple liver tissue compartments, in greater detail than is possible at a single wavelength. CLE imaging may provide valuable intraoperative information on the extent of laparoscopic liver ablation. Lasers Surg. Med. 48:299–310, 2016. © 2015 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

In vivo assessment of diet-induced rat hepatic steatosis development by percutaneous single-fiber spectroscopy detects scattering spectral changes due to fatty infiltration

This study explores percutaneous single-fiber spectroscopy (SfS) of rat livers undergoing fatty infiltration. Eight test rats were fed a methionine-choline-deficient (MCD) diet, and four control rats were fed a normal diet. Two test rats and one control rat were euthanized on days 12, 28, 49, and 77 following initiation of the diet, after percutaneous SfS of the liver under transabdominal ultrasound guidance. Histology of each set of the two euthanized test rats showed mild and mild hepatic lipid accumulations on day 12, moderate and severe on day 28, severe and mild on day 49, and moderate and mild on day 77. Livers with moderate or higher lipid accumulation generally presented higher spectral reflectance intensity when compared to lean livers. Livers of the eight test rats on day 12, two of which had mild lipid accumulation, revealed an average scattering power of 0.37±0.14 in comparison to 0.07±0.14 for the four control rats (p<0.01 ). When livers of the test rats with various levels of fatty infiltration were combined, the average scattering power was 0.36±0.15 0.36±0.15 in comparison to 0.14±0.24 of the control rats (0.05<p<0.1). Increasing lipid accumulation in concentration and size seemed to cause an increase of the scattering power prior to increasing total spectral reflectance.

A linear gradient line source facilitates the use of diffusion models with high order approximation for efficient, accurate turbid sample optical properties recovery

In this paper, we demonstrate that a scanning MEMS mirror can be employed to create a linear gradient line source that is equivalent to a planar source. This light source setup facilitates the use of diffusion models of increased orders of approximation having closed form solution, and thus enhance the efficiency and accuracy in sample optical properties recovery. In addition, compared with a regular planar light source, the linear gradient line source occupies much less source area and has an elevated measurement efficiency. We employed a δ-P1 diffusion equation with a closed form solution and carried out a phantom study to understand the performance of this new method in determining the absorption and scattering properties of turbid samples. Moreover, our Monte Carlo simulation results indicated that this geometry had probing depths comparable to those of the conventional diffuse reflectance measurement geometry with a source-detector separation of 3 mm. We expect that this new source setup would facilitate the investigating of superficial volumes of turbid samples in the wavelength regions where tissue absorption coefficients are comparable to scattering coefficients.

Monitoring of tumor radio frequency ablation using derivative spectroscopy

Despite the widespread use of radio frequency (RF) ablation, an effective way to assess thermal tissue damage during and after the procedure is still lacking. We present a method for monitoring RF ablation efficacy based on thermally induced methemoglobin as a marker for full tissue ablation. Diffuse reflectance (DR) spectra were measured from human blood samples during gradual heating of the samples from 37 to 60, 70, and 85°C. Additionally, reflectance spectra were recorded real-time during RF ablation of human liver tissue ex vivo and in vivo. Specific spectral characteristics of methemoglobin were extracted from the spectral slopes using a custom optical ablation ratio. Thermal coagulation of blood caused significant changes in the spectral slopes, which is thought to be caused by the formation of methemoglobin. The time course of these changes was clearly dependent on the heating temperature. RF ablation of liver tissue essentially led to similar spectral alterations. In vivo DR measurements confirmed that the method could be used to assess the degree of thermal damage during RF ablation and long after the tissue cooled.

Diffuse reflectance spectroscopy: towards clinical application in breast cancer

Diffuse reflectance spectroscopy (DRS) is a promising new technique for breast cancer diagnosis. However, inter-patient variation due to breast tissue heterogeneity may interfere with the accuracy of this technique. To tackle this issue, we aim to determine the diagnostic accuracy of DRS in individual patients. With this approach, DRS measurements of normal breast tissue in every individual patient are directly compared with measurements of the suspected malignant tissue. Breast tissue from 47 female patients was analysed ex vivo by DRS. A total of 1,073 optical spectra were collected. These spectra were analyzed for each patient individually as well as for all patients collectively and results were compared to the pathology analyses. Collective patient data analysis for discrimination between normal and malignant breast tissue resulted in a sensitivity of 90 %, a specificity of 88 %, and an overall accuracy of 89 %. In the individual analyses all measurements per patient were categorized as either benign or malignant. The discriminative accuracy of these individual analyses was nearly 100 %. The diagnosis was classified as uncertain in only one patient. Based on the results presented in this study, we conclude that the analysis of optical characteristics of different tissue classes within the breast of a single patient is superior to an analysis using the results of a cohort data analysis. When integrated into a biopsy device, our results demonstrate that DRS may have the potential to improve the diagnostic workflow in breast cancer.

