U.S. patent application number 09/739089 was filed with the patent office on 2002-01-17 for method and system for characterization and mapping of tissue lesions.
Invention is credited to Balas, Constantinos.
Application Number | 20020007123 09/739089 |
Document ID | / |
Family ID | 40328199 |
Filed Date | 2002-01-17 |
United States Patent
Application |
20020007123 |
Kind Code |
A1 |
Balas, Constantinos |
January 17, 2002 |
Method and system for characterization and mapping of tissue
lesions
Abstract
The present invention provides a method and an apparatus for the
in vivo, non-invasive, early detection of alterations and mapping
of the grade of these alterations, caused in the biochemical and/or
in the functional characteristics of epithelial tissues during the
development of tissue atypias, dysplasias, neoplasias and cancers.
The method is based, at least in part, on the simultaneous
measurement of the spatial, temporal and spectral alterations in
the characteristics of the light that is re-emitted from the tissue
under examination, as a result of a combined tissue excitation with
light and special chemical agents. The topical or systematic
administration of these agents result in an evanescent contrast
enhancement between normal and abnormal areas of tissue. The
apparatus enables the capturing of temporally successive imaging in
one or more spectral bands simultaneously. Based on the measured
data, the characteristic curves that express the agent-tissue
interaction kinetics, as well as numerical parameters derived from
these data, are determined in any spatial point of the examined
area. Mapping and characterization of the lesion, are based on
these parameters.
Inventors: |
Balas, Constantinos;
(Heraklion, GR) |
Correspondence
Address: |
LAHIVE & COCKFIELD
28 STATE STREET
BOSTON
MA
02109
US
|
Family ID: |
40328199 |
Appl. No.: |
09/739089 |
Filed: |
December 15, 2000 |
Current U.S.
Class: |
600/476 ;
356/342; 600/431 |
Current CPC
Class: |
A61B 5/0084 20130101;
A61B 5/0088 20130101; A61B 5/0059 20130101; G01N 21/31 20130101;
G01N 2021/6417 20130101; A61B 1/0646 20130101; G01N 2021/6423
20130101; A61B 1/043 20130101; G01N 21/21 20130101; A61B 1/303
20130101; A61B 5/0071 20130101; A61B 1/00186 20130101; A61B 5/0075
20130101; G01N 21/6486 20130101 |
Class at
Publication: |
600/476 ;
600/431; 356/342 |
International
Class: |
A61B 006/00 |
Foreign Application Data
Date |
Code |
Application Number |
Mar 28, 2000 |
GR |
20000100102 |
Claims
What is claimed:
1. A method for monitoring the effects of a pathology
differentiating agent on a tissue sample, comprising: applying a
pathology differentiating agent on a tissue sample and monitoring
the rate of change of light reflection from said tissue sample over
time, thereby monitoring the effects of a pathology differentiating
agent on a tissue sample.
2. The method of claim 1, wherein said pathology differentiating
agent is acetic acid.
3. The method of claim 1, wherein said tissue sample is a cervical
tissue sample.
4. The method of claim 1, wherein said tissue sample is an
esophagus tissue sample.
5. The method of claim 1, wherein said tissue sample is an ear
tissue sample.
6. A method for the in vivo diagnosis of a tissue abnormality in a
subject, comprising contacting a tissue in a subject with a
pathology differentiating agent; exposing said tissue in said
subject to optical radiation; and monitoring the intensity of light
emitted from said tissue over time, thereby diagnosing a tissue
abnormality in a subject.
7. The method of claim 6, wherein said optical irradiation is broad
band optical radiation.
8. The method of claim 6, wherein said optical irradiation is
polarized optical radiation.
9. The method of claim 6, wherein said tissue abnormality is
selected from the group consisting of a tissue atypia, a tissue
dysplasia, a tissue neoplasia and cancer.
10. The method of claim 6, wherein said tissue abnormality is a
high grade neoplasia.
11. The method of claim 6, wherein said tissue abnormality is a
cervical intraepithelial neoplasia.
12. The method of claim 6, wherein said pathology differentiating
agent is acetic acid.
13. The method of claim 6, wherein said tissue is a cervical
tissue.
14. The method of claim 6, wherein said tissue is an esophagus
tissue.
15. The method of claim 6, wherein said tissue is an ear
tissue.
16. The method of claim 6, wherein the intensity of light emitted
from said tissue over time is monitored in every spatial point of
the tissue.
Description
RELATED APPLICATIONS
[0001] This application claims priority to U.S. provisional
Application No. XXXXXX, entitled "Method And Apparatus For
Amplifying Pathological Features In Tissues", filed on Dec. 15,
1999 and Greek National Application Serial No. 20000100102, filed
on Mar. 28, 2000, incorporated herein in their entirety by this
reference.
FIELD OF THE INVENTION
[0002] The present invention is directed to a method and apparatus
for the in vivo, non invasive detection and mapping of the
biochemical and/or functional pathologic alterations of human
tissues.
BACKGROUND OF THE INVENTION
[0003] Cancer precursors signs are the so called pre-cancerous
states, which are curable if they are detected at an early stage.
In the opposite case the lesion can progress in depth, resulting in
the development of invasive cancer and metastases. At this stage,
the possibilities of successful therapy are dramatically
diminished. Consequently, the early detection and the objective
identification of the severity (stage) of the precancerous lesion
are of crucial importance.
[0004] The conventional clinical process of optical examination
have very limited capabilities in detecting cancerous and
pre-cancerous tissue lesions. This is due to the fact that the
structural and metabolic changes, which take place during the
development of the decease, do not significantly and with
specificity alter the color characteristics of the pathological
tissue.
