  Confocal laser endomicroscopy (CLE) allow on-the-fly in vivo intraoperative
imaging in a discreet field of view, especially for brain tumors, rather than
extracting tissue for examination ex vivo with conventional light microscopy.
Fluorescein sodium-driven CLE imaging is more interactive, rapid, and portable
than conventional hematoxylin and eosin (H&E)-staining. However, it has several
limitations: CLE images may be contaminated with artifacts (motion, red blood
cells, noise), and neuropathologists are mainly trained on colorful stained
histology slides like H&E while the CLE images are gray. To improve the
diagnostic quality of CLE, we used a micrograph of an H&E slide from a glioma
tumor biopsy and image style transfer, a neural network method for integrating
the content and style of two images. This was done through minimizing the
deviation of the target image from both the content (CLE) and style (H&E)
images. The style transferred images were assessed and compared to conventional
H&E histology by neurosurgeons and a neuropathologist who then validated the
quality enhancement in 100 pairs of original and transformed images. Average
reviewers' score on test images showed 84 out of 100 transformed images had
fewer artifacts and more noticeable critical structures compared to their
original CLE form. By providing images that are more interpretable than the
original CLE images and more rapidly acquired than H&E slides, the style
transfer method allows a real-time, cellular-level tissue examination using CLE
technology that closely resembles the conventional appearance of H&E staining
and may yield better diagnostic recognition than original CLE grayscale images.
