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Li Q, Rohringer W, Preißer S, Erkkilä MT, Haindl R, Sattmann H, Liu M, Fischer B, Leitgeb R, Drexler W. Depixelation of coherent fiber bundle imaging by fiber-core-targeted scanning. Appl Opt 2021; 60:7955-7962. [PMID: 34613055 DOI: 10.1364/ao.430537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
A novel fast proximal scanning method, to the best of our knowledge, termed fiber-core-targeted scanning (FCTS), is proposed for illuminating individual fiber cores sequentially to remove the pixelation effect in fiber bundle (FB) imaging. FCTS is based on a galvanometer scanning system. Through a dynamic control of the scan trajectory and speed using the prior knowledge of fiber core positions, FCTS experimentally verifies a precise sequential delivery of laser pulses into fiber cores at a maximal speed of 45,000 cores per second. By applying FCTS on a FB-based photoacoustic forward-imaging probe, the results demonstrate that FCTS eliminates the pixelation effect and improves the imaging quality.
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Erkkilä MT, Reichert D, Gesperger J, Kiesel B, Roetzer T, Mercea PA, Drexler W, Unterhuber A, Leitgeb RA, Woehrer A, Rueck A, Andreana M, Widhalm G. Macroscopic fluorescence-lifetime imaging of NADH and protoporphyrin IX improves the detection and grading of 5-aminolevulinic acid-stained brain tumors. Sci Rep 2020; 10:20492. [PMID: 33235233 PMCID: PMC7686506 DOI: 10.1038/s41598-020-77268-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/05/2020] [Indexed: 12/14/2022] Open
Abstract
Maximal safe tumor resection remains the key prognostic factor for improved prognosis in brain tumor patients. Despite 5-aminolevulinic acid-based fluorescence guidance the neurosurgeon is, however, not able to visualize most low-grade gliomas (LGG) and infiltration zone of high-grade gliomas (HGG). To overcome the need for a more sensitive visualization, we investigated the potential of macroscopic, wide-field fluorescence lifetime imaging of nicotinamide adenine dinucleotide (NADH) and protoporphyrin IX (PPIX) in selected human brain tumors. For future intraoperative use, the imaging system offered a square field of view of 11 mm at 250 mm free working distance. We performed imaging of tumor tissue ex vivo, including LGG and HGG as well as brain metastases obtained from 21 patients undergoing fluorescence-guided surgery. Half of all samples showed visible fluorescence during surgery, which was associated with significant increase in PPIX fluorescence lifetime. While the PPIX lifetime was significantly different between specific tumor tissue types, the NADH lifetimes did not differ significantly among them. However, mainly necrotic areas exhibited significantly lower NADH lifetimes compared to compact tumor in HGG. Our pilot study indicates that combined fluorescence lifetime imaging of NADH/PPIX represents a sensitive tool to visualize brain tumor tissue not detectable with conventional 5-ALA fluorescence.
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Affiliation(s)
- Mikael T Erkkilä
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - David Reichert
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory OPTRAMED, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Johanna Gesperger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Roetzer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Petra A Mercea
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Angelika Unterhuber
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Rainer A Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory OPTRAMED, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Adelheid Woehrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Angelika Rueck
- Core Facility Confocal and Multiphoton Microscopy, Ulm University, N24/4105, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Marco Andreana
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Placzek F, Cordero Bautista E, Kretschmer S, Wurster LM, Knorr F, González-Cerdas G, Erkkilä MT, Stein P, Ataman Ç, Hermann GG, Mogensen K, Hasselager T, Andersen PE, Zappe H, Popp J, Drexler W, Leitgeb RA, Schie IW. Morpho-molecular ex vivo detection and grading of non-muscle-invasive bladder cancer using forward imaging probe based multimodal optical coherence tomography and Raman spectroscopy. Analyst 2020; 145:1445-1456. [PMID: 31867582 DOI: 10.1039/c9an01911a] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-muscle-invasive bladder cancer affects millions of people worldwide, resulting in significant discomfort to the patient and potential death. Today, cystoscopy is the gold standard for bladder cancer assessment, using white light endoscopy to detect tumor suspected lesion areas, followed by resection of these areas and subsequent histopathological evaluation. Not only does the pathological examination take days, but due to the invasive nature, the performed biopsy can result in significant harm to the patient. Nowadays, optical modalities, such as optical coherence tomography (OCT) and Raman spectroscopy (RS), have proven to detect cancer in real time and can provide more detailed clinical information of a lesion, e.g. its penetration depth (stage) and the differentiation of the cells (grade). In this paper, we present an ex vivo study performed with a combined piezoelectric tube-based OCT-probe and fiber optic RS-probe imaging system that allows large field-of-view imaging of bladder biopsies, using both modalities and co-registered visualization, detection and grading of cancerous bladder lesions. In the present study, 119 examined biopsies were characterized, showing that fiber-optic based OCT provides a sensitivity of 78% and a specificity of 69% for the detection of non-muscle-invasive bladder cancer, while RS, on the other hand, provides a sensitivity of 81% and a specificity of 61% for the grading of low- and high-grade tissues. Moreover, the study shows that a piezoelectric tube-based OCT probe can have significant endurance, suitable for future long-lasting in vivo applications. These results also indicate that combined OCT and RS fiber probe-based characterization offers an exciting possibility for label-free and morpho-chemical optical biopsies for bladder cancer diagnostics.
