Enhanced diffuse optical tomographic reconstruction using concurrent ultrasound information.

Multimodal imaging is an active branch of research as it has the potential to improve common medical imaging techniques. Diffuse optical tomography (DOT) is an example of a low resolution, functional imaging modality that typically has very low resolution due to the ill-posedness of its underlying inverse problem. Combining the functional information of DOT with a high resolution structural imaging modality has been studied widely. In particular, the combination of DOT with ultrasound (US) could serve as a useful tool for clinicians for the formulation of accurate diagnosis of breast lesions. In this paper, we propose a novel method for US-guided DOT reconstruction using a portable time-domain measurement system. B-mode US imaging is used to retrieve morphological information on the probed tissues by means of a semi-automatical segmentation procedure based on active contour fitting. A two-dimensional to three-dimensional extrapolation procedure, based on the concept of distance transform, is then applied to generate a three-dimensional edge-weighting prior for the regularization of DOT. The reconstruction procedure has been tested on experimental data obtained on specifically designed dual-modality silicon phantoms. Results show a substantial quantification improvement upon the application of the implemented technique. This article is part of the theme issue 'Synergistic tomographic image reconstruction: part 2'.

Time-domain diffuse optics with 8.6 mm2 fast-gated SiPM for extreme light harvesting.

Fast time-gated single-photon detectors demonstrated high depth sensitivity in the detection of localized absorption perturbations inside scattering media, but their use for in vivo clinical applications-such as functional imaging of brain activation-was impaired by their small (<0.04mm2) active area. Here, we demonstrate, both on phantoms and in vivo, the performance of a fast-gated digital silicon photomultiplier (SiPM) that features an overall active area of 8.6mm2, overcoming the photon collection capability of established time-gated single-pixel detectors by orders of magnitude, enabling deep investigations within scattering media and high signal-to-noise ratios at late photon arrival times.

Note: Comparison between a prism-based and an acousto-optic tunable filter-based spectrometer for diffusive media.

This paper compares two continuously tunable systems for time-resolved spectroscopy of diffusive media based on a supercontinuum laser source. Two approaches for spectral selection are considered relying either on a dispersive prism or on a commercial acoustic-optic tunable filter (AOTF) device. The comparison was performed first in terms of extracted power and spectral response function, then in terms of distortions introduced in the retrieved absorption and scattering spectra. Simulations and experiments on diffusive phantoms confirmed that, besides narrower FWHM in the AOTF bandpass, the prism solution is superior with respect to the distortions produced on the recovered spectra.

The impact of morphology on light transport in cancellous bone.

In recent years, optical techniques based on diffusion approximation have demonstrated their ability to gain rich spectral information about bone. However, these methods normally assume homogeneity, while cancellous bone and marrow form a highly heterogeneous two-phase medium. This paper studies the limitations of this assumption, and quantifies the role of microstructure on long-range transport properties. The propagation of light pulses through trabecular bone is calculated by Monte Carlo simulation of the scattering and absorption in reconstructions of bone samples obtained from x-ray micro tomographic scans. The time-resolved responses are then fitted with the analytical response of a homogeneous material to obtain the apparent transport properties. These properties are used to test different homogenization equations that have been postulated in the past for heterogeneous tissues and to check their accuracy. The results show that nonlinearity and crosstalk between absorption and scattering are statistically significant, although their impact is relatively small. More importantly, we found that the weight of the components is not only affected by their volume fractions, but need to be corrected by other morphologic measures like trabecular spacing or connectivity density. These deviations from the homogeneous assumption are stronger for scattering than for absorption. In conclusion, the average optical properties of cancellous bone are strongly determined by its microstructure, meaning that optical techniques are a valid method for tissue evaluation, but careful consideration of structure-related perturbation sources is required.

Bandpass effects in time-resolved diffuse spectroscopy.

This paper discusses the spectral distortions occurring when time-resolved spectroscopy of diffusive media is performed illuminating with a wide bandpass. It is shown that the spectral region within the bandpass that exhibits the lowest absorption will dominate the resulting time-resolved curve, leading to significant underestimations of absorption as well as distortions in the spectral shape (including shifts in peak positions). Due to the nonlinear behavior of absorption, this effect becomes even more pronounced when including longer and longer photon path lengths. First, a theoretical treatment of the problem is given, and then the distortion is described by time-resolved reflectance simulations and experimental measurements of lipid and water samples. A spectrally constrained data analysis is proposed that takes into account the spectrum of the light injected into the sample, used to overcome the distortion and improve the accuracy of the estimation of chromophore concentrations from absorption spectra. Measurements on a lipid sample show a reduction of the error from 30% to 6%.

