Corneal stromal stem cells restore transparency after N2 injury in mice.

Corneal scarring associated with various corneal conditions is a leading cause of blindness worldwide. The present study aimed to test the hypothesis that corneal stromal stem cells have a therapeutic effect and are able to restore the extracellular matrix organization and corneal transparency in vivo. We first developed a mouse model of corneal stromal scar induced by liquid nitrogen (N2 ) application. We then reversed stromal scarring by injecting mouse or human corneal stromal stem cells in injured cornea. To characterize the mouse model developed in this study and the therapeutic effect of corneal stromal stem cells, we used a combination of in vivo (slit lamp, optical coherence tomography, in vivo confocal microscopy, optical coherence tomography shear wave elastography, and optokinetic tracking response) and ex vivo (full field optical coherence microscopy, flow cytometry, transmission electron microscopy, and histology) techniques. The mouse model obtained features early inflammation, keratocyte apoptosis, keratocyte transformation into myofibroblasts, collagen type III synthesis, impaired stromal ultrastructure, corneal stromal haze formation, increased corneal rigidity, and impaired visual acuity. Injection of stromal stem cells in N2 -injured cornea resulted in improved corneal transparency associated with corneal stromal stem cell migration and growth in the recipient stroma, absence of inflammatory response, recipient corneal epithelial cell growth, decreased collagen type III stromal content, restored stromal ultrastructure, decreased stromal haze, decreased corneal rigidity, and improved vision. Our study demonstrates the ability of corneal stromal stem cells to promote regeneration of transparent stromal tissue after corneal scarring induced by liquid nitrogen.

Stromal striae: a new insight into corneal physiology and mechanics.

We uncover the significance of a previously unappreciated structural feature in corneal stroma, important to its biomechanics. Vogt striae are a known clinical indicator of keratoconus, and consist of dark, vertical lines crossing the corneal depth. However we detected stromal striae in most corneas, not only keratoconus. We observed striae with multiple imaging modalities in 82% of 118 human corneas, with pathology-specific differences. Striae generally depart from anchor points at Descemet's membrane in the posterior stroma obliquely in a V-shape, whereas in keratoconus, striae depart vertically from posterior toward anterior stroma. Optical coherence tomography shear wave elastography showed discontinuity of rigidity, and second harmonic generation and scanning electron microscopies showed undulation of lamellae at striae locations. Striae visibility decreased beyond physiological pressure and increased beyond physiological hydration. Immunohistology revealed striae to predominantly contain collagen VI, lumican and keratocan. The role of these regions of collagen VI linking sets of lamellae may be to absorb increases in intraocular pressure and external shocks.

Diffuse shear wave imaging: toward passive elastography using low-frame rate spectral-domain optical coherence tomography.

Optical coherence tomography (OCT) can map the stiffness of biological tissue by imaging mechanical perturbations (shear waves) propagating in the tissue. Most shear wave elastography (SWE) techniques rely on active shear sources to generate controlled displacements that are tracked at ultrafast imaging rates. Here, we propose a noise-correlation approach to retrieve stiffness information from the imaging of diffuse displacement fields using low-frame rate spectral-domain OCT. We demonstrated the method on tissue-mimicking phantoms and validated the results by comparison with classic ultrafast SWE. Then we investigated the in vivo feasibility on the eye of an anesthetized rat by applying noise correlation to naturally occurring displacements. The results suggest a great potential for passive elastography based on the detection of natural pulsatile motions using conventional spectral-domain OCT systems. This would facilitate the transfer of OCT-elastography to clinical practice, in particular, in ophthalmology or dermatology.

Moving-source elastic wave reconstruction for high-resolution optical coherence elastography.

