Predicting Responses to Neoadjuvant Chemotherapy in Breast Cancer: ACRIN 6691 Trial of Diffuse Optical Spectroscopic Imaging

The prospective multicenter ACRIN 6691 trial was designed to evaluate whether changes from baseline to mid-therapy in a diffuse optical spectroscopic imaging (DOSI)-derived imaging endpoint, the tissue optical index (TOI), predict pathologic complete response (pCR) in women undergoing breast cancer neoadjuvant chemotherapy (NAC). DOSI instruments were constructed at the University of California, Irvine (Irvine, CA), and delivered to six institutions where 60 subjects with newly diagnosed breast tumors (at least 2 cm in the longest dimension) were enrolled over a 2-year period. Bedside DOSI images of the tissue concentrations of deoxy-hemoglobin (ctHHb), oxy-hemoglobin (ctHbO₂), water (ctH₂O), lipid, and TOI (ctHHb × ctH₂O/lipid) were acquired on both breasts up to four times during NAC treatment: baseline, 1-week, mid-point, and completion. Of the 34 subjects (mean age 48.4 ± 10.7 years) with complete, evaluable data from both normal and tumor-containing breast, 10 (29%) achieved pCR as determined by central pathology review. The percent change in tumor-to-normal TOI ratio (%TOI_TN) from baseline to mid-therapy ranged from -82% to 321%, with a median of -36%. Using pCR as the reference standard and ROC curve methodology, %TOI_TN AUC was 0.60 (95% CI, 0.39-0.81). In the cohort of 17 patients with baseline tumor oxygen saturation (%StO₂) greater than the 77% population median, %TOI_TN AUC improved to 0.83 (95% CI, 0.63-1.00). We conclude that the combination of baseline functional properties and dynamic optical response shows promise for clinical outcome prediction. Cancer Res; 76(20); 5933-44. ©2016 AACR.

Mayer waves reduce the accuracy of estimated hemodynamic response functions in functional near-infrared spectroscopy

Analysis of cerebral hemodynamics reveals a wide spectrum of oscillations ranging from 0.0095 to 2 Hz. While most of these oscillations can be filtered out during analysis of functional near-infrared spectroscopy (fNIRS) signals when estimating stimulus evoked hemodynamic responses, oscillations around 0.1 Hz are an exception. This is due to the fact that they share a common spectral range with typical stimulus evoked hemodynamic responses from the brain. Here we investigate the effect of hemodynamic oscillations around 0.1 Hz on the estimation of hemodynamic response functions from fNIRS data. Our results show that for an expected response of ~1 µM in oxygenated hemoglobin concentration (HbO), Mayer wave oscillations with an amplitude > ~1 µM at 0.1 Hz reduce the accuracy of the estimated response as quantified by a 3 fold increase in the mean squared error and decrease in correlation (R(2) below 0.78) when compared to the true HRF. These results indicate that the amplitude of oscillations at 0.1 Hz can serve as an objective metric of the expected HRF estimation accuracy. In addition, we investigated the effect of short separation regression on the recovered HRF, and found that this improves the recovered HRF when large amplitude 0.1 Hz oscillations are present in fNIRS data. We suspect that the development of other filtering strategies may provide even further improvement.

Contribution of low- and high-flux capillaries to slow hemodynamic fluctuations in the cerebral cortex of mice

We employed optical coherence tomography to measure cerebral cortical capillary red blood cell (RBC) flux in mice. The results suggest that baseline-flux weakly depends on cortical depth. Furthermore, under hypercapnia, low baseline-flux capillaries exhibit greater flux increases while the higher ones saturate, resulting in RBC-flux homogenization. Power-spectrum analysis indicates that higher flux capillaries saw greater flux variability in the low-frequency range (0.01-0.1 Hz) both at baseline and during hypercapnia. These results suggest that lower baseline-flux capillaries have more reserve to deliver oxygen with increased blood flow; but higher ones more strongly impact the low-frequency fluctuations associated with BOLD fMRI measurements of resting state functional connectivity.

