Upconverting nanoparticles for pre‐clinical diffuse optical imaging,microscopy and sensing: Current trends and future challenges

Upconverting nanoparticles (UCNPs) are a class of recently developed luminescent biomarkers that – in several aspects – are superior to organic dyes and quantum dots. UCNPs can emit spectrally narrow anti‐Stokes shifted light with quantum yields which greatly exceed those of two‐photon dyes for fluence rates relevant for deep tissue imaging. Compared with conventionally used Stokes‐shifting fluorophores, UCNP‐based imaging systems can acquire completely autofluorescence‐free data with superb contrast. For diffuse optical imaging, the multi‐photon process involved in the upconversion process can be used to obtain images with unprecedented resolution. These unique properties make UCNPs extremely attractive in the field of biophotonics. UCNPs have already been applied in microscopy, small‐animal imaging, multi‐modal imaging, highly sensitive bioassays, temperature sensing and photodynamic therapy. In this review, the current state‐of‐the‐art UCNPs and their applications for diffuse imaging, microscopy and sensing targeted towards solving essential biological issues are discussed.     

Highly Bright and Photostable Li(Gd,Y)F4:Yb,Er/LiGdF4 Core/Shell Upconversion Nanophosphors for Bioimaging Applications

Intense green‐emitting Li(Gd,Y)F₄:Yb,Er/LiGdF₄ core/shell (C/S) upconversion nanophosphors (UCNPs) with a tetragonal bipyramidal morphology are synthesized. The morphology and UC luminescence of the Li(Gd,Y)F₄:Yb,Er UCNPs are significantly affected by the Li precursors, and bright UC green‐emitting Li(Gd,Y)F₄:Yb,Er UCNPs with a tetragonal bipyramidal shape, i.e., UC tetragonal bipyramids (UCTBs), are synthesized using LiOH·H₂O as a Li precursor. A LiGdF₄ shell is grown on the Li(Gd,Y)F₄:Yb,Er UCTBs, and the C/S UCNPs exhibit 4.7 times higher luminescence intensity than core UCTBs. The C/S UCNPs show a high absolute UC quantum yield of 4.6% under excitation with 980 nm near infrared (NIR) light, and the UC luminescence from the C/S UCNPs is stable under continuous irradiation with the 980 nm NIR laser for 1 h. The hydrophobic surfaces of the as‐synthesized C/S UCNPs are modified to hydrophilic surfaces by using poly(acrylic acid) (PAA) for bioimaging applications. They are applied to human cervical adenocarcinoma (HeLa) cell imaging and SK‐MEL‐2 melanoma cell imaging and in vivo imaging, including subcutaneous and intramuscular imaging, and UC luminescence images with high signal‐to‐noise ratio are obtained. Furthermore, sentinel‐lymph‐node imaging is successfully conducted with the PAA‐capped Li(Gd,Y)F₄:Yb,Er/LiGdF₄ C/S UCNPs under illumination with NIR light.     

Facile Synthesis of Lactobionic Acid‐Targeted Iron Oxide Nanoparticles with Ultrahigh Relaxivity for Targeted MR Imaging of an Orthotopic Model of Human Hepatocellular Carcinoma

Development of multifunctional nanoprobes for tumor diagnosis is extremely important in the field of molecular imaging. In this study, the facile synthesis of lactobionic acid (LA)‐targeted superparamagnetic iron oxide (Fe₃O₄) nanoparticles (NPs) with ultrahigh relaxivity for targeted magnetic resonance (MR) imaging of an orthotopic hepatocellular carcinoma (HCC) is reported. Polyethyleneimine (PEI)‐stabilized Fe₃O₄ NPs prepared via a mild reduction route are sequentially coupled with fluorescein isothiocyanate and polyethylene glycol‐LA (LA‐PEG‐COOH) segment, followed by acetylation of the remaining PEI surface amines. The formed LA‐targeted Fe₃O₄ NPs are thoroughly characterized. It is shown that the developed multifunctional LA‐targeted Fe₃O₄ NPs are colloidally stable and water‐dispersible, display an ultrahigh r ₂ relaxivity (579.89 × 10^?3 m ^?1 s^?1) and excellent hemocompatibility and cytocompatibility in the given concentration range, and can target HepG2 cells overexpressing asialoglycoprotein receptors as confirmed by in vitro cellular uptake assay, flow cytometry, and confocal microscopy. Most strikingly, the developed multifunctional LA‐targeted Fe₃O₄ NPs can be used as a nanoprobe for targeted MR imaging of HepG2 cells in vitro and an orthotopic tumor model of HCC in vivo. With the ultrahigh r ₂ relaxivity and the versatile PEI amine‐mediated conjugation chemistry, a range of different Fe₃O₄ NP‐based nanoprobes may be developed for theranostics of different types of cancer.     