Optical coherence tomography (OCT)-based elasticity imaging can map soft tissue elasticity based on speckle-tracking of elastic wave propagation using highly sensitive phase measurements of OCT signals. Using a fixed elastic wave source and moving detection, current imaging sequences have difficulty in reconstructing tissue elasticity within speckle-free regions, for example, within the crystalline lens of the eye. We present a moving acoustic radiation force imaging sequence to reconstruct elastic properties within a speckle-free region by tracking elastic wave propagation from multiple laterally moving sources across the field of view. We demonstrate the proposed strategy using heterogeneous and partial speckle-free tissue-mimicking phantoms. Harder inclusions within the speckle-free region can be detected, and the contrast-to-noise ratio slightly enhanced compared to current OCE imaging sequences. The results suggest that a moving source approach may be appropriate for OCE studies within the large speckle-free regions of the crystalline lens.

Sono-photoacoustic imaging of gold nanoemulsions: Part II. Real time imaging.

Photoacoustic (PA) imaging using exogenous agents can be limited by degraded specificity due to strong background signals. This paper introduces a technique called sono-photoacoustics (SPA) applied to perfluorohexane nanodroplets coated with gold nanospheres. Pulsed laser and ultrasound (US) excitations are applied simultaneously to the contrast agent to induce a phase-transition ultimately creating a transient microbubble. The US field present during the phase transition combined with the large thermal expansion of the bubble leads to 20-30 dB signal enhancement. Aqueous solutions and phantoms with very low concentrations of this agent were probed using pulsed laser radiation at diagnostic exposures and a conventional US array used both for excitation and imaging. Contrast specificity of the agent was demonstrated with a coherent differential scheme to suppress US and linear PA background signals. SPA shows great potential for molecular imaging with ultrasensitive detection of targeted gold coated nanoemulsions and cavitation-assisted theranostic approaches.

Real-time integrated photoacoustic and ultrasound (PAUS) imaging system to guide interventional procedures: ex vivo study.

Because of depth-dependent light attenuation, bulky, low-repetition-rate lasers are usually used in most photoacoustic (PA) systems to provide sufficient pulse energies to image at depth within the body. However, integrating these lasers with real-time clinical ultrasound (US) scanners has been problematic because of their size and cost. In this paper, an integrated PA/US (PAUS) imaging system is presented operating at frame rates >30 Hz. By employing a portable, low-cost, low-pulse-energy (~2 mJ/pulse), high-repetition-rate (~1 kHz), 1053-nm laser, and a rotating galvo-mirror system enabling rapid laser beam scanning over the imaging area, the approach is demonstrated for potential applications requiring a few centimeters of penetration. In particular, we demonstrate here real-time (30 Hz frame rate) imaging (by combining multiple single-shot sub-images covering the scan region) of an 18-gauge needle inserted into a piece of chicken breast with subsequent delivery of an absorptive agent at more than 1-cm depth to mimic PAUS guidance of an interventional procedure. A signal-to-noise ratio of more than 35 dB is obtained for the needle in an imaging area 2.8 × 2.8 cm (depth × lateral). Higher frame rate operation is envisioned with an optimized scanning scheme.

Magneto-optical nanoparticles for cyclic magnetomotive photoacoustic imaging.

Photoacoustic imaging has emerged as a highly promising tool to visualize molecular events with deep tissue penetration. Like most other modalities, however, image contrast under in vivo conditions is far from optimal due to background signals from tissue. Using iron oxide-gold core-shell nanoparticles, we have previously demonstrated the concept of magnetomotive photoacoustic (mmPA) imaging, which is capable of dramatically reducing the influence of background signals and producing high-contrast molecular images. Here, we report two significant advances toward clinical translation of this technology. First, we introduce a new class of compact, uniform, magneto-optically coupled core-shell nanoparticles, prepared through localized copolymerization of polypyrrole (PPy) on an iron oxide nanoparticle surface. The resulting iron oxide-PPy nanoparticles feature high colloidal stability and solve the photoinstability and small-scale synthesis problems previously encountered by the gold coating approach. In parallel, we have developed a new generation of mmPA featuring cyclic magnetic motion and ultrasound speckle tracking (USST), whose imaging capture frame rate is several hundred times faster than the photoacoustic speckle tracking (PAST) method we demonstrated previously. These advances enable robust artifact elimination caused by physiologic motions and demonstrate the application of the mmPA technology for in vivo sensitive tumor imaging.

