Intraoperative Echocardiography: Guide to Decision-Making

PURPOSE OF REVIEW

This review aims to provide a concise overview of key recommendations, with a specific focus on common challenges faced by intraoperative echocardiographers when dealing with frequently encountered valvular pathologies and mechanical circulatory support. It offers valuable insights for medical practitioners in this field.

RECENT FINDINGS

The American Society of Echocardiography (ASE) and the American College of Cardiology/American Heart Association (ACC/AHA) have released updated comprehensive guidelines for the use of transesophageal echocardiography (TEE) for the assessment of cardiac structures and implanted devices to help guide intraoperative decision-making. Transesophageal echocardiography (TEE) is a regularly employed intraoperative diagnostic and monitoring tool, offering various modalities for the rapid evaluation of valvular and aortic pathology, hemodynamic disturbances, and cardiac function. It is particularly valuable in assessing and placing mechanical circulatory support (MCS) devices, providing views often challenging to obtain through transthoracic echocardiography. Additionally, intraoperative TEE can be used for decision-making in patients with valvular disease allowing incorporation of patient-specific and situational factors. Echocardiographers can employ this information in real-time to help guide surgical treatment selection such as repair, replacement, or deferral of intervention.

Assessment of the cardiac output at rest and during exercise stress using real-time cardiovascular magnetic resonance imaging in HFpEF-patients

This methodological study aimed to validate the cardiac output (CO) measured by exercise-stress real-time phase-contrast cardiovascular magnetic resonance imaging (CMR) in patients with heart failure and preserved ejection fraction (HFpEF). 68 patients with dyspnea on exertion (NYHA ≥ II) and echocardiographic signs of diastolic dysfunction underwent rest and exercise stress right heart catheterization (RHC) and CMR within 24 h. Patients were diagnosed as overt HFpEF (pulmonary capillary wedge pressure (PCWP) ≥ 15mmHg at rest), masked HFpEF (PCWP ≥ 25mmHg during exercise stress but < 15mmHg at rest) and non-cardiac dyspnea. CO was calculated using RHC as the reference standard, and in CMR by the volumetric stroke volume, conventional phase-contrast and rest and stress real-time phase-contrast imaging. At rest, the CMR based CO showed good agreement with RHC with an ICC of 0.772 for conventional phase-contrast, and 0.872 for real-time phase-contrast measurements. During exercise stress, the agreement of real-time CMR and RHC was good with an ICC of 0.805. Real-time measurements underestimated the CO at rest (Bias:0.71 L/min) and during exercise stress (Bias:1.4 L/min). Patients with overt HFpEF had a significantly lower cardiac index compared to patients with masked HFpEF and with non-cardiac dyspnea during exercise stress, but not at rest. Real-time phase-contrast CO can be assessed with good agreement with the invasive reference standard at rest and during exercise stress. While moderate underestimation of the CO needs to be considered with non-invasive testing, the CO using real-time CMR provides useful clinical information and could help to avoid unnecessary invasive procedures in HFpEF patients.

Ratiometric fluorescent biosensor for detection and real-time imaging of nitric oxide in mitochondria of living cells

Nitric oxide (NO), a ubiquitous gaseous messenger, plays critical roles in various pathological and physiological progresses. The abnormal levels of NO in organisms are closely related to a large number of maladies. Mitochondria are the main area that produce NO in mammalian cells. Thus, detecting and real-time imaging of NO in mitochondria is of great significance for exploring the biological functions of NO. Herein, a ratiometric fluorescent biosensor (Mito-GNP-pNO520) is developed for sensitive and selective detection and real-time imaging of NO in mitochondria of living cells. The detection is achieved through the fluorescence off-on response of Mito-GNP-pNO520 toward NO. This biosensor shows excellent characteristics, such as high sensitivity toward NO with a low detection limit of 0.25 nM, exclusive selectivity to NO without interference from other substances, good biological stability and low cytotoxicity. More importantly, the biosensor is specifically located in mitochondria, enabling the detection and real-time imaging of endogenous and exogenous NO in mitochondria of living cells. Therefore, our biosensor offers a new approach for dynamic detecting and real-time imaging of NO in subcellular organelles, providing an opportunity to explore new biological effects of NO.

The future of cardiovascular magnetic resonance: All-in-one vs. real-time (Part 1)

Cardiovascular magnetic resonance (CMR) protocols can be lengthy and complex, which has driven the research community to develop new technologies to make these protocols more efficient and patient-friendly. Two different approaches to improving CMR have been proposed, specifically "all-in-one" CMR, where several contrasts and/or motion states are acquired simultaneously, and "real-time" CMR, in which the examination is accelerated to avoid the need for breathholding and/or cardiac gating. The goal of this two-part manuscript is to describe these two different types of emerging rapid CMR. To this end, the vision of each is described, along with techniques which have been devised and tested along the pathway of clinical implementation. The pros and cons of the different methods are presented, and the remaining open needs of each are detailed. Part 1 will tackle the "all-in-one" approaches, and Part 2 the "real-time" approaches along with an overall summary of these emerging methods.

The future of CMR: All-in-one vs. real-time CMR (Part 2)

Cardiac Magnetic Resonance (CMR) protocols can be lengthy and complex, which has driven the research community to develop new technologies to make these protocols more efficient and patient-friendly. Two different approaches to improving CMR have been proposed, specifically "all-in-one" CMR, where several contrasts and/or motion states are acquired simultaneously, and "real-time" CMR, in which the examination is accelerated to avoid the need for breathholding and/or cardiac gating. The goal of this two-part manuscript is to describe these two different types of emerging rapid CMR protocols. To this end, the vision of all-in-one and real-time imaging are described, along with techniques which have been devised and tested along the pathway of clinical implementation. The pros and cons of the different methods are presented, and the remaining open needs of each are detailed. Part 1 tackles the "All-in-One" approaches, and Part 2 focuses on the "Real-Time" approaches along with an overall summary of these emerging methods.

Altered anterograde axonal transport of mitochondria in cultured striatal neurons of a knock-in mouse model of Huntington's disease

Huntington's disease (HD) is a progressive genetic neurodegenerative disease caused by an abnormal expansion of a cytosine-adenine-guanine trinucleotide repeat in the huntingtin gene. One pathological feature of HD is neuronal loss in the striatum. Despite many efforts, mechanisms underlying neuronal loss in HD striatum remain elusive. It was suggested that the mutant huntingtin protein interacts mitochondrial proteins and causes mitochondrial dysfunction in striatal neurons. However, whether axonal transport of mitochondria is altered in HD striatal neurons remains controversial. Here, we examined axonal transport of single mitochondria labelled with Mito-DsRed2 in cultured striatal neurons of zQ175 knock-in mice (a knock-in mouse model of HD). We observed decreased anterograde axonal transport of proximal mitochondria in HD striatal neurons compared with wild-type (WT) striatal neurons. Decreased anterograde transport in HD striatal neurons was prevented by overexpressing mitochondrial Rho GTPase 1 (Miro1). Our results offer a new insight into mechanisms underlying neuronal loss in the striatum in HD.

Real-Time Cell Cycle Imaging in a 3D Cell Culture Model of Melanoma, Quantitative Analysis, Optical Clearing, and Mathematical Modeling

Aberrant cell cycle progression is a hallmark of solid tumors. Therefore, cell cycle analysis is an invaluable technique to study cancer cell biology. However, cell cycle progression has been most commonly assessed by methods that are limited to temporal snapshots or that lack spatial information. In this chapter, we describe a technique that allows spatiotemporal real-time tracking of cell cycle progression of individual cells in a multicellular context. The power of this system lies in the use of 3D melanoma spheroids generated from melanoma cells engineered with the fluorescent ubiquitination-based cell cycle indicator (FUCCI). This technique, combined with mathematical modeling, allows us to gain further and more detailed insight into several relevant aspects of solid cancer cell biology, such as tumor growth, proliferation, invasion, and drug sensitivity.

