Atrial fibrillation (AF) is currently the most common arrhythmia encountered in clinical practice, with estimates as high as 6.1 million sufferers in 2010 in the United States alone. AF has been implicated in an increased risk of stroke, dementia, heart failure and an excess mortality rate. Anti-arrhythmic drugs are burdened with significant side effects, toxicity and poor capability to maintain normal sinus rhythm and thus are not the ideal treatment option for AF patients. Radio-frequency (RF) trans-catheter ablation is currently the most effective treatment for AF as it can isolate the firing of ectopic foci, typically located around the pulmonary veins. Unfortunately, RF ablation lesions can vary considerably with catheter contact force, orientation, size and RF energy parameters. Lesion “reconnection” and “recovery” has been a major cause for procedural failure and can necessitate repeat procedures. Furthermore, ablation procedures carry the risk of severe complications, such as atrio-esophageal fistulae or cardiac tamponade. These limitations of RF trans-catheter ablation will not be significantly improved without a real-time (RT) tool to characterize lesions intraoperatively.
The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.
A more complete understanding of this disclosure may be acquired by referring to the following description taken in combination with the accompanying figures in which:
While the present disclosure is susceptible to various modifications and alternative forms, specific example embodiments have been shown in the figures and are herein described in more detail. It should be understood, however, that the description of specific example embodiments is not intended to limit the invention to the particular forms disclosed, but on the contrary, this disclosure is to cover all modifications and equivalents as defined by the appended claims.
The present disclosure generally relates to methods comprising imaging a tissue with multi-wavelength photoacoustic imaging, to provide a three-dimensional visualization, characterization and/or thermographic imaging of the tissue, and systems thereof.
Photoacoustic (PA) imaging is an imaging technique utilizing short-duration laser pulses which are absorbed by chromophores (such as deoxy-hemoglobin [Hb]) in the tissue, resulting in thermoelastic expansion and generation of an acoustic transient. These local transients can be imaged using a traditional US transducer, providing an optical absorption map with resolutions on the order of tens of micrometers (or hundreds of micrometers using a 7.5 MHz US probe, which is common for EP intracardiac or transesophageal US applications) and at imaging depths in excess of a centimeter.
The peak photoacoustic pressure, generated during thermal and stress confinement, is commonly modeled as
where β(T) [K−1] is the temperature dependent thermal coefficient of volume expansion, νs(T) [cm s−1] is the sound velocity in tissue, Cp(T) [J kg−1 K−1] is the heat capacity at constant pressure, μabs(r, λ) [cm−1] is the optical absorption coefficient and Φ(r, λ) [J cm−2] is the local optical fluence. As such, r, λ and T represent spatial distribution, optical wavelength and temperature, respectively.
PA imaging contrast is provided by variations in optical absorption (μabs) resulting from variations in the concentration of endogenous or exogenous chromophores. Due to the wavelength dependence of μabs, multi-wavelength photoacoustic imaging can be performed for tissue characterization purposes. PA imaging's reliance upon ultrasonic sensing allows straightforward co-registration with anatomical US images, providing molecularly-sensitive anatomical PA/US images. For these reasons, PA imaging is a powerful medical imaging modality in cancer detection, disease staging, and therapy guidance.
The present disclosure provides, according to certain embodiments, methods comprising imaging a tissue with multi-wavelength photoacoustic imaging, to provide a three-dimensional visualization, characterization, and/or thermographic imaging of the tissue. The present disclosure also provides systems and components for imaging a tissue with multi-wavelength photoacoustic imaging. In certain embodiments, the multi-wavelength photoacoustic imaging may be spectroscopic photoacoustic imaging [sPA].
In certain embodiments, the tissue imaged is a cardiac tissue, a liver tissue, or a prostate tissues.
In another embodiment, the method further comprises applying ultrasound imaging to the tissue. See, e.g.,
In another embodiment, the method further comprises imaging the tissue with a single-wavelength photoacoustic imaging. In a further embodiment, the single-wavelength photoacoustic imaging occurs before the multi-wavelength photoacoustic imaging.
