Strain and elasticity imaging in compression optical coherence elastography: The two-decade perspective and recent advances

Quantitative mapping of deformation and elasticity in optical coherence tomography has attracted much attention of researchers during the last two decades. However, despite intense effort it took ~15 years to demonstrate optical coherence elastography (OCE) as a practically useful technique. Similarly to medical ultrasound, where elastography was first realized using the quasi-static compression principle and later shear-wave-based systems were developed, in OCE these two approaches also developed in parallel. However, although the compression OCE (C-OCE) was proposed historically earlier in the seminal paper by J. Schmitt in 1998, breakthroughs in quantitative mapping of genuine local strains and the Young's modulus in C-OCE have been reported only recently and have not yet obtained sufficient attention in reviews. In this overview, we focus on underlying principles of C-OCE; discuss various practical challenges in its realization and present examples of biomedical applications of C-OCE. The figure demonstrates OCE-visualization of complex transient strains in a corneal sample heated by an infrared laser beam.     

Interplay of temperature,thermal‐stresses and strains in laser‐assisted modification of collagenous tissues: Speckle‐contrast and OCT‐based studies

Moderate heating of collagenous tissues such as cartilage and cornea by infrared laser irradiation can produce biologically nondestructive structural rearrangements and relaxation of internal stresses resulting in the tissue reshaping. The reshaping results and eventual changes in optical and biological properties of the tissue strongly depend on the laser‐irradiation regime. Here, a speckle‐contrast technique based on monochromatic illumination of the tissue in combination with strain mapping by means of optical coherence elastography (OCE) is applied to reveal the interplay between the temperature and thermal stress fields producing tissue modifications. The speckle‐based technique ensured en face visualization of cross correlation and contrast of speckle images, with evolving proportions between contributions of temperature increase and thermal‐stresses determined by temperature gradients. The speckle‐technique findings are corroborated by quantitative OCE‐based depth‐resolved imaging of irradiation‐induced strain‐evolution. The revealed relationships can be used for real‐time control of the reshaping procedures (e.g., for laser shaping of cartilaginous implants in otolaryngology and maxillofacial surgery) and optimization of the laser‐irradiation regimes to ensure the desired reshaping using lower and biologically safer temperatures. The figure of waterfall OCE‐image demonstrates how the strain‐rate maximum arising in the heating‐beam center gradually splits and drifts towards the zones of maximal thermal stresses located at the temperature‐profile slopes.     

Relaxation time constant based optical coherence elastography

This study aimed at visualizing relative relaxation time constant (RTC) in soft tissue by using optical coherence elastography (OCE). We proposed a forced vibration model as a theoretical base to express RTC using axial gradient of periodic vibration phase captured by phase sensitive optical coherence tomography (PhS‐OCT). Validation of the model had been accomplished by experiments with isotropic and double‐layered phantoms. A fresh chicken breast sample treated with focused ultrasound was prepared to test performance of the RTC‐OCE in real tissue. All results were cross‐validated with indentation test and traditional strain‐based elastography. This study first utilized RTC mapping in 2D and 3D that covers the information of both elasticity and viscosity. The generated RTC mapping revealed the same mechanical difference internal sample which is correlated with conventional strain mapping. RTC mapping is potentially to be served as new biomarker for disease diagnosis in the future.     

Quantification of biomechanical properties of human corneal scar using acoustic radiation force optical coherence elastography

Biomechanical properties of corneal scar are strongly correlated with many corneal diseases and some types of corneal surgery, however, there is no elasticity information available about corneal scar to date. Here, we proposed an acoustic radiation force optical coherence elastography system to evaluate corneal scar elasticity. Elasticity quantification was first conducted on ex vivo rabbit corneas, and the results validate the efficacy of our system. Then, experiments were performed on an ex vivo human scarred cornea, where the structural features, the elastic wave propagations, and the corresponding Young’s modulus of both the scarred region and the normal region were achieved and based on this, 2D spatial distribution of Young’s modulus of the scarred cornea was depicted. Up to our knowledge, we realized the first elasticity quantification of corneal scar, which may provide a potent tool to promote clinical research on the disorders and surgery of the cornea.     