Shear wave elastography using amplitude-modulated acoustic radiation force and phase-sensitive optical coherence tomography.

Investigating the elasticity of ocular tissue (cornea and intraocular lens) could help the understanding and management of pathologies related to biomechanical deficiency. In previous studies, we introduced a setup based on optical coherence tomography for shear wave elastography (SWE) with high resolution and high sensitivity. SWE determines tissue stiffness from the propagation speed of shear waves launched within tissue. We proposed acoustic radiation force to remotely induce shear waves by focusing an ultrasound (US) beam in tissue, similar to several elastography techniques. Minimizing the maximum US pressure is essential in ophthalmology for safety reasons. For this purpose, we propose a pulse compression approach. It utilizes coded US emissions to generate shear waves where the energy is spread over a long emission, and then numerically compressed into a short, localized, and high-energy pulse. We used a 7.5-MHz single-element focused transducer driven by coded excitations where the amplitude is modulated by a linear frequency-swept square wave (1 to 7 kHz). An inverse filter approach was used for compression. We demonstrate the feasibility of performing shear wave elastography measurements in tissue-mimicking phantoms at low US pressures (mechanical index < 0.6)

Optimization of the laser irradiation pattern in a high frame rate integrated photoacoustic / ultrasound (PAUS) imaging system.

To integrate real-time photoacoustics (PA) into ultrasound (US) scanners and accelerate clinical translation of combined PAUS imaging, we previously developed a system using a portable, low-cost, low pulse energy, high-repetition rate laser (~1kHz) with a 1D galvo-mirror for rapid laser beam scanning over the imaging area. However, the frame rate and pulse energy are limited because of regulations on the radiance (1 W/cm2). Therefore, a laser scan scheme needs to be optimized to provide high frame rate within this safety limit. In addition, the laser light should be evenly distributed to minimize any artifacts caused by the scanning approach. In this paper, we calculated the laser light distribution using 3D Monte Carlo simulation and further developed the system to scan the laser beam in elevation as well as laterally using a 2-dimensional galvo-mirror scanner to achieve higher frame rates within the radiance safety limit. Insertion of a needle into chicken breast tissue was used to demonstrate our optimized scan scheme.

Real-time interleaved photoacoustic/ultrasound (PAUS) imaging for interventional procedure guidance.

Ultrasound-guided photoacoustic imaging has shown great potential for many clinical applications including vascular visualization, detection of nanoprobes sensing molecular profiles, and guidance of interventional procedures. However, bulky and costly lasers are usually required to provide sufficient pulse energies for deep imaging. The low pulse repetition rate also limits potential real-time applications of integrated photoacoustic/ultrasound (PAUS) imaging. With a compact and low-cost laser operating at a kHz repetition rate, we aim to integrate photoacoustics (PA) into a commercial ultrasound (US) machine utilizing an interleaved scanning approach for clinical translation, with imaging depth up to a few centimeters and frame rates > 30 Hz. Multiple PA sub-frames are formed by scanning laser firings covering a large scan region with a rotating galvo mirror, and then combined into a final frame. Ultrasound pulse-echo beams are interleaved between laser firings/PA receives. The approach was implemented with a diode-pumped laser, a commercial US scanner, and a linear array transducer. Insertion of an 18-gauge needle into a piece of chicken tissue, with subsequent injection of an absorptive agent into the tissue, was imaged with an integrated PAUS frame rate of 30 Hz, covering a 2.8 cm × 2.8 cm imaging plane. Given this real-time image rate and high contrast (> 40 dB at more than 1-cm depth in the PA image), we have demonstrated that this approach is potentially attractive for clinical procedure guidance.

Cyclic Magnetomotive Photoacoustic/Ultrasound Imaging.

