SignificanceThe ability to monitor cerebral blood flow (CBF) at the bedside is essential to managing critical-care patients with neurological emergencies. Diffuse correlation spectroscopy (DCS) is ideal because it is non-invasive, portable, and inexpensive. We investigated a near-infrared spectroscopy (NIRS) approach for converting DCS measurements into physiological units of blood flow.AimUsing magnetic resonance imaging perfusion as a reference, we investigated the accuracy of absolute CBF measurements from a bolus-tracking NIRS method that used transient hypoxia as a flow tracer and hypercapnia-induced increases in CBF measured by DCS.ApproachTwelve participants (7 female, 28±6 years) completed a hypercapnia protocol with simultaneous CBF recordings from DCS and arterial spin labeling (ASL). Nine participants completed the transient hypoxia protocol while instrumented with time-resolved NIRS. The estimate of baseline CBF was subsequently used to calibrate hypercapnic DCS data.ResultsModerately strong correlations at baseline (slope=0.79 and R2=0.59) and during hypercapnia (slope=0.90 and R2=0.58) were found between CBF values from calibrated DCS and ASL (range 34 to 85 mL/100 g/min).ConclusionsResults demonstrated the feasibility of an all-optics approach that can both quantify CBF and perform continuous perfusion monitoring.
SignificanceCerebral oximeters have the potential to detect abnormal cerebral blood oxygenation to allow for early intervention. However, current commercial systems have two major limitations: (1) spatial coverage of only the frontal region, assuming that surgery-related hemodynamic effects are global and (2) susceptibility to extracerebral signal contamination inherent to continuous-wave near-infrared spectroscopy (NIRS).AimThis work aimed to assess the feasibility of a high-density, time-resolved (tr) NIRS device (Kernel Flow) to monitor regional oxygenation changes across the cerebral cortex during surgery.ApproachThe Flow system was assessed using two protocols. First, digital carotid compression was applied to healthy volunteers to cause a rapid oxygenation decrease across the ipsilateral hemisphere without affecting the contralateral side. Next, the system was used on patients undergoing shoulder surgery to provide continuous monitoring of cerebral oxygenation. In both protocols, the improved depth sensitivity of trNIRS was investigated by applying moment analysis. A dynamic wavelet filtering approach was also developed to remove observed temperature-induced signal drifts.ResultsIn the first protocol (28±5 years; five females, five males), hair significantly impacted regional sensitivity; however, the enhanced depth sensitivity of trNIRS was able to separate brain and scalp responses in the frontal region. Regional sensitivity was improved in the clinical study given the age-related reduction in hair density of the patients (65±15 years; 14 females, 13 males). In five patients who received phenylephrine to treat hypotension, different scalp and brain oxygenation responses were apparent, although no regional differences were observed.ConclusionsThe Kernel Flow has promise as an intraoperative neuromonitoring device. Although regional sensitivity was affected by hair color and density, enhanced depth sensitivity of trNIRS was able to resolve differences in scalp and brain oxygenation responses in both protocols.
When transitioning onto cardiopulmonary bypass (CPB) during cardiac surgery, blood flow to the brain is maintained by controlling the CPB flow rate and mean arterial pressure (MAP). CPB flow rates are based on patient body mass, and a MAP target of 60 mmHg is based on clinical experience and guidelines for CPB. However, studies have shown that up to 20% of the population has limited cerebral autoregulation and that conditions such as hypertension can exceed an individual’s autoregulatory limits, leaving room for potential adverse cerebral events. Therefore, maintenance of adequate cerebral blood flow (CBF), oxygen delivery, and metabolism during surgery plays a critical role in reducing the risk of neurological complications. Given its sensitivity to tissue oxygen saturation (StO2), near-infrared spectroscopy (NIRS) is frequently used for intraoperative neuromonitoring modalities; however, StO2 is not a direct marker of CBF, or the energy demands of brain tissue. CBF can be measured by diffuse correlation spectroscopy (DCS) and the unique absorption features of cytochrome c oxidase (oxCCO) offers a means of assessing oxygen metabolism. In this study, an in-house built hyperspectral NIRS/DCS system was used to continuously monitor changes in the redox state of oxCCO (ΔoxCCO), StO2, and CBF in fifteen patients when transitioning onto CPB, with the purpose of evaluating the relationship between MAP on pump and brain blood flow and metabolism. Results demonstrated a nonsignificant ΔoxCCO (-0.13 ± 0.12 μM) in those patients with MAP > 70 mmHg, while a significant decrease in ΔoxCCO (-0.69 ± 0.17 μM) was found for patients for whom their MAP dropped to < 50 mmHg when placed on CPB. These results indicate that ΔoxCCO monitoring has the capability of providing real-time assessment of the effect of MAP on brain health during cardiac surgery, which could help reduce the incidence of cerebral complications.