Three‐dimensional static optical coherence elastography based on inverse compositional Gauss‐Newton digital volume correlation

The three‐dimensional (3D) mechanical properties characterization of tissue is essential for physiological and pathological studies, as biological tissue is mostly heterogeneous and anisotropic. A digital volume correlation (DVC)‐based 3D optical coherence elastography (OCE) method is developed to measure the 3D displacement and strain tensors. The DVC algorithm includes a zero‐mean normalized cross‐correlation criterion‐based coarse search regime, an inverse compositional Gauss‐Newton fine search algorithm and a local ternary quadratic polynomial fitting strain calculation method. A 3D optical coherence tomography (OCT) scanning protocol is proposed through theoretical analysis and experimental verification. Measurement errors of the DVC‐based 3D OCE method are evaluated to be less than 2.0 μm for displacements and 0.30% for strains by rigid body motion experiments. The 3D displacements and strains of a phantom and a specimen of chicken breast tissue under compression are measured. Results of the phantom show a good agreement with theoretical analysis and tensile testing. The strains of the chicken breast tissue indicate anisotropic biomechanical properties. This study provides an effective method for 3D biomechanical property studies of soft tissue and improves the development of 3D OCE techniques.     

Translational optical coherence elastography for assessment of systemic sclerosis

Systemic sclerosis (SSc‐scleroderma) is an autoimmune disorder with high mortality rate that results in excessive accumulation of collagen in the skin and internal organs. Currently, the modified Rodnan Skin Score (mRSS) is the gold standard for evaluating the dermal thickening due to SSc. However, mRSS has noticeable inter‐ and intra‐observer variabilities as quantified by the interclass correlation coefficient (ICC: 0.6‐0.75). In this work, optical coherence elastography (OCE) combined with structural optical coherence tomography (OCT) image analysis was used to assess skin thickness in 12 SSc patients and healthy volunteers. Inter‐ (ICC: 0.62‐0.99) and intra‐observer (ICC > 0.90) assessment of OCT/OCE showed excellent reliability. Clinical assessments, including histologically assessed dermal thickness (DT), mRSS, and site‐specific mRSS (SMRSS) were also performed for further validation. The OCE and OCT results from the forearm demonstrated the highest correlation (OCE: 0.78, OCT: 0.65) with SMRSS. Importantly, OCE and OCT had stronger correlations with the histological DT (OCT: r = .78 and OCE: r = .74) than SMRSS (r = .57), indicating the OCT/OCE could outperform semi‐quantitative clinical assessments such as SMRSS. Overall, these results demonstrate that OCT/OCE could be useful for rapid, noninvasive and objective assessments of SSc onset and monitoring skin disease progression and treatment response.     

Application of compression optical coherence elastography for characterization of human pericardium: A pilot study

The recent impressive progress in Compression Optical Coherence Elastography (C-OCE) demonstrated diverse biomedical applications, comprising ophthalmology, oncology, etc. High resolution of C-OCE enables spatially resolved characterization of elasticity of rather thin (thickness < 1 mm) samples, which previously was impossible. Besides Young's modulus, C-OCE enables obtaining of nonlinear stress–strain dependences for various tissues. Here, we report the first application of C-OCE to nondestructively characterize biomechanics of human pericardium, for which data of conventional tensile tests are very limited and controversial. C-OCE revealed pronounced differences among differently prepared pericardium samples. Ample understanding of the influence of chemo-mechanical treatment on pericardium biomechanics is very important because of rapidly growing usage of own patients' pericardium for replacement of aortic valve leaflets in cardio-surgery. The figure demonstrates differences in the tangent Young's modulus after glutaraldehyde-induced cross-linking for two pericardium samples. One sample was over-stretched during the preparation, which caused some damage to the tissue.     