Construction of a Dual Drug Carrier on the Basis of Hollow Structured Upconversion Nanoparticles for pH‐Responsive Drug Delivery and UCL/MRI Dual Mode Imaging

A series of Gd³⁺ doping hollow upconversion nanoparticles NaYF₄:Yb,Gd,Tm (h‐UNCP) are prepared successfully. The hollow NaYF₄:Yb,Gd,Tm possess excellent upconversion luminescence (UCL) and large longitudinal relativity (r₁ = 128.3 mm ^?1 s^?1), which can be potentially used for UCL/magnetic resonance imaging (MRI) dual mode imaging. On the basis of the optimal h‐UCNP, doxorubicin hydrochloride (DOX) and methotrexate (MTX) are used as drug models to prepare a dual drug carrier. After the encapsulation of DOX on the h‐UCNP, chitosan (CS) is further wrapped and then used to load MTX to obtain a dual drug carrier h‐UCNPs/DOX/CS/MTX. The pH responsive release of DOX and MTX is discussed. The MTX release climbs from 33% to 100% by regulating the pH from 5.8 to 7.4. The DOX release is different at different pH conditions. The synergistic effect of DOX and MTX on the cancer cells is confirmed by cell viability. The h‐UCNPs/DOX/CS/MTX are tracked by cells UCL imaging and vivo MRI imaging. The excellent performance of UCL imaging and positive MRI images demonstrates that h‐UCNPs/DOX/CS/MTX can be used for UCL/MRI dual mode imaging. All the results show the potential application of h‐UCNPs/DOX/CS/MTX in pH responsive release and UCL/MRI dual imaging.     

Recent Advancements in Ln‐Ion‐Based Upconverting Nanomaterials and Their Biological Applications

Upconversion nanoparticles (UCNPs) convert low‐energy infrared (IR) or near‐infrared (NIR) photons into high‐energy emission radiation ranging from ultraviolet to visible through a photon upconversion process. In comparison to conventional fluorophores, such as organic dyes or semiconductor quantum dots, lanthanide‐ion‐doped UCNPs exhibit high photostability, no photoblinking, no photobleaching, low cytotoxicity, sharp emission lines, and long luminescent lifetimes. Additionally, the use of IR or NIR for excitation in such UCNPs reduces the autofluorescence background and enables deeper penetration into biological samples due to reduced light scattering with negligible damage to the samples. Because of these attributes, UCNPs have found numerous potential applications in biological and medicinal fields as novel fluorescent materials. Different upconversion mechanisms commonly observed in UCNPs, various methods that are used in their synthesis, and surface modification processes are discussed. Recent applications of Ln‐UCNPs in the biological and medicinal fields, including in vivo and in vitro biological imaging, multimodal imaging, photodynamic therapy, drug delivery, and antibacterial activity, are also presented.     

Applications of silica-based nanoparticles for multimodal bioimaging

Multimodal imaging, as an important approach to circumvent the limitations of single imaging modality, has attracted extensive attention in recent years. With the rapid development of nanotechnology and the ongoing efforts to improve their targeting capability and endow multiple imaging ability, nanoprobes are expected to play crucial roles in multimodal imaging through integrating different imaging moieties or molecules into a single nanoparticle, where silica has been used intensively as a carrier or a medium for the construction of the nanoprobes due to its preferable characteristics including good biocompatibility, long blood circulation time, and ease of modification. Based on the types of the silica used for the fabrication of nanoprobes, solid silica-based and mesoporous silica-based nanoparticles were developed for multimodal imaging. Herein, the newly developed silica-based nanoparticles as multimodal imaging agents for disease diagnosis and therapy in the last 5 years were summarized, along with their fabrication process, specific applications, and especially the role of the silica.     

