Hybrid ultrasound and single wavelength optoacoustic imaging reveals muscle degeneration in peripheral artery disease

Peripheral arterial disease (PAD) leads to chronic vascular occlusion and results in end organ damage in critically perfused limbs. There are currently no clinical methods available to determine the muscular damage induced by chronic mal-perfusion. This monocentric prospective cross-sectional study investigated n = 193 adults, healthy to severe PAD, in order to quantify the degree of calf muscle degeneration caused by PAD using a non-invasive hybrid ultrasound and single wavelength optoacoustic imaging (US/SWL-OAI) approach. While US provides morphologic information, SWL-OAI visualizes the absorption of pulsed laser light and the resulting sound waves from molecules undergoing thermoelastic expansion. US/SWL-OAI was compared to multispectral data, clinical disease severity, angiographic findings, phantom experiments, and histological examinations from calf muscle biopsies. We were able to show that synergistic use of US/SWL-OAI is most likely to map clinical degeneration of the muscle and progressive PAD.

Fisheye piezo polymer detector for scanning optoacoustic angiography of experimental neoplasms

A number of optoacoustic (or photoacoustic) microscopy and mesoscopy techniques have successfully been employed for non-invasive tumor angiography. However, accurate rendering of tortuous and multidirectional neoplastic vessels is commonly hindered by the limited aperture size, narrow bandwidth and insufficient angular coverage of commercially available ultrasound transducers. We exploited the excellent flexibility and elasticity of a piezo polymer (PVDF) material to devise a fisheye-shape ultrasound detector with a high numerical aperture of 0.9, wide 1-30 MHz detection bandwidth and 27 mm diameter aperture suitable for imaging tumors of various size. We show theoretically and experimentally that the wide detector's view-angle and bandwidth are paramount for achieving a detailed visualization of the intricate arbitrarily-oriented neovasculature in experimental tumors. The developed approach is shown to be well adapted to the tasks of experimental oncology thus allows to better exploit the angiographic potential of optoacoustics.

Raster-scanning optoacoustic mesoscopy biomarkers for atopic dermatitis skin lesions

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease worldwide. Its severity is assessed using scores that rely on visual observation of the affected body surface area, the morphology of the lesions and subjective symptoms, like pruritus or insomnia. Ideally, such scores should be complemented by objective and accurate measurements of disease severity to standardize disease scoring in routine care and clinical trials. Recently, it was shown that raster-scanning optoacoustic mesoscopy (RSOM) can provide detailed three-dimensional images of skin inflammation processes that capture the most relevant features of their pathology. Moreover, precise RSOM biomarkers of inflammation have been identified for psoriasis. However, the objectivity and validity of such biomarkers in repeated measurements have not yet been assessed for AD. Here, we report the results of a study on the repeatability of RSOM inflammation biomarkers in AD to estimate their precision. Optoacoustic imaging analysis revealed morphological inflammation biomarkers with precision well beyond standard clinical severity metrics. Our findings suggest that optoacoustic mesoscopy may be a good choice for quantitative evaluations of AD that are inaccessible by other methods. This could potentially enable the optimization of disease scoring and drug development.

Posterior photoacoustic/ultrasound imaging of the periodontal pocket with a compact intraoral transducer

Periodontitis is a public issue and imaging periodontal pocket is important to evaluate periodontitis. Regular linear transducers have limitations in imaging the posterior teeth due to their geometry restrictions. Here we characterized a transducer that can image the posterior teeth including assessment of periodontal pockets via a combination of photoacoustic and ultrasound imaging. Unlike conventional transducer design, this device has a toothbrush-shaped form factor with a side-view transducer to image molars (total size: 1 ×1.9 cm). A laser diode was integrated as the light source to reduce the cost and size and facilitates clinical transition. The in vivo imaging of a molar of a periodontal patient demonstrated that the transducer could image in the posterior area of gum in vivo; the value determined by imaging was within 7 % of the value measured clinically.

Semantic segmentation of multispectral photoacoustic images using deep learning

Photoacoustic (PA) imaging has the potential to revolutionize functional medical imaging in healthcare due to the valuable information on tissue physiology contained in multispectral photoacoustic measurements. Clinical translation of the technology requires conversion of the high-dimensional acquired data into clinically relevant and interpretable information. In this work, we present a deep learning-based approach to semantic segmentation of multispectral photoacoustic images to facilitate image interpretability. Manually annotated photoacoustic and ultrasound imaging data are used as reference and enable the training of a deep learning-based segmentation algorithm in a supervised manner. Based on a validation study with experimentally acquired data from 16 healthy human volunteers, we show that automatic tissue segmentation can be used to create powerful analyses and visualizations of multispectral photoacoustic images. Due to the intuitive representation of high-dimensional information, such a preprocessing algorithm could be a valuable means to facilitate the clinical translation of photoacoustic imaging.