[0005] In order to obtain more accurate diagnosis, biopsy samples
are obtained from suspicious areas, which are submitted for
histological examination. However, biopsy sampling poses several
problems, such as : a) risk for sampling errors associated with the
visual limitations in detecting and localizing suspicious areas; b)
biopsy can alter the natural history of the intraepithelial lesion;
c) mapping and monitoring of the lesion require multiple tissue
sampling, which is subjected to several risks and limitations; d)
the diagnostic procedure performed with biopsy sampling and
histologic evaluation is qualitative, subjective, time consuming,
costly and labor intensive. In recent years there have been
developed and presented quite a few new methods and systems in an
effort to overcome the disadvantages of the conventional diagnostic
procedures. These methods can be classified in two categories: a)
Methods which are based on the spectral analysis of tissues in
vivo, in an attempt to improve the diagnostic information b)
Methods which are based on the chemical excitation of tissues with
the aid of special agents, which have the property to interact with
pathologic tissue and to alter its optical characteristics
selectively, thus enhancing the contrast between lesion and healthy
tissue.
[0006] In the first case, the experimental use of spectroscopic
techniques as a potential solutions to existing diagnostic
problems, is motivated by their capability to detect alterations in
the biochemical and/or the structural characteristics, which take
place in the tissue during the development of the disease. In
particular, fluorescence spectroscopy has been extensively used in
various tissues, where the later are optically excited with the aid
of a light source (usually laser), of short wave length
(blue-ultraviolet range) and their response is measured as
fluorescence intensity vs. wavelength.
[0007] Garfield and Glassman in U.S. Pat. No. 5,450,857 and
Ramanajum et al in U.S. Pat. No. 5,421,339 have presented a method
based on the use of fluorescence spectroscopy for the diagnosis of
cancerous and pre-cancerous lesions of cervix. The main
disadvantage of fluorescence spectroscopy is that the existing
biochemical modifications associated with the progress of the
disease are not manifested in a direct way as modifications in the
measured fluorescence spectra. The fluorescence spectra contain
limited diagnostic information of two basic reasons: a) Tissues
contain non-fluorescent chromophores, such as hemoglobin.
Absorption by such chromophores of the emitted light from
fluorophores can result in artificial dips and peaks in the
fluorescence spectra. In other words the spectra carry convoluted
information for several components and therefore it is difficult
assess alterations in tissue features of diagnostic importance; and
b) The spectra are broad due to the fact that a large number of
tissue components are optically excited and contribute to the
captured optical signal. As a result the spectra do not carry
specific information for the pathologic alterations and thus they
are of limited diagnostic value.
[0008] The latter is expressed as low sensitivity and specificity
in the detection and classification of tissue lesions.
[0009] Aiming to enhance the sensitivity and specificity of the
captured information, Ramanujan et al in the Patent No. WO 98/24369
have presented a method based on the use of neural networks for the
analysis of the spectral data. This method is based on the training
of a computing system with a large number of spectral patterns,
which have been taken from normal and from pathologic tissues. The
spectrum that is captured each time is compared with the stored
spectral data, facilitating this way, the identification of the
tissue pathology.
[0010] R. R. Kortun et al, in U.S. Pat. No. 5,697,373, seeking to
improve the captured diagnostic information, have presented a
method based on the combination of fluorescence spectroscopy and
Raman scattering. The last has the capability of providing more
analytical information, it requires however complex instrumentation
and ideal experimental conditions, which substantially hinder their
clinical use. It is generally known that tissues are characterized
by the lack of spatial homogeneity and consequently the spectral
analysis of distributed spatial points is insufficient for the
characterization of their status.
[0011] Dombrowski in U.S. Pat. No. 5,424,543, describes a
multi-wavelength, imaging system, capable of capturing tissue
images in several spectral bands. With the aid of such a system it
is possible in general to map characteristics of diagnostic
importance based on their particular spectral characteristics.
However, due to the insignificance of the spectral differences
between normal and pathologic tissue, which is in general the case,
inspection in narrow spectral bands does not allow the highlighting
of these characteristics and even more so, the identification and
staging of the pathologic area.
[0012] D. R. Sandison et al, in U.S. Pat. No. 5,920,399 describe an
imaging system, developed for the in vivo investigation of cells,
which combines multi-band imaging and light excitation of the
tissue. The system also employs a dual fiber optic bundle for the
transferring of the emitted from the source light onto the tissue
and the remitted light from the tissue to the optical detector.
These bundles are placed in contact with the tissue, and various
wavelengths of excitation and imaging are combined in attempt to
enhance the spectral differentiation between normal and pathologic
tissue.
[0013] In U.S. Pat. No. 5,921,926, J. R. Delfyett et al have
presented a method for the diagnosis of diseases of the cervix,
which is based on the combination of Spectral Interferometry and
Optical Coherence Tomography (OCT). This system combines
three-dimensional imaging and spectral analysis of the tissue.
[0014] Moreover, several improved versions of colposcopes have been
presented, (D. R.Craine et al, U.S. Pat. No. 5,791,346 and K. L.
Blaiz U.S. Pat. No. 5,989,184) in most of which, electronic imaging
systems have been integrated for image capturing, analysis of
tissue images, including the quantitative assessment of lesion's
size. For the enhancement of the optical differentiation between
normal and pathologic tissue, special agents are used in various
fields of biomedical diagnostics, which are administered topically
or systematically. Such agents are acetic acid solution, toluidine
blue, various photosensitizers (porphyrines) (S. Anderson Engels,
C. Klinteberg, K. Svanberg, S. Svanberg, In vivo fluorescence
imaging for tissue diagnostics, Phys Med. Biol. 42 (1997) 815-24).
The provoked selective staining of the pathologic tissue is owed to
the property of these agents to interact with the altered metabolic
and structural characteristics of the pathologic area. This
interaction enhances progressively and reversibly the differences
in the spectral characteristics of reflection and/or fluorescence
between normal and pathologic tissue. Despite the fact that the
provoked selective staining of the pathologic tissue is a dynamic
phenomenon, in clinical practice the intensity and the extent of
the staining are assessed qualitatively and statically.
