Intravascular endoscopy improvement through narrow-band imaging

Advancing hyperspectral imaging and machine learning tools toward clinical adoption in tissue diagnostics: A comprehensive review

Hyperspectral imaging (HSI) has become an evident transformative apparatus in medical diagnostics. The review aims to appraise the present advancement and challenges in HSI for medical applications. It features a variety of medical applications namely diagnosing diabetic retinopathy, neurodegenerative diseases like Parkinson's and Alzheimer's, which illustrates its effectiveness in early diagnosis, early caries detection in periodontal disease, and dermatology by detecting skin cancer. Regardless of these advances, the challenges exist within every aspect that limits its broader clinical adoption. It has various constraints including difficulties with technology related to the complexity of the HSI system and needing specialist training, which may act as a drawback to its clinical settings. This article pertains to potential challenges expressed in medical applications and probable solutions to overcome these constraints. Successful companies that perform advanced solutions with HSI in terms of medical applications are being emphasized in this study to signal the high level of interest in medical diagnosis for systems to incorporate machine learning ML and artificial intelligence AI to foster precision diagnosis and standardized clinical workflow. This advancement signifies progressive possibilities of HSI in real-time clinical assessments. In conclusion despite HSI has been presented as a significant advanced medical imaging tool, addressing its limitations and probable solutions is for broader clinical adoption.

Advancing hyperspectral imaging and machine learning tools toward clinical adoption in tissue diagnostics: A comprehensive review

Hyperspectral imaging (HSI) has become an evident transformative apparatus in medical diagnostics. The review aims to appraise the present advancement and challenges in HSI for medical applications. It features a variety of medical applications namely diagnosing diabetic retinopathy, neurodegenerative diseases like Parkinson's and Alzheimer's, which illustrates its effectiveness in early diagnosis, early caries detection in periodontal disease, and dermatology by detecting skin cancer. Regardless of these advances, the challenges exist within every aspect that limits its broader clinical adoption. It has various constraints including difficulties with technology related to the complexity of the HSI system and needing specialist training, which may act as a drawback to its clinical settings. This article pertains to potential challenges expressed in medical applications and probable solutions to overcome these constraints. Successful companies that perform advanced solutions with HSI in terms of medical applications are being emphasized in this study to signal the high level of interest in medical diagnosis for systems to incorporate machine learning ML and artificial intelligence AI to foster precision diagnosis and standardized clinical workflow. This advancement signifies progressive possibilities of HSI in real-time clinical assessments. In conclusion despite HSI has been presented as a significant advanced medical imaging tool, addressing its limitations and probable solutions is for broader clinical adoption.

Objective Comparison of White Light and Narrow-Band Imaging for Detecting Scars, Sulci and Nodules

INTRODUCTION

Narrow-band imaging (NBI) can improve detection of lesions in the aerodigestive tract. However, its role in benign lesions of the larynx is unclear. This study aims to determine whether NBI improves the detection of scars, sulci, and nodules compared to panchromatic lighting using objective image analysis.

METHODS

In total, 120 vocal folds (VFs) were analyzed with and without NBI (21 normal, 15 scars, 16 sulci, and 45 nodules). Each VF image had anterior, middle, and posterior thirds analyzed for brightness using an area morphometry software (Optimas 5.1a). The middle-third with the lesion was analyzed against surrounding VF segments for average and standard deviation (SD) in absolute grayscale.

RESULTS

The use of panchromatic light resulted in greater illumination and grayscale values than NBI. All lesions tended to be in the mid-membranous fold. Under panchromatic light, change in brightness when comparing anterior versus middle (A-M) was +6.1% for normal, versus 6.5%, 8.1%, and 7.1% for sulci, nodules, and scars, respectively. Under NBI, they were 9.0% (normal), 12.3% (sulci), 13.7% (nodules), and 13.1% (scars). A greater SD of luminescence was observed at pathology sites (p < 0.05) when using NBI. The change in absolute grayscale at all lesion sites was greater when using NBI than when using panchromatic light (p < 0.05).

CONCLUSION

NBI significantly enhanced the area of pathology in patients with nodules, sulci, and scars. Greater SD values in grayscale at pathologic sites were observed compared at normal sites. Thus, NBI may improve the detection of phonotraumatic lesions compared to panchromatic light.

LEVEL OF EVIDENCE

N/A Laryngoscope, 134:4066-4070, 2024.

The Evolution of Endovascular Therapy for Intracranial Aneurysms: Historical Perspective and Next Frontiers

The history of cerebral aneurysm treatment has a rich and storied past with multiple notable luminaries contributing insights. The modern era has transitioned from primarily clip ligation to increasing use of endovascular therapy. Even more recently, the use of intrasaccular flow diverters has been introduced for the treatment of wide necked aneurysms. The field is continuing to transform, and bioactive coils and stents have resurfaced as promising adjuvants to promote aneurysm healing. Advanced imaging modalities are being developed that could further advance the endovascular arsenal and allow for porous memory polymer devices to enter the field. This focused review highlights notable historic contributions and advances to the point of futuristic technology that is actively being developed.