Algorithms for optoacoustically controlled selective retina therapy (SRT)

OBJECTIVES

Selective Retina Therapy (SRT) uses microbubble formation (MBF) to target retinal pigment epithelium (RPE) cells selectively while sparing the neural retina and the choroid. Intra- and inter-individual variations of RPE pigmentation makes frequent radiant exposure adaption necessary. Since selective RPE cell disintegration is ophthalmoscopically non-visible, MBF detection techniques are useful to control adequate radiant exposures. It was the purpose of this study to evaluate optoacoustically based MBF detection algorithms.

METHODS

Fifteen patients suffering from central serous chorioretinopathy and diabetic macula edema were treated with a SRT laser using a wavelength of 527 nm, a pulse duration of 1.7 µs and a pulse energy ramp (15 pulses, 100 Hz repetition rate). An ultrasonic transducer for MBF detection was embedded in a contact lens. RPE damage was verified with fluorescence angiography.

RESULTS

An algorithm to detect MBF as an indicator for RPE cell damage was evaluated. Overall, 4646 irradiations were used for algorithm optimization and testing. The tested algorithms were superior to a baseline model. A sensitivity/specificity pair of 0.96/1 was achieved. The few false algorithmic decisions were caused by unevaluable signals.

CONCLUSIONS

The algorithm can be used for guidance or automatization of microbubble related treatments like SRT or selective laser trabeculoplasty (SLT).

Multispectral optoacoustic tomography for non-invasive disease phenotyping in pediatric spinal muscular atrophy patients

Proximal spinal muscular atrophy (SMA) is a rare progressive, life limiting genetic motor neuron disease. While promising causal therapies are available, meaningful prognostic biomarkers for therapeutic monitoring are missing. We demonstrate handheld Multispectral Optoacoustic Tomography (MSOT) as a novel non-invasive imaging approach to visualize and quantify muscle wasting in pediatric SMA. While MSOT signals were distributed homogeneously in muscles of healthy volunteers (HVs), SMA patients showed moth-eaten optoacoustic signal patterns. Further signal quantification revealed greatest differences between groups at the isosbestic point for hemoglobin (SWL 800 nm). The SWL 800 nm signal intensities further correlated with clinical phenotype tested by standard motor outcome measures. Therefore, handheld MSOT could enable non-invasive assessment of disease burden in SMA patients.

Predicting optoacoustic spectral behaviour of human erythrocytes, stomatocytes and echinocytes using a modified Green's function method

Optoacoustic (OA) spectral properties of various sources mimicking normal and pathological red blood cells (RBCs) have been studied. The shapes of normal RBC and cells suffering from stomatocytosis (denoted by ST) were generated using mathematical models. However, the shape corresponding to the cells affected by echinocytosis (referred to as ET) was constructed by uniformly distributing half prolate spheroids on a central spherical object. The OA field emitted by an acoustically inhomogeneous source was calculated for a wide acoustic frequency bandwidth (1-1500 MHz with an increment 5 MHz) by solving the time-independent wave equation employing a modified Green's function approach. The OA spectra averaged over 200 orientations for normal RBC and STs demonstrate similar features (one minimum occurring nearly at 906 MHz). The same graphs for ETs are remarkably different from that of normal RBC and exhibit better match with that of a spherical RBC (first minimum appearing at around 425 MHz). The spectral features of ETs above 425 MHz may enable us to differentiate diseased cells (echinocytosis) from normal RBCs.