Simplifying the assessment of human breast cancer by mapping a micro‐scale heterogeneity index in optical coherence elastography

Surgical treatment of breast cancer aims to identify and remove all malignant tissue. Intraoperative assessment of tumor margins is, however, not exact; thus, re‐excision is frequently needed, or excess normal tissue is removed. Imaging methods applicable intraoperatively could help to reduce re‐excision rates whilst minimizing removal of excess healthy tissue. Optical coherence elastography (OCE) has been proposed for use in breast‐conserving surgery; however, intraoperative interpretation of complex OCE images may prove challenging. Observations of breast cancer on multiple length scales, by OCE, ultrasound elastography, and atomic force microscopy, have shown an increase in the mechanical heterogeneity of malignant breast tumors compared to normal breast tissue. In this study, a micro‐scale mechanical heterogeneity index is introduced and used to form heterogeneity maps from OCE scans of 10 ex vivo human breast tissue samples. Through comparison of OCE, optical coherence tomography images, and corresponding histology, malignant tissue is shown to possess a higher heterogeneity index than benign tissue. The heterogeneity map simplifies the contrast between tumor and normal stroma in breast tissue, facilitating the rapid identification of possible areas of malignancy, which is an important step towards intraoperative margin assessment using OCE.

     

Diurnal variation of corneal elasticity in healthy young human using air-puff optical coherence elastography

Due to the disruption of intraocular pressure (IOP) and central corneal thickness (CCT), diurnal variation in normal young human corneal elasticity is not clear. Using the custom-built air-puff optical coherence elastography, one eye of 21 normal subjects is enrolled randomly to measure the central corneal elasticity, IOP, and CCT in different time points within a day. Based on the multi-level model, the corneal elastic modulus is found to have a linear positive relation with IOP (P < .01) but not CCT (P = .175) and time point (P = .174–.686). A new indicator, corneal elasticity change rate, is proposed to present the magnitude of corneal elasticity change caused by 1 mmHg IOP, which can correct the interference effect of IOP. The results show that the corneal elasticity in the normal young human does not have the characteristics of diurnal variation under IOP control. Furthermore, IOP plays an important role in the corneal elasticity, and corneal elasticity change rate can increase the comparability of results between individuals.     

Vascular elasticity measurement of the great saphenous vein based on optical coherence elastography

Vascular elasticity is important in physiological and clinical problems. The mechanical properties of the great saphenous vein (GSV) deserve attention. This research aims to measure the radial elasticity of ex vivo GSV using the optical coherence elasticity (OCE). The finite element model of the phantom is established, the displacement field is calculated, the radial mechanical characteristics of the simulation body are obtained. Furthermore, we performed OCE on seven isolated GSVs. The strain field is obtained by combining the relationship between strain and displacement to obtain the radial elastic modulus of GSVs. In the phantom experiment, the strain of the experimental region of interest is mainly between 0.1 and 0.4, while the simulation result is between 0.06 and 0.40. The radial elastic modulus of GSVs ranged from 3.83 kPa to 7.74 kPa. This study verifies the feasibility of the OCE method for measuring the radial elastic modulus of blood vessels.     

Acoustic radiation force optical coherence elastography for evaluating mechanical properties of soft condensed matters and its biological applications

Evaluating mechanical properties of biological soft tissues and viscous mucus is challenging because of complicated dynamic behaviors. Soft condensed matter models have been successfully used to explain a number of dynamical behaviors. Here, we reported that optical coherence elastography (OCE) is capable of quantifying mechanical properties of soft condensed matters, micellar fluids. A 7.5 MHz focused transducer was utilized to generate acoustic radiation force exerted on the surface of soft condensed matters in order to produce Rayleigh waves. The waves were recorded by optical coherence tomography (OCT). The Kelvin‐Voigt model was adopted to evaluate shear modulus and loss modulus of soft condensed matters. The results reported that various concentrations of micellar fluids can provide reasonable ranges of elasticity from 65.71 to 428.78 Pa and viscosity from 0.035 to 0.283 Pa·s, which are close to ranges for actual biological samples, like mucus. OCE might be a promising tool to differentiate pathologic mucus samples from healthy cases as advanced applications in the future.     

