Purpose: Transvaginal ultrasound (TVUS) is a widely used real-time and non-invasive imaging technique for fetal and maternal care. It can provide structural and functional measurements about the fetal brain, such as blood vessel diameter and blood flow. However, it lacks certain biochemical estimations, such as hemoglobin oxygen saturation (SO2), which limits its ability to indicate a fetus at risk of birth asphyxia. Photoacoustic (PA) imaging has been steadily growing in recognition as a complement to ultrasound (US). Studies have shown PA imaging is capable of providing such biochemical estimations as SO2 at relatively high penetration depth (up to 30 mm).
Approach: In this study, we have designed and developed a multi-modal (US, PA, and Doppler) endocavity imaging system (ECUSPA) around a commercialized TVUS probe (Philips ATL C9-5).
Results: The integrated system was evaluated through a set of in-vitro, ex-vivo, and in-vivo studies. Imaging of excised sheep brain tissue demonstrated the system’s utility and penetration depth in transfontanelle imaging conditions. The accuracy of using the spectroscopic PA imaging (sPA) method to estimate SO2 was validated by comparing sPA oximetry results with the gold standard measurements indicated by a blood gas analyzer. The ability of US and Doppler to measure moving blood volume was evaluated in-vivo. Spectral unmixing capabilities were tested using fluorophores within sheep brains.
Conclusion: The developed system is a high resolution (about 200 μm at 30 mm depth), real-time (at 30 Hz), and quantitative (SO2 estimation error <10 % ) imaging tool with a total diameter less than 30 mm, making it suitable for intrapartum applications such as fetal and maternal diagnostics.
Spontaneous preterm birth (sPTB) occurs in about one in ten infants born in the United States and is leading to almost 1 million neonatal deaths worldwide [1]. Diagnostic imaging of cervix is mostly limited to using ultrasound (US) to measure cervical length and has shown a low specificity to determine the risk of sPTB [2-7]. Quantitative functional imaging modalities such as elastography (EL) and photoacoustic (PA) imaging, are commonly used in conjunction with US imaging to provide additional information on tissue compositions and function. We propose using an endocavity probe to acquire US, PA, and EL information of the cervical tissue. Specifically, spectroscopic PA (sPA) is proposed to provide information on cervical tissue such as total hemoglobin (blood perfusion), tissue oxygenation level, and more importantly the collagen-to-water ratio in tissue. Shear wave elastography (SWE) measurements of cervical tissue indicates the correlation between cervical ripening and lower tissue elasticity. Our custom-designed imaging system consists of an endovaginal US transducer (ATL C9-5) capable of performing high frame rate US and acoustic radiation force shear wave imaging, and an optimized fiber-optic light delivery system’s for PA imaging. Our experimental results indicate the system’s ability to measure the presence of different concentrations of hemoglobin in tissue-mimicking phantoms as well as accurate measurement of hemoglobin oxygen saturation (SO2). In another set of experiments, we demonstrated the feasibility of monitoring collagen-to-water ratio in tissues through monitoring changes in sPA signature between 1100 and 1650 nm. Monitoring the variations of collagen in cervical tissue can help to predict sPTB.
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