In vivo optical molecular imaging of inflammation and immunity

Inflammation is the phenotypic form of various diseases. Recent development in molecular imaging provides new insights into the diagnostic and therapeutic evaluation of different inflammatory diseases as well as diseases involving inflammation such as cancer. While conventional imaging techniques used in the clinical setting provide only indirect measures of inflammation such as increased perfusion and altered endothelial permeability, optical imaging is able to report molecular information on diseased tissue and cells. Optical imaging is a quick, noninvasive, nonionizing, and easy-to-use diagnostic technology which has been successfully applied for preclinical research. Further development of optical imaging technology such as optoacoustic imaging overcomes the limitations of mere fluorescence imaging, thereby enabling pilot clinical applications in humans. By means of endogenous and exogenous contrast agents, sites of inflammation can be accurately visualized in vivo. This allows for early disease detection and specific disease characterization, enabling more rapid and targeted therapeutic interventions. In this review, we summarize currently available optical imaging techniques used to detect inflammation, including optical coherence tomography (OCT), bioluminescence, fluorescence, optoacoustics, and Raman spectroscopy. We discuss advantages and disadvantages of the different in vivo imaging applications with a special focus on targeting inflammation including immune cell tracking.

Bioengineered bacterial vesicles for optoacoustics-guided phototherapy

Genetically engineered bacterial outer membrane vesicles (OMVs) offer promising applications for gene therapy, immunotherapy, and vaccine delivery. Importantly, OMVs are biocompatible, biodegradable, and easy to engineer and produce on a large scale. In this chapter, we discuss the development and application of bioengineered OMVs for optoacoustics-guided phototherapy applications (theranostics). We provide detailed protocols for OMVs preparation, characterization, and in vitro and in vivo validation. The engineered OMVs carry the biopolymer melanin, which generates a strong optoacoustic (OA) signal and intense heat upon absorption of near-infrared (NIR) light, enabling optoacoustics-guided cancer diagnosis and photothermal therapy in vivo.

Emerging photoacoustic and thermoacoustic imaging technologies for detecting primary and metastatic cancer and guiding therapy

In recent years, there has been a progressive trend towards less invasive technologies for detecting metastatic cancer and guiding therapy with the goal of lower morbidity, better outcomes, and superior cosmetic appearance than traditional methods. This mini-review examines three emerging noninvasive hybrid technologies for detecting primary cancer, metastasis and guiding thermal therapy. Real-time thermoacoustic imaging and thermometry potentially provides valuable and critical feedback for guiding focused microwave ablation therapy. Label-free photoacoustic monitoring of cancer cells is a promising clinical diagnostic and theranostic tool for detecting metastatic disease and monitoring the response to therapy. Finally, immunologically targeted gold nanoparticles combined with photoacoustic imaging is able to detect lymph node micrometastasis in mouse models of breast cancer. These emerging techniques have the potential to improve the decision to biopsy, provide more accurate prognosis, and enhance the efficacy of therapy for early and late stage cancers.

Pendant breast immobilization and positioning in photoacoustic tomographic imaging

This work describes the design, development and added value of breast-supporting cups to immobilize and position the pendant breast in photoacoustic tomographic imaging. We explain the considerations behind the choice of the material, the shape and sizes of a cup-shaped construct for supporting the breast in water in an imaging tank during full-breast imaging. We provide details of the fabrication, and other processing and testing procedures used. Various experiments were conducted to demonstrate the added value of using these cups. We show that breast movement during a measurement time of four minutes is reduced from maximum 2 mm to 0.1 mm by the use of cups. Further, the presence of the cup, centered in the aperture leading to the imaging tank, ensures that the breast can be reproducibly positioned at the center of the field-of-view of the detection aperture in the tank. Finally, since an accurate delineation of the water-tissue boundary can now be made, the use of the cup enables accurate application of a two-speed of sound model for reconstruction. All in all, we demonstrate that the use of cups to support the breast provides clear enhancement in contrast and resolution of breast images in photoacoustic imaging.

Precision of handheld multispectral optoacoustic tomography for muscle imaging

Photo-or optoacoustic imaging (OAI) allows quantitative imaging of target tissues. Using multi-wavelength illumination with subsequent ultrasound detection, it may visualize a variety of different chromophores at centimeter depth. Despite its non-invasive, label-free advantages, the precision of repeated measurements for clinical applications is still elusive. We present a multilayer analysis of n = 1920 imaging datasets obtained from a prospective clinical trial (NCT03979157) in n = 10 healthy adult volunteers. All datasets were analyzed for 13 single wavelengths (SWL) between 660 nm-1210 nm and five MSOT-parameters (deoxygenated/oxygenated/total hemoglobin, collagen and lipid) by a semi-automated batch mode software. Intraclass correlation coefficients (ICC) were good to excellent for intrarater (SWL: 0.82-0.92; MSOT-parameter: 0.72-0.92) and interrater reproducibility (SWL: 0.79-0.87; MSOT-parameter: 0.78-0.86), with the exception for MSOT-parameter lipid (interrater ICC: 0.56). Results were stable over time, but exercise-related effects as well as inter-and intramuscular variability were observed. The findings of this study provide a framework for further clinical OAI implementation.