Optical methods are well-suited for non-invasive bedside brain imaging: near-infrared spectroscopy (NIRS) for measuring brain oxygenation and diffuse correlation spectroscopy (DCS) for measuring cerebral blood flow. However, data obtained with those optical techniques are prone to signal contamination from extracerebral tissue. This study aimed to evaluate extracerebral signal contamination in trNIRS/multidistance DCS data acquired during transient hypotension and assess suitable means of separating scalp and brain signals. An in-house built hybrid system was used to acquire oxygenation and blood flow data simultaneously during transient orthostatic hypotension induced by rapid-onset lower body negative pressure (LBNP). In nine healthy young adults, LBNP significantly decreased arterial blood pressure (-18 ± 14%), scalp blood flow (-36 ± 25%), and scalp tissue oxygenation (all p ≤ 0.04 vs baseline). In contrast, LBNP had no significant effect on cerebral blood flow or oxygenation. This finding was confirmed by transcranial Doppler ultrasound, which found no significant changes (-8 ± 16%) in middle cerebral artery blood velocity during LBNP. These results demonstrate the importance of using depth-enhanced methods when applying these optical technologies to physiological paradigms designed to test cerebral autoregulation that also affect systemic physiology.
SignificanceCombining diffuse correlation spectroscopy (DCS) and near-infrared spectroscopy (NIRS) permits simultaneous monitoring of multiple cerebral hemodynamic parameters related to cerebral autoregulation; however, interpreting these optical measurements can be confounded by signal contamination from extracerebral tissue.AimWe aimed to evaluate extracerebral signal contamination in NIRS/DCS data acquired during transient hypotension and assess suitable means of separating scalp and brain signals.ApproachA hybrid time-resolved NIRS/multidistance DCS system was used to simultaneously acquire cerebral oxygenation and blood flow data during transient orthostatic hypotension induced by rapid-onset lower body negative pressure (LBNP) in nine young, healthy adults. Changes in microvascular flow were verified against changes in middle cerebral artery velocity (MCAv) measured by transcranial Doppler ultrasound.ResultsLBNP significantly decreased arterial blood pressure (−18 % ± 14 % ), scalp blood flow (>30 % ), and scalp tissue oxygenation (all p ≤ 0.04 versus baseline). However, implementing depth-sensitive techniques for both DCS and time-resolved NIRS indicated that LBNP did not significantly alter microvascular cerebral blood flow and oxygenation relative to their baseline values (all p ≥ 0.14). In agreement, there was no significant reduction in MCAv (8 % ± 16 % ; p = 0.09).ConclusionTransient hypotension caused significantly larger blood flow and oxygenation changes in the extracerebral tissue compared to the brain. We demonstrate the importance of accounting for extracerebral signal contamination within optical measures of cerebral hemodynamics during physiological paradigms designed to test cerebral autoregulation.