Furthermore, in several cases of early pathologic conditions, the
phenomenon of temporary staining after administering the agent, is
short-lasting and thus the examiner is not able to detect the
provoked alterations and even more so, to assess their intensity
and extent. In other cases, the staining of the tissue progresses
very slowly, with the consequence of patient discomfort and
creation of problems for the examiner in assessing the intensity
and extent of the alterations, since they are continuously
changing. The above have as direct consequence, the downgrading of
the diagnostic value of these diagnostic procedures and thus its
usefulness is limited to facilitate the localization of suspected
areas for obtaining biopsy samples.
[0015] Summarizing the above mentioned, the following conclusions
are drawn:
[0016] a) Various conventional light dispersion spectroscopic
techniques (fluorescence, elastic, non elastic scattering, etc)
have been proposed and experimentally used for the in vivo
detection of alterations in the structural characteristics of
pathologic tissue. The main disadvantage of these techniques is
that they provide point information, which is inadequate for the
analysis of the spatially non-homogenous tissue. Multi-band imaging
has the potential to solve this problem, by providing spectral
information (of lesser resolution as a rule) but in any spatial
point of the area under examination. These techniques (imaging and
non-imaging) however, provide information of limited diagnostic
value, due to the fact that the structural tissue alterations,
which are accompanying the development of the disease, are not
manifested as significant and characteristic alterations on the
measured spectra. Consequently, the captured spectral information
cannot be directly correlated with the tissue pathology, a fact
which limits the clinical usefulness of these techniques.
[0017] b) The conventional (non-spectral) imaging techniques
provide the capability of mapping characteristics of diagnostic
importance in two or three dimensions. They are basically used for
measuring morphological characteristics and as clinical
documentation tools.
[0018] c) The diagnostic methods which are based on the selective
staining of pathologic tissue with special agents allows the
enhancement of the optical contrast between normal and pathologic
tissue. Nevertheless they provide limited information for the in
vivo identification and staging of the disease.
[0019] Given the fact that the selective interaction of pathologic
tissue with the agents, which enhance its optical contrast with
healthy tissue is a dynamic phenomenon, it is reasonable to suggest
that the capture and analysis of the characteristics of this
phenomenon's kinetics, could provide important information for the
in vivo detection, identification and staging of tissue lesions. In
a previous publication by the inventors (C. Balas, A. Dimoka, E.
Orfanoudaki, E. koumandakis, "In vivo assessment of acetic
acid-cervical tissue interaction using quantitative imaging of
back-scattered light: Its potential use for the in vivo cervical
cancer detection grading and mapping", SPIE-Optical Biopsies and
Microscopic Techniques, Vol. 3568 pp. 31-37, (1998)), measurements
of the alterations in the characteristics of the back-scattered
light as a function of wave-length and time are presented. These
alterations are provoked in the cervix by the topical
administration of acetic acid solution. In this particular case,
there was used as an experimental apparatus, a general-purpose
multi-spectral imaging system built around a tunable liquid crystal
monochromator for measuring the variations in intensity of the
back-scattered light as a function of time and wavelength in
selected spatial points. It was found that the lineshapes of curves
of intensity of back-scattered light versus time, provide advanced
information for the direct identification and staging of tissue
neoplasias. Unpublished results of the same research team support
that similar results can also be obtained with other agents, which
have the property of enhancing the optical contrast between normal
and pathologic tissue. Nevertheless, the experimental method
employed in the published paper is characterized by quite a few
disadvantages, such as: The imaging monochromator requires time for
changing the imaging wavelength and as a consequence it is
inappropriate for multispectral imaging and analysis of dynamic
phenomena. It does not constitute a method for the mapping of the
grade of the tissue lesions, as the presented curves illustrate the
temporal alterations of intensity of the back-scattered light in
selected points. The lack of data modeling and parametric analysis
of the characteristics of the phenomenon kinetics in any spatial
point of the area of interest restrict the usefulness of the method
in experimental studies and hinder its clinical implementation. The
optics used for the imaging of the area of interest are of general
purpose and are not comply with the special technical requirements
for the clinical implementation of the method. Clinical
implementation of the presented system is also hindered by the fact
that it does not integrate appropriate means for ensuring the
stability of the relative position between the tissue surface and
image capturing module, during the snapshot imaging procedure. This
is very important since small movements of the patient (i.e.
breathing) are always present during the examination procedure. If
micro-movements are taking place during successive capturing of
images, after application of the agent, then the spatial features
of the captured images are not coincide. This reduces substantially
the precision in the calculation of the curves in any spatial
point, that express the kinetics of marker-tissue interaction.
SUMMARY OF THE INVENTION
[0020] The present invention provides, at least in part, a method
for monitoring the effects of a pathology differentiating agent on
a tissue sample by applying a pathology differentiating agent,
e.g., acetic acid, on a tissue sample and monitoring the rate of
change of light reflection from the tissue sample over time,
thereby monitoring the effects of a pathology differentiating agent
on a tissue sample. The tissue may be a cervical, ear, oral, skin,
esophagus, or stomach tissue. Without intending to be limited by
theory, it is believed that the pathology differentiating agent
provokes transient alterations in the light scattering properties
of the tissue, e.g., the abnormal epithelium.
[0021] In another aspect, the present invention features a method
for the in vivo diagnosis of a tissue abnormality, e.g., a tissue
atypia, a tissue dysplasia, a tissue neoplasia (such as a cervical
intraepithelial neoplasia, CINI, CINII, CINIII) or cancer, in a
subject. The method includes contacting a tissue in a subject with
a pathology differentiating agent, e.g., an acetic acid solution or
a combination of solutions selected from a plurality of acidic and
basic solutions, exposing the tissue in the subject to optical
radiation; and monitoring the intensity of light emitted from the
tissue over time, thereby diagnosing a tissue abnormality in a
subject. The optical radiation may be broad band optical radiation,
preferably polarized optical radiation.