The Clinical Application of Remimazolam Benzenesulfonate Combined with Esketamine Intravenous Anesthesia in Endoscopic Retrograde Cholangiopancreatography

In this project, algorithm-based image processing methods in 3D endoscopic image processing endoscopic retrograde cholangiopancreatography (ERCP) were analyzed. To enhance local information of images, an adaptive histogram equalization method with limited contrast is introduced. The influences of the algorithm on 3D endoscopic image peak signal-to-noise ratio (PSNR), image discrete information entropy (DE), and average mean brightness error (AMBE) of images before and after the optimization before were compared. A total of 92 patients receiving ERCP at Yuhuangding Hospital between December 2019 and December 2021 were selected and divided into the control group (fentanyl+propofol) and the observation group (remimazolam benzenesulfonate+esketamine). Mean arterial pressure heart rate (HR), oxygen saturation (SpO2), and respiratory rate (RR) of the patients at each time point including the entry into the operation room (T0), 2 minutes after the beginning of medication (T1), after endoscopy (T2), endoscopy withdrawal (T3), and postoperative awakening (T4) were recorded. The comparison of MAP between T1, T2, T3, and T4 and T0 among patients in the observation group and the control group showed statistical differences (P < 0.05). Besides, HR and RR at T4 in the observation group were obviously higher than those in the control group (P < 0.05). The comparison of SpO2 at T3 and T4 and that at T0 both showed statistical differences (P < 0.05). Awakening time and VAS scores in the observation group were obviously lower than those in the control group (P < 0.05). The incidence of bradycardia, nausea, vomiting, and chill in the observation group was all lower than that in the control group (P < 0.05). The results indicated that an effective endoscopic image processing method was established based on an image enhancement algorithm, and the combination of remimazolam benzenesulfonate and esketamine showed high safety and efficacy in ERCP.

Flush Flow Behaviour Affected by the Morphology of Intravascular Endoscope: A Numerical Simulation and Experimental Study

Background: Whilst intravascular endoscopy can be used to identify lesions and assess the deployment of endovascular devices, it requires temporary blockage of the local blood flow during observation, posing a serious risk of ischaemia. Objective: To aid the design of a novel flow-blockage-free intravascular endoscope, we explored changes in the haemodynamic behaviour of the flush flow with respect to the flow injection speed and the system design. Methods: We first constructed the computational models for three candidate endoscope designs (i.e., Model A, B, and C). Using each of the three endoscopes, flow patterns in the target vessels (straight, bent, and twisted) under three different sets of boundary conditions (i.e., injection speed of the flush flow and the background blood flowrate) were then resolved through use of computational fluid dynamics and in vitro flow experiments. The design of endoscope and its optimal operating condition were evaluated in terms of the volume fraction within the vascular segment of interest, as well as the percentage of high-volume-fraction area (PHVFA) corresponding to three cross-sectional planes distal to the microcatheter tip. Results: With a mild narrowing at the endoscope neck, Model B exhibited the highest PHVFA, irrespective of location of the cross-sectional plane, compared with Models A and C which, respectively, had no narrowing and a moderate narrowing. The greatest difference in the PHVFA between the three models was observed on the cross-sectional plane 2 mm distal to the tip of the microcatheter (Model B: 33% vs. Model A: 18%). The background blood flowrate was found to have a strong impact on the resulting volume fraction of the flush flow close to the vascular wall, with the greatest difference being 44% (Model A). Conclusion: We found that the haemodynamic performance of endoscope Model B outperformed that of Models A and C, as it generated a flush flow that occupied the largest volume within the vascular segment of interest, suggesting that the endoscope design with a diameter narrowing of 30% at the endoscope neck might yield images of a better quality.

Submillimeter diameter rotary-pullback fiber-optic endoscope for narrowband red-green-blue reflectance, optical coherence tomography, and autofluorescence in vivo imaging

A fiber-based endoscopic imaging system combining narrowband red-green-blue (RGB) reflectance with optical coherence tomography (OCT) and autofluorescence imaging (AFI) has been developed. The system uses a submillimeter diameter rotary-pullback double-clad fiber imaging catheter for sample illumination and detection. The imaging capabilities of each modality are presented and demonstrated with images of a multicolored card, fingerprints, and tongue mucosa. Broadband imaging, which was done to compare with narrowband sources, revealed better contrast but worse color consistency compared with narrowband RGB reflectance. The measured resolution of the endoscopic system is 25  μm in both the rotary direction and the pullback direction. OCT can be performed simultaneously with either narrowband RGB reflectance imaging or AFI.