Review on practical photoacoustic microscopy

Photoacoustic imaging (PAI) has many interesting advantages, such as deep imaging depth, high image resolution, and high contrast to intrinsic and extrinsic chromophores, enabling morphological, functional, and molecular imaging of living subjects. Photoacoustic microscopy (PAM) is one form of the PAI inheriting its characteristics and is useful in both preclinical and clinical research. Over the years, PAM systems have been evolved in several forms and each form has its relative advantages and disadvantages. Thus, to maximize the benefits of PAM for a specific application, it is important to configure the PAM system optimally by targeting a specific application. In this review, we provide practical methods for implementing a PAM system to improve the resolution, signal-to-noise ratio (SNR), and imaging speed. In addition, we review the preclinical and the clinical applications of PAM and discuss the current challenges and the scope for future developments.

Optoacoustic inversion via convolution kernel reconstruction in the paraxial approximation and beyond

In this article we address the numeric inversion of optoacoustic signals to initial stress profiles. Therefore we study a Volterra integral equation of the second kind that describes the shape transformation of propagating stress waves in the paraxial approximation of the underlying wave-equation. Expanding the optoacoustic convolution kernel in terms of a Fourier-series, a best fit to a pair of observed near-field and far-field signals allows to obtain a sequence of expansion coefficients that describe a given "apparative" setup. The resulting effective kernel is used to solve the optoacoustic source reconstruction problem using a Picard-Lindelöf correction scheme. We verify the validity of the proposed inversion protocol for synthetic input signals and explore the feasibility of our approach to also account for the shape transformation of signals beyond the paraxial approximation including the inversion of experimental data stemming from measurements on melanin doped PVA hydrogel tissue phantoms.

Clinical photoacoustic imaging platforms

Photoacoustic imaging (PAI) is a new promising medical imaging technology available for diagnosing and assessing various pathologies. PAI complements existing imaging modalities by providing information not currently available for diagnosing, e.g., oxygenation level of the underlying tissue. Currently, researchers are translating PAI from benchside to bedside to make unique clinical advantages of PAI available for patient care. The requirements for a successful clinical PAI system are; deeper imaging depth, wider field of view, and faster scan time than the laboratory-level PAI systems. Currently, many research groups and companies are developing novel technologies for data acquisition/signal processing systems, detector geometry, and an acoustic sensor. In this review, we summarize state-of-the-art clinical PAI systems with three types of the imaging transducers: linear array transducer, curved linear array transducer, and volumetric array transducer. We will also discuss the limitations of the current PAI systems and describe latest techniques being developed to address these for further enhancing the image quality of PAI for successful clinical translation.

Multispectral Optoacoustic Tomography of Brown Adipose Tissue

MSOT has revolutionized biomedical imaging because it allows anatomical, functional, and molecular imaging of deep tissues in vivo in an entirely noninvasive, label-free, and real-time manner. This imaging modality works by pulsing light onto tissue, triggering the production of acoustic waves, which can be collected and reconstructed to provide high-resolution images of features as deep as several centimeters below the body surface. Advances in hardware and software continue to bring MSOT closer to clinical translation. Most recently, a clinical handheld MSOT system has been used to image brown fat tissue (BAT) and its metabolic activity by directly resolving the spectral signatures of hemoglobin and lipids. This opens up new possibilities for studying BAT physiology and its role in metabolic disease without the need to inject animals or humans with contrast agents. In this chapter, we overview how MSOT works and how it has been implemented in preclinical and clinical contexts. We focus on our recent work using MSOT to image BAT in resting and activated states both in mice and humans.