Magnetomotive photoacoustic/ultrasound imaging has shown superior specificity in visualizing targeted objects at cellular and molecular levels. By detecting magnet-induced displacements, magnetic-particle-targeted objects can be differentiated from background signals insensitive to the magnetic field. Unfortunately, background physiologic motion interferes during measurement, such as cardiac-induced motion and respiration, greatly reducing the robustness of the technique. In this paper, we propose cyclic magnetomotive imaging with narrowband magnetic excitation. By synchronizing magnetic motion with the excitations, targeted objects moving coherently can be distinguished from background static signals and signals moving incoherently. HeLa cells targeted with magnetic nanoparticle-polymer core-shell particles were used as the targets for an initial test. A linear ultrasound array was interfaced with a commercial scanner to acquire a photoacoustic/ultrasound image sequence (maximum 1000 frames per second) during multi-cycle magnetic excitation (0.5 - 40 Hz frequency range) with an electromagnet. An image mask defined by a threshold on the displacement-coherence map was applied to the original images for background suppression. The results show that contrast was increased by more than 60 dB in an in-vitro experiment with the tagged cells fixed in a polyvinyl-alcohol gel and sandwiched between porcine liver tissues. Using a single sided system, cells injected subcutaneously on the back of a mouse were successfully differentiated from the background, with less than 20 µm coherent magnetic induced displacements isolated from millimetric background breathing motion. These results demonstrate the technique's motion robustness for highly sensitive and specific diagnosis.

Toric focusing for radiation force applications using a toric lens coupled to a spherically focused transducer.

Dynamic elastography using radiation force requires that an ultrasound field be focused during hundreds of microseconds at a pressure of several megapascals. Here, we address the importance of the focal geometry. Although there is usually no control of the elevational focal width in generating a tissue mechanical response, we propose a tunable approach to adapt the focus geometry that can significantly improve radiation force efficiency. Several thin, in-house-made polydimethylsiloxane lenses were designed to modify the focal spot of a spherical transducer. They exhibited low absorption and the focal spot widths were extended up to 8-fold in the elevation direction. Radiation force experiments demonstrated an 8-fold increase in tissue displacements using the same pressure level in a tissue-mimicking phantom with a similar shear wave spectrum, meaning it does not affect elastography resolution. Our results demonstrate that larger tissue responses can be obtained for a given pressure level, or that similar response can be reached at a much lower mechanical index (MI). We envision that this work will impact 3-D elastography using 2-D phased arrays, where such shaping can be achieved electronically with the potential for adaptive optimization.

In vivo evidence of porcine cornea anisotropy using supersonic shear wave imaging.

PURPOSE: This work proposes shear wave elastography to quantify the elastic anisotropy of the cornea. METHODS: Experiments were conducted on enucleated porcine eyeballs and anesthetized swine. We used the supersonic shear wave imaging (SSI) method implemented on a dedicated 15-MHz rotating linear ultrasound array. This setup allows determining the shear wave speed variations for a set of radial propagation directions. RESULTS: All the results showed a local anisotropy with one main direction of maximal stiffness. The influence of pulsatility was observed in vivo, and electrocardiogram (ECG) gating was consequently performed for all anesthetized swine. On ex vivo corneas, n = 27 acquisitions were performed in the limbus region, where the collagen fibrils are reported to run tangentially to the sclera. A good match was shown between the direction of maximal stiffness and the expected direction of the collagen fibrils. CONCLUSIONS: This preliminary study demonstrates the potential of SSI for the assessment of corneal anisotropy in both ex vivo and in vivo conditions.

Visualizing ultrasonically induced shear wave propagation using phase-sensitive optical coherence tomography for dynamic elastography.