First experience with real-time magnetic resonance imaging-based investigation of respiratory influence on cardiac function in pediatric congenital heart disease patients with chronic right ventricular volume overload

BACKGROUND

Congenital heart disease (CHD) is often associated with chronic right ventricular (RV) volume overload. Real-time magnetic resonance imaging (MRI) enables the analysis of cardiac function during free breathing.

OBJECTIVE

To evaluate the influence of respiration in pediatric patients with CHD and chronic RV volume overload.

METHODS AND MATERIALS

RV volume overload patients (n=6) and controls (n=6) were recruited for cardiac real-time MRI at 1.5 tesla during free breathing. Breathing curves from regions of interest reflecting the position of the diaphragm served for binning images in four different tidal volume classes, each in inspiration and expiration. Tidal volumes were estimated from these curves by data previously obtained by magnetic resonance-compatible spirometry. Ventricular volumes indexed to body surface area and Frank-Starling relationships referenced to the typical tidal volume indexed to body height (TTVi) were compared.

RESULTS

Indexed RV end-diastolic volume (RV-EDVi) and indexed RV stroke volume (RV-SVi) increased during inspiration (RV-EDVi/TTVi: RV load: + 16 ± 4%; controls: + 22 ± 13%; RV-SVi/TTVi: RV load: + 21 ± 6%; controls: + 35 ± 17%; non-significant for comparison). The increase in RV ejection fraction during inspiration was significantly lower in RV load patients (RV load: + 1.1 ± 2.2%; controls: + 6.1 ± 1.5%; P=0.01). The Frank-Starling relationship of the RV provided a significantly reduced slope estimate in RV load patients (inspiration: RV load: 0.75 ± 0.11; controls: 0.92 ± 0.02; P=0.02).

CONCLUSION

In pediatric patients with CHD and chronic RV volume overload, cardiac real-time MRI during free breathing in combination with respiratory-based binning indicates an impaired Frank-Starling relationship of the RV.

Dual-targeted transferrin and AS1411 aptamer conjugated micelles for improved therapeutic efficacy and imaging of brain cancer

Brain tumors represent an aggressive form of cancer, posing significant challenges in achieving complete remission. Development of advanced therapies is crucial for improving clinical outcomes in cancer patients. This study aimed to create a novel treatment approach using dual-targeted transferrin (TF) and AS1411 conjugated micelles, designed to enhance therapeutic effectiveness of docetaxel (DTX) and facilitate gadolinium (Gd) based imaging in brain cancer. Micelles were prepared using a slightly modified solvent-casting method, and the dual-targeting ligands were attached to the micelle's surface through a physical adsorption process. Average particle size of micelles ranged from 117.49 ± 3.90-170.38 ± 3.39 nm, with a low polydispersity index. Zeta potential ranged from - 1.5 ± 0.02 to - 18.7 ± 0.04 mV. Encapsulation efficiency of DTX in micelles varied from 92.64 ± 4.22-79.77 ± 4.13 %. Simultaneously, encapsulation of Gd in micelles was found to be 48.27 ± 3.18-58.52 ± 3.17, respectively. In-vitro drug release studies showed a biphasic sustained release profile, with DTX and Gd release continuing up to 72 h with their t50 % at 4.95, 11.29, and 24.14 h for GDTP, GDTP-TF and GDTP-TF-AS1411 micelles, respectively. Cytotoxicity effect of GDTP-TF-AS1411 micelles has shown significant improvement (P < 0.001) and reduced IC50 value up to 0.19 ± 0.14 μg/ml compared to Taxotere® (2.73 ± 0.73 μg/ml). Theranostic study revealed higher accumulation of GDTP-TF and GDTP-TF-AS1411 micelles free GD treated animal brains. The AUC of GDTP-TF-AS1411 micelles exhibited 23.79 ± 17.82 μg.h/ml higher than Taxotere® (14.14 ± 10.59 μg.h/ml). These findings direct enhanced effectiveness in brain cancer therapy leading to improved therapeutics in brain cancer patients. The combined targeted ligands and therapeutic agents strategy can direct advancement in brain cancer therapy and offer improved therapy for patients.

Logic gate controlled theranostic nanoagents for in situ microwave thermal therapeutic efficacy evaluation

In vivo monitoring of treatment response is of great significance for tumor therapy in clinical trials, but it remains a formidable challenge. Herein, we demonstrate a logic AND gate theranostic nanoagent that responds to the coexistence of endogenous and exogenous stimuli, namely HAuCl4@1-Tetradecanol@Gd-based metal-organic framework@SiO2 nanocomposites (APGS NCs). Upon microwave (MW) irradiation, HAuCl4 in the inner part of APGS NCs reacts with the tumor-associated glutathione (GSH). Subsequently, it transforms into an active luminescent form of Au@1-Tetradecanol@Gd-MOF@SiO2 nanocomposites (AuPGS NCs). The intensity of generated fluorescence is correlated with the tumor thermal-injury status. Thus, the generation of AuPGS NCs with high intensity fluorescence under the co-activation of MW and GSH can visualize the treatment effects during MW thermal therapy and instantly modulate the irradiation time and range for optimal outcomes. Hence, this logic gate controlled APGS NCs makes MW thermal therapy eliminate tumor cells completely. This research offers an effective strategy for the design and preparation of activatable theranostic nanoagents for precise tumor imaging and therapy.

Real-time monitoring of endogenous cysteine in LPS-induced oxidative stress process with a novel lysosome-targeted fluorescent probe

Cysteine (Cys), one of essential small-molecule-based biothiols in the human body, contributes to the regulation of redox reactions and is closely associated with many physiological and pathological metabolic processes. Herein, a novel fluorescent probe, hydroxyphenyl-conjugated benzothiazole (HBT-Cys) capable of detecting Cys was constructed, where acrylate served as the recognition group and hydroxyphenyl-linked benzothiazole acted as the fluorophore. The fluorescence of the probe was negligible in the absence of Cys, and an intense blue fluorescence was observed upon addition of Cys. The Cys-sensing mechanism could be ascribed to the Cys-involved hydrolysis reaction with acrylate, leading to light up the emission at 430 nm with about 80-fold enhancement. In addition, HBT-Cys exhibited a fast response time, remarkable selectivity and low detection limit. HBT-Cys also worked well in real-time monitoring of Cys in three different food samples (wolfberry, hawthorn, and red dates). Importantly, our probe had an excellent lysosomes-targeted ability, which was successfully employed to real-time visualize the fluctuation of both exogenous and endogenous Cys in living cells and zebrafish under lipopolysaccharide (LPS)-induced oxidative stress. Hopefully, the work shown here provides a potent candidate for the real-time tracking of Cys fluctuations in various biological samples.

Real-Time and Delayed Imaging of Tissue and Effects of Prostate Tissue Ablation

PURPOSE OF REVIEW

Prostate ablation is increasingly being utilized for the management of localized prostate cancer. There are several energy modalities with varying mechanism of actions which are currently used for prostate ablation. Prostate ablations, whether focal or whole gland, are performed under ultrasound and/or MRI guidance for appropriate treatment plan execution and monitoring. A familiarity with different intraoperative imaging findings and expected tissue response to these ablative modalities is paramount. In this review, we discuss the intraoperative, early, and delayed imaging findings in prostate from the effects of prostate ablation.