SPIO–RGD nanoparticles as a molecular targeting probe for imaging tumor angiogenesis using synchrotron radiation

Angiogenesis, new blood vessels sprouting from pre‐existing vessels, is essential to tumor growth, invasion and metastasis. It can be used as a biomarker for early stage tumor diagnosis and targeted therapy. To visualize angiogenesis many molecular imaging modalities have been used. In this study a novel X‐ray molecular targeting probe using superparamagnetic iron oxide (SPIO) conjugated with arginine–glycine–aspartic acid (SPIO–RGD) has been developed. Based on the extremely high sensitivity to the iron element of synchrotron radiation X‐ray fluorescence and the superior spatial resolution of third‐generation synchrotron radiation, the feasibility of SPIO–RGD as a promising molecular probe for imaging tumor angiogenesis has been demonstrated.     

核酸功能化纳米探针在细胞荧光成像中的应用

核酸是携带遗传信息的物质,既存在于自然界中也能够通过成熟技术人工合成。通过体外筛选技术还可以筛选出具有特殊功能的核酸序列,例如核酸适体和脱氧核酶。核酸通过沃森-克里克碱基互补配对原则进行杂交,具有很强的专一性。无论是通过序列设计还是体外筛选,核酸探针在生物标志物的分析与成像应用方面都发挥着重要作用。纳米材料辅助构建核酸功能化纳米探针,可以保护负载的核酸探针不被核酸酶降解,并且无需转染试剂就能进入细胞,在细胞荧光成像应用上具有很大优势。为解决细胞内有些生物标志物含量低、难于检测的问题,目前已构建多种适用于细胞水平的成像信号放大方法来实现对低丰度生物标志物的高灵敏成像。本文主要综述了核酸功能化纳米探针在细胞荧光成像中的应用进展,包括反义寡核苷酸功能化纳米探针、核酸适体功能化纳米探针、脱氧核酶功能化纳米探针等,同时介绍了他们在成像信号放大中的应用。     

钆掺杂的类普鲁士蓝空心配位聚合物作为多模式成像探针及药物载体的研究

本文通过溶剂热法制备了具有多模式成像能力的钆掺杂的类普鲁士蓝空心配位聚合物,并包覆二氧化硅层以进一步应用. 磁共振成像实验表明纳米粒子表现出相当好的双模式磁共振成像能力. 此外,在各种波长的激光束下纳米粒子也会发出多色荧光. 由于其空心多孔结构,该聚合物具有1166 mg/g的高载药(阿霉素)能力和83.29%的药物封装效率,这使其成为潜在的药物载体平台. 特别在二氧化硅包覆之后,生物相容性也都得到了增强.     

Visualization of mouse spinal cord intramedullary arteries using phase‐ and attenuation‐contrast tomographic imaging

Many spinal cord circulatory disorders present the substantial involvement of small vessel lesions. The central sulcus arteries supply nutrition to a large part of the spinal cord, and, if not detected early, lesions in the spinal cord will cause irreversible damage to the function of this organ. Thus, early detection of these small vessel lesions could potentially facilitate the effective diagnosis and treatment of these diseases. However, the detection of such small vessels is beyond the capability of current imaging techniques. In this study, an imaging method is proposed and the potential of phase‐contrast imaging (PCI)‐ and attenuation‐contrast imaging (ACI)‐based synchrotron radiation for high‐resolution tomography of intramedullary arteries in mouse spinal cord is validated. The three‐dimensional vessel morphology, particularly that of the central sulcus arteries (CSA), detected with these two imaging models was quantitatively analyzed and compared. It was determined that both PCI‐ and ACI‐based synchrotron radiation can be used to visualize the physiological arrangement of the entire intramedullary artery network in the mouse spinal cord in both two dimensions and three dimensions at a high‐resolution scale. Additionally, the two‐dimensional and three‐dimensional vessel morphometric parameter measurements obtained with PCI are similar to the ACI data. Furthermore, PCI allows efficient and direct discrimination of the same branch level of the CSA without contrast agent injection and is expected to provide reliable biological information regarding the intramedullary artery. Compared with ACI, PCI might be a novel imaging method that offers a powerful imaging platform for evaluating pathological changes in small vessels and may also allow better clarification of their role in neurovascular disorders.     

