Photoacoustic tomography (PAT) is an emerging biomedical imaging modality that combines optical and ultrasonic imaging, providing overlapping fields of view. This hybrid approach allows for a natural integration of PAT and ultrasound (US) imaging in a single platform. Due to the similarities in signal acquisition and processing, the combination of PAT and US imaging creates a new hybrid imaging for novel clinical applications. Over the recent years, particular attention is paid to the development of PAT/US dual-modal systems highlighting mutual benefits in clinical cases, with an aim of substantially improving the specificity and sensitivity for diagnosis of diseases. The demonstrated feasibility and accuracy in these efforts open an avenue of translating PAT/US imaging to practical clinical applications. In this review, the current PAT/US dual-modal imaging systems are discussed in detail, and their promising clinical applications are presented and compared systematically. Finally, this review describes the potential impacts of these combined systems in the coming future.

Photoacoustic imaging (PAI) is an emerging biomedical imaging modality, offering numerous advantages, including high resolution and high contrast. In its application to brain imaging, however, the photoacoustic (PA) signals from brain tissue weaken considerably due to the distortion effects of the skull. This attenuation reduces the resolution and contrast significantly. To address this issue, here we describe a Log-MSR algorithm that combines the logarithmic depth logarithmic enhancement (Log) algorithm and the multi-scale Retinex (MSR) algorithm. In this method, the Log algorithm performs local weighted compensation based on signal attenuation for different depths, while the MSR algorithm improves the contrast of the image. The proposed Log-MSR algorithm was tested and validated using several phantom and in vivo experiments. The enhanced images constructed by the Log-MSR algorithm were qualitatively and quantitatively analyzed in terms of brain structure and function. Our results show that the Log-MSR algorithm may provide a significant enhancement to photoacoustic imaging of deep brain tissue.

Detailed insight into the radiation-induced changes in tumor microvasculature is crucial to maximize the efficacy of radiotherapy against breast cancer. Recent advances in imaging have enabled precise targeting of solid lesions. However, intratumoral heterogeneity makes treatment planning and monitoring more challenging. Conventional imaging cannot provide high-resolution observation and longitudinal monitoring of large-scale microvascular in response to radiotherapy directly in deep tissues. Herein, we report on an emerging non-invasive imaging assessment method of morphological and functional tumor microvasculature responses with high spatio-temporal resolution by means of optoacoustic imaging (OAI). In vivo imaging of 4T1 breast tumor response to a conventional fractionated radiotherapy at varying dose (14 × 2 Gy and 3 × 8 Gy) has been performed after 2 weeks following treatment. Remarkably, optoacoustic images can generate richful contrast for the tumor microvascular architecture. Besides, the functional status of tumor microvasculature and tumor oxygenation levels were further estimated using OAI. The results revealed the differential (size-dependent) nature of vascular responses to radiation treatments at varying doses. The vessels exhibited an decrease in their density accompanied by a decline in the number of vascular segments following irradiation, compared to the control group. The measurements further revealed an increase of tumor oxygenation levels for 14 × 2 Gy and 3 × 8 Gy irradiations. Our results suggest that OAI could be used to assess the response to radiotherapy based on changes in the functional and morphological status of tumor microvasculature, which are closely linked to the intratumor microenvironment. OAI assessment of the tumor microenvironment such as oxygenation status has the potential to be applied to precise radiotherapy strategy.

Photoacoustic imaging (PAI) has emerged as a transformative modality for bridging traditional Chinese medicine (TCM) theory and contemporary biomedical research in acupuncture mechanism studies. This review assesses PAI’s capacity to decode acupuncture-induced neuromodulatory and hemodynamic effects, with dual focus on the central nervous system (CNS) responses and acupoint-specific microcirculatory dynamics. Leveraging the photoacoustic effect coupled with ultrasonic detection, PAI enables non-invasive, high-resolution mapping of cerebral hemodynamic parameters, including blood flow, oxygen saturation and hemoglobin concentrations, in real time. Experimental evidence from murine models of cerebral hypoperfusion and ischemic stroke demonstrates acupoint-specific spatiotemporal activation patterns, particularly at Yongquan (KI1) and Yanglingquan (GB34), revealing cortical hemodynamic reorganization and angiogenesis. At the microcirculatory level, PAI identifies functional transitions from quiescent to activated vascular states during disease progression, characterized by altered perfusion dynamics and vascular permeability. While structural metrics (e.g., microvascular density and curvature) show no significant differences in knee osteoarthritis models, functional parameters such as hemoglobin flux and oxygen metabolism emerge as critical biomarkers of acupoint specificity. PAI further enhances treatment precision through standardized acupoint localization, as evidenced by electrostimulation studies at Hegu (LI4) and Zhongwan (CV12). This synthesis highlights PAI’s dual contributions: (1) validating CNS-mediated systemic regulation via acupoint-brain functional correlations, and (2) providing multimodal quantification of microcirculatory dynamics. Future directions emphasize integration of molecular probes for neuroendocrine pathway visualization and multimodal imaging to address unresolved thermal/optical interactions. By synergizing TCM principles with advanced biophotonics, PAI establishes a paradigm for mechanistic acupuncture research and clinical translation.

In photoacoustic imaging (PAI), a delay-and-sum (DAS) beamforming reconstruction algorithm is widely used due to its ease of implementation and fast execution. However, it is plagued by issues such as high sidelobe artifacts and low contrast, that significantly hinder the ability to differentiate various structures in the reconstructed images. In this study, we propose an adaptive weighting factor called spatial coherence mean-to-standard deviation factor (scMSF) in DAS, which is extended into the spatial frequency domain. By combining scMSF with a minimum variance (MV) algorithm, the clutter level is reduced, thereby enhancing the image contrast. Quantitative results obtained from the phantom experiment demonstrate that our proposed method improves contrast ratio (CR) by 30.15 dB and signal-to-noise ratio (SNR) by 8.62 dB compared to DAS while also improving full-width at half maxima (FWHM) by 56%. From the in-vivo experiments, the scMSF-based reconstruction image exhibits a higher generalized contrast-to-noise ratio (gCNR), indicating improved target detectability with a 25.6% enhancement over DAS and a 22.5% improvement over MV.

This study aims to explore the feasibility of fine-needle aspiration biopsy (FNAB) under dual modal photoacoustic tomography(PAT)/ultrasound (US) imaging. A total of 25 patients who have thyroid nodules with thyroid imaging reporting and data system (TIRADS) 3 and 4 (malignant risk <85%) were recruited. The specimens obtained from the PAT/US-guided FNAB were collected for cytology analysis. Cytological diagnoses for the 25 patients were classified in perspective of the Bethesda system for reporting thyroid cytopathology diagnostic category (DC) I: 4%(1/25); DC II: 12% (3/25); DC III: 20% (5/25); DC IV: 8% (2/25); DC V: 32% (8/25); and DC VI: 24% (6/25). The DC I nodule exhibited inadequate cytology and had structural characteristic of predominant calcifications in PAT/US mapping. The DC V-VI nodules showed lower photoacoustic (PA) signals compared to the DC I-IV nodules. Regions with a high PA signal demonstrated a significant number of erythrocytes in FNAB cytology. Moreover, nodules with microcalcifications did not show a significant difference compared to their surroundings in the PA signal, while nodules with macrocalcifications gave higher PA signals compared to their surroundings. The conclusions are as follows: combining US with PAT can evaluate the structure and function of thyroid nodules in vivo. This study demonstrates that dual modal PAT/US imaging has the potential to be an effective clinical tool to guide FNAB of thyroid nodules.