Validation of interventional fiber optic spectroscopy with MR spectroscopy, MAS-NMR spectroscopy, high-performance thin-layer chromatography, and histopathology for accurate hepatic fat quantification

OBJECTIVES

To validate near-infrared (NIR)-based optical spectroscopy measurements of hepatic fat content using a minimally invasive needle-like probe with integrated optical fibers, enabling real-time feedback during percutaneous interventions. The results were compared with magnetic resonance spectroscopy (MRS) as validation and with histopathology, being the clinical gold standard. Additionally, ex vivo magic angle spinning nuclear magnetic resonance spectroscopy and high-performance thin-layer chromatography were performed for comparison.

MATERIALS AND METHODS

Ten mice were used for the study, of which half received a regular chow diet and the other half received a high-fat diet to induce obesity and hepatosteatosis. The mice were imaged with a clinical 3-Tesla MR to select a region of interest within the right and left lobes of the liver, where MRS measurements were acquired in vivo. Subsequently, optical spectra were measured ex vivo at the surface of the liver at 6 different positions immediately after resection. Additionally, hepatic fat was determined by magic angle spinning nuclear magnetic resonance spectroscopy and high-performance thin-layer chromatography. Histopathologic analyses were performed and used as the reference standard. Pearson correlation and linear regression analyses were performed to assess the correlation of the various techniques with NIR. A 1-way analysis of variance including post hoc Tukey multiple comparison tests was used to study the difference in fat estimation between the various techniques.

RESULTS

For both the mice groups, the estimated fat fractions by the various techniques were significantly similar (P = 0.072 and 0.627 for chow diet and high-fat diet group, respectively). The Pearson correlation value between NIR and the other techniques for fat determination showed the same strong linear correlation (P above 0.990; P < 0.001), whereas for histopathologic analyses, which is a rather qualitative measure, the Pearson correlation value was slightly lower (P = 0.925, P < 0.001) . Linear regression coefficient computed to compare NIR with the other techniques resulted in values close to unity with MRS having the narrowest confidence interval (r = 0.935, 95% confidence interval: 0.860-1.009), demonstrating highly correlating results between NIR and MRS.

CONCLUSIONS

NIR spectroscopy measurements from a needle-like probe with integrated optical fibers for sensing at the tip of the needle can quickly and accurately determine hepatic fat content during an interventional procedure and might therefore be a promising novel diagnosing tool in the clinic.

Optical spectroscopy: current advances and future applications in cancer diagnostics and therapy

Optical spectroscopy (OS) is a tissue-sensing technique that could enhance cancer diagnosis and treatment in the near future. With OS, tissue is illuminated with a selected light spectrum. Different tissue types can be distinguished from each other based on specific changes in the reflected light spectrum that are a result of differences on a molecular level between compared tissues. Therefore, OS has the potential to become an important optical tool for cancer diagnosis and treatment monitoring. In recent years, significant progress has been made in the discriminating abilities of OS techniques between normal and cancer tissues of multiple human tissue types. This article provides an overview of the advances made with diffuse reflectance, fluorescence and Raman spectroscopy techniques in the field of clinical oncology, and focuses on the different clinical applications that OS could enhance.

Diagnosis of breast cancer using diffuse optical spectroscopy from 500 to 1600 nm: comparison of classification methods

We report on the use of diffuse optical spectroscopy analysis of breast spectra acquired in the wavelength range from 500 to 1600 nm with a fiber optic probe. A total of 102 ex vivo samples of five different breast tissue types, namely adipose, glandular, fibroadenoma, invasive carcinoma, and ductal carcinoma in situ from 52 patients were measured. A model deriving from the diffusion theory was applied to the measured spectra in order to extract clinically relevant parameters such as blood, water, lipid, and collagen volume fractions, β-carotene concentration, average vessels radius, reduced scattering amplitude, Mie slope, and Mie-to-total scattering fraction. Based on a classification and regression tree algorithm applied to the derived parameters, a sensitivity-specificity of 98%-99%, 84%-95%, 81%-98%, 91%-95%, and 83%-99% were obtained for discrimination of adipose, glandular, fibroadenoma, invasive carcinoma, and ductal carcinoma in situ, respectively; and a multiple classes overall diagnostic performance of 94%. Sensitivity-specificity values obtained for discriminating malignant from nonmalignant tissue were compared to existing reported studies by applying the different classification methods that were used in each of these studies. Furthermore, in these reported studies, either lipid or β-carotene was considered as adipose tissue precursors. We estimate both chromophore concentrations and demonstrate that lipid is a better discriminator for adipose tissue than β-carotene.