Time-resolved optical spectroscopy of wood.

We have proposed and experimentally demonstrated that picosecond time-resolved optical spectroscopy in the visible/near-infrared (NIR) region (700-1040 nm) is a useful technique for noninvasive characterization of wood. This technique has been demonstrated on both softwood and hardwood samples treated in different ways simulating the aging process suffered by waterlogged woods. In all the cases, alterations of absorption and scattering spectra were observed, revealing changes of chemical and structural composition.

Multi-wavelength time domain optical mammography.

A time-resolved optical mammograph operating at 7 wavelengths (637, 683, 785, 832, 905, 916, and 975 nm) in compressed breast geometry was developed. Its clinical application was started on patients bearing malignant and benign lesions. Late gated intensity images are used to obtain information on the spatial distribution of the absorption properties of breast. Scattering images derived from the diffusion theory are also applied for lesion detection and characterization. Cancers are identified in intensity images at short wavelengths, due to the high blood content, while cysts are typically characterized by low scattering at all wavelengths. The increase (from 4 to 7) in the number of wavelengths as compared to the previous versions of the instrument aims at improving the robustness of the fitting procedures for a better estimate of tissue composition and structure and of physiological parameters. Moreover, the new wavelengths contribute to the qualitatively identify tissue composition from intensity images, and could assist lesion detection.

Does iodine concentration affect the diagnostic efficacy of biphasic spiral CT in patients with hepatocellular carcinoma?

BACKGROUND: We investigated the effect of iodinated contrast medium concentration on increased neoplastic lesion enhancement and its direct relation to diagnostic efficacy in biphasic spiral computed tomography for detection of hepatocellular carcinoma. METHODS: A pilot, single-center, randomized, double-blind, crossover, comparative study was performed and included 22 participants. Each patient underwent two separate biphasic contrast-enhanced spiral computed tomographic examinations. Scans were performed with iomeprol containing 400 (iomeprol 400) or 300 (iomeprol 300) mg of iodine per milliliter (Iomeron, Bracco Imaging SpA, Milan, Italy) with a 2- to 12-day window scan; patients were given an equal total dose of 45 g of iodine at a fixed injection rate of 4 mL/s. Comparison included assessment of quantitative and qualitative parameters. RESULTS: Lesion density and lesion-to-liver contrast increased more markedly with the higher concentration of contrast medium during the arterial phase (p = 0.0016 and 0.0005, respectively). There was no significant difference in any parameter between the two concentrations during the portal phase. Number of lesions detected during the arterial phase increased from 37 with iomeprol 300 to 42 with iomeprol 400; in the portal phase, the respective numbers were 34 and 36. CONCLUSION: Even though a small number of patients was examined, our study suggests that, in patients with cirrhosis, an increased concentration of iodine improves liver-to-lesion contrast and may improve the detection of hepatocellular carcinoma.

Do shorter wavelengths improve contrast in optical mammography?

The detection of tumours with time-resolved transmittance imaging relies essentially on blood absorption. Previous theoretical and phantom studies have shown that both contrast and spatial resolution of optical images are affected by the optical properties of the background medium, and high absorption and scattering are generally beneficial. Based on these observations, wavelengths shorter than presently used (680-780 nm) could be profitable for optical mammography. A study was thus performed analysing time-resolved transmittance images at 637, 656, 683 and 785 nm obtained from 26 patients bearing 16 tumours and 15 cysts. The optical contrast proved to increase upon decreasing wavelengths for the detection of cancers in late-gated intensity images, with higher gain in contrast for lesions of smaller size (<1.5 cm diameter). For cysts either a progressive increase or decrease in contrast with wavelength was observed in scattering images.

Liquid phantom for investigating light propagation through layered diffusive media.

A liquid phantom for investigating light propagation through layered diffusive media is described. The diffusive medium is an aqueous suspension of calibrated scatterers and absorbers. A thin membrane separates layers with different optical properties. Experiments showed that a material with scattering properties should be used for the membrane to avoid the perturbation due to the guided propagation that occurs through a transparent layer. Examples of measurements on a three-layered medium are reported both in the cw and in the time domain.