Capturing Pain in the Cortex during General Anesthesia: Near Infrared Spectroscopy Measures in Patients Undergoing Catheter Ablation of Arrhythmias

The predictability of pain makes surgery an ideal model for the study of pain and the development of strategies for analgesia and reduction of perioperative pain. As functional near-infrared spectroscopy reproduces the known functional magnetic resonance imaging activations in response to a painful stimulus, we evaluated the feasibility of functional near-infrared spectroscopy to measure cortical responses to noxious stimulation during general anesthesia. A multichannel continuous wave near-infrared imager was used to measure somatosensory and frontal cortical activation in patients undergoing catheter ablation of arrhythmias under general anesthesia. Anesthetic technique was standardized and intraoperative NIRS signals recorded continuously with markers placed in the data set for the timing and duration of each cardiac ablation event. Frontal cortical signals only were suitable for analysis in five of eight patients studied (mean age 14 ± 1 years, weight 66.7 ± 17.6 kg, 2 males). Thirty ablative lesions were recorded for the five patients. Radiofrequency or cryoablation was temporally associated with a hemodynamic response function in the frontal cortex characterized by a significant decrease in oxyhemoglobin concentration (paired t-test, p<0.05) with the nadir occurring in the period 4 to 6 seconds after application of the ablative lesion. Cortical signals produced by catheter ablation of arrhythmias in patients under general anesthesia mirrored those seen with noxious stimulation in awake, healthy volunteers, during sedation for colonoscopy, and functional Magnetic Resonance Imaging activations in response to pain. This study demonstrates the feasibility and potential utility of functional near-infrared spectroscopy as an objective measure of cortical activation under general anesthesia.

On the other hand: Increased cortical activation to human versus mechanical hands in infants

There is a large body of work demonstrating that infants are sensitive to the distinction between human and mechanical entities from the early months of life, and have different expectations for the way these entities move and interact. The current work investigates the extent to which the functional organization of the immature brain reflects these early emerging sensitivities. Infants aged 8months watched two kinds of hands (human or mechanical) engage in two kinds of events (one with a functional outcome and one without). Using functional near-infrared spectroscopy (fNIRS), we assessed hemodynamic activation in the left and right temporal and temporal-occipital cortex in response to these events. The neuroimaging data revealed a significantly greater increase in activation in the right middle-posterior temporal cortex to events executed by the human than the mechanical hand; the event in which the hand engaged (function or non-function) did not significantly influence hemodynamic responses. In comparison, the left middle-temporal cortex showed significantly greater activation to events executed by the human than mechanical hand, but only when the events were functionally relevant. That is, the left middle-posterior temporal cortex responded selectively to human (as compared to mechanical) agents, but only in the context of functionally relevant actions on objects. These results reveal that the immature brain is functionally specialized to support infants' processing of human and non-human agents as distinct entities. These results also shed light on the cognitive and cortical mechanisms that guide infants' learning about agentive action and object function.

Establishing the diffuse correlation spectroscopy signal relationship with blood flow

Diffuse correlation spectroscopy (DCS) measurements of blood flow rely on the sensitivity of the temporal autocorrelation function of diffusively scattered light to red blood cell (RBC) mean square displacement (MSD). For RBCs flowing with convective velocity [Formula: see text], the autocorrelation is expected to decay exponentially with [Formula: see text], where [Formula: see text] is the delay time. RBCs also experience shear-induced diffusion with a diffusion coefficient [Formula: see text] and an MSD of [Formula: see text]. Surprisingly, experimental data primarily reflect diffusive behavior. To provide quantitative estimates of the relative contributions of convective and diffusive movements, we performed Monte Carlo simulations of light scattering through tissue of varying vessel densities. We assumed laminar vessel flow profiles and accounted for shear-induced diffusion effects. In agreement with experimental data, we found that diffusive motion dominates the correlation decay for typical DCS measurement parameters. Furthermore, our model offers a quantitative relationship between the RBC diffusion coefficient and absolute tissue blood flow. We thus offer, for the first time, theoretical support for the empirically accepted ability of the DCS blood flow index ([Formula: see text]) to quantify tissue perfusion. We find [Formula: see text] to be linearly proportional to blood flow, but with a proportionality modulated by the hemoglobin concentration and the average blood vessel diameter.