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with postoperative neurological complications. Targeted mean arterial blood pressure (MAP) during cardiac surgery is used as one method of maintaining adequate cerebral blood flow (CBF) and perfusion pressure. However, an MAP target of 60 mmHg after transitioning on CPB, which is used in many centers, does not account for the reported broad range of lower autoregulatory limits (50-90 mmHg) [1]. In an effort to maintain cerebral perfusion, near-infrared spectroscopy (NIRS) is used to monitor tissue oxygen saturation (StO2); however, StO2 is not a direct marker of CBF or tissue oxygen demand. As an alternative, possible effects on cerebral energy metabolism could be monitored by using hyperspectral NIRS (hsNIRS) to measure changes in the redox state of cytochrome c oxidase (ΔoxCCO), which are linked to ATP production. In this study, an in-house built hsNIRS/diffuse correlation spectroscopy (DCS) was used to monitor ΔoxCCO, CBF and StO2 in patients during cardiac surgery with CPB. Fourteen patients were retrospectively grouped according to the level of their MAP when transitioning onto CPB: high (70-90 mmHg), target (57-69 mmHg), and low MAP (40-56 mmHg). The aim was to evaluate the potential effects of MAP on ΔoxCCO during the transition onto CPB. Results demonstrated that the smallest changes in oxCCO (-0.08 ± 0.24 μM) were observed in the high MAP group and significantly larger changes (-0.73 ± 0.25 μM) in the low MAP group. The results highlight the potential of ΔoxCCO monitoring for real-time assessment of MAP management during CPB with the ultimate aim of mitigating adverse cerebral events.
Neuromonitoring during cardiac surgery helps prevent brain injury by detecting evidence of cerebral ischemia. Current neuromonitoring devices, such as cerebral oximeters, generally monitor one brain region, which prevents the detection of blood flow impairment in other vascular territories. A potential solution is to use a device with full-head coverage such as the newly developed high-density time-resolved NIRS system, Kernel Flow. This work aimed to assess Kernel Flow’s sensitivity to regional cerebral oxygenation changes using momentary carotid compression (CC), a paradigm that causes substantial decreases in cerebral blood flow and oxyhemoglobin (HbO) throughout the ipsilateral hemisphere. Five healthy volunteers were imaged using a Kernel Flow headset during a 30-s CC. To assess the sensitivity of the device to regional changes, the number of good quality channels was compared between four brain regions: frontal, somatosensory, temporal, and occipital. HbO and deoxyhemoglobin (HbR) time series in the ipsilateral and contralateral hemispheres were analyzed. Overall, the frontal region had the largest amount of good-quality channels, and the ipsilateral regions showed the expected HbO decrease during CC. All contralateral regions showed minimal changes during CC, as expected. Overall, the Flow device showed good sensitivity to reduced cerebral blood flow; however, its use as a neuromonitor during cardiac surgery could be challenged by signal degradation due to hair, although this may be less of an issue with cardiac patients considering that most are older and have less hair.
Diffuse Correlation Spectroscopy (DCS) provides a non-invasive method of measuring microvasculature cerebral blood flow (CBF). Recent advancements have enabled flow pulsatility to be captured, providing a means of continuously monitoring critical closing pressure (CCP), which is intrinsically linked to intracranial pressure [1]. Similar to DCS measurements of mean CBF, DCS pulsatility data can be contaminated by blood flow in the extracerebral (EC) tissue [2]. This study focuses on extracting CBF pulsatility using the probe pressure modulation algorithm proposed by Baker et al. for removing EC contamination [3]. DCS data were collected from five healthy volunteers, along with continuous recordings of arterial blood pressure and ECG. Data were acquired at two source detector distances (rSD = 1 and 2.5 cm) at a sampling frequency of 20 Hz [4]. The pulsatile waveform was generated by two methods: (1) fitting the semi-infinite model to data acquired at rSD = 2.5 cm and (2) applying the pressure modulation algorithm to data from both distances. The two waveforms were compared based on extracting waveform features, including the systolic-to-diastolic amplitude (YSD), reflective flow peak (S2), dicrotic notch (d), diastolic peak (D), and Δt (Δt = tS1 - td). Preliminary results indicated that removing EC contamination caused a significant increase in YSD and Δt. Reductions in S2 and d were also observed, but these changes did not reach statistical significance. In conclusion, these preliminary findings suggest that EC contamination can alter the shape of the pulsatile waveform, which could influence parameters such as CCP used to assess brain health. Collecting multi-distance DCS data and incorporating the pressure modulation algorithm to remove EC contamination is recommended.
