Ex Vivo Perfusion-Simulation Measurements of Microbubbles as a Scattering Contrast Agent for Grating-Based X-Ray Dark-Field Imaging

Developing a Microbubble-Based Contrast Agent for Synchrotron Multiple-Image Radiography

PURPOSE

Multiple-image radiography (MIR) is an analyzer-based synchrotron X-ray imaging approach capable of dissociating absorption, refraction, and scattering components of X-ray interaction with the material. It generates additional image contrast mechanisms (besides absorption), especially in the case of soft tissues, while minimizing absorbed radiation dose. Our goal is to develop a contrast agent for MIR using ultrasound microbubbles by carrying out a systematic assessment of size, shell material, and concentration.

PROCEDURES

Microbubbles were synthesized with two different shell materials: phospholipid and polyvinyl-alcohol. Polydisperse perfluorobutane-filled lipid microbubbles were divided into five size groups using centrifugation. Two distributions of air-filled polymer microbubbles were generated: 2-3 µm and 3-4 µm. A subset of polymer microbubbles 3-4 µm had iron oxide nanoparticles incorporated into their shell or coated on their surface. Microbubbles were immobilized in agar with different concentrations: 5 × 10⁷, 5 × 10⁶, and 5 × 10⁵ MBs/ml. MIR was conducted on the BioMedical Imaging and Therapy beamline at the Canadian Light Source. Three images were generated: Gaussian amplitude, refraction, and ultra-small-angle X-ray scattering (USAXS). The contrast signal was quantified by measuring mean pixel values and comparing them with agar.

RESULTS

No difference was detected in absorption or refraction images of all tested microbubbles. Using USAXS, a significant signal increase was observed with lipid microbubbles 6-10 µm at the highest concentration (p = 0.02), but no signal was observed at lower concentrations.

CONCLUSIONS

These data indicate that lipid microbubbles 6-10 µm are candidates as contrast agents for MIR, specifically for USAXS. A minimum concentration of 5 × 10⁷ microbubbles (lipid-shell 6-10 µm) per milliliter was needed to generate a detectable signal.

Phase retrieval-based phase-contrast CT for vascular imaging with microbubble contrast agent

PURPOSE

The introduction of microbubble contrast agent into tissues can create significant phase shifts. Phase retrieval (PR)-based phase-contrast computed tomography (PCCT) is an imaging method for retrieving and reconstructing the phase shifts within an object. This study aimed to evaluate the feasibility of PR-based PCCT with microbubble contrast agent for vascular imaging.

METHODS

Projection phase-contrast images of individual microbubbles and a cluster of microbubbles were captured and compared. Contrast enhancement from microbubbles was evaluated by comparing to the gold standard iodine-based contrast agent in vitro. The arterial systems of 14 Sprague-Dawley rats were perfused with microbubbles or saline. The rat hearts and the arterial systems were excised and imaged ex vivo. CT imaging was performed at the energy of 22 keV. PR was performed using the phase-attenuation duality (PAD) method with different δ/β values (PAD property). The contrast-to-noise ratio (CNR) was used for quantitatively assessing the contrast enhancement.

RESULTS

Individual microbubbles functioned as a lens to focus the x rays, whereas, a cluster of microbubbles scattered the x rays. In the in vitro experiment, the contrast enhancement from iodine was significantly greater than that from microbubbles (P < 0.05). In the heart samples, the CNRs for microbubbles on PR-based PCCT were significantly greater than those on absorption-contrast CT (ACCT) and PR-free PCCT (both P < 0.001). The CNRs for microbubbles were also significantly greater than those for saline on PR-based PCCT in the samples (P < 0.001). Although they provided weaker contrast enhancement than that from iodine, microbubbles could still provide sufficient contrast enhancement to clearly show the 3D architecture of rat aortas and their main branches.

CONCLUSION

The imaging modality can currently be used as a complement or alternative to absorption-based microCT for imaging vessels in biological samples.

Imaging characteristics of intravascular spherical contrast agents for grating-based x-ray dark-field imaging – effects of concentrations, spherical sizes and applied voltage

This study investigates the x-ray scattering characteristics of microsphere particles in x-ray-grating-based interferometric imaging at different concentrations, bubble sizes and tube voltages (kV). Attenuation (ATI), dark-field (DFI) and phase-contrast (PCI) images were acquired. Signal-to-noise (SNR) and contrast-to-noise ratios with water (CNRw) and air as reference (CNRa) were determined. In all modalities, a linear relationship between SNR and microbubbles concentration, respectively, microsphere size was found. A significant gain of SNR was found when varying kV. SNR was significantly higher in DFI and PCI than ATI. The highest gain of SNR was shown at 60 kV for all media in ATI and DFI, at 80 kV for PCI. SNR for all media was significantly higher compared to air and was slightly lower compared to water. A linear relationship was found between CNRa, CNRw, concentration and size. With increasing concentration and decreasing size, CNRa and CNRw increased in DFI, but decreased in PCI. Best CNRa and CNRw was found at specific combination of kV and concentration/size. Highest average CNRa and CNRw was found for microspheres in ATI and PCI, for microbubbles in DFI. Microspheres are a promising contrast-media for grating-based-interferometry, if kV, microsphere size and concentration are appropriately combined.