Single-wavelength PA imaging shows high contrast from the lesion core (see, e.g.,
In another embodiment, the method further comprising processing the multi-wavelength photoacoustic imaging data to form 3-D sPA data. In a further embodiment, the method further comprising generating a TCM from the 3-D sPA data.
One caveat of PA imaging is that imaging artifacts, resulting from refractive index discontinuities, can occasionally be seen near tissue boundary locations. These artifacts, however, would be minimal in an in vivo environment, as the imaging target would not be an explanted tissue sample with tissue-solution boundaries. Also, spectroscopic-based images, such as a TCM, may further reduce artifacts by correlating multiple wavelengths and reducing the effects of saturated voxel regions by identifying absorbers. Given the 3-D datasets (
For the side-view orientation, lateral offset was improved when compared to the top-view orientation (0.1 mm vs. to 0.4 mm). The relatively high axial offset (1.2 mm) observed in this orientation is attributable to the limited ability in this initial implementation of sPA imaging to characterize tissue at depths greater than 3 mm; this penetration depth can be increased with improved frame averaging, improved energy normalization and increased laser fluence. With said improvements the ability of this imaging modality to reliably characterize tissue and assess transmurality at depths >3 mm could be determined. As can be seen in
The 3-D rendering (
Given that the PA spectrum observed in ablated tissue results from bulk hyperthermia-induced protein denaturation, resulting from tissue heating, it is believed that this spectrum would not vary significantly from patient to patient, nor vary significantly between normal or pathologic myocardium. Also, given that thermal damage generally eliminates the observed birefringence resulting from myocardial muscle-fiber orientation, it is believed that PA imaging would be insensitive to fiber orientation.
In certain embodiments, the imaging is conducted in vitro.
In other embodiments, the imaging is conducted in vivo.
In certain embodiments, the imaging is a real time (RT) imaging.
In other embodiments, the imaging is a near-RT imaging.
In another embodiment, the method further comprising distinguishing an ablated portion from a non-ablated portion of the tissue.
The present invention can be used to determine prominent optical absorbers and characterize ablated and non-abated tissue during tissue ablation. Suitable absorbers include, but are not limited to deoxygenated hemoglobin, oxygenated hemoglobin, and spectra derived from ablated tissue.
Typically, during tissue ablation, physicians rely on indirect or bulk measurements of tissue properties to characterize ablated and non-ablated tissue (tissue-surface temperature, bulk tissue impedance, etc.). Photoacoustic imaging probes the optical properties of the tissue directly to image tissue optical absorption (molecular imaging) to identify which tissue has been ablated and which has not.
In another embodiment, the method can be used to visualize myocardial and other tissue ablation lesions.
In general, any tool used to guide ablation must be RT or near-RT. PA imaging frame rate is practically limited by the pulse repetition frequency of the irradiating laser source (10-20 Hz in this initial setup). Our initial system is capable of providing near-RT imaging (1-2 fps each consisting of 11 optical wavelengths with no averaging), and many laser systems, operating at kHz frequencies, are currently available that could provide RT PA imaging. Once studies have demonstrated which wavelengths are optimal for in vivo imaging, a system could be constructed using several diode-pumped lasers, operating at kHz pulse repetition rates, to provide frame rates well in excess of 30 fps.
In an in vivo environment, the ablation and imaging substrate will be highly oxygenated tissue. Given that the optical absorption of oxy-Hb can be nearly an order of magnitude less in the NIR regime, when compared to deoxy-Hb, one could expect that the background signal may be lower in highly oxygenated tissue. While this may require modification of the wavelengths chosen to image, if the spectrum of ablated tissue remains unchanged in vivo, then an in vivo environment could provide greater PA signal contrast between ablated and non-ablated tissue.