Cell type specificity of neurovascular coupling in cerebral cortex

Identification of the cellular players and molecular messengers that communicate neuronal activity to the vasculature driving cerebral hemodynamics is important for (1) the basic understanding of cerebrovascular regulation and (2) interpretation of functional Magnetic Resonance Imaging (fMRI) signals. Using a combination of optogenetic stimulation and 2-photon imaging in mice, we demonstrate that selective activation of cortical excitation and inhibition elicits distinct vascular responses and identify the vasoconstrictive mechanism as Neuropeptide Y (NPY) acting on Y1 receptors. The latter implies that task-related negative Blood Oxygenation Level Dependent (BOLD) fMRI signals in the cerebral cortex under normal physiological conditions may be mainly driven by the NPY-positive inhibitory neurons. Further, the NPY-Y1 pathway may offer a potential therapeutic target in cerebrovascular disease.

The pulsatility volume index: an indicator of cerebrovascular compliance based on fast magnetic resonance imaging of cardiac and respiratory pulsatility

The influence of cardiac activity on the viscoelastic properties of intracranial tissue is one of the mechanisms through which brain-heart interactions take place, and is implicated in cerebrovascular disease. Cerebrovascular disease risk is not fully explained by current risk factors, including arterial compliance. Cerebrovascular compliance is currently estimated indirectly through Doppler sonography and magnetic resonance imaging (MRI) measures of blood velocity changes. In order to meet the need for novel cerebrovascular disease risk factors, we aimed to design and validate an MRI indicator of cerebrovascular compliance based on direct endogenous measures of blood volume changes. We implemented a fast non-gated two-dimensional MRI pulse sequence based on echo-planar imaging (EPI) with ultra-short repetition time (approx. 30-50 ms), which stepped through slices every approximately 20 s. We constrained the solution of the Bloch equations for spins moving faster than a critical speed to produce an endogenous contrast primarily dependent on spin volume changes, and an approximately sixfold signal gain compared with Ernst angle acquisitions achieved by the use of a 90° flip angle. Using cardiac and respiratory peaks detected on physiological recordings, average cardiac and respiratory MRI pulse waveforms in several brain compartments were obtained at 7 Tesla, and used to derive a compliance indicator, the pulsatility volume index (pVI). The pVI, evaluated in larger cerebral arteries, displayed significant variation within and across vessels. Multi-echo EPI showed the presence of significant pulsatility effects in both S0 and [Formula: see text] signals, compatible with blood volume changes. Lastly, the pVI dynamically varied during breath-holding compared with normal breathing, as expected for a compliance indicator. In summary, we characterized and performed an initial validation of a novel MRI indicator of cerebrovascular compliance, which might prove useful to investigate brain-heart interactions in cerebrovascular disease and other disorders.

En face speckle reduction in optical coherence microscopy by frequency compounding

We report the use of frequency compounding to significantly reduce speckle noise in optical coherence microscopy, more specifically on the en face images. This method relies on the fact that the speckle patterns recorded from different wavelengths simultaneously are independent; hence their summation yields significant reduction in noise, with only a single acquisition. The results of our experiments with microbeads show that the narrow confocal parameter, due to a high numerical aperture objective, restricts the axial resolution loss that would otherwise theoretically broaden linearly with the number of optical frequency bands used. This speckle reduction scheme preserves the lateral resolution since it is performed on individual A-scans. Finally, we apply this technique to images of fixed human brain tissue, showing significant improvements in contrast-to-noise ratio with only moderate loss of axial resolution, in an effort to improve automatic three-dimensional detection of cells and fibers in the cortex.

Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy

Colonoscopy is an invaluable tool for the screening and diagnosis of many colonic diseases. For most colonoscopies, moderate sedation is used during the procedure. However, insufflation of the colon produces a nociceptive stimulus that is usually accompanied by facial grimacing/groaning while under sedation. The objective of this study was to evaluate whether a nociceptive signal elicited by colonic insufflation could be measured from the brain. Seventeen otherwise healthy patients (age 54.8 ± 9.1; 6 female) undergoing routine colonoscopy (ie, no history of significant medical conditions) were monitored using near-infrared spectroscopy (NIRS). Moderate sedation was produced using standard clinical protocols for midazolam and meperidine, titrated to effect. Near-infrared spectroscopy data captured during the procedure was analyzed offline to evaluate the brains' responses to nociceptive stimuli evoked by the insufflation events (defined by physician or observing patients' facial responses). Analysis of NIRS data revealed a specific, reproducible prefrontal cortex activity corresponding to times when patients grimaced. The pattern of the activation is similar to that previously observed during nociceptive stimuli in awake healthy individuals, suggesting that this approach may be used to evaluate brain activity evoked by nociceptive stimuli under sedation, when there is incomplete analgesia. Although some patients report recollection of procedural pain after the procedure, the effects of repeated nociceptive stimuli in surgical patients may contribute to postoperative changes including chronic pain. The results from this study indicate that NIRS may be a suitable technology for continuous nociceptive afferent monitoring in patients undergoing sedation and could have applications under sedation or anesthesia.

Sensitivity of laser speckle contrast imaging to flow perturbations in the cortex

Laser speckle contrast imaging has become a ubiquitous tool for imaging blood flow in a variety of tissues. However, due to its widefield imaging nature, the measured speckle contrast is a depth integrated quantity and interpretation of baseline values and the depth dependent sensitivity of those values to changes in underlying flow has not been thoroughly evaluated. Using dynamic light scattering Monte Carlo simulations, the sensitivity of the autocorrelation function and speckle contrast to flow changes in the cerebral cortex was extensively examined. These simulations demonstrate that the sensitivity of the inverse autocorrelation time, [Formula: see text], varies across the field of view: directly over surface vessels [Formula: see text] is strongly localized to the single vessel, while parenchymal ROIs have a larger sensitivity to flow changes at depths up to 500 μm into the tissue and up to 200 μm lateral to the ROI. It is also shown that utilizing the commonly used models the relate [Formula: see text] to flow resulted in nearly the same sensitivity to the underlying flow, but fail to accurately relate speckle contrast values to absolute [Formula: see text].

Abstract P4-03-04: Dynamic tomographic optical breast imaging (TOBI) for neoadjuvant chemotherapy monitoring

Background: Dynamic Diffuse optical imaging using near-infrared light was shown to be promising method for neoadjuvant therapy monitoring as an alternative functional imaging that is low-cost, non-invasive, portable, safe and simple to operate. While optical breast imaging methods rely on "static" assessments of tissue oxy- and deoxy- hemoglobin concentration without contrast agents, they are insufficient for clinical applications. Dynamic tomographic optical imaging induces tumor-sensitive hemodynamic variations, as a contrast mechanism, driven by fractional mammographic compression. These tumor contrast measurements are governed by interlay of tissue biomechanics and oxygen metabolism. In this study we seek to evaluate the predictive value of these biomarkers with respect to treatment outcome.

Methods: A group of 22 patients with locally advanced breast cancer were scanned using our dynamic TOBI system before and during neoadjuvant chemotherapy. In this analysis we focused on pre-treatment, day 7 and day 30 post-treatment dynamic TOBI scans. Both breasts are compressed in turn to 4-8 lbs of force (depending on size) and optical images are acquired every 2 seconds over 2 minutes. We calculate the time course of oxy (HbO), deoxy (HbR)and total (HbT) hemoglobin concentration as well as the hemoglobin oxygen saturation (SO2). Regions of interest are defined in the optical images to correspond to the radiology identified tumor location, and the healthy tissue in the same breast, respectively. We compare the time courses in the two regions at baseline, day 7 and 30 days after initiation of treatment.