Significance: Hyperspectral near-infrared spectroscopy (hsNIRS) combined with diffuse correlation spectroscopy (DCS) provides a noninvasive approach for monitoring cerebral blood flow (CBF), the cerebral metabolic rate of oxygen (CMRO2) and the oxidation state of cytochrome-c-oxidase (oxCCO). CMRO2 is calculated by combining tissue oxygen saturation (StO2) with CBF, whereas oxCCO can be measured directly by hsNIRS. Although both reflect oxygen metabolism, a direct comparison has yet to be studied.Aim: We aim to investigate the relationship between CMRO2 and oxCCO during periods of restricted oxygen delivery and lower metabolic demand.Approach: A hybrid hsNIRS/DCS system was used to measure hemodynamic and metabolic responses in piglets exposed to cerebral ischemia and anesthetic-induced reductions in brain activity.Results: Although a linear relationship was observed between CMRO2 and oxCCO during ischemia, both exhibited a nonlinear relationship with respect to CBF. In contrast, linear correlation was sufficient to characterize the relationships between CMRO2 and CBF and between the two metabolic markers during reduced metabolic demand.Conclusions: The observed relationship between CMRO2 and oxCCO during periods of restricted oxygen delivery and lower metabolic demand indicates that the two metabolic markers are strongly correlated.
Significance: Despite its advantages in terms of safety, low cost, and portability, functional near-infrared spectroscopy applications can be challenging due to substantial signal contamination from hemodynamics in the extracerebral layer (ECL). Time-resolved near-infrared spectroscopy (tr NIRS) can improve sensitivity to brain activity but contamination from the ECL remains an issue. This study demonstrates how brain signal isolation can be further improved by applying regression analysis to tr data acquired at a single source–detector distance.
Aim: To investigate if regression analysis can be applied to single-channel trNIRS data to further isolate the brain and reduce signal contamination from the ECL.
Approach: Appropriate regressors for trNIRS were selected based on simulations, and performance was evaluated by applying the regression technique to oxygenation responses recording during hypercapnia and functional activation.
Results: Compared to current methods of enhancing depth sensitivity for trNIRS (i.e., higher statistical moments and late gates), incorporating regression analysis using a signal sensitive to the ECL significantly improved the extraction of cerebral oxygenation signals. In addition, this study demonstrated that regression could be applied to trNIRS data from a single detector using the early arriving photons to capture hemodynamic changes in the ECL.
Conclusion: Applying regression analysis to trNIRS metrics with different depth sensitivities improves the characterization of cerebral oxygenation signals.
During surgery with cardiopulmonary bypass (CPB), maintaining adequate cerebral blood flow (CBF) is paramount to prevent adverse neurological outcome; tissue damage can occur if CBF reduction is sufficient to impair energy metabolism. Ten adult patients undergoing cardiothoracic surgery with CPB received perfusion and metabolic neuromonitoring using a novel optical system combining diffuse correlation spectroscopy and broadband near-infrared spectroscopy. CPB onset resulted in large increases in CBF and significant drops in mean arterial pressure and metabolism. No changes were observed transitioning off CPB. Real-time assessment of cerebral perfusion and metabolism could alert clinicians to relevant hemodynamic events before brain injury occurs.
Despite its advantages in terms of safety, low cost and portability, the reliability of functional near-infrared spectroscopy (fNIRS) is challenged by substantial signal contamination from hemodynamic changes in the extracerebral layer (ECL). The time-resolved (tr) variant of NIRS can improve the sensitivity to the brain by recording the distribution of times-offlight (DTOF) of diffusely reflected photons that contain both time and intensity information. trNIRS data can be analyzed to obtain signals related to absorption changes at different depths within the medium; however, it can still be affected by ECL contamination. To further improve the isolation of the brain signal, this study adapted regression analysis, commonly used with short-channel functional NIRS, to trNIRS. Signals related to the early-arriving photons (0th moment, gates), selected based on sensitivity analysis, were used as the regressors, given their inherent sensitivity to superficial tissue. Performance of the regression was optimized using data from previously published studies that used trNIRS to measure oxygenation responses to hypercapnia caused by a rapid increase in end-tidal carbon dioxide pressure (PETCO2). To assess the effect of the regression approach, correlations between reconstructed hemoglobin signals and modelled hemodynamic response function were calculated. The results confirmed that the regression approach successfully removed large residue signals observed in the oxyhemoglobin signals.