RECENT FINDINGS

The monitoring of ablation both during and after the therapy became increasingly important due to the precise targeting of the target tissue. Recent findings suggest that real-time imaging techniques such as MRI or ultrasound can provide anatomical and functional information, allowing for precise ablation of the targeted tissue and increasing the effectiveness and precision of prostate cancer treatment. While intraprocedural imaging findings are variable, the follow-up imaging demonstrates similar findings across various energy modalities. MRI and ultrasound are two of the frequently used imaging techniques for intraoperative monitoring and temperature mapping of important surrounding structures. Follow-up imaging can provide valuable information about ablated tissue, including the success of the ablation, presence of residual cancer or recurrence after the ablation. It is critical and helpful to understand the imaging findings during the procedure and at different follow-up time periods to evaluate the procedure and its outcome.

APELLA: Open-Source, miniaturized All-in-One powered Lab-on-a-Disc platform

We present an unconventional approach to a common Lab-on-a-Disc (LoD) that combines a quadcopter propulsion system, a miniaturized 2.4 GHz Wi-Fi spy camera, 9.74 Watt Qi wireless power, and an Arduino into an open-source, miniaturized All-in-one powered lab-on-disc platform (APELLA). The quadcopter propulsion generates thrust to rotate (from 0.1 to 24.5 Hz) or shake the LoD device, while the spy camera enables a real-time (30 frames per second) and high definition (1280 × 720 pixels) visualization of microfluidic channels without requiring a bulky and heavy stroboscopic imaging setup. A mobile device can communicate with an Arduino microcontroller inside the APELLA through a Bluetooth interface for closed loop and sequential frequency control. In a proof-of-concept study, the APELLA achieved comparable mixing efficiency to a traditional spin stand and can capture rapid microfluidic events at low rotational frequencies (<5Hz). The APELLA is low-cost (c.a. 100 Euro), compact (15.6 × 15.6 × 10 cm³), lightweight (0.59 kg), portable (powered by a 5 V USB power bank), and energy efficient (uses < 6% power of the conventional system), making it ideal for field deployment, education, resource-limited labs.

Low-field 0.55 T MRI evaluation of the fetus

Fetal magnetic resonance imaging (MRI) is an important adjunct modality for the evaluation of fetal abnormalities. Recently, low-field MRI systems at 0.55 Tesla have become available which can produce images on par with 1.5 Tesla systems but with lower power deposition, acoustic noise, and artifact. In this article, we describe a technical innovation using low-field MRI to perform diagnostic quality fetal MRI.

Radical nucleophilic substitution/cyclization: A novel strategy for selective and ultrafast fluorescence imaging of cysteine levels in ferroptosis process

Diphenylisoindolo[2,1-a]quinoline can be used to detect cysteine among homocysteine, glutathione, and other 19 natural amino acids. Unlike other reported probes, the response mechanism involves sulfhydryl radical nucleophilic substitution and cyclization, and thus the differences in ring-formation kinetics enable high selectivity. After treated with Cys, the response process was completed rapidly and the maximum fluorescence intensity (at 496 nm) was reached extremely fast (<1 s) when excited at 380 nm in MeCN-PBS buffer (10.0 mM, pH = 7.4, 3:7 (v/v)). The quantum yield after the reaction was increased almost 7 times to be 0.02 from 0.003. Fluorescence intensity displayed a good quantitative linear relationship in the range 1-10 μM Cys with a detection limit of 270 nM. Furthermore, the probe was demonstrated for real-time monitoring of intracellular cysteine levels within HepG2 cells in ferroptosis process.

Quantitative Analysis of Nuclear Poly(ADP-Ribose) Dynamics in Response to Laser-Induced DNA Damage

Poly(ADP-ribose) (PAR), catalyzed by members of the poly(ADP-ribose) polymerase family of enzymes, is a posttranslational modification with a critical role in most mechanisms of DNA repair. Upon activation of poly(ADP-ribose) polymerase isoforms 1 and 2 (PARP-1 and PARP-2), the proteins of the base excision repair (BER) and single-strand break repair (SSBR) pathways form DNA lesion-dependent, transient complexes to facilitate repair. PAR is central to the temporal dynamics of BER/SSBR complex assembly and disassembly. To enhance cellular PAR analysis, we developed LivePAR, a fluorescently tagged PAR-binding fusion protein and genetically encoded imaging probe for live cell, quantitative analysis of PAR in mammalian cells. LivePAR has the advantage that it enables real-time imaging of PAR formation in cells and significantly overcomes limitations of immunocytochemistry for PAR analysis. This chapter describes the protocols needed to develop cells expressing LivePAR or EGFP-tagged BER proteins and to evaluate laser-induced formation of PAR and comparison to the assembly of the BER proteins XRCC1 and DNA polymerase-β.

Confocal Scanning Laser Ophthalmoscopy to Image Retinal Ganglion Cells in Real-Time

Real-time imaging of retinal ganglion cells (RGCs) provides an opportunity for detailed investigation of retinal development, disease mechanisms, and the evaluation of interventions affecting ocular structures. Here we use a transgenic model to describe a step-by-step protocol for visualizing RGC survival in real-time by using confocal scanning laser ophthalmoscopy (cSLO).

Single-shot multi-parametric mapping based on multiple overlapping-echo detachment (MOLED) imaging

Multi-parametric quantitative magnetic resonance imaging (mqMRI) allows the characterization of multiple tissue properties non-invasively and has shown great potential to enhance the sensitivity of MRI measurements. However, real-time mqMRI during dynamic physiological processes or general motions remains challenging. To overcome this bottleneck, we propose a novel mqMRI technique based on multiple overlapping-echo detachment (MOLED) imaging, termed MQMOLED, to enable mqMRI in a single shot. In the data acquisition of MQMOLED, multiple MR echo signals with different multi-parametric weightings and phase modulations are generated and acquired in the same k-space. The k-space data is Fourier transformed and fed into a well-trained neural network for the reconstruction of multi-parametric maps. We demonstrated the accuracy and repeatability of MQMOLED in simultaneous mapping apparent proton density (APD) and any two parameters among T₂, T₂*, and apparent diffusion coefficient (ADC) in 130-170 ms. The abundant information delivered by the multiple overlapping-echo signals in MQMOLED makes the technique potentially robust to system imperfections, such as inhomogeneity of static magnetic field or radiofrequency field. Benefitting from the single-shot feature, MQMOLED exhibits a strong motion tolerance to the continuous movements of subjects. For the first time, it captured the synchronous changes of ADC, T₂, and T₁-weighted APD in contrast-enhanced perfusion imaging on patients with brain tumors, providing additional information about vascular density to the hemodynamic parametric maps. We expect that MQMOLED would promote the development of mqMRI technology and greatly benefit the applications of mqMRI, including therapeutics and analysis of metabolic/functional processes.