Results: In this analysis we present results from 10 patients including 6 responders (defined as greater than 50% reduction in the largest tumor axis from baseline imaging and final pathology) and 4 non-responders. As the compression plates are held in place the tissue collagen matrix begins to stretch, effectively reducing the compression force. At baseline, all patients exhibit a decrease followed by delayed recovery in HbT, and SO2 in the tumor area, in contrast to immediate recovery in surrounding tissue. At day 7 and 30, this contrast is maintained in non-responders (&lt;50% reduction in tumor maximum diameter); however, in responders, the contrast starts decreasing at day 7 and substantially disappears at day 30. Average changes in HbT and SO2, show that the contrast between normal and tumor increases somewhat at day 7 and more noticeably at day 30 in non-responders to NACT. Comparing hemodynamic changes in responders and non-responders, it is clear that at three selected time points (30, 60 and 90 s) during the scan, the contrast between tumor and normal tissue in both ΔHbT and ΔSO2 is reduced for the responders at day 7 and day 30.

Conclusions: These initial results suggest that dynamic optical breast imaging can detect changes due to treatment and have predictive value for the treatment outcome. DTOBI can show the difference in hemodynamic response to compression between tumor and normal tissue and demonstrates the feasibility of using dynamic optical breast tomography for neoadjuvant chemotherapy monitoring. ongoing.

Citation Format: Sajjadi AY, Singh B, Deng B, Boas DA, Moy B, Schapira L, Bardia A, Specht MC, Carp SA, Isakoff SJ. Dynamic tomographic optical breast imaging (TOBI) for neoadjuvant chemotherapy monitoring. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-03-04.

Early capillary flux homogenization in response to neural activation

This Brief Communication reports early homogenization of capillary network flow during somatosensory activation in the rat cerebral cortex. We used optical coherence tomography and statistical intensity variation analysis for tracing changes in the red blood cell flux over hundreds of capillaries nearly at the same time with 1-s resolution. We observed that while the mean capillary flux exhibited a typical increase during activation, the standard deviation of the capillary flux exhibited an early decrease that happened before the mean flux increase. This network-level data is consistent with the theoretical hypothesis that capillary flow homogenizes during activation to improve oxygen delivery.

Frequency domain near-infrared multiwavelength imager design using high-speed, direct analog-to-digital conversion

Frequency domain near-infrared spectroscopy (FD-NIRS) has proven to be a reliable method for quantification of tissue absolute optical properties. We present a full-sampling direct analog-to-digital conversion FD-NIR imager. While we developed this instrument with a focus on high-speed optical breast tomographic imaging, the proposed design is suitable for a wide-range of biophotonic applications where fast, accurate quantification of absolute optical properties is needed. Simultaneous dual wavelength operation at 685 and 830 nm is achieved by concurrent 67.5 and 75 MHz frequency modulation of each laser source, respectively, followed by digitization using a high-speed (180  MS/s) 16-bit A/D converter and hybrid FPGA-assisted demodulation. The instrument supports 25 source locations and features 20 concurrently operating detectors. The noise floor of the instrument was measured at <1.4  pW/√Hz, and a dynamic range of 115+ dB, corresponding to nearly six orders of magnitude, has been demonstrated. Titration experiments consisting of 200 different absorption and scattering values were conducted to demonstrate accurate optical property quantification over the entire range of physiologically expected values.

