Significance: Detailed biochemical and morphological imaging of the plaque burdened coronary arteries holds the promise of improved understanding of atherosclerosis plaque development, ultimately leading to better diagnostics and therapies.
Aim: Development of a dual-modality intravascular catheter supporting swept-source optical coherence tomography (OCT) and frequency-domain fluorescence lifetime imaging (FD-FLIM) of endogenous fluorophores with UV excitation.
Approach: We instituted a refined approach to endoscope development that combines simulation in a commercial ray tracing program, fabrication, and a measurement method for optimizing ball-lens performance. With this approach, we designed and developed a dual-modality catheter endoscope based on a double-clad fiber supporting OCT through the core and fluorescence collection through the first cladding. We varied the relative percent of UV excitation launched into the core and first cladding to explore the potential resolution improvement for FD-FLIM. The developed catheter endoscope was optically characterized, including measurement of spatial resolution and fluorescent lifetimes of standard fluorophores. Finally, the system was demonstrated on fresh ex vivo human coronary arteries.
Results: The developed endoscope was shown to have optical performance similar to predictions derived from the simulation approach. The FLIM resolution can be improved by over a factor of 4 by primarily illuminating through the core rather than the first cladding. However, time-dependent solarization losses need to be considered when choosing the relative percentage. We ultimately chose to illuminate with 7% of the power transmitting through the core. The resulting catheter endoscope had 40-μm lateral resolution for OCT and <100 μm lateral resolution for FD-FLIM. Images of ex vivo coronary arteries are consistent with expectations based on histopathology.
Conclusions: The results demonstrate that our approach for endoscope simulation produces reliable predictions of endoscope performance. Simulation results guided our development of a multimodal OCT/FD-FLIM catheter imaging system for investigating atherosclerosis in coronary arteries.
Atherosclerosis is a progressive asymptomatic disease that has the highest rate of death and morbidity in the United States. High macrophage infiltration and thin cap fibroatheromas are known to be the precursor lesions of plaque rupture. Lipid-laden macrophages called foam cells are formed by the uptake of lipids within the plaque. These foam cells eventually die forming a necrotic core. Ruptured plaques are characterized by a necrotic core with an overlying thin-ruptured cap highly infiltrated by macrophages. Imaging modalities capable of identifying macrophage clusters in atherosclerotic plaques could be used for plaque vulnerability assessment. In this study, Multispectral Fluorescence Lifetime Imaging (FLIM) is used to retrieve information of biochemical markers present in atherosclerotic tissue. Here, we present a computational methodology that makes use of FLIM-based biochemical plaque features in order to identify macrophage/foam cells in atherosclerotic plaques. In the proposed methodology, the FLIM lifetime map obtained from a spectral channel of 494 ± 20.5 nm provides information about the accumulation of macrophages, which produce long lifetimes (>6 ns). This methodology was validated against histopathological assessment (CD68 staining specific for macrophages) in terms of statistical correlation, a 10-fold cross validation (sensitivity = 88.45%; specificity= 91.21%), and receiver operating characteristic (ROC AUC = 0.91) analyses.
We report the design and validation of a novel ball lens-based imaging catheter based on dual-clad fiber for frequency-domain fluorescence lifetime imaging microscopy (FLIM) of atherosclerosis. The illumination and collection performance of the catheter endoscope was modeled and optimized with the ray-tracing program Zemax. A 1.55-m-long dual-clad fiber was spliced with a short length of coreless fiber, and then heated and polished to fabricate the angled ball lens. The fiber endoscope was enclosed in a torque cable and had a diameter of 2Fr. The catheter was affixed to a custom built lensless rotary joint which had high coupling efficiency (>90%) over a broad spectral range, accommodating both the UV (375 nm) excitation and the broad fluorescence emission (385 nm - 600 nm). The computer controlled rotary joint and translation stage for pullback imaging can routinely achieve rotation rates of 6000 rpm. The endoscope has two configurations depending on different illumination methods. Lateral resolution was improved more than twice by illuminating the core instead of the inner cladding, while SNR decreased due to higher attenuation of the core. Experiments conducted using a resolution target demonstrate a lateral resolution 80 μm at 1 mm lens-to-sample distance. Experiments conducted using a fluorescein phantom and a segment of ex vivo human coronary artery demonstrate the system performance for fluorescence lifetime imaging with pullback velocities of >10mm/s. This study demonstrates the novel design of a ball lens-based FLIM catheter system to record fluorescence in a continuous helical scanning method across broad-spectral emission bands.
We have shown in an ex vivo human coronary artery study that the biochemical information derived from FLIM interpreted in the context of the morphological information from OCT enables a detailed classification of human coronary plaques associated with atherosclerosis. The identification of lipid-rich plaques prone to erosion or rupture and associated with sudden coronary events can impact current clinical practice as well as future development of targeted therapies for “vulnerable” plaques. In order to realize clinical translation of intravascular OCT/FLIM we have had to develop several key technologies. A multimodal catheter endoscope capable of delivering near UV excitation for FLIM and shortwave IR for OCT has been fabricated using a ball lens design with a double clad fiber. The OCT illumination and the FLIM excitation propogate down the inner core while the large outer multimode core captures the fluorescence emission. To enable intravascular pullback imaging with this endoscope we have developed an ultra-wideband fiber optic rotary joint using the same double clad fiber. The rotary joint is based on a lensless design where two cleaved fibers, one fixed and one rotating, are brought into close proximity but not touching. Using water as the lubricant enabled operation over the near UV-shortwave IR range. Transmission over this bandwidth has been measured to be near 100% at rotational frequencies up to 147 Hz. The entire system has been assembled and placed on a mobile cart suitable for cath lab based imaging. System development, performance, and early ex vivo imaging results will be discussed.
Access to the requested content is limited to institutions that have purchased or subscribe to SPIE eBooks.
You are receiving this notice because your organization may not have SPIE eBooks access.*
*Shibboleth/Open Athens users─please
sign in
to access your institution's subscriptions.
To obtain this item, you may purchase the complete book in print or electronic format on
SPIE.org.
INSTITUTIONAL Select your institution to access the SPIE Digital Library.
PERSONAL Sign in with your SPIE account to access your personal subscriptions or to use specific features such as save to my library, sign up for alerts, save searches, etc.