In vivo optical characterization of human tissues from 610 to 1010 nm by time-resolved reflectance spectroscopy.

A fully automated system for time-resolved reflectance spectroscopy based on tunable mode-locked laser sources and on time-correlated single-photon counting for the detection of time-resolved reflectance data was applied to the evaluation of the optical properties of biological tissues (arm, abdomen and forehead) in vivo from 610 to 1010 nm. The scattering decreases progressively with increasing wavelength, while the absorption line shapes show the typical spectral features of the principal tissue components (haemoglobin, water and lipid), with different weights depending on the tissue type. The best fit of the absorption spectra measured in vivo with the spectra of the pure constituents yielded information on the percentage composition of the different tissues. The interpretation of transport scattering spectra with Mie theory provided information on tissue structure.

Effects of photodynamic therapy on the absorption properties of disulphonated aluminum phthalocyanine in tumor-bearing mice.

Time-resolved reflectance spectroscopy was performed on tumor-bearing mice, administered with disulphonated aluminum phthalocyanine (AlS(2)Pc, 5 mg/kg body weight), before, during and after photodynamic therapy. This allowed us to evaluate the absorption spectrum of AlS(2)Pc in vivo from 610 to 700 nm, and to investigate how the therapeutic irradiation affects it. Two tumor locations (intraderma on the back and intramuscular in the leg), and two uptake times (3 and 12 h) were considered. As already observed previously, the absorption spectrum of AlS(2)Pc in vivo is centered at 680-685 nm. The irradiation causes a blue-shift of the measured line shape, more or less marked depending on the experimental conditions. A reduction in absorption is also often observed upon illumination with therapeutic light doses.

Pharmacokinetics and safety of iomeprol in healthy volunteers and in patients with renal impairment or end-stage renal disease requiring hemodialysis.

RATIONALE AND OBJECTIVES: To present the results of two studies conducted to evaluate the pharmacokinetics and safety of iomeprol in healthy volunteers and in patients with various degrees of renal impairment. METHODS: In these two open-label, single-dose, phase I studies, a 50-mL dose of iomeprol 400 was administered intravenously to a total of 30 subjects of either sex. In study 1, six healthy volunteers with normal renal function, six patients with mild renal failure, six patients with moderate renal failure, and four patients with severe renal failure were enrolled. In study 2, eight patients with end-stage renal disease requiring hemodialysis were enrolled. Safety was determined by predose and postdose (up to 10 days) measurement of vital signs, hematology, blood chemistry, urinalysis, electrocardiogram, physical examinations, and the incidence of adverse events. Pharmacokinetics was determined by measuring iomeprol levels in plasma, urine, feces, and dialysate samples, by using a validated high-performance liquid chromatography assay, up to 7 days after administration. RESULTS: The plasma concentration of iomeprol declined biexponentially in both healthy subjects and patients. As expected, mean body and renal clearances decreased progressively with increasing renal impairment, with a significant correlation with the glomerular filtration rate. The elimination half-life increased progressively with increasing renal impairment. The extraction efficiency of dialyser was estimated as approximately 40%, and dialysis clearance of iomeprol was approximately 1.26 mL. min-1. kg-1 (80.6 mL/min), slightly less than the body clearance previously observed in healthy subjects. It appears that dialysis is almost as efficient as renal function in healthy subjects in the removal of iomeprol. After a single dialysis session, approximately 58% of the dose was recovered in dialysate. Mild to moderate adverse events were reported by 17 of 30 subjects; none was clinically meaningful. One serious adverse event, unrelated to iomeprol, was reported. No clinically meaningful findings were noted for other safety parameters. CONCLUSIONS: Iomeprol was almost completely eliminated both in patients with renal impairment and in patients receiving dialysis. No dose adjustment appears to be necessary either in patients with renal impairment or with end-stage renal disease requiring hemodialysis. In this risk population, iomeprol 400 was safe and well tolerated.

Clinical experience with iomeprol in myelography and myelo-CT: clinical pharmacology and double-blind comparisons with iopamidol, iohexol, and iotrolan.