Multimodal optical imaging system for in vivo investigation of cerebral oxygen delivery and energy metabolism

Improving our understanding of brain function requires novel tools to observe multiple physiological parameters with high resolution in vivo. We have developed a multimodal imaging system for investigating multiple facets of cerebral blood flow and metabolism in small animals. The system was custom designed and features multiple optical imaging capabilities, including 2-photon and confocal lifetime microscopy, optical coherence tomography, laser speckle imaging, and optical intrinsic signal imaging. Here, we provide details of the system's design and present in vivo observations of multiple metrics of cerebral oxygen delivery and energy metabolism, including oxygen partial pressure, microvascular blood flow, and NADH autofluorescence.

High-resolution in vivo optical imaging of stroke injury and repair

Central nervous system (CNS) function and dysfunction are best understood within a framework of interactions between neuronal, glial and vascular compartments comprising the neurovascular unit (NVU), all of which contribute to stroke-induced CNS injury, plasticity, repair, and recovery. Recent advances in in vivo optical microscopy have enabled us to observe and interrogate cells and their processes with high spatial resolution in real time and in their natural environment deep in the brain tissue. Here, we review some of these state-of-the-art imaging techniques with an emphasis on imaging the interactions among the constituents of the NVU during ischemic injury and repair in small animal models. This article is part of a Special Issue entitled SI: Cell Interactions In Stroke.

Validating a new methodology for optical probe design and image registration in fNIRS studies

Functional near-infrared spectroscopy (fNIRS) is an imaging technique that relies on the principle of shining near-infrared light through tissue to detect changes in hemodynamic activation. An important methodological issue encountered is the creation of optimized probe geometry for fNIRS recordings. Here, across three experiments, we describe and validate a processing pipeline designed to create an optimized, yet scalable probe geometry based on selected regions of interest (ROIs) from the functional magnetic resonance imaging (fMRI) literature. In experiment 1, we created a probe geometry optimized to record changes in activation from target ROIs important for visual working memory. Positions of the sources and detectors of the probe geometry on an adult head were digitized using a motion sensor and projected onto a generic adult atlas and a segmented head obtained from the subject's MRI scan. In experiment 2, the same probe geometry was scaled down to fit a child's head and later digitized and projected onto the generic adult atlas and a segmented volume obtained from the child's MRI scan. Using visualization tools and by quantifying the amount of intersection between target ROIs and channels, we show that out of 21 ROIs, 17 and 19 ROIs intersected with fNIRS channels from the adult and child probe geometries, respectively. Further, both the adult atlas and adult subject-specific MRI approaches yielded similar results and can be used interchangeably. However, results suggest that segmented heads obtained from MRI scans be used for registering children's data. Finally, in experiment 3, we further validated our processing pipeline by creating a different probe geometry designed to record from target ROIs involved in language and motor processing.

Characterizing breast lesions through robust multimodal data fusion using independent diffuse optical and x-ray breast imaging

To enable tissue function-based tumor diagnosis over the large number of existing digital mammography systems worldwide, we propose a cost-effective and robust approach to incorporate tomographic optical tissue characterization with separately acquired digital mammograms. Using a flexible contour-based registration algorithm, we were able to incorporate an independently measured two-dimensional x-ray mammogram as structural priors in a joint optical/x-ray image reconstruction, resulting in improved spatial details in the optical images and robust optical property estimation. We validated this approach with a retrospective clinical study of 67 patients, including 30 malignant and 37 benign cases, and demonstrated that the proposed approach can help to distinguish malignant from solid benign lesions and fibroglandular tissues, with a performance comparable to the approach using spatially coregistered optical/x-ray measurements.

Characterization of structural-prior guided optical tomography using realistic breast models derived from dual-energy x-ray mammography