[0022] The non-invasive methods of the present invention are useful
for the in vivo early detection of tissue abnormalities/alterations
and mapping of the grade of these tissue abnormalities/alterations,
caused in the biochemical and/or in the functional characteristics
of epithelial tissues, during the development of tissue atypias,
dysplasias, neoplasias and cancers.
[0023] In one embodiment, the tissue area of interest is
illuminated with a broad band optical radiation and contacted with
a pathology differentiating agent, e.g., an agent or a combination
of agents which interact with pathologic tissue areas characterized
by an altered biochemical composition and/or cellular functionality
and provoke a transient alteration in the characteristics of the
light that is re-emitted from the tissue. The light that is
re-emitted from the tissue may be in the form of reflection,
diffuse scattering, fluorescence or combinations or subcombinations
thereof. The intensity of the light emitted from the tissue may be
measured, e.g., simultaneously, in every spatial point of the
tissue area of interest, at a given time point or over time (e.g.,
for the duration of agent-tissue interaction). A diagnosis may be
made based on the quantitative assessment of the spatial
distribution of alterations in the characteristics of the light
re-emitted from the tissue at given time points, before and after
the optical and chemical excitation of the tissue and/or based on
the quantitative assessment of the spatial distribution of
parameters, calculated from the characteristic curves that express
the kinetics of the provoked alterations in the characteristics of
the light re-emitted from the tissue, which characteristic curves
are simultaneously measured in every spatial point of the area
under examination during the optical and chemical excitation of the
tissue.
[0024] In one embodiment of the invention, the step of tissue
illumination comprises exposing the tissue area under analysis to
optical radiation of narrower spectral width than the spectral
width of the light emitted by the illumination source. In another
embodiment, the step of measuring the intensity of light comprises
measuring the intensity of the re-emitted light in a spectral band,
the spectral width of which is narrower than the spectral width of
the detector's sensitivity. In yet another embodiment, the step of
measuring the intensity of light comprises measuring simultaneously
the intensity of the re-emitted light in a plurality of spectral
bands, the spectral widths of which are narrower than the spectral
width of the detector's sensitivity.
[0025] In yet another aspect, the present invention features an
apparatus for the in vivo, non-invasive early detection of tissue
abnormalities/alterations and mapping of the grade of these tissue
abnormalities/alterations, caused in the biochemical and/or in the
functional characteristics of epithelial tissues, during the
development of tissue atypias, dysplasias, neoplasias and cancers.
The apparatus includes optics for collecting the light re-emitted
by the area under analysis, selecting magnification and focusing
the image of the area; optical imaging detector(s); means for the
modulation, transfer, display and capturing of the image of the
tissue area of interest; a computer which includes data storage,
processing and analysis means; a monitor for displaying images,
curves and numerical data; optics for the optical multiplication of
the image of the tissue area of interest; a light source for
illuminating the area of interest; optionally, optical filters for
selecting the spectral band of imaging and illumination; means for
transmitting light and illuminating the area of interest; control
electronics; and optionally, software for the analysis and
processing of data, which also enables the tissue image capturing
and storing in specific time points and for a plurality of time
points, before and after administration of the pathology
differentiating agent.
[0026] Using the foregoing apparatus an image or a series of images
may be created which express the spatial distribution of the
characteristics of the kinetics of the provoked changes in the
tissue's optical characteristics, before and after the
administration of the agent, with pixel values corresponding with
the spatial distribution of the alterations in the intensity of the
light emitted from the tissue, in given time instances, before and
after the optical and chemical excitation of tissue and/or with the
spatial distribution of parameters derived from the function: pixel
gray value versus time. The foregoing function may be calculated
from the captured and stored images and for each row of pixels with
the same spatial coordinates.
[0027] In one embodiment, the step of optical filtering the imaging
detector comprises an optical filter that is placed in the optical
path of the rays that form the image of the tissue, for the
recording of temporally successive images in a selected spectral
band, the spectral width of which is narrower than the spectral
width of the detector's sensitivity.
[0028] In yet another embodiment, the image multiplication optics
comprise light beam splitting optics that create two identical
images of the area of interest, which are recorded by two imaging
detectors, in front of which optical filters are placed, with in
general different transmission characteristics and capable of
transmitting light of spectral width shorter than the spectral
width of the detector's sensitivity, so that two groups of
temporally successive images of the same tissue area are recorded
simultaneously, each one corresponding to a different spectral
band.
[0029] In another embodiment, the image multiplication optics
comprise more than one beam splitter for the creation of multiple
identical images of the area of interest, which are recorded by
multiple imaging detectors, in front of which optical filters are
placed, with, preferably, different transmission characteristics
and capable of transmitting light of spectral width shorter than
the spectral width of the detector's sensitivity, so that multiple
groups of temporally successive images of the same tissue area are
recorded simultaneously, each one corresponding to a different
spectral band.
[0030] In a further embodiment, the image multiplication optics
comprise one beam splitter for the creation of multiple identical
images of the area of interest, which are recorded by multiple
imaging detectors, in front of which optical filters are placed
with, preferably, different transmission characteristics and
capable of transmitting light of spectral width shorter than the
spectral width of the detector's sensitivity, so that multiple
groups of temporally successive images of the same tissue area are
recorded simultaneously, each one corresponding to a different
spectral band.
[0031] In yet a further embodiment, the image multiplication optics
comprise one beam splitter for the creation of multiple identical
images of the area of interest, which are recorded in different
sub-areas of the same detector, and in front these areas optical
filters are placed with, preferably, different transmission
characteristics and capable of transmitting light of spectral width
shorter than the spectral width of the detector's sensitivity, so
that multiple groups of temporally successive images of the same
tissue area are recorded simultaneously in the different areas of
the detector, each one corresponding to a different spectral
band.
