Array-based high-intensity focused ultrasound therapy system integrated with real-time ultrasound and photoacoustic imaging

Photoacoustic imaging plus X: a review

Significance

Photoacoustic (PA) imaging (PAI) represents an emerging modality within the realm of biomedical imaging technology. It seamlessly blends the wealth of optical contrast with the remarkable depth of penetration offered by ultrasound. These distinctive features of PAI hold tremendous potential for various applications, including early cancer detection, functional imaging, hybrid imaging, monitoring ablation therapy, and providing guidance during surgical procedures. The synergy between PAI and other cutting-edge technologies not only enhances its capabilities but also propels it toward broader clinical applicability.

Aim

The integration of PAI with advanced technology for PA signal detection, signal processing, image reconstruction, hybrid imaging, and clinical applications has significantly bolstered the capabilities of PAI. This review endeavor contributes to a deeper comprehension of how the synergy between PAI and other advanced technologies can lead to improved applications.

Approach

An examination of the evolving research frontiers in PAI, integrated with other advanced technologies, reveals six key categories named "PAI plus X." These categories encompass a range of topics, including but not limited to PAI plus treatment, PAI plus circuits design, PAI plus accurate positioning system, PAI plus fast scanning systems, PAI plus ultrasound sensors, PAI plus advanced laser sources, PAI plus deep learning, and PAI plus other imaging modalities.

Results

After conducting a comprehensive review of the existing literature and research on PAI integrated with other technologies, various proposals have emerged to advance the development of PAI plus X. These proposals aim to enhance system hardware, improve imaging quality, and address clinical challenges effectively.

Conclusions

The progression of innovative and sophisticated approaches within each category of PAI plus X is positioned to drive significant advancements in both the development of PAI technology and its clinical applications. Furthermore, PAI not only has the potential to integrate with the above-mentioned technologies but also to broaden its applications even further.

Super-Low-Dose Functional and Molecular Photoacoustic Microscopy

Photoacoustic microscopy can image many biological molecules and nano-agents in vivo via low-scattering ultrasonic sensing. Insufficient sensitivity is a long-standing obstacle for imaging low-absorbing chromophores with less photobleaching or toxicity, reduced perturbation to delicate organs, and more choices of low-power lasers. Here, the photoacoustic probe design is collaboratively optimized and a spectral-spatial filter is implemented. A multi-spectral super-low-dose photoacoustic microscopy (SLD-PAM) is presented that improves the sensitivity by ≈33 times. SLD-PAM can visualize microvessels and quantify oxygen saturation in vivo with ≈1% of the maximum permissible exposure, dramatically reducing potential phototoxicity or perturbation to normal tissue function, especially in imaging of delicate tissues, such as the eye and the brain. Capitalizing on the high sensitivity, direct imaging of deoxyhemoglobin concentration is achieved without spectral unmixing, avoiding wavelength-dependent errors and computational noises. With reduced laser power, SLD-PAM can reduce photobleaching by ≈85%. It is also demonstrated that SLD-PAM achieves similar molecular imaging quality using 80% fewer contrast agents. Therefore, SLD-PAM enables the use of a broader range of low-absorbing nano-agents, small molecules, and genetically encoded biomarkers, as well as more types of low-power light sources in wide spectra. It is believed that SLD-PAM offers a powerful tool for anatomical, functional, and molecular imaging.