Constructing turn-on bioluminescent probes for real-time imaging of reactive oxygen species during cisplatin chemotherapy

Real-time imaging of reactive oxygen species (ROS) during cisplatin chemotherapy of cancer is imperative to fully reveal their functions in the biological response to cisplatin. Currently, using a bioluminescent probe for real-time imaging of a specific ROS in vivo during cisplatin chemotherapy has not been achieved. Herein, three bioluminescent probes, F Probe, N Probe and P Probe were synthesized for real-time imaging of the primary ROS, O₂^•-. They all consisted of a bioluminescent emitter _D-luciferin (_D-LH₂) and an O₂^•--recognition group, and their bioluminescent signal could be turned on in response to O₂^•-. In vitro results indicated that P Probe was the most suitable one among the three probes for detection of O₂^•-, with high sensitivity, excellent selectivity and stability. P Probe was then successfully applied for real-time imaging of O₂^•- in both cancer cells and tumors during cisplatin chemotherapy. The imaging results demonstrated that O₂^•- amount in cancer cells increased with the increasing dose of cisplatin, and that cisplatin-induced upregulation of O₂^•- level in cancer cells was upstream of the cancer-killing pathway of cisplatin. We envision that P Probe may serve as an elucidative tool to further explore the role of O₂^•- in cisplatin chemotherapy.

Hypoxia responsive and tumor-targeted mixed micelles for enhanced cancer therapy and real-time imaging

Most chemotherapy agents have serious side effects due to lack of tumor targeting, which affects their clinical application. In addition, as an essential characteristic of malignant tumor, hypoxia is attracting exclusive research focus regarding its non-invasive real-time tracing in novel targeting delivery system. Herein, we designed a mixed micelle with tumor targeting and hypoxia responsiveness for tumor therapy and imaging. In particular, the dual-modified mix micelles were self-assembled by folic acid (FA) and 2-(2-nitroimidazole) ethylamine (NI) conjugated polymers, in which paclitaxel (PTX) and quantum dots (QDs) were co-loaded into the hydrophobic core. The drug loaded micelles showed satisfactory drug encapsulation, good storage stability, and sustained release properties. In vitro cell experiments showed that the mixed micelles exhibited enhanced cytotoxic effect and improved the cellular uptake, especially under hypoxic conditions, which was due to the FA mediated active targeting effect and NI induced hypoxic responsive release. In vivo experiments further proved that the mixed micelles possessed outstanding tumor targeting and hypoxia responsive properties. Furthermore, the drug loaded micelles showed excellent anti-tumor effect and can realize real-time in vivo imaging. This work demonstrates that the dual-modified mixed micelles co-loading with PTX and QDs might provide a novel approach for tumor therapy and imaging.

Use of real-time phase-contrast MRI to quantify the effect of spontaneous breathing on the cerebral arteries

Quantification of the effect of breathing on the cerebral circulation provides a better mechanistic understanding of the brain's circulatory system and is important in the early diagnosis of certain neurological diseases. However, conventional cine phase-contrast (CINE-PC) MRI cannot be used in this field of study because it only provides an average cardiac cycle flow curve reconstructed from multiple cardiac cycles. Unlike CINE-PC, phase-contrast echo-planar imaging (EPI-PC) can be used to quantify the blood flow rate in "real-time" and thus assess the effect of breathing on blood flow. Here, we first used post-processing software (developed in-house) to determine the feasibility of quantifying cerebral arterial blood flow with EPI-PC (relative to CINE-PC) in 16 participants. In a second step, we developed a new time-domain method for quantifying the intensity and the phase shift of the effects of breathing on the mean flow rate, stroke volume, cardiac period and amplitude of cerebral blood flow (in 10 participants). Our results showed that EPI-PC can quantify cerebral arterial blood flow rate with much the same degree of accuracy as CINE-PC but is more strongly influenced by differences in magnetic susceptibility. We found that breathing affected the mean flow rate, stroke volume and cardiac period of cerebral arterial blood flow.

Image-guided surgery with a new tumour-targeting probe improves the identification of positive margins

Background

Given the lack of visual discrepancy between malignant and surrounding normal tissue, current breast conserving surgery (BCS) is associated with a high re-excision rate. Due to the increasing cases of BCS, a novel method of complete tumour removal at the initial surgical resection is critically needed in the operating room to help optimize the surgical procedure and to confirm tumour-free edges.

Methods

We developed a unique near-infrared (NIR) fluorescence imaging probe, ICG-p28, composed of the clinically nontoxic tumour-targeting peptide p28 and the FDA-approved NIR dye indocyanine green (ICG). ICG-p28 was characterized in vitro and evaluated in multiple breast cancer animal models with appropriate control probes. Our experimental approach with multiple-validations and -blinded procedures was designed to determine whether ICG-p28 can accurately identify tumour margins in mimicked intraoperative settings.

Findings

The in vivo kinetics were analysed to optimize settings for potential clinical use. Xenograft tumours stably expressing iRFP as a tumour marker showed significant colocalization with ICG-p28, but not ICG alone. Image-guided surgery with ICG-p28 showed an over 6.6 × 10³-fold reduction in residual normalized tumour DNA at the margin site relative to control approaches (i.e., surgery with ICG or palpation/visible inspection alone), resulting in an improved tumour recurrence rate (92% specificity) in multiple breast cancer animal models independent of the receptor expression status. ICG-p28 allowed accurate identification of tumour cells in the margin to increase the complete resection rate.

Interpretation

Our simple and cost-effective approach has translational potential and offers a new surgical procedure that enables surgeons to intraoperatively identify tumour margins in a real-time, 3D fashion and that notably improves overall outcomes by reducing re-excision rates.

Funding

This work was supported by NIH/ National Institute of Biomedical Imaging and Bioengineering, R01EB023924.

Optical Flow Analysis of Left Ventricle Wall Motion with Real-Time Cardiac Magnetic Resonance Imaging in Healthy Subjects and Heart Failure Patients

In cardiology, magnetic resonance imaging (MRI) provides a clinical standard for measuring ventricular volumes. Owing to their reliability, volumetric measurements with cardiac MRI have become an essential tool for quantitative assessment of ventricular function. However, as volumetric indices are indirectly related to myocardial motion that drives ventricular filling and ejection, cardiac MRI cannot provide comprehensive evaluation of ventricular performance. To overcome this limitation, the presented work sought to measure ventricular wall motion directly with optical flow analysis of real-time cardiac MRI. By modeling left ventricle (LV) walls in real-time images based on myocardial architecture, we developed an optical flow approach to analyzing LV radial and circumferential wall motion for improved quantitative assessment of ventricular function. For proof-of-concept, a cardiac MRI study was conducted with healthy volunteers and heart failure (HF) patients. It was found that, as real-time images provided sufficient temporal information for correlation analysis between different LV wall motion velocity components, optical flow assessment detected the difference of ventricular performance between the HF patients and the healthy volunteers more effectively than volumetric measurements. We expect that this model-based optical flow assessment with real-time cardiac MRI would offer intricate analysis of ventricular function beyond conventional volumetric measurements.

Micro-2D Cell Culture for cAMP Measurements Using FRET Reporters in Human iPSC-Derived Cardiomyocytes

In the last years human induced pluripotent stem cell-derived cardiomyocytes (hIPS-CMs) have emerged as a promising alternative to rodent-derived cardiomyocytes. However, as the differentiation process is lengthy and commercially available cells are expensive, the cell number is limited. Here we provide detailed information on how to scale down 2D cell cultures of hIPS-CMs for the purpose of cAMP FRET measurements, thereby extending the number of possible experiments by more than tenfold. Crucial factors like cell density or cell number to culturing media volume can be maintained exactly as under normal culturing conditions and existing equipment does not need to be modified.The chapter covers the preparation of downscaled cell culture vessels, coating and seeding procedures, transduction or transfection of the cells with a genetically encoded cAMP FRET sensor, performing real-time cAMP FRET measurements with this sensor and the analysis of generated imaging data. Numbers for seeding areas, seeding densities, coating volumes and concentrations, media volumes, and concentrations of reagents are given as guidelines.