Assessment of corneal viscoelasticity using elastic wave optical coherence elastography

The corneal viscoelasticity have great clinical significance, such as the early diagnosis of keratoconus. In this work, an analysis method which utilized the elastic wave velocity, frequency and energy attenuation to assess the corneal viscoelasticity is presented. Using phase‐resolved optical coherence tomography, the spatial‐temporal displacement map is derived. The phase velocity dispersion curve and center frequency are obtained by transforming the displacement map into the wavenumber‐frequency domain through the 2D fast Fourier transform (FFT). The shear modulus is calculated through Rayleigh wave equation using the phase velocity in the high frequency. The normalized energy distribution is plotted by transforming the displacement map into the spatial‐frequency domain through the 1D FFT. The energy attenuation coefficient is derived by exponential fitting to calculate the viscous modulus. Different concentrations of tissue‐mimicking phantoms and porcine corneas are imaged to validate this method, which demonstrates that the method has the capability to assess the corneal viscoelasticity.     

High‐intensity‐focused ultrasound and phase‐sensitive optical coherence tomography for high resolution surface acoustic wave elastography

Elastography has the ability of quantitatively evaluating the mechanical properties of soft tissue; thus it is helpful for diagnosis and treatment monitoring of many diseases, for example, skin diseases. Surface acoustic waves (SAWs) have been proven to be a non‐invasive, non‐destructive method for accurate characterization of tissue elastic properties. Current SAW elastography using high‐energy laser pulse or mechanical shaker still have some problems. In order to improve SAW elastography in medical application, a new technique was proposed in this paper, which combines high‐intensity‐focused ultrasound as a SAWs impulse inducer and phase‐sensitive optical coherence tomography as a SAWs detector. A 2% agar‐agar phantom and ex‐vivo porcine skin were tested. The data were processed by a new algorithm based on the Fourier analysis. The results show that the proposed method has the capability of quantifying the elastic properties of soft tissue‐mimicking materials. The lateral resolution of the elastogram has been significantly improved and the different layers in heterogeneous material could also been distinguished. Our improved technique of SAW elastography has a large potential to be widely applied in clinical use for skin disease diagnosis and treatment monitoring.      

K‐distribution three‐dimensional mapping of biological tissues in optical coherence tomography

Probability density function (PDF) analysis with K‐distribution model of optical coherence tomography (OCT) intensity signals has previously yielded a good representation of the average number of scatterers in a coherence volume for microspheres‐in‐water systems, and has shown initial promise for biological tissue characterization. In this work, we extend these previous findings, based on single point M‐mode or two‐dimenstional slice analysis, to full three‐dimensional (3D) imaging maps of the shape parameter α of the K‐distribution PDF. After selecting a suitably sized 3D evaluation window, and verifying methodology in phantoms, the resultant parametric α images obtained in different animal tissues (rat liver and brain) show new contrasting ability not seen in conventional OCT intensity images.      

In vivo noninvasive measurement of spatially resolved corneal elasticity in human eyes using Lamb wave optical coherence elastography

Current elastography techniques are limited in application to accurately assess spatially resolved corneal elasticity in vivo for human eyes. The air‐puff optical coherence elastography (OCE) with an eye motion artifacts correction algorithm is developed to distinguish the in vivo cornea vibration from the eye motion and visualize the Lamb wave propagation clearly in healthy subjects. Based on the Lamb wave model, the phase velocity dispersion curve in the high‐frequency is calculated to obtain spatially resolved corneal elasticity accurately with high repeatability. It is found that the corneal elasticity has regional variations and is correlated with intraocular pressure, which suggests that the method has the potential to provide noninvasive measurement of spatially resolved corneal elasticity in clinical practice.     