HoF3 and DyF3 Nanoparticles as Contrast Agents for High‐Field Magnetic Resonance Imaging

Clinical contrast agents (CAs) currently used in magnetic resonance imaging (MRI) at low fields are less effective at high magnetic fields. The development of new CAs is mandatory to improve diagnostic capabilities of the new generation of high field MRI scanners. The purpose of this study is to synthesize uniform, water dispersible LnF₃ (Ln = Ho, Dy) nanoparticles (NPs) and to evaluate their relaxivity at high magnetic field (9.4 T) as a function of size and composition. Two different types of HoF₃ NPs are obtained by homogeneous precipitation in ethylene glycol at 120 °C. The use of holmium acetate as holmium precursor leads to rhombus‐like nanoparticles, while smaller, ellipsoid‐like nanoparticles are obtained when nitrate is used as the holmium salt. To explain this behavior, the mechanism of formation of both kinds of particles is analyzed in detail. Likewise, rhombus‐like DyF₃ nanoparticles are prepared following the same method as for the rhombus‐like HoF₃ nanoparticles. We have found, to the best of knowledge, the highest transverse relaxivity values at 9.4 T described in the literature for this kind of CAs. Finally, the LnF₃ NPs have shown negligible cytotoxicity for C6 rat glioma cells for concentrations up to 0.1 mg mL^?1.     

NIR‐Triggered Release of Nitric Oxide with Upconversion Nanoparticles Inhibits Platelet Aggregation in Blood Samples

There is a great challenge to overcome the limitation of tissue penetration depth, while maximizing the benefit of light‐triggered biochemical cascades in a well‐defined mode simultaneously. Here, a new method of near‐infrared (NIR) light‐triggered release of nitric oxide (NO) by developing upconversion nanoparticles (UCNPs)‐based conjugate chemistry is reported. As the key nanotransducer in the design, core–shell‐structured UCNPs are encapsulated with a layer of SiO₂ and then covalently linked with a potent NO‐releasing donor (S‐nitroso‐N‐acetyl‐dl ‐penicillamine, SNAP). It is featured with highly localized breakage of chemical bonds of SNAP molecules by NIR–UV upconversion, enabling simultaneous NO release in a light dosage‐dependent manner. The biological effects of NO releasing are demonstrated by cellular imaging and inhibition of platelet aggregation from blood samples. This work provides a flexible and robust platform to generate cell‐signaling gas molecules trigged by NIR laser with deep tissue penetration.     

Self‐Assembly of Bidirectional‐Signal Nanoclusters for Two miRNAs Simultaneously Monitoring in Single Cancer Cells

A novel finding is herein reported that the bidirectional‐signal nanoclusters self‐assemble simultaneously on the nanoflowers as a result of four‐way folding (FWF) nanoprobes and DNA rolling circle replication reactions. The functionalized FWF nanoprobe containing the identification region for two targets monitoring and the trigger region for amplification signals is first used to activate the clustered amplification for two cancer‐related microRNAs (miRNAs) assays in single cells. Furthermore, the self‐assembled nanoclusters with two‐way amplification signals can provide more reliable information in situ in individual cell. Importantly, this new method can significantly distinguish cancer cells from normal cells and identify changes in the expression levels of cancer‐related miRNAs for single cells. These findings have exciting potential to provide new opportunities for detection and enhance the accuracy of early disease diagnosis.     

Facile Functionalization of Gold Nanoparticles with PLGA Polymer Brushes and Efficient Encapsulation into PLGA Nanoparticles: Toward Spatially Precise Bioimaging of Polymeric Nanoparticles

Nanocarriers prepared from poly(lactide‐co‐glycolide) (PLGA) have broad biomedical applications. Understanding their cellular uptake and distribution requires appropriate visualization in complex biological compartments with high spatial resolution, which cannot be offered by traditional imaging techniques based on fluorescent or radioactive probes. Herein, the encapsulation of gold nanoparticles (GNPs) into PLGA nanoparticles is proposed, which should allow precise spatial visualization in cells using electron microscopy. Available protocols for encapsulating GNPs into polymeric matrices are limited and associated with colloidal instability and low encapsulation efficiency. In this report, the following are described: 1) a facile protocol to functionalize GNPs with PLGA polymer followed by 2) encapsulation of the prepared PLGA‐capped GNPs into PLGA nanocarriers with 100% encapsulation efficiency. The remarkable encapsulation of PLGA‐GNPs into PLGA matrix obeys the general rule in chemistry “like dissolves like” as evident from poor encapsulation of GNPs capped with other polymers. Moreover, it is shown that how the encapsulated gold nanoparticles serve as nanoprobes to visualize PLGA polymeric hosts inside cancer cells at the spatial resolution of the electron microscope. The described methods should be applicable to a wide range of inorganic nanoprobes and provide a new method of labeling pharmaceutical polymeric nanocarriers to understand their biological fate at high spatial resolution.     