Developing a Microbubble-Based Contrast Agent for Synchrotron In-Line Phase Contrast Imaging

OBJECTIVE

X-ray phase contrast imaging generates contrast from refraction of X-rays, enhancing soft tissue contrast compared to conventional absorption-based imaging. Our goal is to develop a contrast agent for X-ray in-line phase contrast imaging (PCI) based on ultrasound microbubbles (MBs), by assessing size, shell material, and concentration.

METHODS

Polydisperse perfluorobutane-core lipid-shelled MBs were synthesized and size separated into five groups between 1 and 10 μm. We generated two size populations of polyvinyl-alcohol (PVA)-MBs, 2-3 μm and 3-4 μm, whose shells were either coated or integrated with iron oxide nanoparticles (SPIONs). Microbubbles were then embedded in agar at three concentrations: 5 × 10⁷, 5 × 10⁶ and 5 × 10⁵ MBs/ml. In-line phase contrast imaging was performed at the Canadian Light Source with filtered white beam micro-computed tomography. Phase contrast intensity was measured by both counting detectable MBs, and comparing mean pixel values (MPV) in minimum and maximum intensity projections of the overall samples.

RESULTS

Individual lipid-MBs 6-10 μm, lipid-MBs 4-6 μm and PVA-MBs coated with SPIONs were detectable at each concentration. At the highest concentration, lipid-MBs 6-10 μm and 4-6 μm showed an overall increase in positive contrast, whereas at a moderate concentration, only lipid-MBs 6-10 μm displayed an increase. Negative contrast was also observed from two largest lipid-MBs at high concentration.

CONCLUSION

These data indicate that lipid-MBs larger than 4 μm are candidates for PCI, and 5 × 10⁶ MBs/ml may be the lowest concentration suitable for generating visible phase contrast in vivo.

SIGNIFICANCE

Identifying a suitable MB for PCI may facilitate future clinical translation.

Microbubbles as a contrast agent in grating interferometry mammography: an ex vivo proof-of-mechanism study

Grating interferometry mammography (GIM) is an experimental breast imaging method at the edge of being clinically implemented. Besides attenuation, GIM can measure the refraction and scattering of x-rays resulting in differential phase contrast (DPC) and dark-field (DF) images. In this exploratory study, we assessed the feasibility of using microbubbles as a contrast agent in GIM. Two millilitres of microbubbles and iodine were respectively injected into ex vivo breast phantoms, consisting of fresh chicken breasts. Native and postcontrast images were acquired with a clinically compatible GIM setup, operated at 38 kVp, 14-s acquisition time, and with a dose of 1.3 mGy. The visibility of the contrast agents was analysed in a side-by-side comparison by three radiologists. The contrast-to-noise-ratio (CNR) was calculated for each contrast agent. We found that both contrast agents were judged to be visible by the readers. The mean CNR was 3.1 ± 1.9 for microbubbles in DF and 24.2 ± 6.5 for iodine in attenuation. In conclusion, this is a first proof-of-mechanism study that microbubbles could be used as a contrast agent in clinically compatible GIM, due to their scattering properties, which implies the potential use of a contrast agent with a high safety profile in x-ray-based breast imaging.

Implementation of a Talbot-Lau interferometer in a clinical-like c-arm setup: A feasibility study

X-ray grating-based phase-contrast imaging has raised interest regarding a variety of potential clinical applications, whereas the method is feasible using a medical x-ray tube. Yet, the transition towards a clinical setup remains challenging due to the requirement of mechanical robustness of the interferometer and high demands applying to medical equipment in clinical use. We demonstrate the successful implementation of a Talbot-Lau interferometer in an interventional c-arm setup. The consequence of vibrations induced by the rotating anode of the tube is discussed and the prototype is shown to provide a visibility of 21.4% at a tube voltage of 60 kV despite the vibrations. Regarding clinical application, the prototype is mainly set back due to the limited size of the field of view covering an area of 17 mm × 46 mm. A c-arm offers the possibility to change the optical axis according to the requirements of the medical examination. We provide a method to correct for artifacts that result from the angulation of the c-arm. Finally, the images of a series of measurements with the c-arm in different angulated positions are shown. Thereby, it is sufficient to perform a single reference measurement in parking position that is valid for the complete series despite angulation.

Simultaneous wood and metal particle detection on dark-field radiography

Background

Currently, the detection of retained wood is a frequent but challenging task in emergency care. The purpose of this study is to demonstrate improved foreign-body detection with the novel approach of preclinical X-ray dark-field radiography.

Methods

At a preclinical dark-field x-ray radiography, setup resolution and sensitivity for simultaneous detection of wooden and metallic particles have been evaluated in a phantom study. A clinical setting has been simulated with a formalin fixated human hand where different typical foreign-body materials have been inserted. Signal-to-noise ratios (SNR) have been determined for all test objects.