Near-infrared spectroscopy (NIRS) combined with diffuse correlation spectroscopy (DCS) provides a non-invasive approach for monitoring oxygenation, cerebral blood flow (CBF) and the cerebral metabolic rate of oxygen (CMRO2); however, these methods are vulnerable to signal contamination from the extracerebral layer (ECL). The aim of this work was to evaluate methods of reducing the impact of this contamination using time-resolved (tr) NIRS and multi-distance (MD) DCS. Experiments involved healthy participants, and oxygenation and CBF changes in response to hypercapnia were measured. A pneumatic tourniquet was used to impede scalp blood flow to assess ECL contamination. Responses acquired with and without the tourniquet demonstrated that trNIRS technique substantially reduced scalp contributions in the oxygenation signals, while blood flow responses from the scalp and brain could be separated by analyzing MD DCS data with a multi-layer model. Finally, no change in CMRO2 during hypercapnia was observed, despite the large increases in CBF and oxygenation. These results indicate that NIRS/DCS techniques can accurately monitor cerebral blood flow and metabolism, highlighting the potential of these techniques for neuromonitoring
The premature brain embodies an underdeveloped vascular system, which can lead to poor cerebral blood flow (CBF), impaired metabolism, and subsequent brain injury. NNeMo (Neonatal NeuroMonitor) is an in-house built brain monitor that provides continuous and simultaneous measurements of CBF, tissue saturation (StO2), and metabolism. Nine premature infants were monitored for 6 h on day 1 and 3 of life. An oscillatory signal was observed in CBF and StO2 which diminished by day 3; metabolic response was not impacted by minor fluctuations in perfusion. Hemodynamic neuromonitoring could aid in predicting the onset of cerebral hemorrhaging or gauging brain injury severity.
Significance: Near-infrared spectroscopy (NIRS) combined with diffuse correlation spectroscopy (DCS) provides a noninvasive approach for monitoring cerebral blood flow (CBF), oxygenation, and oxygen metabolism. However, these methods are vulnerable to signal contamination from the scalp. Our work evaluated methods of reducing the impact of this contamination using time-resolved (TR) NIRS and multidistance (MD) DCS.
Aim: The magnitude of scalp contamination was evaluated by measuring the flow, oxygenation, and metabolic responses to a global hemodynamic challenge. Contamination was assessed by collecting data with and without impeding scalp blood flow.
Approach: Experiments involved healthy participants. A pneumatic tourniquet was used to cause scalp ischemia, as confirmed by contrast-enhanced NIRS, and a computerized gas system to generate a hypercapnic challenge.
Results: Comparing responses acquired with and without the tourniquet demonstrated that the TR-NIRS technique could reduce scalp contributions in hemodynamic signals up to 4 times (rSD = 3 cm) and 6 times (rSD = 4 cm). Similarly, blood flow responses from the scalp and brain could be separated by analyzing MD DCS data with a multilayer model. Using these techniques, there was no change in metabolism during hypercapnia, as expected, despite large increases in CBF and oxygenation.
Conclusion: NIRS/DCS can accurately monitor CBF and metabolism with the appropriate enhancement to depth sensitivity, highlighting the potential of these techniques for neuromonitoring.
Optical methods are attractive tools for neuromonitoring given their safety and sensitivity to key markers of brain health: tissue oxygenation can be assessed by near-infrared spectroscopy (NIRS) and cerebral blood flow by diffuse correlation spectroscopy (DCS). Although the application of these tools to neonatal patients is fairly straightforward, since it is reasonable to model the head as an optically homogeneous medium, their use with adult patients is more complicated due to substantial signal contamination caused by hemodynamic fluctuations in the extracerebral (EC) tissue. The purpose of this study was to assess the magnitude of this contamination by acquiring NIRS and DCS data in response to a hypercapnic challenge with and without scalp contributions. Scalp blood flow was impeded by a pneumatic tourniquet, which was confirmed by dynamic contrast-enhanced (DCE) NIRS. The results showed that EC contamination for intensity measurements could be as high as 75%; however, using time-resolved detection can reduce this value to 30%.