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Affiliation(s)
- Fabian Placzek
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4L, 1090 Vienna, Austria
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Reichert D, Erkkilä MT, Holst G, Hecker-Denschlag N, Wilzbach M, Hauger C, Drexler W, Gesperger J, Kiesel B, Roetzer T, Unterhuber A, Widhalm G, Leitgeb RA, Andreana M. Towards real-time wide-field fluorescence lifetime imaging of 5-ALA labeled brain tumors with multi-tap CMOS cameras. Biomed Opt Express 2020; 11:1598-1616. [PMID: 32206431 PMCID: PMC7075617 DOI: 10.1364/boe.382817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 05/24/2023]
Abstract
Fluorescence guided neurosurgery based on 5-aminolevulinic acid (5-ALA) has significantly increased maximal safe resections. Fluorescence lifetime imaging (FLIM) of 5-ALA could further boost this development by its increased sensitivity. However, neurosurgeons require real-time visual feedback which was so far limited in dual-tap CMOS camera based FLIM. By optimizing the number of phase frames required for reconstruction, we here demonstrate real-time 5-ALA FLIM of human high- and low-grade glioma with up to 12 Hz imaging rate over a wide field of view (11.0 x 11.0 mm). Compared to conventional fluorescence imaging, real-time FLIM offers enhanced contrast of weakly fluorescent tissue.
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Affiliation(s)
- David Reichert
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, 1090 Vienna, Austria
- Medical University of Vienna, Christian Doppler Laboratory OPTRAMED, 1090 Vienna, Austria
- These authors contributed equally to this work
| | - Mikael T. Erkkilä
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, 1090 Vienna, Austria
- These authors contributed equally to this work
| | - Gerhard Holst
- PCO AG, Science and Research, 93309 Kelheim, Germany
| | | | | | | | - Wolfgang Drexler
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, 1090 Vienna, Austria
| | - Johanna Gesperger
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, 1090 Vienna, Austria
- General Hospital and Medical University of Vienna, Institute of Neurology, 1090 Vienna, Austria
| | - Barbara Kiesel
- General Hospital and Medical University of Vienna, Department of Neurosurgery, 1090 Vienna, Austria
| | - Thomas Roetzer
- General Hospital and Medical University of Vienna, Institute of Neurology, 1090 Vienna, Austria
| | - Angelika Unterhuber
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, 1090 Vienna, Austria
| | - Georg Widhalm
- General Hospital and Medical University of Vienna, Department of Neurosurgery, 1090 Vienna, Austria
| | - Rainer A. Leitgeb
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, 1090 Vienna, Austria
- Medical University of Vienna, Christian Doppler Laboratory OPTRAMED, 1090 Vienna, Austria
| | - Marco Andreana
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, 1090 Vienna, Austria
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Erkkilä MT, Reichert D, Hecker-Denschlag N, Wilzbach M, Hauger C, Leitgeb RA, Gesperger J, Kiesel B, Roetzer T, Widhalm G, Drexler W, Unterhuber A, Andreana M. Surgical microscope with integrated fluorescence lifetime imaging for 5-aminolevulinic acid fluorescence-guided neurosurgery. J Biomed Opt 2020; 25:1-7. [PMID: 32096368 PMCID: PMC7039165 DOI: 10.1117/1.jbo.25.7.071202] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/31/2020] [Indexed: 06/10/2023]
Abstract
SIGNIFICANCE 5-Aminolevulinic acid (5-ALA)-based fluorescence guidance in conventional neurosurgical microscopes is limited to strongly fluorescent tumor tissue. Therefore, more sensitive, intrasurgical 5-ALA fluorescence visualization is needed. AIM Macroscopic fluorescence lifetime imaging (FLIM) was performed ex vivo on 5-ALA-labeled human glioma tissue through a surgical microscope to evaluate its feasibility and to compare it to fluorescence intensity imaging. APPROACH Frequency-domain FLIM was integrated into a surgical microscope, which enabled parallel wide-field white-light and fluorescence imaging. We first characterized our system and performed imaging of two samples of suspected low-grade glioma, which were compared to histopathology. RESULTS Our imaging system enabled macroscopic FLIM of a 6.5 × 6.5 mm2 field of view at spatial resolutions <20 μm. A frame of 512 × 512 pixels with a lifetime accuracy <1 ns was obtained in 65 s. Compared to conventional fluorescence imaging, FLIM considerably highlighted areas with weak 5-ALA fluorescence, which was in good agreement with histopathology. CONCLUSIONS Integration of macroscopic FLIM into a surgical microscope is feasible and a promising method for improved tumor delineation.