Freehand and video-rate all-optical ultrasound imaging

All-optical ultrasound (AOUS) imaging, which uses light to both generate and detect ultrasound, is an emerging alternative to conventional electronic ultrasound imaging. To date, AOUS imaging has been performed using paradigms that either resulted in long acquisition times or employed bench-top imaging systems that were impractical for clinical use. In this work, we present a novel AOUS imaging paradigm where scanning optics are used to rapidly synthesise an imaging aperture. This paradigm enabled the first AOUS system with a flexible, handheld imaging probe, which represents a critical step towards clinical translation. This probe, which provides video-rate imaging and a real-time display, is demonstrated with phantoms and in vivo human tissue.

Optimisation of the event-based TOF filtered back-projection for online imaging in total-body J-PET

We perform a parametric study of the newly developed time-of-flight (TOF) image reconstruction algorithm, proposed for the real-time imaging in total-body Jagiellonian PET (J-PET) scanners. The asymmetric 3D filtering kernel is applied at each most likely position of electron-positron annihilation, estimated from the emissions of back-to-back γ-photons. The optimisation of its parameters is studied using Monte Carlo simulations of a 1-mm spherical source, NEMA IEC and XCAT phantoms inside the ideal J-PET scanner. The combination of high-pass filters which included the TOF filtered back-projection (FBP), resulted in spatial resolution, 1.5 times higher in the axial direction than for the conventional 3D FBP. For realistic 10-minute scans of NEMA IEC and XCAT, which require a trade-off between the noise and spatial resolution, the need for Gaussian TOF kernel components, coupled with median post-filtering, is demonstrated. The best sets of 3D filter parameters were obtained by the Nelder-Mead minimisation of the mean squared error between the resulting and reference images. The approach allows training the reconstruction algorithm for custom scans, using the IEC phantom, when the temporal resolution is below 50 ps. The image quality parameters, estimated for the best outcomes, were systematically better than for the non-TOF FBP.

Image Integration Using Intracardiac Echography and Three-dimensional Reconstruction for Mapping and Ablation of Atrial and Ventricular Arrhythmias

This article reviews the basis for image integration of intracardiac echocardiography (ICE) with three-dimensional electroanatomic mapping systems and preprocedural cardiac imaging modalities to enhance anatomic understanding and improve guidance for atrial and ventricular ablation procedures. It discusses the technical aspects of ICE-based integration and the clinical evidence for its use. In addition, it presents the current technical limitations and future directions for this technology. This article also includes figures and videos of clinical representative arrhythmia cases where the use of ICE is key to a safe and successful outcome.

Ultrasound with needle guiding exploration as a real-time modality for exploration of air rifle bullet close to cervical spine: A case report

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Real-time imaging modalities are needed while performing surgical exploration of retained foreign body.

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Ultrasonography offered an ability to visualize retained foreign body in a real-time.

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Needle guiding ultrasonography is a technique that allows surgeon to extracts the retained foreign body precisely.

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The combination of a needle guided ultrasonography, and other imaging studies may increase the accuracy of exploration.

Introduction and importance

Surgical exploration of retained air rifle bullet at the neck region is challenging because it is difficult to find bullets during exploration and prevent damage to vital structures. A bedside real-time imaging technique is needed to determine the retained bullet's location to the surrounding structures and guiding exploration.

Case presentation

A 19-year-old male patient was admitted to the emergency department with neck pain after being shot by an air rifle. The patient's vital signs were stable. A small entry wound to the right lateral side of the neck without exit wound was found without neurological symptoms. The cervical X-ray showed the bullet at the third cervical vertebrae level. Surgical exploration was performed with needle-guiding ultrasonography. The bullet is a one-centimeter anterior transverse process of the third cervical vertebra marked by a hyperechoic object. Exploration was done by tracing the needle. Postoperative neurological evaluation was conducted, and no abnormalities were found.

Clinical discussion

Preoperative imaging modalities are crucial before the surgical exploration of a retained air rifle bullet. X-ray and CT-scan are imaging modalities that are often used as an initial assessment of retained foreign bodies. However, ultrasonography provides advantages over X-ray and CT scan to provide real-time imaging that supports the surgeon while performing surgical exploration. Ultrasonography with needle guiding exploration increases the precise location of a retained air rifle bullet.

Conclusion

Ultrasonography was a simple and precise real-time imaging modality for identifying and guiding the exploration of a retained air rifle bullet in the neck area.

Real-time magnetic resonance imaging in pediatric radiology - new approach to movement and moving children

The recent development of highly undersampled radial gradient echo sequences in combination with nonlinear inverse image reconstruction now allows for MRI examinations in real time. Image acquisition times as short as 20 ms yield MRI videos with rates of up to 50 frames per second with spin density, T1- and T2-type contrast. The addition of an initial 180° inversion pulse achieves accurate T1 mapping within only 4 s. These technical advances promise specific advantages for studies of infants and young children by eliminating the need for sedation or anesthesia. Our preliminary data demonstrate new diagnostic opportunities ranging from dynamic studies of speech and swallowing processes and body movements to a rapid volumetric assessment of brain cerebrospinal fluid spaces in only few seconds. Real-time MRI of the heart and blood flow can be performed without electrocardiogram gating and under free breathing. The present findings support the idea that real-time MRI will complement existing methods by providing long-awaited diagnostic options for patients in early childhood. Major advantages are the avoidance of sedation or anesthesia and the yet unexplored potential to gain insights into arbitrary body functions.

4D deep learning for real-time volumetric optical coherence elastography

PURPOSE

Elasticity of soft tissue provides valuable information to physicians during treatment and diagnosis of diseases. A number of approaches have been proposed to estimate tissue stiffness from the shear wave velocity. Optical coherence elastography offers a particularly high spatial and temporal resolution. However, current approaches typically acquire data at different positions sequentially, making it slow and less practical for clinical application.

METHODS

We propose a new approach for elastography estimations using a fast imaging device to acquire small image volumes at rates of 831 Hz. The resulting sequence of phase image volumes is fed into a 4D convolutional neural network which handles both spatial and temporal data processing. We evaluate the approach on a set of image data acquired for gelatin phantoms of known elasticity.

RESULTS

Using the neural network, the gelatin concentration of unseen samples was predicted with a mean error of 0.65 ± 0.81 percentage points from 90 subsequent volumes of phase data only. We achieve a data acquisition and data processing time of under 12 ms and 22 ms, respectively.

CONCLUSIONS

We demonstrate direct volumetric optical coherence elastography from phase image data. The approach does not rely on particular stimulation or sampling sequences and allows the estimation of elastic tissue properties of up to 40 Hz.

A pH-activated charge convertible quantum dot as a novel nanocarrier for targeted protein delivery and real-time cancer cell imaging

The rapid developments of nanocarriers based on quantum dots (QDs) have been confirmed to show substantial promise for drug delivery and bioimaging. However, optimal QDs-based nanocarriers still need to have their controlled behavior in vitro and in vivo and decrease heavy metal-associated cytotoxicity. Herein, a pH-activated charge convertible QD-based nanocarrier was fabricated by capping multifunctional polypeptide ligands (mPEG-block-poly(ethylenediamine-dihydrolipoic acid-2,3-dimethylmaleic anhydride)-L-glutamate, PEG-P(ED-DLA-DMA)LG) onto the surface of core/multishell CdSe@ZnS/ZnS QD by means of a ligand exchange strategy, followed by uploading of cytochrome C (CC) (CC-loaded QD-PEG-P(ED-DLA-DMA)LG) via electrostatic interactions, in which QDs that were water-soluble and protein-loading were perfectly integrated. That is, the CC-loaded QD-PEG-P(ED-DLA-DMA)LG inherited excellent fluorescence properties from CdSe@ZnS/ZnS QD for real-time imaging, as well as tumor-microenvironment sensitivities from PEG-P(ED-DLA-DMA)LG for enhanced cellular uptake and CC release. Experimental results verified that the QD-PEG-P(ED-DLA-DMA)LG showed enhanced internalization, rapid endo/lysosomal escape, and supplied legible real-time imaging for lung carcinoma cells. Furthermore, pH-triggered charge-convertible ability enabled the QD-PEG-P(ED-DLA-DMA)LG-CC to effectively kill cancer cells better than did the control groups. Hence, constructing smart nanocomposites by facile ligand-exchange strategy is beneficial to QD-based nanocarrier for tumor-targeting cancer therapy.

