EMIM 2018 ControlCenter

Online Program Overview Session: PL-02

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Award Plenary Session

Session chair: Chrit Moonen - Utrecht, The Netherlands; Silvio Aime - Torino, Italy
 
Shortcut: PL-02
Date: Wednesday, 21 March, 2018, 8:00 PM
Room: Chamber Hall | level 0
Session type: Plenary Session

MICKAEL TANTER, Paris (ESMI Award winner) & NYNKE van den BERG (PhD Award Winner 2017)

Abstract

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8:00 PM PL-02-1

Advancing surgical guidance: From (hybrid) molecule to man and beyond (#598)

N. S. van den Berg1

1 Stanford University, Department of Otolaryngology, Head and Neck Surgery, Stanford, United States of America

Content

Surgery, often combined with (neo-adjuvant) chemo-, hormonal- or radiotherapy, is considered the main pillar in cancer management. However, during the surgical procedure it is not always clear what exactly has to be removed. My PhD research at the Leiden University Medical Center (dept. Radiology)- Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital (dept. Urology & dept. Head and Neck Surgery and Oncology) aimed to use interventional molecular imaging technologies to provide the surgeon with additional guidance during surgery as such to improve outcome. We focused on the clinical evaluation and validation of the hybrid, radioactive and fluorescent, tracer indocyanine green (ICG)-technetium 99m-nanocolloid to identify and excise lymph nodes that are in direct contact with the primary tumor (so-called sentinel nodes) in e.g. patients with head-and-neck or urological cancer. Using the hybrid tracer, we created a hybrid approach wherein diagnostic imaging findings could be directly translated into the operation room. Here, for diagnostic imaging the radioactive signature of the tracer could be used to non-invasively identify the target lesions (sentinel nodes). In addition, during surgery, the fluorescent signature of the hybrid tracer allowed visual identification of the sentinel nodes. In comparison to the conventional approach of radiocolloid and blue dye a definitive value of the hybrid tracer was found with more sentinel nodes identified during surgery. This value seemed biggest when sentinel nodes are located near the injection site and/or at locations of complex anatomy (e.g. parotid gland, presacral). Secondly, in collaboration with industrial partners, optimization of radioactive- and fluorescence imaging devices was investigated. Subsequently, in clinical first-in-human pilot studies we found that we were able to improve intraoperative lesion detection and resection. For example, using an optimized fluorescence camera, compared to its predecessor, we could visually more sentinel nodes. Even more so, the use of these optimized fluorescence camera’s resulted in a shift where by the surgeon now can perform real-time fluorescence-guided sentinel node excision rather than using fluorescence imaging for confirmation only.

8:30 PM PL-02-2

Changes of Paradigm in Biomedical Ultrasound (#574)

M. Tanter1

1 Inserm, Institut Langevin (ESPCI Paris, CNRS, Inserm, PSL University), Paris, France

Content

In the last twenty years, the introduction of plane or diverging wave transmissions rather than line by line scanning focused beams broke the resolution limits of ultrasound imaging. By using such large field of view transmissions, the frame rate reaches the theoretical limit of physics dictated by the ultrasound speed and an ultrasonic map can be provided typically in tens of micro-seconds (several thousands of frames per second). Interestingly, this leap in frame rate is not only a technological breakthrough but it permits the advent of completely new ultrasound imaging modes, including shear wave elastography1,2, electromechanical wave imaging, ultrafast Doppler, ultrafast contrast imaging, and even functional ultrasound imaging of brain activity (fUltrasound) introducing Ultrasound as an emerging full-fledged neuroimaging modality.

At ultrafast frame rates, it becomes possible to track in real time the transient vibrations – known as shear waves – propagating through organs. Such "human body seismology" provides quantitative maps of local tissue stiffness whose added value for diagnosis has been recently demonstrated in many fields of radiology (breast, prostate and liver cancer, cardiovascular imaging, ...).

For blood flow imaging, ultrafast Doppler permits high-precision characterization of complex vascular and cardiac flows. It also gives ultrasound the ability to detect very subtle blood flow in very small vessels. In the brain, such ultrasensitive Doppler paves the way for fUltrasound (functional ultrasound imaging) of brain activity with unprecedented spatial and temporal resolution compared to fMRI (figure 1).

It provides the first modality for imaging of the whole brain activity working on awake and freely moving animals with unprecedented resolutions 3,4,5.

Finally, we recently demonstrated that it can be combined with 3 µm diameter microbubbles injections in order to provide a first in vivo and non-invasive imaging modality at microscopic scales deep into organs (figure 2) combined with contrast agents by localizing the position of millions of microbubbles at ultrafast frame rates.

This ultrasound localization microscopy technique solves for the first time the problem of in vivo imaging at microscopic scale the whole brain vasculature 6. Beyond fundamental neuroscience or stroke diagnosis, it will certainly provide new insights in the understanding of tumor angiogenesis.

All these new features of ultrafast Ultrasound could be combined in the future with PET/CT acquisitions for unique hybrid and simultaneous imaging of anatomy, metabolism, hemodynamics and functional activity as recently demonstrated7.
 

References

  1. M. Tanter et al, Ultrasound in Medicine and Biology, 34(9), 2008
  2. M.E. Fernandez-Sanchez et al, Nature, July 2015
  3. Mace et al., Nature Methods, Jun. 2011
  4. Osmanski et al, Nature Comm., Oct. 2014
  5. L.A. Sieu et al, Nature Methods, Jul. 2015
  6. C.Errico et al, Nature, Dec. 2015
  7. J. Provost et al, Nature Biomedical Engineering, Feb. 2018

 

 

 

Acknowledgement

This work was supported by a research grant from the European Research Council under the European Union's Seventh Framework Program (FP7/2007-2013) / ERC Advanced grant agreement n° 339244-FUSIMAGINE and , by France Life Imaging and by the Inserm Technology Research Accelerator in Biomedical Ultrasound.

Ultrafast Ultrasound becomes a full fledged neuroimaging and microscopic modality

A & B.) 3D Functional Ultrasound imaging of the rat brain neuronal activity during a visual stimulus (from Gesnik et al Neuroimage 2015)

C) Superresolution Ultrasound based on ultrasound localization microscopy leads to non invasive deep  in vivo microscopy of the vasculature up to the capillary level (from Errico et al Nature 2015)

Hybrid PET/CT and Ultrafast Ultrasound imaging of a growing tumor in mice
Ultrafast Ultrasound can be implemented simultaneously with PET/CT for an hybrid modality providing simultaneously anatomy, metabolism, hemodynamics and functional activity (from Provost et al, Nature BME 2018) : Images of mice tumor at different growth stages with vascularization provided by Ultrasound, Metabolism provided by PET, and Anatomy by CT.
Keywords: ultrasound, fus imaging, neuroimaging, ultrafast ultrasound, ultrasound localization microscopy, superresolution, functional ultrasound