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Affiliation(s)
- Mikael T. Erkkilä
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - David Reichert
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
- Medical University of Vienna, Christian Doppler Laboratory OPTRAMED, Vienna, Austria
| | | | - Marco Wilzbach
- Carl Zeiss Meditec AG, Advanced Development Microsurgery, Oberkochen, Germany
| | - Christoph Hauger
- Carl Zeiss Meditec AG, Advanced Development Microsurgery, Oberkochen, Germany
| | - Rainer A. Leitgeb
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
- Medical University of Vienna, Christian Doppler Laboratory OPTRAMED, Vienna, Austria
| | - Johanna Gesperger
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
- General Hospital and Medical University of Vienna, Institute of Neurology, Vienna, Austria
| | - Barbara Kiesel
- General Hospital and Medical University of Vienna, Department of Neurosurgery, Vienna, Austria
| | - Thomas Roetzer
- General Hospital and Medical University of Vienna, Institute of Neurology, Vienna, Austria
| | - Georg Widhalm
- General Hospital and Medical University of Vienna, Department of Neurosurgery, Vienna, Austria
| | - Wolfgang Drexler
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Angelika Unterhuber
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Marco Andreana
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
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Andreana M, Sentosa R, Erkkilä MT, Drexler W, Unterhuber A. Depth resolved label-free multimodal optical imaging platform to study morpho-molecular composition of tissue. Photochem Photobiol Sci 2019; 18:997-1008. [PMID: 30882117 DOI: 10.1039/c8pp00410b] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Multimodal imaging platforms offer a vast array of tissue information in a single image acquisition by combining complementary imaging techniques. By merging different systems, better tissue characterization can be achieved than is possible by the constituent imaging modalities alone. The combination of optical coherence tomography (OCT) with non-linear optical imaging (NLOI) techniques such as two-photon excited fluorescence (TPEF), second harmonic generation (SHG) and coherent anti-Stokes Raman scattering (CARS) provides access to detailed information of tissue structure and molecular composition in a fast, label-free and non-invasive manner. We introduce a multimodal label-free approach for morpho-molecular imaging and spectroscopy and validate the system in mouse skin demonstrating the potential of the system for colocalized acquisition of OCT and NLOI signals.
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Affiliation(s)
- Marco Andreana
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Erkkilä MT, Bauer B, Hecker‐Denschlag N, Madera Medina MJ, Leitgeb RA, Unterhuber A, Gesperger J, Roetzer T, Hauger C, Drexler W, Widhalm G, Andreana M. Widefield fluorescence lifetime imaging of protoporphyrin IX for fluorescence-guided neurosurgery: An ex vivo feasibility study. J Biophotonics 2019; 12:e201800378. [PMID: 30636030 PMCID: PMC7065606 DOI: 10.1002/jbio.201800378] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/07/2018] [Accepted: 01/09/2019] [Indexed: 05/28/2023]
Abstract
Achieving a maximal safe extent of resection during brain tumor surgery is the goal for improved patient prognosis. Fluorescence-guided neurosurgery using 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX has thereby become a valuable tool enabling a high frequency of complete resections and a prolonged progression-free survival in glioblastoma patients. We present a widefield fluorescence lifetime imaging device with 250 mm working distance, working under similar conditions such as surgical microscopes based on a time-of-flight dual tap CMOS camera. In contrast to intensity-based fluorescence imaging, our method is invariant to light scattering and absorption while being sensitive to the molecular composition of the tissue. We evaluate the feasibility of lifetime imaging of protoporphyrin IX using our system to analyze brain tumor phantoms and fresh 5-ALA-labeled human tissue samples. The results demonstrate the potential of our lifetime sensing device to go beyond the limitation of current intensity-based fluorescence-guided neurosurgery.
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Affiliation(s)
- Mikael T. Erkkilä
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
- Advanced Development Microsurgery, Carl Zeiss Meditec AGOberkochenGermany
| | - Bianca Bauer
- Advanced Development Microsurgery, Carl Zeiss Meditec AGOberkochenGermany
| | | | | | - Rainer A. Leitgeb
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
- Christian Doppler Laboratory for Innovative Optical Imaging and Its Translation to MedicineMedical University of ViennaViennaAustria
| | - Angelika Unterhuber
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | - Johanna Gesperger
- Institute of NeurologyGeneral Hospital and Medical University of ViennaViennaAustria
| | - Thomas Roetzer
- Institute of NeurologyGeneral Hospital and Medical University of ViennaViennaAustria
| | - Christoph Hauger
- Advanced Development Microsurgery, Carl Zeiss Meditec AGOberkochenGermany
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | - Georg Widhalm
- Department of NeurosurgeryGeneral Hospital and Medical University of ViennaViennaAustria
| | - Marco Andreana
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
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