We report on the use of phase-sensitive optical coherence tomography (PhS-OCT) to detect and track temporal and spatial shear wave propagation within tissue, induced by ultrasound radiation force. Kilohertz-range shear waves are remotely generated in samples using focused ultrasound emission and their propagation is tracked using PhS-OCT. Cross-sectional maps of the local shear modulus are reconstructed from local estimates of shear wave speed in tissue-mimicking phantoms. We demonstrate the feasibility of combining ultrasound radiation force and PhS-OCT to perform high-resolution mapping of the shear modulus.

Supersonic shear wave elastography for the in vivo evaluation of transepithelial corneal collagen cross-linking.

PURPOSE: To assess corneal stiffening with supersonic shear wave imaging (SSI) technology in an experimental model of iontophoresis-assisted transepithelial corneal collagen cross-linking (I-CXL). METHODS: Six rabbits underwent full, central I-CXL in one eye. The contralateral eye served as control. In vivo iontophoresis was used for 10 minutes to perform transepithelial delivery of riboflavin prior to UV-A irradiation. Accelerated UV-A protocol was applied for 9 minutes with a 10-mW/cm(2) irradiance. Animals were killed and both treated and control corneas were then immediately mounted on a corneal artificial anterior chamber and internal pressure was varied from 15 to 50 mm Hg in 5-mm Hg increments. Swelling was evaluated via central corneal thickness measurements. Ex vivo inflation tests were monitored using SSI technology that provides real-time mapping of the corneal elasticity. RESULTS: Corneal yellowing of the central 9-mm diameter area was clearly visible in the iontophoresis area of all treated eyes. Elasticity versus internal pressure revealed significant differences of the change in elasticity coefficient with pressure between I-CXL-treated and control corneas with a mean slope that was 27.1 and 16.9 kPa/mm Hg, respectively (P = 0.029). Differences in elasticity at individual pressure levels between groups were statistically significant above 40 mm Hg (P < 0.05). CONCLUSIONS: Intraocular pressure variations were the most important limitations for in vivo stiffness monitoring with SSI because stiffness is a function of internal pressure. Supersonic shear wave imaging succeeded in comparing corneas that underwent I-CXL by performing ex vivo inflation tests where pressure was controlled. Iontophoresis-assisted transepithelial corneal collagen cross-linking corneas exhibited increased resistance to pressure rise, indicating stiffening. In vivo I-CXL and ex vivo SSI is an interesting model to evaluate the sole effect of photopolymerization occurring in the CXL process close to physiological conditions.

Shear wave pulse compression for dynamic elastography using phase-sensitive optical coherence tomography.

Assessing the biomechanical properties of soft tissue provides clinically valuable information to supplement conventional structural imaging. In the previous studies, we introduced a dynamic elastography technique based on phase-sensitive optical coherence tomography (PhS-OCT) to characterize submillimetric structures such as skin layers or ocular tissues. Here, we propose to implement a pulse compression technique for shear wave elastography. We performed shear wave pulse compression in tissue-mimicking phantoms. Using a mechanical actuator to generate broadband frequency-modulated vibrations (1 to 5 kHz), induced displacements were detected at an equivalent frame rate of 47 kHz using a PhS-OCT. The recorded signal was digitally compressed to a broadband pulse. Stiffness maps were then reconstructed from spatially localized estimates of the local shear wave speed. We demonstrate that a simple pulse compression scheme can increase shear wave detection signal-to-noise ratio (>12 dB gain) and reduce artifacts in reconstructing stiffness maps of heterogeneous media.

Feasibility of a hybrid elastographic-microfluidic device to rapidly process and assess pancreatic cancer biopsies for pathologists.

