Comparison of morphologic criteria for actinic keratosis and squamous cell carcinoma using in vivo multiphoton tomography.

The routine diagnostic procedure of actinic keratosis (AK) and invasive squamous cell carcinoma (SCC) is a histological examination after taking a biopsy. In the past decades, non-invasive optical methods for skin examination have been developed. Patients with clinical diagnosis of AK or SCC were examined. The morphological criteria were determined for healthy, AK and SCC skin and compared for statistically significant differences. In this study, the applicability of multiphoton tomography (MPT) as an in vivo diagnostic tool for AK and SCC was evaluated. Changes in the morphology of the keratinocytes such as broadened epidermis, large intercellular spaces, enlarged nucleus and a large variance in cell shape could easily be recognized. The cell nuclei of AK and SCC were significantly larger compared to healthy skin cells in all cell layers. The nucleus-cytoplasm ratio was also significantly higher for AK and SCC than for the healthy skin cells. It was even higher in SCC compared to spinous and basal cell layer of AK. The cell density in AK and SCC was significantly lower than in the basal and spinous cell layers of healthy skin. In SCC, the cell density was significantly lower than in AK. Concerning the intercellular spaces, significant differences were found for AK and healthy skin in spinous and basal cell layer and for SCC compared to AK and healthy skin. In this study, MPT proved to be a valuable non-invasive imaging method for in vivo detection and discrimination of AK and SCC from healthy skin.

In vivo multiphoton tomography and fluorescence lifetime imaging of human brain tumor tissue.

High resolution multiphoton tomography and fluorescence lifetime imaging differentiates glioma from adjacent brain in native tissue samples ex vivo. Presently, multiphoton tomography is applied in clinical dermatology and experimentally. We here present the first application of multiphoton and fluorescence lifetime imaging for in vivo imaging on humans during a neurosurgical procedure. We used a MPTflex™ Multiphoton Laser Tomograph (JenLab, Germany). We examined cultured glioma cells in an orthotopic mouse tumor model and native human tissue samples. Finally the multiphoton tomograph was applied to provide optical biopsies during resection of a clinical case of glioblastoma. All tissues imaged by multiphoton tomography were sampled and processed for conventional histopathology. The multiphoton tomograph allowed fluorescence intensity- and fluorescence lifetime imaging with submicron spatial resolution and 200 picosecond temporal resolution. Morphological fluorescence intensity imaging and fluorescence lifetime imaging of tumor-bearing mouse brains and native human tissue samples clearly differentiated tumor and adjacent brain tissue. Intraoperative imaging was found to be technically feasible. Intraoperative image quality was comparable to ex vivo examinations. To our knowledge we here present the first intraoperative application of high resolution multiphoton tomography and fluorescence lifetime imaging of human brain tumors in situ. It allowed in vivo identification and determination of cell density of tumor tissue on a cellular and subcellular level within seconds. The technology shows the potential of rapid intraoperative identification of native glioma tissue without need for tissue processing or staining.

Multiphoton tomography visualizes collagen fibers in the tumor microenvironment that maintain cancer-cell anchorage and shape.

Second harmonic generation (SHG) multiphoton imaging can visualize fibrillar collagen in tissues. SHG has previously shown that fibrillar collagen is altered in various types of cancer. In the present study, in vivo high resolution SHG multi-photon tomography in living mice was used to study the relationship between cancer cells and intratumor collagen fibrils. Using green fluorescent protein (GFP) to visualize cancer cells and SHG to image collagen, we demonstrated that collagen fibrils provide a scaffold for cancer cells to align themselves and acquire optimal shape. These results suggest a new paradigm for a stromal element of tumors: their role in maintaining anchorage and shape of cancer cells that may enable them to proliferate.

Exploration of chromatic aberration for multiplanar imaging: proof of concept with implications for fast, efficient autofocus.

Image-based autofocus determines focus directly from the specimen (as opposed to reflective surface positioning with an offset), but sequential acquisition of a stack of images to measure resolution/sharpness and find best focus is slower than reflective positioning. Simultaneous imaging of multiple focal planes, which is also useful for 3D imaging of live cells, is faster but requires complicated optics. With color CCD cameras and white light sources commonly available, we asked if axial chromatic aberration can be utilized to acquire multiple focal planes simultaneously, and if it can be controlled through a range sufficient for practical use. For proof of concept, we theoretically and experimentally explored the focal differences between three narrow wavelength bands on a 3-chip color CCD camera with and without glass inserts of various thicknesses and dispersions. Ray tracing yielded changes in foci of 0.65-0.9 microm upon insertion of 12.5-mm thick glass samples for green (G, 522 nm) vs. blue (B, 462 nm) and green vs. red (G-R, 604 nm). On a microscope: (1) With no glass inserts, the differences in foci were 2.15 microm (G-B) and 0.43 microm (G-R); (2) With glass inserts, the maximum change in foci for G vs. B was 0.44 microm and for G vs. R was 0.26 microm; and (3) An 11.3 mm thick N-BK7 glass insert shifted the foci 0.9 microm (R), 0.6 microm (G), and 0.35 microm (B), such that the B and R foci were farther apart (2.1 microm vs. 1.7 microm) and the R and G foci were closer together (0.25 microm vs. 0.45 microm). The slopes of the differences in foci were dependent on thickness, index of refraction, and dispersion. The measured differences in foci are comparable to the axial steps of 0.1-0.24 microm commonly used for autofocus, and focal plane separation can be altered by inserting optical elements of various dispersions and thicknesses. By enabling acquisition of multiple, axially offset images simultaneously, chromatic aberration, normally an imaging pariah, creates a possible mechanism for efficient multiplanar imaging of multiple spectral bands from white light illumination.