In vivo applications of PA imaging have already demonstrated feasibility of PA imaging through luminal blood using relatively low optical fluences and observing minimal signal from blood. An ICE implementation of PA imaging could achieve higher fluences than previous studies, and optical scattering due to blood may aid in homogenizing optical fluence at the endocardial surface. As with other clinical imaging modalities (US, MRI, CT), PA imaging can be implemented using a cardiac gating function to minimize motion between frames as well to reduce optical changes resulting from the cardiac perfusion cycle. Although the technical integration of an intracardiac probe capable of concurrent ablation and PA imaging will not be trivial, the development of such a clinical probe should be possible given recent advances in combined RFA-US catheters and the development of light delivery mechanisms utilized for intracardiac laser ablation.
In another embodiment, the present invention can be used to guide trans-catheter ablation of atrial arrhythmia.
In another embodiment, the temperature-induced changes of the photoacoustic signal from said tissue can be used to estimate tissue temperature.
By using the temperature dependence of the mechanism of photoacoustic signal generation, tissue temperature can be directly inferred, even at several millimeters of depth. assessment of tissue temperature during energy application can be used to monitor tissue temperature to reduce complications.
By supplying the physician with accurate molecular and temperature information during a procedure, the present invention can guide ablation procedures to both improve procedural efficacy and reduce procedural complications.
Additionally, due to the temperature dependence of β(T) (Equation 1), thermographic PA (tPA) mapping with high thermal and temporal resolutions (<1 K and ˜1 s, respectively) is possible. Guidance of ablation procedures represents an ideal application of tPA mapping as PA imaging has the potential to provide thermographic information co-registered with anatomical (US) and molecular (sPA) information. This feature of PA imaging may be used for laser, RF- and cryo-ablation guidance.
In another embodiment, during pacemaker/ICD lead placement, the multi-wavelength PA imaging can characterize the myocardial substrate to determine if it is a suitable position for lead placement.
In certain embodiments, the present invention can identify scar tissue from previous procedures or from damaged tissue.
The present invention can be used to directly characterize the tissue adjacent to pacing leads, rather than rely on electrogram studies to assess tissue conductivity. The present invention can also be used to identify sites where pacemaker lead conduction would likely be affected by scar tissue.
To facilitate a better understanding of the present disclosure, the following examples of certain aspects of some embodiments are given. In no way should the following examples be read to limit, or define, the entire scope of the invention.
Fresh porcine hearts (Sierra for Medical Science, Whittier, Calif.) were acquired within 24 hours of sacrifice and were never frozen. The ventricles were harvested and samples were excised from these portions to produce approximately 20×20×10 mm3 sized specimens for ablation. The ablation system consisted of a Stockert 70 RF generator combined with a COOLFLOW® irrigation pump and a THERMOCOOL® irrigated tip catheter (Biosense Webster Inc., Diamond Bar, Calif.). During each ablation, the catheter was flushed with PBS at a rate of 10 ml min−1. RF energy was applied at a rate of 20-30 W for 40-60 s. Tissue samples were submerged in normal PBS during ablation and imaging. After the ablation, samples were patted dry and returned to an airtight container (to minimize desiccation) and refrigerated.
Normal PBS was used to acoustically couple the imaging system with the tissue. Imaging was performed on a combined PA/US imaging system that consisted of a Vevo® 2100 US imaging system (FUJIFILM VisualSonics Inc., Toronto, ON, Canada) paired with an LZ-250 transducer (21-MHz center frequency) with integrated fiber optics connected to a pulsed, tunable Nd:YAG laser (680-970 nm wavelength range). A single (i.e. no averaging) three-dimensional (3-D) combined PA/US B-mode scan was performed on each sample at 710 nm, which was the wavelength for peak laser energy (22 mJ per pulse). From that 3-D volume, a single 2-D plane corresponding to the brightest region of the PA signal was selected for sPA imaging from 680 -840 nm (20-14 mJ per pulse) in 2-nm steps. Ten PA frames at each wavelength were acquired and averaged into a single PA/US image at each sampled wavelength (
For the purpose of sample staining, nitro-tetrazolium blue (NTB) salt (Sigma-Aldrich Corp., St. Louis, Mo.) was chosen to identify macroscopic myocardial tissue necrosis. The NTB solution was prepared by dissolving NTB in normal PBS at 0.5 mg ml−1, as outlined by Ramkissoon. All specimens were incubated for 15 minutes in NTB solution maintained at 35° C. Specimens were then patted dry and photographed for gross pathology.