Retention Using Selective Hooks-Synchronized Secretion to Measure Local Exocytosis

Proteins destined to be exposed to the extracellular space enter the secretory pathway at the level of the endoplasmic reticulum. Proteins are then transported to the Golgi apparatus and addressed to their destination compartment, such as the plasma membrane for exocytic cargos. Exocytosis constitutes the last step of the anterograde transport of secretory cargos. Exocytic vesicles fuse with the plasma membrane, releasing soluble proteins to the extracellular milieu and transmembrane proteins to the plasma membrane. In order to monitor local exocytosis of cargos, we describe in this chapter how to perform synchronization of the anterograde transport of an exocytic cargo of interest using the retention using selective hooks (RUSH) assay in combination with selective protein immobilization (SPI). SPI is based on the coating of coverslips with anti-green fluorescent protein (GFP) antibodies, which capture the GFP-tagged RUSH cargos once exposed to the cell surface after its release by the addition of biotin.

Benefits of contrast-enhanced ultrasonography for interventional procedures

For evaluating unclear tumorous lesions, contrast-enhanced ultrasonography (CEUS) is an important imaging modality in addition to contrast-enhanced computed tomography and magnetic resonance imaging, and may provide valuable insights into the microvascularization of tumors in dynamic examinations. In interventional procedures, CEUS can make a valuable contribution in pre-, peri-, and post-interventional settings, reduce radiation exposure and, under certain circumstances, decrease the number of interventions needed for patients.

Dynamic imaging reveals surface exposure of virulent Leishmania amastigotes during pyroptosis of infected macrophages

Leishmania spp. are obligate intracellular parasites that infect phagocytes, notably macrophages. No information is available on how Leishmania parasites respond to pyroptosis of their host cell, which is known to limit microbial infection. Here, we analyzed the pyroptotic process and the fate of intracellular amastigotes at the single-cell level using high-content real-time imaging. Bone marrow-derived macrophages were infected with virulent Leishmania amazonensis amastigotes and sequentially treated with lipopolysaccharide and ATP to induce pyroptosis. Real-time monitoring identified distinct pyroptotic phases, including rapid decay of the parasitophorous vacuole (PV), progressive cell death and translocation of the luminal PV membrane to the cell surface in 40% of macrophages, resulting in the extracellular exposure of amastigotes that remained anchored to PV membranes. Electron microscopy analyses revealed an exclusive polarized orientation of parasites, with the anterior pole exposed toward the extracellular milieu, and the parasite posterior pole attached to the PV membrane. Exposed parasites retained their full infectivity towards naïve macrophages suggesting that host cell pyroptosis may contribute to parasite dissemination.

A reporter cell line for real-time imaging of autophagy and apoptosis

Simultaneous detection of autophagy and apoptosis is important in drug discovery and signaling studies. Here we report, a real-time reporter cell line for the simultaneous detection of apoptosis and autophagy at single-cell level employing stable integration of two fluorescent protein reporters of apoptosis and autophagy. Cells stably expressing EGFP-LC3 fusion was developed initially as a marker for autophagy and subsequently stably expressed with inter-mitochondrial membrane protein SMAC with RFP fusion to detect mitochondrial permeabilization event of apoptosis. The cell lines faithfully reported the LC3 punctae formation and release of intermembrane proteins in response to diverse apoptotic and autophagic stimuli.

Effect of Ultrasound on the Vasculature and Extravasation of Nanoscale Particles Imaged in Real Time

Ultrasound and microbubbles have been found to improve the delivery of drugs and nanoparticles to tumor tissue. To obtain new knowledge on the influence of vascular parameters on extravasation and to elucidate the effect of acoustic pressure on extravasation and penetration of nanoscale particles into the extracellular matrix, real-time intravital multiphoton microscopy was performed during sonication of tumors growing in dorsal window chambers. The impact of vessel diameter, vessel structure and blood flow was characterized. Fluorescein isothiocyanate-dextran (2 MDa) was injected to visualize blood vessels. Mechanical indexes (MI) of 0.2-0.8 and in-house-made, nanoparticle-stabilized microbubbles or Sonovue were applied. The rate and extent of penetration into the extracellular matrix increased with increasing MI. However, to achieve extravasation, smaller vessels required MIs (0.8) higher than those of blood vessels with larger diameters. Ultrasound changed the blood flow rate and direction. Interestingly, the majority of extravasations occurred at vessel branching points.

A lysosome-targetable fluorescent probe for real-time imaging cysteine under oxidative stress in living cells

As an effective lysosomal biomarker for oxidative stress status, cysteine (Cys) plays an important role in lysosomal proteolysis. Herein, we report the first lysosome-targetable fluorescence probe (MCAB) for Cys-selective detection based on nucleophilic addition reaction of sulfhydryl toward a α, β-unsaturated ketone and demonstrate its application to lysosomal-targetable imaging. MCAB is designed based on a α, β-unsaturated ethanoylcarbazole as the fluorophore and the thiols reaction site, and a methylcarbitol unit as a lysosome-targetable group. Upon reacting with Cys, this probe turns on highly specific fluorescence signals linearly proportional to Cys concentrations over the range of 0-300 μM. MCAB detects Cys with a rapid response time (within 12 min) and low limit of detection (0.38 μM). MCAB is highly selective to Cys over other similar biothiols including homocysteine (Hcy) and glutathione (GSH). Moreover, it also exhibits significant lysosomal-targetable ability, which is ideal for lysosomal Cys-selective imaging. Using MCAB, we have successfully visualized the fluctuation endogenous Cys in lysosomes under oxidative stress status in real-time.

Real-time monitoring of NADPH levels in living mammalian cells using fluorescence-enhancing protein bound to NADPHs

Nicotinamide adenine nucleotide phosphate (NADPH) has been known to be involved in the multiple pathways of cell metabolism. However, conventional quantification assays for NADPH have required breaking down the cell membranes of around one million cells per assay, and monitoring NADPH flux in living cells has been limited by a few available tools. Here, we visualized NADPH levels in human cervical cancer cells HeLa using metagenome-derived blue fluorescent protein (mBFP), which specifically binds to NADPH and enhances the intrinsic fluorescence of NADPH up to 10-fold when imaged by two-photon microscopy to reduce photodamage. Adding an oxidizing agent such as diamide to HeLa cells that expressed mBFP led to an immediate decrease of intracellular NADPH depending on glucose availability in culture media. Furthermore, inhibiting glucose-6-phosphate dehydrogenase (G6PD) in the pentose phosphate pathway with dehydroandrosterone (DHEA) and knockdown of G6PD transcripts gradually decreased NADPH when diamide was added to living cells. These results demonstrate that introducing a bacterial mBFP gene into mammalian cells is a straightforward approach to monitoring intracellular NADPH flux in real time at the single-cell level. Moreover, this strategy can be expanded to tracking the spatio-temporal changes in NADPH even in single-cell organelles such as mitochondria and chloroplasts, which will allow us to more precisely assess the efficacy of biochemically or biophysically metabolic perturbations in animal and plant cells.