[0032] In another embodiment, the step of filtering the light
source comprises an optical filter, which is placed in the optical
path of an illumination light beam, and transmits light of spectral
width shorter than the spectral width of sensitivity of the
detector used.
[0033] In a further embodiment, the step of filtering the light
source comprises a plurality of optical filters and a mechanism for
selecting the filter that is interposed to the tissue illumination
optical path, thus enabling the tuning of the center wavelength and
the spectral width of the light illuminating the tissue.
[0034] In another embodiment, the mapping of the grade of the
alterations to the biochemical and/or functional characteristics of
the tissue area of interest, is based on the pixel values of one
image, from the group of the recorded temporally successive images
of the tissue area of interest.
[0035] In a further embodiment, the mapping of the grade of the
alterations to the biochemical and/or functional characteristics of
the tissue area of interest, is based on the pixel values belonging
to plurality of images, which are members of the group of the
recorded temporally successive images of the tissue area of
interest.
[0036] In another embodiment, the mapping of the grade of the
alterations to the biochemical and/or functional characteristics of
the tissue area of interest, is based on numerical data derived
from mathematical operations and calculations between the pixel
values belonging a plurality of images, which are members of the
group of the recorded temporally successive images of the tissue
area of interest.
[0037] In a further embodiment, a pseudo-color scale, which
represents with different colors the different pixel values of the
image or of the images used for the mapping of abnormal tissue
areas, is used for the visualization of the mapping of the grade of
the alterations to the biochemical and /or functional
characteristics of the tissue area under examination.
[0038] In one embodiment, the image or images which are determined
for the mapping of the grade of the alterations in biochemical
and/or functional characteristics of tissue, are used for the in
vivo detection, mapping, as well as for the determination of the
borders of epithelial lesions.
[0039] In another embodiment, the pixel values of the image or of
the images which are determined for the mapping of the grade of
alterations in biochemical and/or functional characteristics of
tissue, are used as diagnostic indices for the in vivo
identification and staging of epithelial lesions.
[0040] In yet another embodiment, the image or the images which are
determined for the mapping of the grade of the alterations in
biochemical and/or functional characteristics of tissue can be
overimposed onto the color or black and white image of the same
area of tissue under examination displayed on the monitor, so that
abnormal tissue areas are highlighted and their borders are
demarcated, facilitating the selection of a representative area for
taking a biopsy sample, the selective surgical removal of the
abnormal area and the evaluation of the accuracy in selecting and
removing the appropriate section of the tissue.
[0041] In a further embodiment, the image or the images which are
determined for the mapping of the grade of alterations in
biochemical and/or functional characteristics of tissue are used
for the evaluation of the effectiveness of various therapeutic
modalities such as radiotherapy, nuclear medicine treatments,
pharmacological therapy, and chemotherapy.
[0042] In another embodiment, the optics for collecting the light
re-emitted by the area under analysis, comprises the optomechanical
components employed in microscopes used in clinical diagnostic
examinations, surgical microscopes, colposcopes and endoscopes.
[0043] In one embodiment of the invention, for colposcopy
applications, the apparatus may comprise a speculum, an articulated
arm onto which the optical head is attached, which optical head
comprises a refractive objective lens, focusing optics, a mechanism
for selecting the magnification, an eyepiece, a mount for attaching
a camera, and an illuminator, where the speculum is attached in a
fixed location onto the system articulated arm-optical head, in
such a way such that the central longitudinal axis of the speculum
is perpendicular to the central area of the objective lens, so that
when the speculum is inserted into the vagina and fixed in it, the
relative position of the image-capturing optics and of the tissue
area of interest remains unaltered, regardless of micro-movements
of the cervix, which are taking place during the examination of the
female subject.
[0044] In a further embodiment, the apparatus may further comprise
an atomizer for delivering the agent, where the atomizer is
attached in a fixed point onto the system articulated arm-optical
head of the apparatus and in front of the vaginal opening, where
the spraying of the tissue may be controlled and synchronized with
a temporally successive image capturing procedure, with the aid of
electronic control means.
[0045] In another embodiment of the apparatus of the invention, the
image capturing detector means and image display means comprise a
camera system with detector spatial resolution greater than
1000.times.1000 pixels and a monitor of at least 17 inches
(diagonal), so that high magnification is ensured together with a
large field of view, while the image quality is maintained.
[0046] In a further embodiment, in the case of microscopes used in
clinical diagnostic examinations, surgical microscopes and
colposcopes, comprise an articulated arm onto which the optical
head is attached, which optical head comprises an objective lens,
focusing optics, a mechanism for selecting the magnification, an
eyepiece, a mount for attaching a camera, an illuminator and two
linear polarizers, where the two linear polarizers are attached,
one at a point along the optical path of the illuminating light
beam and the other at a point along the optical path of the rays
that form the image of the tissue, with the capability of rotating
the polarization planes of these light polarizing optical elements,
so that when these planes are perpendicular to each other, the
contribution of the tissue's surface reflection to the formed image
is eliminated.
[0047] In another embodiment, in the case of endoscopy, the
endoscope may comprise optical means for transferring light from
the light source onto the tissue surface and for collecting and
transferring along almost the same axis and focusing the rays that
form the image of the tissue, and two linear polarizers, where the
two linear polarizers are attached, one at a point along the
optical path of the illuminating light beam and the other at a
point along the optical path of the rays that form the image of the
tissue, with the capability of rotating the polarization planes of
these light polarizing optical elements, so that when these planes
are perpendicular to each other, the contribution of the tissue's
surface reflection to the formed by the endoscope image is
eliminated.