Results

On the phantom, the SNR value for wood in the dark-field channel was strongly improved by a factor 6 compared to conventional radiography and even compared to the SNR of an aluminium structure of the same size in conventional radiography. Splinters of wood < 300 μm in diameter were clearly detected on the dark-field radiography. Dark-field radiography of the formalin-fixated human hand showed a clear signal for wooden particles that could not be identified on conventional radiography.

Conclusions

x-ray dark-field radiography enables the simultaneous detection of wooden and metallic particles in the extremities. It has the potential to improve and simplify the current state-of-the-art foreign-body detection.

Ex Vivo Assessment of Coronary Atherosclerotic Plaque by Grating-Based Phase-Contrast Computed Tomography: Correlation With Optical Coherence Tomography

OBJECTIVES

The aim of this study was to determine the diagnostic accuracy of grating-based phase-contrast computed tomography (gb-PCCT) to classify and quantify coronary vessel characteristics in comparison with optical coherence tomography (OCT) and histopathology in an ex vivo setting.

MATERIALS AND METHODS

After excision from 5 heart specimens, 15 human coronary arteries underwent gb-PCCT examination using an experimental imaging setup consisting of a rotating molybdenum anode x-ray tube, a Talbot-Lau grating interferometer, and a single photon counting detector. Subsequently, all vessels were imaged by OCT and histopathologically processed. Optical coherence tomography, gb-PCCT, and histopathology images were manually matched using anatomical landmarks. Optical coherence tomography and gb-PCCT were reviewed by 2 independent observers blinded to histopathology. Vessel, lumen, and plaque area were measured, and plaque characteristics (lipid rich, calcified, and fibrous) were determined for each section. Measures of diagnostic accuracy were derived, applying histopathology as the standard of reference.

RESULTS

Of a total of 286 assessed cross sections, 241 corresponding sections were included in the statistical analysis. Quantitative measures derived from gb-PCCT were significantly higher than from OCT (P < 0.001) and were strongly correlated with histopathology (Pearson r ≥0.85 for gb-PCCT and ≥0.61 for OCT, respectively). Results of Bland-Altman analysis demonstrated smaller mean differences between OCT and histopathology than for gb-PCCT and histopathology. Limits of agreement were narrower for gb-PCCT with regard to lumen area, for OCT with regard to plaque area, and were comparable with regard to vessel area. Based on histopathology, 228/241 (94.6%) sections were classified as fibrous, calcified, or lipid rich. The diagnostic accuracy of gb-PCCT was excellent for the detection of all plaque components (sensitivity, ≥0.95; specificity, ≥0.94), whereas the results for OCT showed sensitivities of ≥0.73 and specificities of ≥0.66.

CONCLUSIONS

In this ex vivo setting, gb-PCCT provides excellent results in the assessment of coronary atherosclerotic plaque characteristics and vessel dimensions in comparison to OCT and histopathology. Thus, the technique may serve as adjunct nondestructive modality for advanced plaque characterization in an experimental setting.

X-ray Dark-field Radiography - In-Vivo Diagnosis of Lung Cancer in Mice

Accounting for about 1.5 million deaths annually, lung cancer is the prevailing cause of cancer deaths worldwide, mostly associated with long-term smoking effects. Numerous small-animal studies are performed currently in order to better understand the pathogenesis of the disease and to develop treatment strategies. Within this letter, we propose to exploit X-ray dark-field imaging as a novel diagnostic tool for the detection of lung cancer on projection radiographs. Here, we demonstrate in living mice bearing lung tumors, that X-ray dark-field radiography provides significantly improved lung tumor detection rates without increasing the number of false-positives, especially in the case of small and superimposed nodules, when compared to conventional absorption-based imaging. While this method still needs to be adapted to larger mammals and finally humans, the technique presented here can already serve as a valuable tool in evaluating novel lung cancer therapies, tested in mice and other small animal models.

Potential use of microbubbles (MBs) as contrast material in x-ray dark field (DF) imaging: How does the DF signal change with the characteristic parameters of the MBs?

One of the most exciting aspects of the grating based x-ray differential phase contrast (DPC) acquisition method is the concurrent generation of the so-called dark field (DF) signal, along with the classical absorption signal and the novel DPC signal. The DF signal is associated with local distribution of small angle scatterers in an image object, while the absorption signal and DPC signal are often used to characterize the relatively uniform structure of the image object. Besides the endogenous image contrast, exogenous contrast media are often used in x-ray imaging to locally enhance the image signal. This paper proposes a potential contrast medium for DF signal enhancement: microbubbles (MBs). MBs have already been developed for clinical use in ultrasound imaging, and recent experimental studies have shown that MBs may also enhance the DF signal, although it remained unclear how the physical characteristics of the MBs quantitatively impact the DF signal. In this paper, a systematic study was performed to investigate the quantitative relationships between the DF signal and the following properties of MBs: size, concentration, shell thickness, size uniformity, and whether gold nanoparticles were attached. The experimental results demonstrated that, an increased MB size (about 4 microns) may generate a stronger DF signal for our DPC imaging system; additionally, a moderately increased shell thickness and the use of gold nanoparticles on the shell surface also resulted in further enhancement of the DF signal. These findings may provide critical information needed for using MBs as the contrast agent of x-ray DF imaging.