RATIONALE AND OBJECTIVES: To evaluate iomeprol, a new nonionic iodinated contrast medium, as a contrast agent for myelography and to compare it with iopamidol, iohexol, and iotrolan. METHODS: An extensive clinical program was conducted on more than 600 patients to assess iomeprol's pharmacokinetics, tolerability, safety, and efficacy after intrathecal injection. RESULTS: Pharmacokinetics study results showed that after intrathecal administration iomeprol is completely absorbed from the cerebrospinal fluid compartment; once absorbed into the systemic circulation, it is rapidly excreted, unmetabolized, by glomerular filtration. Dose-finding studies showed that the opacification produced by iomeprol depends on the injected dose. Although a dose-dependent increase in efficacy was observed, no differences in neurotolerability and safety were detected between the doses tested. Doses of iomeprol greater than 3 g I did not cause a greater incidence of adverse events and produced significantly better contrast efficacy. Comparative clinical trials showed that iomeprol and iopamidol, iohexol, and iotrolan always provided adequate opacification of the subarachnoid space, both in conventional myelography and myelo-CT, with adequate delineation of normal structures and pathologic processes. No serious adverse events occurred up to a total dose of 4.5 g I. No differences between the agents with regard to tolerance, adverse events, and effects on vital signs, physical examination, and neurologic examination were observed. CONCLUSIONS: Iomeprol is safe and effective and can be recommended for myelography and myelo-CT.

Iomeprol: current and future profile of a radiocontrast agent.

RATIONALE AND OBJECTIVES: To review the safety and efficacy profiles of iomeprol by examining the most indicative comparative clinical studies of iomeprol with widely used low-osmolar ionic or nonionic contrast agents, and to illustrate the recent development in iomeprol liposomal formulations for liver imaging and intravascular enhancement. METHODS: Randomized, double-blind, comparative studies were performed of iomeprol versus iopamidol, iopromide, ioxaglate, iopentol, iodixanol, ioversol, and iohexol. In all studies, safety controls included pre- and postadministration physical examinations, monitoring of vital signs, electrocardiography, clinical laboratory investigations, and 24- or 72-hour postadministration monitoring of patients for adverse events. Technically adequate images were rated for diagnostic efficacy by masked assessors. RESULTS: Iomeprol showed similar safety and diagnostic efficacy compared with the nonionic monomers iopamidol, iohexol, and ioversol, and no statistically significant differences were observed. No differences in diagnostic efficacy between iomeprol and iopromide were observed, but in one study on 1,200 patients, the incidence of adverse events and adverse reactions was significantly higher with iopromide than with iomeprol. Iomeprol caused significantly less heat/pain than iopentol in one study; it showed similar safety and tolerability to the nonionic dimer iodixanol, the two agents causing no or modest, superimposable pain and heat sensation at injection and showing similar renal tolerability after intra-arterial injection. A comparison of iomeprol versus ionic dimer ioxaglate in 2,000 patients undergoing percutaneous coronary interventions showed that the incidence of thrombus-related events was similar with the two agents, but ioxaglate caused a significantly higher incidence of allergy-like reactions. First results with iomeprol-containing liposomal formulations show that these agents may facilitate the CT assessment of intrahepatic malignancies and CT angiography procedures. CONCLUSIONS: The overall results of numerous randomized, double-blind, comparative clinical studies in a variety of indications show that the diagnostic efficacy of iomeprol solutions does not differ significantly from that of the low-osmolar contrast media available on the marketplace when similar iodine strengths are used, although iomeprol may have better tolerability and safety than the ionic dimer and some of the nonionic monomers in selective applications. First results obtained with iomeprol-containing liposomal formulations are promising and may foster additional clinical testing.

Nondestructive quantification of chemical and physical properties of fruits by time-resolved reflectance spectroscopy in the wavelength range 650-1000 nm.

Time-resolved reflectance spectroscopy can be used to assess nondestructively the bulk (rather than the superficial) optical properties of highly diffusive media. A fully automated system for time-resolved reflectance spectroscopy was used to evaluate the absorption and the transport scattering spectra of fruits in the red and the near-infrared regions. In particular, data were collected in the range 650-1000 nm from three varieties of apples and from peaches, kiwifruits, and tomatoes. The absorption spectra were usually dominated by the water peak near 970 nm, whereas chlorophyll was detected at 675 nm. For all species the scattering decreased progressively with increasing wavelength. A best fit to water and chlorophyll absorption line shapes and to Mie theory permitted the estimation of water and chlorophyll content and the average size of scattering centers in the bulk of intact fruits.