Equal-sized region of interests (ROIs; 0.04 mm2) of the PA signal center (Ablated) and a specimen region external to the lesion (Non-ablated) were selected from the 2-D sPA dataset for analysis, as shown in the white boxes in
Contrast-to-background ratio (CBR) was calculated using Equation 2, where ĪAbl and ĪNabl represent the mean PA signal intensity for the Ablated and Non-ablated ROI, respectively. This was done at 710 nm, the wavelength of peak laser energy. To obtain PA signal spectra, the mean PA intensities for both ROIs were calculated and plotted as a function of wavelength;
Prior to the correlation test, each sPA dataset was filtered spatially and spectrally (740-780 nm range) to reduce noise. Each 2-D sPA data frame was first filtered using a 0.22×0.19 mm2 (Lateral×Axial) sliding average kernel at a specific wavelength. Then each pixel spectrum (740-780 nm) was filtered using a 6-nm wide median filter. For the 3-D sPA data, each 3-D volume was filtered using a 0.40×0.33×1.12 mm3 (Lateral×Axial×Elevation) sliding average kernel. No spectral filtering was applied to the 3-D sPA data. Voxel-by-voxel correlation, using both the Ablation-reference and the Hb-reference spectra, was performed on each 2-D and 3-D sPA dataset through 740-780 nm. For each sPA dataset, Ablation reference and Hb reference correlation maps were obtained. A final tissue characterization map (TCM,
Three-dimensional TCM/US data was co-registered with matching photographed gross pathology. Gross pathology photographs were acquired in top-view and side-view orientations. Both orientations were cropped and centered so that the gross pathology field of view (FOV) represented the same FOV as the US volume. In the top-view gross pathology images, tissue sample boundaries were manually segmented from the photograph background (
A straightforward rigid image registration was applied to both the top-view and the side-view orientation image sets; each gross pathology image was resampled to match the TCM/US scan line density, and the TCM/US data was then registered with the gross pathology by translating the boundary segmentation centroids (
Once both the top-view and side-view orientations were co-registered, the accuracy of the TCM was determined. The centroids of the ablated-region segmentations were calculated for each gross pathology and TCM set of both the top- and side-view orientations. For each orientation and sample, the lateral, axial and elevation offsets between the centroids were measured. Agreement between the segmentations was assessed by comparing the maximum axial, lateral or elevation extent of the segmented region. The % Area Agreement was defined as the area of the segmentations' intersection divided by the area of the segmentations' union,
where SGP and STCM represent the segmented ablated region from the gross pathology and TCM, respectively. For the side-view co-registered samples, two samples were cut parallel to the elevation axis, and four samples were cut parallel to the lateral axis, such that two samples were utilized to assess elevation offset, while four samples were utilized to assess lateral offset; all six side-view co-registered samples were utilized to assess axial offset.
Both normalized spectra from the ROIs in
An example of the TCM overlaying the corresponding B-mode US image is displayed in
The results of the 3-D segmentation comparison are shown in Table 1 above. For the top-view orientation (
For the side-view orientation (
The 3-D rendered data compared well with the matching gross pathology (
The features and advantages of the present disclosure will be readily apparent to those skilled in the art. While numerous changes may be made by those skilled in the art, such changes are within the spirit of the invention.
This Application claims the benefit of U.S. Provisional Application Ser. No. 61/881,743 filed on Sep. 24, 2013, the entirety of which is incorporated by reference.
This invention was made with support under Award No. EB007507-03, awarded by National Institute of Health. The U.S. government has certain rights in the invention.
Number | Date | Country | |
---|---|---|---|
61881743 | Sep 2013 | US |