多模态光声分子成像进展*

现代的各种医学影像术,如射线成像、CT、正电子发射(PET)、磁共振(MR)、超声(US)、荧光(FL)等都各具特色,并成功地应用于多种疾病的诊疗。但每种影像术都不能对生物组织做出完整的描述。由若干个成像技术组成的多模态成像技术,是获得组织更多信息的有效途径。光声(PA)成像是能提供组织的成分和功能信息的新成像技术。它不仅灵敏,可以对较深层的组织进行实时、快速、安全的成像,而且可以利用光声光热造影剂实施非侵入的光热靶向治疗。因此,与光声成像相结合的多模态分子成像是实现精准诊疗的重要技术途径。该文以手持US-PA探头的双模态成像系统,直径为1 mm的血管內窥镜US-PA成像系统,可同时用于术前和术中的US-PA-FL三模态成像系统,以及采用外磁场可操控的磁共振-光声光热分子造影剂、进行MR-PA成像引导的光热治疗技术为例,对多模态光声分子成像系统在医学诊断、手术和光热治疗方面的进展做简单介绍。     

MISTRAL: a transmission soft X‐ray microscopy beamline for cryo nano‐tomography of biological samples and magnetic domains imaging

The performance of MISTRAL is reported, the soft X‐ray transmission microscopy beamline at the ALBA light source (Barcelona, Spain) which is primarily dedicated to cryo soft X‐ray tomography (cryo‐SXT) for three‐dimensional visualization of whole unstained cells at spatial resolutions down to 30 nm (half pitch). Short acquisition times allowing for high‐throughput and correlative microscopy studies have promoted cryo‐SXT as an emerging cellular imaging tool for structural cell biologists bridging the gap between optical and electron microscopy. In addition, the beamline offers the possibility of imaging magnetic domains in thin magnetic films that are illustrated here with an example.     

Diffusion changes in patients with systemic lupus erythematosus

BACKGROUND AND PURPOSE: Systemic lupus erythematosus (SLE) is an autoimmune disease in which almost all the organs are involved. Neuropsychiatric SLE is of one of the major concerns in the clinical evaluation of this disease. Routine magnetic resonance imaging (MRI) findings are often nonspecific or negative. In this study, we explored the use of diffusion tensor imaging in assisting with the diagnosis of SLE. METHODS: Data from 34 SLE patients (age range, 18-73 years) and 29 age-matched volunteers (age range, 29-64 years) were analyzed. MRI was performed on a 1.5-T clinical MR scanner with a quadrature head coil. The average diffusion constant (D(av)) and diffusion anisotropy maps [fractional anisotropy (FA)] were determined on a pixel-by-pixel basis. Regional diffusion measurements were made by region of interest in the genu and splenium of the corpus callosum (CC), anterior and posterior limb of the internal capsule (IC) and frontal lobe and thalamus. The diffusion distribution was fitted to a triple-Gaussian model. The mean of the brain tissue distribution was determined as a mean diffusion constant for the whole brain (BD(av)). Student's t test was used to determine the diffusion difference between SLE patients and control subjects. The SLE patients were separated into two groups according to their MRI results. A P value lower than .05 was considered to be statistically significant. RESULTS: Twenty of the 34 SLE patients with abnormal MRI results showed findings dominated by nonspecific white matter disease. The BD(av) and D(av) values of the frontal lobe, splenium CC and anterior IC were significantly higher in all SLE patients as compared with the control subjects. The SLE patients with normal MRI results also showed higher BD(av) and D(av) values in the frontal lobe, splenium and anterior and posterior limbs of the IC as compared with the control subjects. There was no significant difference in the D(av) values of the thalamus between the SLE patients and the control subjects. The BD(av) value in the SLE patient group was robustly correlated with the D(av) values of the frontal lobe, splenium and thalamus. These correlations were found to be similarly significant for the SLE patients with normal MRI findings. The diffusion anisotropy measurements showed that splenium CC had the highest FA value in both the control subjects and SLE patients. Overall, SLE patients had lower FA values in the genu and splenium CC as compared with the control subjects. In the group of patients with normal MRI findings, the FA values of the genu and splenium CC as well as the anterior IC were also lower than those in the control subjects. Pearson's correlation statistics revealed robust correlations between the measurements of D(av) and FA values in the SLE patient group. CONCLUSION: Quantitative diffusion imaging and diffusion anisotropy showed early changes in the brains of the SLE patients. Increased BD(av) and D(av) values of the frontal lobe as well as decreased anisotropy in the genu CC and anterior IC may represent preclinical signs of central nervous system involvement of SLE even when the routine MRI findings are negative or nonspecific. Quantitative diffusion analysis may prove to be useful in detecting the initial brain involvement of SLE and may enable monitoring of early disease progression and treatment efficacy.     