We investigate a scheme for noninvasive continuous monitoring of absolute cerebral blood flow (CBF) in adult human patients based on a combination of time-resolved dynamic contrast-enhanced near-infrared spectroscopy (DCE-NIRS) and diffuse correlation spectroscopy (DCS) with semi-infinite head model of photon propogation. Continuous CBF is obtained via calibration of the DCS blood flow index (BFI) with absolute CBF obtained by intermittent intravenous injections of the optical contrast agent indocyanine green. A calibration coefficient (γ) for the CBF is thus determined, permitting conversion of DCS BFI to absolute blood flow units at all other times. A study of patients with acute brain injury (N = 7) is carried out to ascertain the stability of γ. The patient-averaged DCS calibration coefficient across multiple monitoring days and multiple patients was determined, and good agreement between the two calibration coefficients measured at different times during single monitoring days was found. The patient-averaged calibration coefficient of 1.24 × 109 ( mL / 100 g / min ) / ( cm2 / s ) was applied to previously measured DCS BFI from similar brain-injured patients; in this case, absolute CBF was underestimated compared with XeCT, an effect we show is primarily due to use of semi-infinite homogeneous models of the head.
KEYWORDS: Brain, Near infrared spectroscopy, Eye, Neuroimaging, Functional magnetic resonance imaging, Consciousness, Brain-machine interfaces, Monte Carlo methods, Photons, Electroencephalography
There is a growing interest in the possibility of using functional neuroimaging techniques to aid in detecting covert awareness in patients who are thought to be suffering from a disorder of consciousness. Immerging optical techniques such as time-resolved functional near-infrared spectroscopy (TR-fNIRS) are ideal for such applications due to their low-cost, portability, and enhanced sensitivity to brain activity. The aim of this case study was to investigate for the first time the ability of TR-fNIRS to detect command driven motor imagery (MI) activity in a functionally locked-in patient suffering from Guillain–Barré syndrome. In addition, the utility of using TR-fNIRS as a brain–computer interface (BCI) was also assessed by instructing the patient to perform an MI task as affirmation to three questions: (1) confirming his last name, (2) if he was in pain, and (3) if he felt safe. At the time of this study, the patient had regained limited eye movement, which provided an opportunity to accurately validate a BCI after the fNIRS study was completed. Comparing the two sets of responses showed that fNIRS provided the correct answers to all of the questions. These promising results demonstrate for the first time the potential of using an MI paradigm in combination with fNIRS to communicate with functionally locked-in patients without the need for prior training.
KEYWORDS: Optical properties, Monte Carlo methods, Data modeling, Tissue optics, Medical research, Statistical analysis, Absorption, Scattering, Tissues, Error analysis
The analysis of statistical moments of time-resolved (TR) diffuse optical signals can be used to evaluate the absorption and scattering coefficients of turbid media; however, this method requires careful measurement of the instrument response function. We propose an alternative approach that avoids this step by estimating the optical properties from the difference of TR measurements acquired at different source-detector separations. The efficiency of this method was validated using simulated data (from analytical model and Monte-Carlo simulations) and tissue-mimicking phantoms. Results for a homogenous and layered medium showed that the subtraction technique can accurately estimate the optical properties. Specifically, our preliminary results show that the method can estimate the optical properties of a homogeneous medium (simulated using μa = 0.1 mm-1, μs’ = 10 mm-1) with an error less than 10 %. Accurate results were obtained at source-detector separations large enough (5 mm or greater) to resolve differences in the moments. Moreover, we also observed that the subtraction method has improved depth sensitivity compared to the classic method of moments. These results suggests that time-resolved subtraction is a simple but effective means of quantifying optical properties of turbid media, in addition to offering a new approach for obtaining spatially sensitive measurements, although additional studies are required to confirm the latter.
Functional near-infrared spectroscopy (fNIRS) is a non-invasive optical technique for detecting brain activity, which has
been previously used during motor and motor executive tasks. There is an increasing interest in using fNIRS as a brain
computer interface (BCI) for patients who lack the physical, but not the mental, ability to respond to commands. The
goal of this study is to assess the feasibility of time-resolved fNIRS to detect brain activity during motor imagery.