[0048] In another embodiment, in the case of microscopes used in
clinical diagnostic examinations, surgical microscopes and
colposcopes, may additionally comprise a reflective objective lens,
where the reflective objective replaces the refractive one, which
reflective objective is devised so that in the central part of its
optical front aperture the second reflection mirror is located, and
in the rear part (non-reflective) of this mirror, illumination
means are attached from which light is emitted toward the object,
so that with or without illumination beam zooming and focusing
optics the central ray of the emitted light cone is coaxial, with
the central ray of the light beam that enters the imaging lens, and
with the aid of zooming and focusing optics of illumination beam
that may be adjusted simultaneously and automatically with the
mechanism for varying the magnification of the optical imaging
system, the illuminated area and the field-of-view of the imaging
system, are varying simultaneously and proportionally, so that any
decrease in image brightness caused by increasing the
magnification, is compensated with the simultaneous zooming and
focusing of the illumination beam.
[0049] Other features and advantages of the invention will be
apparent from the following detailed description and claims.
BRIEF DESCRIPTION OF THE DRAWINGS
[0050] FIG. 1 is a schematic representation of the present method's
basic principle.
[0051] FIG. 2, illustrates an embodiment of the invention
comprising a method for capturing in two spectral bands
simultaneously and in any spatial point of the area under analysis,
the kinetics of the alterations in the characteristics of the
remitted from the tissue light, before and the after the
administration of the contrast enhancing agent
[0052] FIG. 3 illustrates another embodiment of the invention
comprising a method for capturing in different spectral bands
simultaneously and in any spatial point of the area under analysis,
the kinetics of the alterations in the characteristics of the
remitted from the tissue light, before and the after the
administration of the contrast enhancing agent.
[0053] FIG. 4 illustrates a schematic diagram of a medical
microscope comprising a light source (LS), a magnification
selection mechanism (MS), an eyepiece (EP) and a mount for
attaching the image capturing module (CA), (detector(s), readout
electronics etc).
[0054] FIG. 5 illustrates an endoscope comprising an eyepiece (EP),
which can be adapted to an electronic imaging system, optical
fibers or crystals for the transmission of both illumination and
image rays, optics for the linear polarization of light, one
interposed to the optical path of the illumination rays (LE) and
one to the path of the ray that form the optical image of the
tissue (II).
[0055] FIG. 6 depicts a colposcopic apparatus comprising an
articulated arm (AA), onto which the optical head (OH) is affixed,
which includes a light source (LS), an objective lens (OBJ), an
eye-piece (EP) and optics for selecting the magnification (MS).
[0056] FIG. 7 illustrates an optical imaging apparatus which
comprises a light source located at the central part of its
front-aperture.
DETAILED DESCRIPTION OF THE INVENTION
[0057] The present invention is directed to a method and system for
the in-vivo, non-invasive detection and mapping of the biochemical
and or functional alterations of tissue, e.g., tissue within a
subject. Upon selection of the appropriate agent which enhances the
optical contrast between normal and pathologic tissue (depending on
the tissue's pathology), this agent is administered, e.g.,
topically to the tissue. In FIG. 1, the tissue (T), is sprayed
using an atomizer (A), which contains the agent, e.g., acetic acid.
At the same time, the tissue is illuminated with a source that
emits light at a specific spectral band, depending on the optical
characteristics of both the agent and the tissue. Illumination and
selection of the spectral characteristics of the incident to the
tissue light can be performed with the aid of a light source (LS)
and a mechanism for selecting optical filters (OFS). Of course
there are several other methods for illuminating the tissue and for
selecting the spectral characteristics of the incident light (e.g.,
Light emission diodes, LASERS and the like).
[0058] For the imaging of the area of interest, light collection
optics (L) are used, which focus the image onto a two-dimensional
optical detector (D). The output signal of the latter is amplified,
modulated and digitized with the aid of appropriate electronics
(EIS) and finally the image is displayed on a monitor (M) and
stored in the data-storing means of a personal computer (PC).
Between tissue (T) and detector (D), optical filters (OFI) can be
interposed. The interposition of the filter can be performed for
tissue (T) imaging in selected spectral bands, at which the maximum
contrast is obtained between areas that are subjected to different
grade of alterations in their optical characteristics, provoked
after administering the appropriate agent.
[0059] Before administration of the latter, images can be captured
and used as reference. After the agent has been administered, the
detector (D), captures images of the tissue, in successive time
instances, which are then stored in the computer's data-storage
means. The capturing rate is proportional to the rate at which the
tissue's optical characteristics are altered, following the
administration of the agent.
[0060] In FIG. 1, images of the same tissue area are schematically
illustrated, which have been stored successively before and after
administering the agent (STI). In these images, the black areas
represent tissue areas that do not alter their optical
characteristics (NAT), while the gray-white tones represent areas
which alter their optical characteristics (AT), following the
administration of the agent. The simultaneous capture of the
intensity of the light re-emitted from every spatial point of the
tissue area under analysis and in predetermined time instances,
allows the calculation of the kinetics of the provoked
alterations.
[0061] In FIG. 1, two curves are illustrated: pixel value in
position xy (Pvxy), versus time t. The curve ATC corresponds to an
area where agent administration provoked alterations (AT) in the
tissue's optical characteristics. The curve (NATC) corresponds to
an area where no alteration took place (NAT).
[0062] The mathematical analysis of these curves, leads to the
calculation of quantitative parameters for every pixel such as: The
value PVxy that corresponds to the time ti, the relaxation time
trel which corresponds to the value Pvxy=A/e (where e is the base
of Neper logarithms), etc.
[0063] The calculation of these parameters (P) in every spatial
point of the area under analysis, allows the calculation of the
image or images of the kinetics of the phenomenon (KI), with pixel
values that are correlated with these parameters. These values can
be represented with a scale of pseudocolors (Pmin, Pmax), the
spatial distribution of which allows for immediate optical
evaluation of the intensity and extent of the provoked alterations.