Real-time OCT guidance and multimodal imaging monitoring of subretinal injection induced choroidal neovascularization in rabbit eyes

Choroidal neovascularization (CNV) is a major cause of vision loss that consists of abnormal growth of new blood vessels from the choroidal vasculature. High resolution in vivo imaging of animal models is essential to better elucidate and conduct research on CNV. This study evaluates a novel multimodal imaging platform combining optical coherence tomography (OCT) and photoacoustic microscopy (PAM). Using real-time OCT guidance subretinal injection to induce and multimodality imaging system to monitor CNV over time in rabbit eyes. The significance of our work lies in providing the optimal setting and conditions to make use of the OCT image guided system to improve the consistency and reproducibility of experimental results in subretinal injection induced CNV model in rabbits. For the first time, this study successfully demonstrated the dual-modality PAM-OCT system, without using exogenous contrast agents, can detect and visualize CNV in the rabbit eye with high resolution. This is promising system for diagnosing and monitoring CNV.

[Contrast-enhanced ultrasound (CEUS) and image fusion for procedures of liver interventions]

CLINICAL/METHODICAL ISSUE

Contrast-enhanced ultrasound (CEUS) is becoming increasingly important for the detection and characterization of malignant liver lesions and allows percutaneous treatment when surgery is not possible. Contrast-enhanced ultrasound image fusion with computed tomography (CT) and magnetic resonance imaging (MRI) opens up further options for the targeted investigation of a modified tumor treatment.

METHODICAL INNOVATIONS

Ultrasound image fusion offers the potential for real-time imaging and can be combined with other cross-sectional imaging techniques as well as CEUS.

PERFORMANCE

With the implementation of ultrasound contrast agents and image fusion, ultrasound has been improved in the detection and characterization of liver lesions in comparison to other cross-sectional imaging techniques. In addition, this method can also be used for intervention procedures. The success rate of fusion-guided biopsies or CEUS-guided tumor ablation lies between 80 and 100% in the literature.

ACHIEVEMENTS

Ultrasound-guided image fusion using CT or MRI data, in combination with CEUS, can facilitate diagnosis and therapy follow-up after liver interventions.

PRACTICAL RECOMMENDATIONS

In addition to the primary applications of image fusion in the diagnosis and treatment of liver lesions, further useful indications can be integrated into daily work. These include, for example, intraoperative and vascular applications as well applications in other organ systems.

Assembly of upconversion nanophotosensitizer in vivo to achieve scatheless real-time imaging and selective photodynamic therapy

A perfect "off" to "on" switch of the therapeutic function is very important to minimize the phototoxicity of nanoplatforms assisted imaging-guided photodynamic therapy (PDT) of cancer. Current approaches rely on preloaded photosensitizers, where the off/on state of PDT is regulated by the sensitizing light of photosensitizers. However, the photoactivities inevitably occur when imaging/diagnosis or exposure to sunlight, etc. These preloading approaches will cause the damage to normal cells and the photosensitivity to the skin. Taking upconversion photodynamic therapy as an example we report here a biorthogonal chemistry solution to circumvent this problem. The luminescence upconversion nanoparticles (UCNPs) are anchored with one handle of click reaction and targeting entity, these nanoplatforms enable the imaging/labelling/tracking, especially for imaging-guided surgery. Once they are targeted, the photosensitizers armed with the other match handle will be injected in situ and click reaction will occur between the two handles to link the photosensitizers closely with the targeted nanoplatforms in a very short time, enabling the PDT function of the nanoplatforms. Proof of principle has been demonstrated in vitro and in vivo. This approach can be readily extended to chemotherapy, radiotherapy, etc. to overcome the side effect of these therapies of cancers.

Validation of cardiac magnetic-resonance-derived left ventricular strain measurements from free-breathing motion-corrected cine imaging

BACKGROUND

Myocardial strain is an important measure of cardiac function and can be assessed on cardiac magnetic resonance (MR) through the current gold standard of breath-held segmented steady-state free precession (SSFP) cine imaging. Novel free-breathing techniques have been validated for volumetry and systolic function, allowing for evaluation of sicker and younger children who cannot reliably hold their breath. It is unclear whether strain measurements can be reliably performed on free-breathing, motion-corrected, re-binning cine images.

OBJECTIVE

To compare strain analysis from motion-corrected retrospective re-binning images to the breath-held SSFP cine images to explore their validity.

MATERIALS AND METHODS

Twenty-five children and young adults, ages (2.1-18.6 years) underwent breath-held and motion-corrected retrospective re-binning cine techniques during the same MR examination on a 1.5-tesla magnet. We measured endocardial end-systolic global circumferential strain and endocardial averaged segmental strain using commercial software (MEDIS QStrain 2.1). We used Pearson correlation coefficients to test agreement across techniques.

RESULTS

Analysis was possible in all 25 breath-held and motion-corrected retrospective re-binning studies. Global circumferential strain and endocardial averaged segmental strain obtained by motion-corrected retrospective re-binning compared favorably to breath-held studies. Global circumferential strain linear regression models demonstrated acceptable agreement, with coefficients of determination of 0.75 for breath-held compared to motion-corrected retrospective re-binning (P<0.001) and for endocardial averaged segmental strain comparisons yielded 0.77 for breath-held vs. motion-corrected retrospective re-binning (P<0.001). Bland-Altman assessment demonstrated minimal bias for breath-held compared to motion-corrected retrospective re-binning (mean 2.4 and 1.9, respectively, for global circumferential strain and endocardial averaged segmental strain).

CONCLUSION

Free-breathing imaging by motion-corrected retrospective re-binning cine imaging provides adequate spatial and temporal resolution to measure myocardial deformation when compared to the gold-standard breath-held SSFP cine imaging in children with normal or borderline systolic function.

Real-Time Monitoring of Yersinia pestis Promoter Activity by Bioluminescence Imaging

Bioluminescence imaging (BLI) has become a major strategy for real-time analysis of dynamic biological processes. In particular, bioluminescent reporter microorganisms have been designed to advance our understanding of infectious diseases. Non-invasive monitoring of light-emitting pathogenic bacteria has revealed novel features of pathogenesis and enabled quantitative and qualitative analysis of antibacterial therapies. Transcriptional gene fusions using the bacterial luciferase operon luxCDABE as a reporter have been successfully used to monitor gene expression in vitro and in vivo, leading to valuable applications and major findings. In this chapter, we describe the construction of Yersinia pestis strains bearing a chromosomal copy of the luxCDABE operon under the control of promoters regulated by temperature and their application to quantify gene expression in real-time in bacteria growing in vitro and in a murine bubonic plague model.

Real-time cardiac MRI with radial acquisition and k-space variant reduced-FOV reconstruction

This work aims to demonstrate that radial acquisition with k-space variant reduced-FOV reconstruction can enable real-time cardiac MRI with an affordable computation cost. Due to non-uniform sampling, radial imaging requires k-space variant reconstruction for optimal performance. By converting radial parallel imaging reconstruction into the estimation of correlation functions with a previously-developed correlation imaging framework, Cartesian k-space may be reconstructed point-wisely based on parallel imaging relationship between every Cartesian datum and its neighboring radial samples. Furthermore, reduced-FOV correlation functions may be used to calculate a subset of Cartesian k-space data for image reconstruction within a small region of interest, making it possible to run real-time cardiac MRI with an affordable computation cost. In a stress cardiac test where the subject is imaged during biking with a heart rate of >100 bpm, this k-space variant reduced-FOV reconstruction is demonstrated in reference to several radial imaging techniques including gridding, GROG and SPIRiT. It is found that the k-space variant reconstruction outperforms gridding, GROG and SPIRiT in real-time imaging. The computation cost of reduced-FOV reconstruction is ~2 times higher than that of GROG. The presented work provides a practical solution to real-time cardiac MRI with radial acquisition and k-space variant reduced-FOV reconstruction in clinical settings.