In this study, our collaborative research group explored the possibility of incorporating ultrasound elastography technology with a microfluidic device that is designed to prepare fine needle core biopsies (CBs; L=0.5-2.0 cm, D=0.4-1.2 mm) for pancreatic cancer diagnosis. For the first time, elastographic techniques were employed to measure shear wave velocity in fresh (3.7 m/s) and formalin-fixed (14.7 m/s) pancreatic CBs. Shear wave velocity did not vary whether fixed specimens were free on a microscope slide, or constrained within glass microfluidic channels: 11.5±1.9 v. 11.8±2.1 m/s. 4% agarose inclusions were also embedded within 1% agarose hydrogels to simulate cysts, neoplastic, or necrotic tissue within CBs. Inclusions were successfully visualized and measured using optical coherence elastography. These preliminary experiments demonstrate in a rudimentary fashion that elastographic measurements of pancreatic CBs may be incorporated with our microfluidic device. The rapid mapping of CB stiffness may provide qualitative spatial information for pathologists to determine a more accurate diagnosis for patients.

From supersonic shear wave imaging to full-field optical coherence shear wave elastography.

Elasticity maps of tissue have proved to be particularly useful in providing complementary contrast to ultrasonic imaging, e.g., for cancer diagnosis at the millimeter scale. Optical coherence tomography (OCT) offers an endogenous contrast based on singly backscattered optical waves. Adding complementary contrast to OCT images by recording elasticity maps could also be valuable in improving OCT-based diagnosis at the microscopic scale. Static elastography has been successfully coupled with full-field OCT (FF-OCT) in order to realize both micrometer-scale sectioning and elasticity maps. Nevertheless, static elastography presents a number of drawbacks, mainly when stiffness quantification is required. Here, we describe the combination of two methods: transient elastography, based on speed measurements of shear waves induced by ultrasonic radiation forces, and FF-OCT, an en face OCT approach using an incoherent light source. The use of an ultrafast ultrasonic scanner and an ultrafast camera working at 10,000 to 30,000 images/s made it possible to follow shear wave propagation with both modalities. As expected, FF-OCT is found to be much more sensitive than ultrafast ultrasound to tiny shear vibrations (a few nanometers and micrometers, respectively). Stiffness assessed in gel phantoms and an ex vivo rat brain by FF-OCT is found to be in good agreement with ultrasound shear wave elastography.

Shear modulus imaging by direct visualization of propagating shear waves with phase-sensitive optical coherence tomography.

We propose an integrated method combining low-frequency mechanics with optical imaging to map the shear modulus within the biological tissue. Induced shear wave propagating in tissue is tracked in space and time using phase-sensitive optical coherence tomography (PhS-OCT). Local estimates of the shear-wave speed obtained from tracking results can image the local shear modulus. A PhS-OCT system remotely records depth-resolved, dynamic mechanical waves at an equivalent frame rate of ∼47 kHz with the high spatial resolution. The proposed method was validated by examining tissue-mimicking phantoms made of agar and light scattering material. Results demonstrate that the shear wave imaging can accurately map the elastic moduli of these phantoms.

Monitoring of cornea elastic properties changes during UV-A/riboflavin-induced corneal collagen cross-linking using supersonic shear wave imaging: a pilot study.

PURPOSE: Keratoconus disease or post-LASIK corneal ectasia are increasingly treated using UV-A/riboflavin-induced corneal collagen cross-linking (CXL). However, this treatment suffers from a lack of techniques to provide an assessment in real-time of the CXL effects. Here, we investigated the potential interest of corneal elasticity as a biomarker of the efficacy of this treatment. METHODS: For this purpose, supersonic shear wave imaging (SSI) was performed both ex vivo and in vivo on porcine eyes before and after CXL. Based on ultrasonic scanners providing ultrafast frame rates (~30 kHz), the SSI technique generates and tracks the propagation of shear waves in tissues. It provides two- and three-dimensional (2-D and 3-D) quantitative maps of the corneal elasticity. RESULTS: After CXL, quantitative maps of corneal stiffness clearly depicted the cross-linked area with a typical 200-µm lateral resolution. The CXL resulted in a 56% ± 15% increase of the shear wave speed for corneas treated in vivo (n = 4). CONCLUSIONS: The in vivo CXL experiments performed on pigs demonstrated that the quantitative estimation of local stiffness and the 2-D elastic maps of the corneal surface provide an efficient way to monitor the local efficacy of corneal cross-linking.