Reconstruction of absorber concentrations in a two-layer structure by use of multidistance time-resolved reflectance spectroscopy.

The characterization of a two-layer structure was investigated by use of time-resolved reflectance over a wide spectral range. We exploited the nonlinear dependence of the measured spectra on the upper-and lower-layer properties to formulate an algorithm for the recovery of absorber concentrations in both layers. The method assumes that the spectral features of the key absorbers are known, but it does not rely on a priori knowledge of the layer thickness. Phantom tests confirmed the accuracy of the estimate of the absorber concentrations to within 10% for thickness values ranging from 0.3 to 1.2 cm. Multidistance absorption spectra from 610 to 1000 nm were obtained in vivo from the forearms of human subjects, allowing us to estimate the concentration of key tissue constituents in a two-layer approximation. Good agreement between the reconstructed spectra and the experimental data taken from two volunteers with opposite predominance of adipose and muscular tissues demonstrated the validity of this approach.

Fluorescence imaging during photodynamic therapy of experimental tumors in mice sensitized with disulfonated aluminum phthalocyanine.

A fluorescence imaging system was used to monitor the emission of disulfonated aluminum phthalocyanine (AlS2Pc) during the photodynamic therapy (PDT) of murine tumors. Cells of the MS-2 fibrosarcoma were injected in mice in two compartments in order to cause the development of tumors in different host tissues. Two drug doses and two uptake times were considered. Moreover, the fluorescence of the AlS2Pc was excited using two wavelengths on the opposite sides of the absorption peak to detect a possible change in the absorption spectrum of the sensitizer induced by the PDT. In the tumors, the treatment induces a variation of the fluorescence intensity: in some mice a mild photobleaching takes place, in others a fluorescence enhancement occurs. Which effect predominates depends on the experimental conditions, even though a large spread of data was found amongst mice of the same group. In all mice, independently of the drug dose, uptake time or tumor compartment, a marked increase in the fluorescence signal takes place at the borders of the irradiated area. To quantify this effect we evaluated the ratio between the fluorescence intensities in the peritumoral area and in the tumor itself. This ratio increases monotonically during the PDT, showing a different behavior with the two excitation wavelengths. This indicates that the AlS2Pc absorption spectrum shifts toward shorter wavelengths as a result of the irradiation.

Effects of the menstrual cycle on the red and near-infrared optical properties of the human breast.

Time-resolved reflectance and transmittance spectroscopy was applied to measure in vivo the absorption and transport scattering spectra of the female breast from 610 to 1010 nm. Three measurement configurations were used to probe different breast regions, and data were collected two or three times in each of the five phases of the menstrual cycle. The absorption spectra were best-fitted with a linear combination of the spectra of the main tissue constituents (water, lipids, oxy- and deoxyhemoglobin). This allowed us to evaluate percentage contents of water and lipids, total hemoglobin content and hemoglobin oxygen saturation. The scattering spectra were interpreted with a function derived from Mie theory, providing information on the density and average size of the tissue scatterers. Significant changes in the estimated variables were observed with measurement geometry, reflecting the heterogeneous nature of the breast, and with time, in agreement with expected physiological changes over the menstrual cycle.

Preliminary evaluation of two fluorescence imaging methods for the detection and the delineation of basal cell carcinomas of the skin.

BACKGROUND AND OBJECTIVE: Fluorescence techniques can provide powerful noninvasive means for medical diagnosis, based on the detection of either endogenous or exogenous fluorophores. The fluorescence of delta-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) has already shown promise for the diagnosis of tumors. The aim of the study was to investigate the localization of skin tumors after the topical application of ALA, by detecting the PpIX fluorescence either in the spectral or in the time domain. STUDY DESIGN/MATERIALS N AND METHODS: Two fluorescence imaging systems were used to identify basal cell carcinomas of the skin in humans, after topical application of 20% ALA ointment. Both systems rely on the comparison between the exogenous and the endogenous fluorescence, performed either in the spectral domain or in the time domain. The first system works by using three images acquired through different spectral filters, whereas the second one measures the spatial map of the average fluorescence lifetime of the sample. RESULTS: A clear demarcation of skin malignancies was successfully performed in vivo noninvasively with both fluorescence imaging systems. CONCLUSION: The two complementary approaches considered in the present study show promise for skin tumor detection and delineation based on specific fluorescence features.