Wide bandwidth fiber-optic ultrasound probe in MOMS technology: Preliminary signal processing results

An ultrasonic probe consisting of two optical fiber-based miniaturized transducers for wideband ultrasound emission and detection is employed for the characterization of in vitro biological tissues. In the probe, ultrasound generation is obtained by thermoelastic emission from patterned carbon films in Micro-Opto-Mechanical-System (MOMS) devices mounted on the tip of an optical fiber, whereas acousto-optical detection is performed in a similar way by a miniaturized polymeric interferometer. The microprobe presents a wide, flat bandwidth that is a very attractive feature for ultrasonic investigation, especially for tissue characterization. Thanks to the very high ultrasonic frequencies obtained, the probe is able to reveal different details of the object under investigation by analyzing the ultrasonic signal within different frequencies ranges, as shown by specific experiments performed on a patterned cornstarch flour sample in vitro. This is confirmed by measurements executed to determine the lateral resolution of the microprobe at different frequencies of about 70μm at 120MHz. Moreover, measurements performed with the wideband probe in pulsed-echo mode on a histological finding of porcine kidney are presented, on which two different spectral signal processing algorithms are applied. After processing, the ultrasonic spectral features show a peculiar spatial distribution on the sample, which is expected to depend on different ultrasonic backscattering properties of the analyzed tissues.

Detection, numerical simulation and approximate inversion of optoacoustic signals generated in multi-layered PVA hydrogel based tissue phantoms

Optoacoustic (OA) measurements can not only be used for imaging purposes but as a more general tool to "sense" physical characteristics of biological tissue, such as geometric features and intrinsic optical properties. In order to pave the way for a systematic model-guided analysis of complex objects we devised numerical simulations in accordance with the experimental measurements. We validate our computational approach with experimental results observed for layered polyvinyl alcohol hydrogel samples, using melanin as the absorbing agent. Experimentally, we characterize the acoustic signal observed by a piezoelectric detector in the acoustic far-field in backward mode and we discuss the implication of acoustic diffraction on our measurements. We further attempt an inversion of an OA signal in the far-field approximation.

Optoacoustic image segmentation based on signal domain analysis

Efficient segmentation of optoacoustic images has importance in enhancing the diagnostic and quantification capacity of this modality. It may also aid in improving the tomographic reconstruction accuracy by accounting for heterogeneous optical and acoustic tissue properties. In particular, when imaging through complex biological tissues, the real acoustic properties often deviate considerably from the idealized assumptions of homogenous conditions, which may lead to significant image artifacts if not properly accounted for. Although several methods have been proposed aiming at estimating and accounting for the complex acoustic properties in the image domain, accurate delineation of structures is often hindered by low contrast of the images and other artifacts produced due to incomplete tomographic coverage and heuristic assignment of the tissue properties during the reconstruction process. In this letter, we propose instead a signal domain analysis approach that retrieves acoustic properties of the object to be reconstructed from characteristic features of the detected optoacoustic signals prior to image reconstruction. Performance of the proposed method is first tested in simulation and experiment using two-dimensional tissue-mimicking phantoms. Significant improvements in the segmentation abilities and overall reconstructed image quality are further showcased in experimental cross-sectional data acquired from a human finger.

NDT of fiber-reinforced composites with a new fiber-optic pump-probe laser-ultrasound system

Laser-ultrasonics is an attractive and powerful tool for the non-destructive testing and evaluation (NDT&E) of composite materials. Current systems for non-contact detection of ultrasound have relatively low sensitivity compared to contact peizotransducers. They are also expensive, difficult to adjust, and strongly influenced by environmental noise. Moreover, laser-ultrasound (LU) systems typically launch only about 50 firings per second, much slower than the kHz level pulse repetition rate of conventional systems. As demonstrated here, most of these drawbacks can be eliminated by combining a new generation of compact, inexpensive, high repetition rate nanosecond fiber lasers with new developments in fiber telecommunication optics and an optimally designed balanced probe beam detector. In particular, a modified fiber-optic balanced Sagnac interferometer is presented as part of a LU pump-probe system for NDT&E of aircraft composites. The performance of the all-optical system is demonstrated for a number of composite samples with different types and locations of inclusions.

Optoacoustic detection of intra- and extracranial hematomas in rats after blast injury

Surgical drainage of intracranial hematomas is often required within the first four hours after traumatic brain injury (TBI) to avoid death or severe disability. Although CT and MRI permit hematoma diagnosis, they can be used only at a major health-care facility. This delays hematoma diagnosis and therapy. We proposed to use an optoacoustic technique for rapid, noninvasive diagnosis of hematomas. In this study we developed a near-infrared OPO-based optoacoustic system for hematoma diagnosis and cerebral venous blood oxygenation monitoring in rats. A specially-designed blast device was used to inflict TBI in anesthetized rats. Optoacoustic signals were recorded from the superior sagittal sinus and hematomas that allowed for measurements of their oxygenations. These results indicate that the optoacoustic technique may be used for early diagnosis of hematomas and may provide important information for improving outcomes in patients with TBI.