Quantitative discrimination of NPC cell lines using optical coherence tomography

We tried to explore the intrinsic differences in the optical properties of the four representative NPC cell lines on the models of radiobiology and metastasis by OCT. The scattering coefficients and anisotropies were extracted by fitting the average a‐scan attenuation curves based on the multiple scatter effect. The values of scattering coefficients and anisotropy factors were 5.21 ± 0.11, 5.30 ± 0.09, 5.92 ± 0.21, 6.97 ± 0.22, and 0.892 ± 0.009, 0.886 ± 0.006, 0.884 ± 0.009, 0.86 ± 0.01 for CNE1, CNE2, 5‐8F and 6‐10B pellets (p < 0.05, P = 0.07 for CNE1 and CNE2), respectively. The results showed that the radiobiology and metastasis cell's model could be distinguished obviously; which implied that the corresponding types of NPC tissue might be potentially differentiated by OCT. (© 2012 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Laser thermal therapy monitoring using complex differential variance in optical coherence tomography

Conventional thermal therapy monitoring techniques based on temperature are often invasive, limited by point sampling, and are indirect measures of tissue injury, while techniques such as magnetic resonance and ultrasound thermometry are limited by their spatial resolution.  The visualization of the thermal coagulation zone at high spatial resolution is particularly critical to the precise delivery of thermal energy to epithelial lesions. In this work, an integrated thulium laser thermal therapy monitoring system was developed based on complex differential variance (CDV), which enables the 2D visualization of the dynamics of the thermal coagulation process at high spatial and temporal resolution with an optical frequency domain imaging system. With proper calibration to correct for noise, the CDV‐based technique was shown to accurately delineate the thermal coagulation zone, which is marked by the transition from high CDV upon heating to a significantly reduced CDV once the tissue is coagulated, in 3 different tissue types ex vivo: skin, retina, and esophagus. The ability to delineate thermal lesions in multiple tissue types at high resolution opens up the possibility of performing microscopic image‐guided procedures in a vast array of epithelial applications ranging from dermatology, ophthalmology, to gastroenterology and beyond. 

     

Imaging depth extension of optical coherence tomography in rabbit eyes using optical clearing agents

Optical coherence tomography has become an indispensable diagnostic tool in ophthalmology for imaging the retina and the anterior segment of the eye. However, the imaging depth of optical coherence tomography is limited by light attenuation in tissues due to optical scattering and absorption. In this study of rabbit eye both ex vivo and in vivo, optical coherence tomography imaging depth of the anterior and posterior segments of the eye was extended by using optical clearing agents to reduce multiple scattering. The sclera, the iris, and the ciliary body were clearly visualized by direct application of glycerol at an incision on the conjunctiva, and the posterior boundary of sclera and even the deeper tissues were detected by submerging the posterior segment of eye in glycerol solution ex vivo or by retro-bulbar injection of glycerol in vivo. The ex vivo rabbit eyes recovered to their original state in 60 s after saline-wash treatment, and normal optical coherence tomography images of the posterior segment of the sample eyes proved the self-recovery of in vivo performance. Signal intensities of optical coherence tomography images obtained before and after glycerol treatment were compared to analysis of the effect of optical clearing. To the best of our knowledge, this is the first study for imaging depth extension of optical coherence tomography in both the anterior and posterior segments of eye by using optical clearing agents.     

An automatic diagnostic system of coronary artery lesions in Kawasaki disease using intravascular optical coherence tomography imaging

Intravascular optical coherence tomography (IV‐OCT) is a light‐based imaging modality with high resolution, which employs near‐infrared light to provide tomographic intracoronary images. Morbidity caused by coronary heart disease is a substantial cause of acute coronary syndrome and sudden cardiac death. The most common intracoronay complications caused by coronary artery disease are intimal hyperplasia, calcification, fibrosis, neovascularization and macrophage accumulation, which require efficient prevention strategies. OCT can provide discriminative information of the intracoronary tissues, which can be used to train a robust fully automatic tissue characterization model based on deep learning. In this study, we aimed to design a diagnostic model of coronary artery lesions. Particularly, we trained a random forest using convolutional neural network features to distinguish between normal and diseased arterial wall structure. Then, based on the arterial wall structure, fully convolutional network is designed to extract the tissue layers in normal cases, and pathological tissues regardless of lesion type in pathological cases. Then, the type of the lesions can be characterized with high precision using our previous model. The results demonstrate the robustness of the model with the approximate overall accuracy up to 90%.