Stability tests were conducted to ensure the temporal stability of the signal, and motor imagery data were acquired on
healthy subjects. The NIRS probes were placed on the scalp over the premotor cortex (PMC) and supplementary motor
area (SMA), as these areas are responsible for motion planning. To confirm the fNIRS results, subjects underwent
functional magnetic resonance imaging (fMRI) while performing the same task. Seven subjects have participated to date,
and significant activation in the SMA and/or the PMC during motor imagery was detected by both fMRI and fNIRS in 4
of the 7 subjects. No activation was detected by either technique in the remaining three participants, which was not
unexpected due to the nature of the task. The agreement between the two imaging modalities highlights the potential of
fNIRS as a BCI, which could be adapted for bedside studies of patients with disorders of consciousness.
The aim of the study was to determine optimal measurement conditions for assessment of brain perfusion with the use of optical contrast agent and time-resolved diffuse reflectometry in the near-infrared wavelength range. The source-detector separation at which the distribution of time of flights (DTOF) of photons provided useful information on the inflow of the contrast agent to the intracerebral brain tissue compartments was determined. Series of Monte Carlo simulations was performed in which the inflow and washout of the dye in extra- and intracerebral tissue compartments was modeled and the DTOFs were obtained at different source-detector separations. Furthermore, tests on diffuse phantoms were carried out using a time-resolved setup allowing the measurement of DTOFs at 16 source-detector separations. Finally, the setup was applied in experiments carried out on the heads of adult volunteers during intravenous injection of indocyanine green. Analysis of statistical moments of the measured DTOFs showed that the source-detector separation of 6 cm is recommended for monitoring of inflow of optical contrast to the intracerebral brain tissue compartments with the use of continuous wave reflectometry, whereas the separation of 4 cm is enough when the higher-order moments of DTOFs are available.
The nEUROPt protocol is one of two new protocols developed within the European project nEUROPt to characterize the performances of time-domain systems for optical imaging of the brain. It was applied in joint measurement campaigns to compare the various instruments and to assess the impact of technical improvements. This protocol addresses the characteristic of optical brain imaging to detect, localize, and quantify absorption changes in the brain. It was implemented with two types of inhomogeneous liquid phantoms based on Intralipid and India ink with well-defined optical properties. First, small black inclusions were used to mimic localized changes of the absorption coefficient. The position of the inclusions was varied in depth and lateral direction to investigate contrast and spatial resolution. Second, two-layered liquid phantoms with variable absorption coefficients were employed to study the quantification of layer-wide changes and, in particular, to determine depth selectivity, i.e., the ratio of sensitivities for deep and superficial absorption changes. We introduce the tests of the nEUROPt protocol and present examples of results obtained with different instruments and methods of data analysis. This protocol could be a useful step toward performance tests for future standards in diffuse optical imaging.
Performance assessment of instruments devised for clinical applications is of key importance for validation and quality assurance. Two new protocols were developed and applied to facilitate the design and optimization of instruments for time-domain optical brain imaging within the European project nEUROPt. Here, we present the “Basic Instrumental Performance” protocol for direct measurement of relevant characteristics. Two tests are discussed in detail. First, the responsivity of the detection system is a measure of the overall efficiency to detect light emerging from tissue. For the related test, dedicated solid slab phantoms were developed and quantitatively spectrally characterized to provide sources of known radiance with nearly Lambertian angular characteristics. The responsivity of four time-domain optical brain imagers was found to be of the order of 0.1 m2 sr. The relevance of the responsivity measure is demonstrated by simulations of diffuse reflectance as a function of source-detector separation and optical properties. Second, the temporal instrument response function (IRF) is a critically important factor in determining the performance of time-domain systems. Measurements of the IRF for various instruments were combined with simulations to illustrate the impact of the width and shape of the IRF on contrast for a deep absorption change mimicking brain activation.
Novel protocols were developed and applied in the European project “nEUROPt” to assess and compare the performance
of instruments for time-domain optical brain imaging and of related methods of data analysis. The objective of the first
protocol, “Basic Instrumental Performance”, was to record relevant basic instrumental characteristics in a direct way.
