UC Irvine

Medical imaging traces its roots back to the discovery of X-rays in 1895, which for the first time gave physicians a way to see inside the body without surgery. Over the following decades, imaging technologies rapidly expanded in both capability and application. The invention of computed tomography (CT) in the 1970s helped enable cross-sectional reconstructions and three-dimensional views of anatomical structures. Soon after, magnetic resonance imaging (MRI) emerged, offering superior soft tissue contrast and functional capabilities such as diffusion and perfusion mapping. Ultrasound (US) was developed in parallel as a safe, real-time, and cost-effective method, widely adopted for obstetrics, cardiology, and abdominal imaging. In the last few decades, optical imaging techniques have risen as powerful complements. Optical coherence tomography (OCT), introduced in the 1990s, provides micrometer-scale resolution resembling “optical biopsy,” while photoacoustic imaging (PA) bridges optical contrast and ultrasound penetration. Building upon these, functional extensions such as OCT angiography (OCTA), polarization-sensitive OCT (PS-OCT), and optical coherence elastography (OCE) provide vascular, collagen, and biomechanical insights beyond traditional structural imaging. In recent years, it has become increasingly evident that although each imaging modality provides distinct advantages, no single technique can deliver all the information required for a comprehensive diagnosis. This limitation has stimulated the development of multimodality strategies, particularly in the field of minimally invasive imaging. Intravascular modalities such as ultrasound, photoacoustic imaging, optical coherence tomography, and elastography have each demonstrated unique capabilities for characterizing arterial morphology, composition, and biomechanics. However, sequential application of these methods often prolongs procedural time and introduces additional risks. To address these challenges, researchers have developed various multimodality systems that integrate multiple imaging techniques into a single miniaturized catheter, enabling the simultaneous acquisition of co-registered images. Here, we introduce an updated multimodality intravascular imaging system for cardiologists. The results from our advanced system enable real-time visualization of the arterial wall and enhance the characterization of atherosclerotic plaques, supported by an improved system signal-to-noise ratio. Looking ahead, we plan to incorporate IVOCT and further miniaturize a tri-modality probe to enable more comprehensive evaluation of plaque composition and risk. In addition, progress has been made in endoscopic imaging, where multifunctional systems integrating optical coherence tomography, optical coherence tomography angiography, and optical coherence elastography enable comprehensive evaluation of the vaginal wall, including its tissue structure, microvasculature, and biomechanical properties. We first validated the system in patients with different menopausal statuses and demonstrated its capability and effectiveness in characterizing physiological differences. Based on our developed predictive model, we found that, with 95% confidence, patients with a vaginal epithelial thickness below 130 µm are more likely to exhibit menopausal symptoms and can be classified as postmenopausal. We will further validate the system’s performance through a longitudinal clinical trial involving patients with genitourinary syndrome of menopause undergoing fractional carbon dioxide laser treatment. The system was used to monitor treatment effects and tissue recovery over post-treatment. Collectively, the results from in vivo clinical evaluations highlight the significant potential of this multifunctional system to advance the field of endoscopic imaging. Multimodality imaging has advanced from isolated techniques to integrated intravascular and endoscopic platforms that provide complementary structural, functional, and biomechanical information in real time. Our work demonstrates the potential of these systems to improve cardiovascular plaque characterization and gynecological assessment, with early clinical studies highlighting their diagnostic and therapeutic value. For intravascular applications, future efforts will focus on incorporating intravascular OCT and developing fully miniaturized tri-modality probes to achieve more comprehensive evaluation of plaque composition and risk stratification. And continued validation in larger trials will be essential to translate these technologies into routine clinical practice and ultimately improve patient outcomes for gynecologists.