Measuring Mitochondrial ROS in Mammalian Cells with a Genetically Encoded Protein Sensor

Reactive oxygen species (ROS) are not only known for their toxic effects on cells, but they also play an important role as second messengers. As such, they control a variety of cellular functions such as proliferation, metabolism, differentiation and apoptosis. Thus, ROS are involved in the regulation of multiple physiological and pathophysiological processes. It is now apparent that there are transient and local changes in ROS in the cell; in so-called 'microdomains' or in specific cellular compartments, which affect signaling events. These ROS hotspots need to be studied in more depth to understand their function and regulation. Therefore, it is necessary to identify and quantify redox signals in single cells with high spatial and temporal resolution. Genetically encoded fluorescence-based protein sensors provide such necessary tools to examine redox-signaling processes. A big advantage of these sensors is the possibility to target them specifically. Mitochondria are essential for energy metabolism and are one of the major sources of ROS in mammalian cells. Therefore, the evaluation of redox potential and ROS production in these organelles is of great interest. Herein, we provide a protocol for the real-time visualization of mitochondrial hydrogen peroxide (H₂O₂) using the H₂O₂-specific ratiometric sensor mitoHyPer in adherent mammalian cells.

Real-time observation of pathophysiological processes during murine experimental Schistosoma japonicum infection using high-resolution ultrasound imaging

BACKGROUND

Hepatosplenic lesion formation is one of the typical clinical symptoms of schistosomiasis japonica. Although it is established that circum-oval granuloma formation mediated by T lymphocytes is the key event triggering the formation of hepatic lesions, the time-course kinetics of disease progression remains to be fully elucidated.

METHODS

The real-time process of the pathophysiology of schistosomiasis japonica from the early to late clinical phase was non-invasively observed in a murine experimental infection model using high-resolution ultrasonography. Together with clinical parameters, including body weight and the levels of serum markers of hepatic damage or fibrosis, ultrasonography was used to assess changes in the liver parenchyma and diameter of the portal vein and portal blood flow velocity. In parallel, parasitological parameters were observed, including egg number in the feces and maturation of parasites.

RESULTS

Abnormal high-echo spot patterns in the liver parenchyma, reflecting hepatic fibrosis in ultrasonography, appeared in the liver at 4 weeks post-infection and the pattern became more enlarged and severe over time. This finding was concordant with parasite maturation and initial egg excretion. The serum M2BPGi level markedly increased from 8 weeks post-infection, suggesting sharp deterioration of hepatic fibrosis. At the same time, the diameter of the portal vein, reflecting portal hypertension, became enlarged and reached the peak level at 8 weeks post-infection. Ascites were apparent around the spleen at 9 weeks post-infection, and dilatation of the splenic vein was noted at 10 weeks post-infection. Live adult worms seemed to be detected in the portal vein at 4 weeks post-infection by ultrasonography.

CONCLUSIONS

We obtained real-time imaging of the development of hepatosplenic lesions of schistosomiasis japonica in mice. The time-course kinetics of the onset, development, and modulation of each symptom was uncovered. These results are expected to provide new clues for understanding the pathophysiology of human schistosomiasis japonica.

Imaging Protein Fibers at the Nanoscale and In Situ

Protein self-assembly offers a rich repertoire of tools and technologies. However, despite significant progress in this area, a deterministic measure of the phenomenon, which might lead to predictable relationships between protein components, assembly mechanisms, and ultimately function, is lacking. Often the challenge relates to the choice of the most informative and precise measurements that can link the chemistry of the building blocks with the resulting assembly, ideally in situ and in real time. Using the example of protein fibrillogenesis-a self-assembly process fundamental to nearly every aspect of biological organization, from viral assembly to tissue restoration-this chapter demonstrates how protein self-assembly can be visually and precisely measured while providing measurement protocols applicable to other self-assembly systems.

Real-time SPARSE-SENSE cine MR imaging in atrial fibrillation: a feasibility study

Background Cardiac magnetic resonance imaging (MRI) relies on correct ECG-gating, which is hindered in arrhythmia. Purpose To examine whether a prototype free-breathing real-time cine sequence using SPARSE-SENSE (SPARSE) improves left ventricular quantification in atrial fibrillation. Material and Methods On a 1.5T MR system left ventricular short-axis stacks were acquired of the SPARSE sequence and of a "reference" steady-state free precession (SSFP) sequence with arrhythmia rejection in 20 patients with atrial fibrillation. Two radiologists independently rated arrhythmia-caused artifact severity in both sequences using a 4-point scale. Coefficients of variation of myocardial signal intensity for both sequences were acquired. Volumetry was performed twice by one reader and once by another reader. Correlation between artifact severity and employed sequence was analyzed by modified Fisher's exact test. Coefficients of variation and volumetric data were compared by paired t-test and intraclass correlation. Results Median arrhythmia-caused artifact severity was 2 in both readers for SSFP and 0 (reader 1)/1 (reader 2) for SPARSE, being significantly lower in SPARSE ( P < 0.001). Mean coefficient of variance was significantly smaller in SPARSE (0.11 ± 0.04) compared to SSFP (0.22 ± 0.13, P = 0.003), which was interpreted as a hint for fewer artifacts in SPARSE. Only a small difference of 9 ± 15 mL was seen for end-systolic volume ( P = 0.019) between sequences, otherwise no significant difference was detected (end-diastolic volume, P = 0.200; stroke volume, P = 0.554; ejection fraction, P = 0.136; myocardial mass, P = 0.353). Intraclass correlation between sequences was good to excellent (range, 0.80-0.97). Conclusion Real-time MRI with SPARSE data sampling is promising in atrial fibrillation because it reduces arrhythmia-caused artifacts.

Synthesis and hyperpolarisation of eNOS substrates for quantification of NO production by 1H NMR spectroscopy

Hyperpolarization enhances the intensity of the NMR signals of a molecule, whose in vivo metabolic fate can be monitored by MRI with higher sensitivity. SABRE is a hyperpolarization technique that could potentially be used to image nitric oxide (NO) production in vivo. This would be very important, because NO dysregulation is involved in several pathologies, including cardiovascular ones. The nitric oxide synthase (NOS) pathway leads to NO production via conversion of l-arginine into l-citrulline. NO is a free radical gas with a short half-life in vivo (≈5s), therefore direct NO quantification is challenging. An indirect method - based on quantifying conversion of an l-Arg- to l-Cit-derivative by 1H NMR spectroscopy - is herein proposed. A small library of pyridyl containing l-Arg derivatives was designed and synthesised. In vitro tests showed that compounds 4a-j and 11a-c were better or equivalent substrates for the eNOS enzyme (NO2- production=19-46μM) than native l-Arg (NO2- production=25μM). Enzymatic conversion of l-Arg to l-Cit derivatives could be monitored by 1H NMR. The maximum hyperpolarization achieved by SABRE reached 870-fold NMR signal enhancement, which opens up exciting future perspectives of using these molecules as hyperpolarized MRI tracers in vivo.