The present paper focuses on the second novel protocol (“nEUROPt” protocol) that was devoted to the assessment of
sensitivity, spatial resolution and quantification of absorption changes within inhomogeneous media. It was implemented
with liquid phantoms based on Intralipid and ink, with black inclusions and, alternatively, in two-layered geometry.
Small black cylinders of various sizes were used to mimic small localized changes of the absorption coefficient. Their
position was varied in depth and lateral direction to address contrast and spatial resolution. Two-layered liquid phantoms
were used, in particular, to determine depth selectivity, i.e. the ratio of contrasts due to a deep and a superficial
absorption change of the same magnitude. We introduce the tests of the “nEUROPt” protocol and present exemplary
results obtained with various instruments. The results are related to measurements with both types of phantoms and to
the analysis of measured time-resolved reflectance based on time windows and moments. Results are compared for the
different instruments or instrumental configurations as well as for the methods of data analysis. The nEUROPt protocol
is also applicable to cw or frequency-domain instruments and could be useful for designing performance tests in future
standards in diffuse optical imaging.
Optical technique based on diffuse reflectance measurement combined with indocyanine green (ICG) bolus tracking is extensively tested as a method for clinical assessment of brain perfusion in adults at the bedside. Methodology of multiwavelength and time-resolved detection of fluorescence light excited in the ICG is presented and advantages of measurements at multiple wavelengths are discussed. Measurements were carried out: 1. on a physical homogeneous phantom to study the concentration dependence of the fluorescence signal, 2. on the phantom to simulate the dynamic inflow of ICG at different depths, and 3. in vivo on surface of the human head. Pattern of inflow and washout of ICG in the head of healthy volunteers after intravenous injection of the dye was observed for the first time with time-resolved instrumentation at multiple emission wavelengths. The multiwavelength detection of fluorescence signal confirms that at longer emission wavelengths, probability of reabsorption of the fluorescence light by the dye itself is reduced. Considering different light penetration depths at different wavelengths, and the pronounced reabsorption at longer wavelengths, the time-resolved multiwavelength technique may be useful in signal decomposition, leading to evaluation of extra- and intracerebral components of the measured signals.
We study fluorescence lifetime of indocyanine green (ICG) using femtosecond laser and sensitive detection based on time-correlated single-photon counting. A time-resolved multichannel spectral system is constructed and applied for determination of the fluorescence lifetime of the ICG in different solvents. Emission properties of ICG in water, milk, and 1% intralipid solution are investigated. Fluorescence of the fluorophore of different concentrations (in a range of 1.7-160 μM) dissolved in different solutions is excited by femtosecond pulses generated with the use of Ti:Sa laser tuned within the range of 740-790 nm. It is observed that fluorescence lifetime of ICG in water is 0.166 ± 0.02 ns and does not depend on excitation and emission wavelengths. We also show that for the diffusely scattering solvents (milk and intralipid), the lifetime may depend on the dye concentration (especially for large concentrations of ICG). This effect should be taken into account when analyzing changes in the mean time of arrival of fluorescence photons excited in ICG dissolved in such optically turbid media.
Recently, it was shown in measurements carried out on humans that time-resolved near-infrared reflectometry and fluorescence spectroscopy may allow for discrimination of information originating directly from the brain avoiding influence of contaminating signals related to the perfusion of extracerebral tissues. We report on continuation of these studies, showing that the near-infrared light can be detected noninvasively on the surface of the tissue at large interoptode distance. A multichannel time-resolved optical monitoring system was constructed for measurements of diffuse reflectance in optically turbid medium at very large source-detector separation up to 9 cm. The instrument was applied during intravenous injection of indocyanine green and the distributions of times of flight of photons were successfully acquired showing inflow and washout of the dye in the tissue. Time courses of the statistical moments of distributions of times of flight of photons are presented and compared to the results obtained simultaneously at shorter source-detector separations (3, 4, and 5 cm). We show in a series of experiments carried out on physical phantom and healthy volunteers that the time-resolved data acquisition in combination with very large source-detector separation may allow one to improve depth selectivity of perfusion assessment in the brain.
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