Depending on the correlation degree between the intensity and the
extent of the provoked alterations with the pathology and the stage
of the tissue lesion, the measured quantitative data and the
derived parameters would allow the mapping, the characterization
and the border-lining of the lesion. The pseudocolor image of the
phenomenon's kinetics (KI), which expresses the spatial
distribution of one or more parameters, can be overimposed (after
being calculated) on the tissue image, which is displayed in
real-time on the monitor. The using the overimposed image as a
guide, facilitates substantially the determination of the lesion's
boundaries, for successful surgical removal of the entire lesion,
or for locating suspicious areas in order to obtain a biopsy
sample(s). Furthermore, based on the correlation of the
phenomenon's kinetics with the pathology of the tissue, the
measured quantitative data and the parameters that derive from
them, can constitute quantitative clinical indices for the in vivo
staging of the lesion or of sub-areas of the latter.
[0064] In some cases it is necessary to capture the kinetics of the
phenomenon in more than one spectral band. This can serve in the in
vivo determination of illumination and/or imaging spectral bands at
which the maximum diagnostic signal is obtained. Furthermore, the
simultaneous imaging in more than one spectral bands can assist in
minimizing the contribution of the unwanted endogenous scattering,
fluorescence and reflection of the tissue, to the optical signal
captured by the detector. The captured optical signal comprise the
optical signal generated by the marker-tissue interaction and the
light emitted from the endogenous components of the tissue. In many
cases the recorded response of the components of the tissue
constitute noise, since it occludes the generated optical signal,
which caries the diagnostic information. Therefore, separation of
these signals, based on their particular spectral characteristics,
will result in the maximization of the signal-to-noise ratio and
consequently in the improvement of the obtained diagnostic
information.
[0065] FIG. 2, illustrates a method for capturing in two spectral
bands simultaneously and in any spatial point of the area under
analysis, the kinetics of the alterations in the characteristics of
the remitted from the tissue light, before and the after the
administration of the contrast enhancing agent. The remitted from
the tissue light, is collected and focused by the optical imaging
module (L) and passes through a beam splitting (BSP) optical
element. Thus, two identical images of the tissue (T) are
generated, which can be captured by two detectors (D1, D2). In
front of the detector, appropriate optical filters (Of.lambda.1),
(Of.lambda.2) can be placed, so that images with different spectral
characteristics are captured. Besides beam splitters, optical
filters, dichroic mirrors etc, can also be used for splitting the
image of the object. The detectors (D1), (D2) are synchronized so
that they capture simultaneously the corresponding spectral images
of the tissue (Ti.lambda.1), (Ti.lambda.2) and in successive
time-intervals, which are stored in the computer's data storage
means. Generalizing, multiple spectral images can be captured
simultaneously by combining multiple splitting elements, filters
and sources.
[0066] FIG. 3 illustrates another method for capturing in different
spectral bands simultaneously and in any spatial point of the area
under analysis, the kinetics of the alterations in the
characteristics of the remitted from the tissue light, before and
the after the administration of the contrast enhancing agent. With
the aid of a special prism (MIP) and imaging optics, it is possible
to form multiple copies of the same image onto the surface of the
same detector (D). Various optical filters
(OF.lambda.1),(OF.lambda.2),(OF.lambda.3),(OF.lambda.4), can be
interposed along the length of the optical path of the rays that
form the copies of the object's image, so that the captured
multiple images correspond to different spectral areas.
[0067] For the clinical use of the methods of the invention, the
different implementations of image capturing module described above
can be integrated to conventional optical imaging diagnostic
devises. Such devises are the various medical microscopes,
colposcopes and endoscopes, which are routinely used for the in
vivo diagnostic inspection of tissues. Imaging of internal tissues
of the human body requires in most cases the illumination and
imaging rays to travel along the same optical path, through the
cavities of the body. Due to this fact, in the common optical
diagnostic devises the tissue's surface reflection contributes
substantially in the formed image. This limits the imaging
information for the subsurface characteristics, which are in
general of great diagnostic importance. This problem becomes more
serious especially in epithelial tissues such as the cervix,
larynx, oral cavity etc, which are covered by fluids such as mucus
and saliva. Surface reflection also obstructs the detection and the
measurement of the alterations in the tissue's optical properties,
provoked after the administration of agents which enhance the
optical contrast between normal and pathologic tissue. More
specifically, when a special agent alters selectively the
scattering characteristics of the pathologic tissue, the strong
surface reflection that takes place in both pathologic (agent
responsive) and normal (agent non responsive) tissue areas,
occludes the diagnostic signal that originates from the interaction
of the agent with the subsurface features of the tissue. In other
words, surface reflection constitutes optical noise in the
diagnostic signal degrading substantially the perceived contrast
between agent responsive and agent non responsive tissue areas.
[0068] Based on the above, the effective integration of the method
to imaging diagnostic devises, requires embodiments of appropriate
optics that ensure the elimination of the contribution of surface
reflection to the captured image. FIG. 4 illustrates a schematic
diagram of a medical microscope consisted from a light source (LS),
a magnification selection mechanism (MS), an eyepiece (EP) and a
mount for attaching the image capturing module (CA), (detector(s),
readout electronics etc). For the elimination of the surface
reflection a pair of linear polarizers is employed. The incident to
the tissue light (LS), is linearly polarized by passing though a
linear polarizer (LPO). The surface reflected light (TS), has the
same polarization plane with the incident to the tissue light
(Fresnel reflection). By interposing the other linear polarizer to
the optical path of the rays that are remitted from the tissue and
form the optical image of the object, with its polarization plane
perpendicular to the polarization level of the incident to the
tissue light (IPO), the contribution of the surface reflection to
the image of the object is eliminated. The light which is not
surface-reflected enters the tissue, where due to multiple
scattering, light polarization is randomized. Thus, a portion of
the re-emitted light passes through the imaging polarization
optics, carrying improved information for the subsurface
features.