Tens of thousands‐fold upconversion luminescence enhancement induced by a single gold nanorod

Upconversion nanoparticles (UCNPs) have gained increasing attention for their wide applications in bioimaging, displays and photovoltaics. However, low efficiency has been an ongoing challenge for further developments. In this work, it is proposed that the ultrasmall size of UCNPs is essential for achieving large enhancement factors and experimentally demonstrated with 4‐nm UCNPs. A strategy of plasmonic dual resonance is proposed in which two distinct localized surface plasmon resonance (LSPR) peaks of gold nanorods (GNRs) were designed to perfectly match both the excitation and emission light wavelength of UCNPs. Combining the excitation enhancement and Purcell effect, a huge enhancement factor of tens of thousands‐fold is stochastically demonstrated for single UCNPs in solution. The largest overall enhancement region is close to the end of a GNR but not in its central part. The excitation enhancement (up to three orders of magnitude) and the emission enhancement (larger than one order of magnitude) induced by the Purcell effect are experimentally demonstrated separately. This study provides insight into how to achieve a very large upconversion enhancement factor with surface plasmons and will catalyze development of UCNPs’ extensive applications.

     

Dye‐Sensitized Core/Shell Upconversion Nanoparticles for Detecting Nitrites in Plant Cells

A fluorescent nanoprobe is reported for rapid detection of nitrites (NO₂^?) in plant cells. The probe is fabricated by linking neutral reds (NR) to the surface of upconversion fluorescent core/shell nanocrystalline with the bridging of polyethylene glycol (PEG) molecules. The fluorescence of upconversion nanoparticles (UCNPs) is stored by NR through fluorescence resonance energy transfer (FRET) under 980 nm excitation that can be released by further linking to NO₂^?. It is observed that the intensity rate of green to red emission of NR‐modified UCNPs changes linearly with increasing the amount of NO₂^?. So that concentration of NO₂^? can be accordingly addressed. Worth mentioning is that, comparing with bare core upconversion nanoparticles (NPs), core/shell UCNPs can greatly reduce the surface quenching of the fluorescence induced by solvents instead of NR and thus leading to the enhancement of signal‐to‐noise ratios. Moreover, excitation of core/shell UCNPs requires only a much lower power (0.06 W cm^?2) than bare cores which is beneficial to reducing the decomposition of NR to stabilize the FRET processes. Under the optimum conditions, the detection limit of nitrite in plant cells was 0.1 µg mL^?1.     

Advances in fluorescence diagnosis to track footprints of cancer progression in vivo

Fluorescence spectroscopy and imaging have been widely used for in vivo cancer diagnosis and therapy monitoring in preclinical models, as well as clinical translation. Great attempts have been made to develop novel fluorescence techniques and improve on existing ones, which can now be used in conjunction with newly developed fluorescent probes for specific cancer imaging. In this review, a broad overview of fluorescence techniques is provided, including photodynamic diagnosis, laser confocal endomicroscopy and fluorescence lifetime imaging, coupled with endogenous and exogenous fluorophores. In particular, endogenous fluorophores, such as nicotinamide adenine dinucleotide (NADH) and flavin adenine dinucleotide (FAD), are highlighted as they are linked to cellular metabolism in precancer growth. The use of near‐infrared dyes, such as indocynanine green (ICG), for imaging deep‐tissue regions is also reviewed. In addition, diagnostic algorithms used for tissue classification and cancer detection will be discussed. Lastly, emerging technologies in fluorescence diagnosis will also be included.