Multipurpose nonlinear optical imaging system for in vivo and ex vivo multimodal histology.

We report on a flexible multipurpose nonlinear microscopic imaging system based on a femtosecond excitation source and a photonic crystal fiber with multiple miniaturized time-correlated single-photon counting detectors. The system provides the simultaneous acquisition of e.g., two-photon autofluorescence, second-harmonic generation, and coherent anti-Stokes Raman scattering images. Its flexible scan head permits ex vivo biological imaging with subcellular resolution such as rapid biopsy examination during surgery as well as imaging on small as well as large animals. Above all, such an arrangement perfectly matches the needs for the clinical investigation of human skin in vivo where knowledge about the distribution of endogenous fluorophores, second-harmonic generation-active collagen as well as nonfluorescent lipids is of high interest.

Three-dimensional multiphoton/optical coherence tomography for diagnostic applications in dermatology.

A preliminary clinical trial using state-of-the-art multiphoton tomography (MPT) and optical coherence tomography (OCT) for three-dimensional (3D) multimodal in vivo imaging of normal skin, nevi, scars and pathologic skin lesions has been conducted. MPT enabled visualization of sub-cellular details with axial and transverse resolutions of <2 µm and <0.5 µm, respectively, from a volume of 0.35 × 0.35 × 0.2 mm(3) at a frame rate of 0.14 Hz (512 × 512 pixels). State-of-the-art OCT, operating at a center wavelength of 1300 nm, was capable of acquiring 3D images depicting the layered architecture of skin with axial and transverse resolutions ~8 µm and ~20 µm, respectively, from a volume of 7 × 3.5 × 1.5 mm(3) at a frame rate of 46 Hz (1024 × 1024 pixels). This study demonstrates the clinical diagnostic potential of MPT/OCT for pre-screening relatively large areas of skin using 3D OCT to identify suspicious regions at microscopic level and subsequently using high resolution MPT to obtain zoomed in, sub-cellular level information of the respective regions.

Cancer-cell killing by engineered Salmonella imaged by multiphoton tomography in live mice.

Our laboratory has previously developed a bacterial cancer therapy strategy by targeting tumors using engineered Salmonella typhimurium auxotrophs (S. typhimurium A1-R) that were generated to grow in viable as well as necrotic areas of tumors but not in normal tissue. The mechanism by which A1-R kills cancer cells is unknown. In the present report, high-resolution multiphoton tomography was used to investigate the cellular basis of bacteria killing of cancer cells in live mice. Lewis lung cancer cells (LLC) were genetically labeled with red fluorescent protein (RFP) and injected subcutaneously in nude mice. After tumor growth was observed, the mice were treated with A1-R bacteria expressing GFP, via tail-vein injection. Mice without A1-R treatment served as untreated controls. The imaging system was 3D scan head mounted on a flexible mechano-optical articulated arm. A tunable 80 MHz titanium:sapphire femtosecond laser (710-920 nm) was used for the multiphoton tomography. We applied this high-resolution imaging tool to visualize A1-R bacteria targeting the Lewis lung cancer cells growing subcutaneously in nude mice. The tomographic images revealed that bacterially-infected cancer cells greatly expanded and burst and thereby lost viability. Similar results were seen in vitro using confocal microscopy. The bacteria targeted the tumor within minutes of tail-vein injection. Using mice in which the nestin-promoter drives GFP and in which blood vessels are labeled with GFP, the bacteria could be imaged in and out of the blood vessels. Collagen scaffolds within the tumor were imaged by second harmonic generation (SHG). The multiphoton tomographic system described here allows imaging of cancer cell killing by bacteria and can therefore be used to further understand its mechanism and optimization for clinical application.

Combined in vivo multiphoton and CARS imaging of healthy and disease-affected human skin.

We present combined epi-coherent anti-Stokes Raman scattering (CARS) and multiphoton imaging with both chemical discrimination and subcellular resolution on human skin in vivo. The combination of both image modalities enables label-free imaging of the autofluorescence of endogenous fluorophores by two-photon excited fluorescence, as well as imaging of the distribution of intercellular lipids, topically applied substances and water by CARS. As an example for medical imaging, we investigated healthy and psoriasis-affected human skin with both image modalities in vivo and found indications for different lipid distributions on the cellular level.

Watching stem cells in the skin of living mice noninvasively.

We demonstrate noninvasive, high-resolution multiphoton tomography of nestin-expressing stem cells of hair follicles in living transgenic nude mice. An imaging system comprised of a compact femtosecond laser, 3D scan head mounted on a flexible mechano-optical articulated arm for simultaneous intra-tissue fluorescence and second harmonic detection (SHG) detection was used. This noninvasive method enables long-term in vivo tracking of intra-tissue stem cells in living animals. Multiphoton animal sectioning with subcellular resolution can visualize the real-time behavior of single stem cells in their native tissue microenvironment.

Multiphoton tissue imaging using high-NA microendoscopes and flexible scan heads for clinical studies and small animal research.

Multiphoton tomographs based on femtosecond laser and GRIN lens technology in combination with flexible scan heads have been developed for clinical high-resolution tissue imaging and small animal research. The novel tissue tomograph possesses a 0.5 m long flexible mirror arm in combination with piezodriven focusing optics and multiple single photon counting PMT detectors. The photodetectors are in particular useful to obtain information on the extracellular matrix by the simultaneous measurement of the two-photon autofluorescence of elastin as well as the second harmonic generation of collagen. A major application is the in vivo determination of the skin age index. The rigid two-photon microendoscope with a high numerical aperture of 0.8 is based on a combination of silver-doped 1.0 mm rod-shaped GRIN lens with a hemispheric front optics. It was used in combination with the multiphoton tomograph for clinical studies as well as for inner organ and eye imaging of small animals.