[0069] FIG. 5 illustrates an endoscope consisted of an eyepiece
(EP), which can be adapted to an electronic imaging system, optical
fibers or crystals for the transmission of both illumination and
image rays, optics for the linear polarization of light, one
interposed to the optical path of the illumination rays (LE) and
one to the path of the ray that form the optical image of the
tissue (II). The polarization plane of the polarizing optics, which
are adapted to the exit of light from the endoscope (LPO), is
perpendicular to the polarization plane of the polarizer, which is
adapted to the point where the light enters the endoscope (IL). The
polarization optics of the incident to the tissue light could also
be adapted at the point where the light enters the endoscope (IL)
but in this case, the endoscope has to be constructed using
polarization preserving crystals or fiber optics for transferring
the light. If polarization preserving light transmission media are
used, then the polarizing optics of the imaging rays can be
interposed in their path and before or after the eyepiece (EP).
[0070] A problem for the effective clinical implementation of the
described method herein is the micro-movements of the patient,
which are always present during the snapshot imaging of the same
tissue area. Obviously this problem is eliminated in case that the
patient is under anesthesia (open surgery). In most cases however
the movements of the tissue relative to the image capturing module,
occurring during the successive image capturing time-course, have
the consequence that the image pixels, with the same image
coordinates, do not correspond to exactly the same spatial point
x,y of the tissue area under examination.
[0071] This problem is typically encountered in colposcopy. A
method to eliminate the influence to the measured temporal data of
the relative movements between tissue and image capturing module is
presented below. A colposcopic apparatus is illustrated in FIG. 6,
consisted of an articulated arm (AA), onto which the optical head
(OH) is affixed, which includes a light source (LS), an objective
lens (OBJ), an eye-piece (EP) and optics for selecting the
magnification (MS). The image capturing module is attached to the
optical head (OH), through an opto-mechanical adapter. A speculum
(KD), which is used to open-up the vaginal canal for the
visualization of the cervix, is connected mechanically with the
optical head (OH), so that the its longitudinal symmetry axis (LA),
to be perpendicular to the central area of the objective lens
(OBJ). The speculum enters the vagina and its blades are opened up
compressing the side walls of the vagina. The Speculum (KD), been
mechanically connected with the optical head (OH), transfer any
micromovement of the patient to the optical head (OH), which been
mounted on an articulated arm (AA), follows these movements. Thus
the relative position between tissue and optical head remains
almost constant.
[0072] An important issue that must also be addressed for the
successful clinical implementation of the diagnostic method
described herein, is the synchronization of the application of the
contrast enhancing agent with the initiation of the snapshot
imaging procedure. FIG. 6, illustrates an atomizer (A) attached to
the optical head of the microscope. The unit (MIC) is comprised of
electronics for controlling the agent sprayer and it can
incorporate also the container for storing the agent. When the unit
(MIC) receives the proper command from the computer it sprays a
predetermined amount of the agent onto the tissue surface, while
the same or another command initiates the snapshot image capturing
procedure.
[0073] The diagnostic examination of non-directly accessible
tissues, located in cavities of the human body (ear, cervix, oral
cavity, esophagus, colon, stomach), is performed with the aid of
common clinical microscopes. In these devises the
illumination-imaging rays are near co-axial. More specifically, the
line perpendicular to the exit point of light into the air, and the
line perpendicular to the objective lens, form an angle of a few
degrees. Due to this fact, these microscopes operate at a specific
distance from the subject (working distance), in which the
illuminated tissue area, coincides with the field-of-view of the
imaging system. These microscopes are found to be inappropriate in
cases where tissue imaging through human body cavities of small
diameter and at short working distances, is required. These
technical limitations are also constituting serious restricting
factors for the successful clinical implementation of the method
described herein. As it has been discussed above, elimination of
surface reflection results in a substantial improvement of the
diagnostic information, obtained from the quantitative assessment
of marker-tissue interaction kinetics. If a common clinical
microscope is employed as the optical imaging module, then due the
above mentioned Illumination-imaging geometry, multiple reflections
are occurring in the walls of the cavity, before the light reaches
the tissue under analysis. In the case of colposcopy, multiple
reflections are much more intense, since they are mainly taking
place onto highly reflective blades of the speculum. Recall that
the latter is inserted into the vagina to facilitate the inspection
of cervix.
[0074] If the illuminator of the imaging apparatus emits linearly
polarized light, the multiple reflections are randomizing the
polarization plane of the incident light. And as it has been
discussed above, if the incident to the tissue under analysis light
is not linearly polarized, then the elimination of the contribution
of the surface reflection to the captured image can not be
effective.
[0075] FIG. 7 illustrates an optical imaging apparatus which
comprises a light source located at the central part of its
front-aperture. With this arrangement, the central ray of the
emitted light cone is coaxial, with the central ray of the light
beam that enters the imaging apparatus. This enables illumination
rays to reach directly the tissue surface under examination and not
after multiple reflections in the wall of the cavity. A
reflective-objective lens is used, consisted at least of a first
reflection (1RM) and a second reflection (2RM) mirror, where at the
rear part of the first reflection mirror (2RM), a light source (LS)
is attached together (if required) with optics for light beam
manipulation such as zooming and focusing (SO). The reflective
objective lens (RO), by replacing the common refractive-objective,
which is used in conventional microscopes, provides imaging
capability in cavities of small diameter, with freedom in choosing
the working distance. The zooming and focusing optics of the light
beam can be adjusted simultaneously with the mechanism for varying
the magnification of the optical imaging system, so that the
illumination area and the field-of-view of the imaging system, are
varying simultaneously and proportionally. This has as a result,
the preservation of image brightness regardless of the
magnification level of the lens. The imaging-illumination geometry
embodied in this optical imaging apparatus among with the light
beam manipulation options, enable the efficient elimination of the
contribution of the surface reflection to the captured image and
consequently the efficient clinical implementation of the method
described herein.
[0076] Equivalents
[0077] Those skilled in the art will recognize, or be able to
ascertain using no more than routine experimentation, many
equivalents to the specific embodiments of the invention described
herein. Such equivalents are intended to be encompassed by the
following claims.
* * * * *