Multi-spectral near-infrared diffuse optical tomography (DOT) is capable of providing functional tissue assessment that can complement structural mammographic images for more comprehensive breast cancer diagnosis. To take full advantage of the readily available sub-millimeter resolution structural information in a multi-modal imaging setting, an efficient x-ray/optical joint image reconstruction model has been proposed previously to utilize anatomical information from a mammogram as a structural prior. In this work, we develop a complex digital breast phantom (available at http://openjd.sf.net/digibreast) based on direct measurements of fibroglandular tissue volume fractions using dual-energy mammographic imaging of a human breast. We also extend our prior-guided reconstruction algorithm to facilitate the recovery of breast tumors, and perform a series of simulation-based studies to systematically evaluate the impact of lesion sizes and contrasts, tissue background, mesh resolution, inaccurate priors, and regularization parameters, on the recovery of breast tumors using multi-modal DOT/x-ray measurements. Our studies reveal that the optical property estimation error can be reduced by half by utilizing structural priors; the minimum detectable tumor size can also be reduced by half when prior knowledge regarding the tumor location is provided. Moreover, our algorithm is shown to be robust to false priors on tumor location.

Short separation regression improves statistical significance and better localizes the hemodynamic response obtained by near-infrared spectroscopy for tasks with differing autonomic responses

Autonomic nervous system response is known to be highly task-dependent. The sensitivity of near-infrared spectroscopy (NIRS) measurements to superficial layers, particularly to the scalp, makes it highly susceptible to systemic physiological changes. Thus, one critical step in NIRS data processing is to remove the contribution of superficial layers to the NIRS signal and to obtain the actual brain response. This can be achieved using short separation channels that are sensitive only to the hemodynamics in the scalp. We investigated the contribution of hemodynamic fluctuations due to autonomous nervous system activation during various tasks. Our results provide clear demonstrations of the critical role of using short separation channels in NIRS measurements to disentangle differing autonomic responses from the brain activation signal of interest.

Supply-demand mismatch transients in susceptible peri-infarct hot zones explain the origins of spreading injury depolarizations

Peri-infarct depolarizations (PIDs) are seemingly spontaneous spreading depression-like waves that negatively impact tissue outcome in both experimental and human stroke. Factors triggering PIDs are unknown. Here, we show that somatosensory activation of peri-infarct cortex triggers PIDs when the activated cortex is within a critical range of ischemia. We show that the mechanism involves increased oxygen utilization within the activated cortex, worsening the supply-demand mismatch. We support the concept by clinical data showing that mismatch predisposes stroke patients to PIDs as well. Conversely, transient worsening of mismatch by episodic hypoxemia or hypotension also reproducibly triggers PIDs. Therefore, PIDs are triggered upon supply-demand mismatch transients in metastable peri-infarct hot zones due to increased demand or reduced supply. Based on the data, we propose that minimizing sensory stimulation and hypoxic or hypotensive transients in stroke and brain injury would reduce PID incidence and their adverse impact on outcome.

VIDEO ABSTRACT

Effect of motion artifacts and their correction on near-infrared spectroscopy oscillation data: a study in healthy subjects and stroke patients

Functional near-infrared spectroscopy is prone to contamination by motion artifacts (MAs). Motion correction algorithms have previously been proposed and their respective performance compared for evoked rain activation studies. We study instead the effect of MAs on "oscillation" data which is at the basis of functional connectivity and autoregulation studies. We use as our metric of interest the interhemispheric correlation (IHC), the correlation coefficient between symmetrical time series of oxyhemoglobin oscillations. We show that increased motion content results in a decreased IHC. Using a set of motion-free data on which we add real MAs, we find that the best motion correction approach consists of discarding the segments of MAs following a careful approach to minimize the contamination due to band-pass filtering of data from "bad" segments spreading into adjacent "good" segments. Finally, we compare the IHC in a stroke group and in a healthy group that we artificially contaminated with the MA content of the stroke group, in order to avoid the confounding effect of increased motion incidence in the stroke patients. After motion correction, the IHC remains lower in the stroke group in the frequency band around 0.1 and 0.04 Hz, suggesting a physiological origin for the difference. We emphasize the importance of considering MAs as a confounding factor in oscillation-based functional near-infrared spectroscopy studies.

Abstract S4-04: Predicting pre-surgical neoadjuvant chemotherapy response in breast cancer using diffuse optical spectroscopic imaging (DOSI): Results from the ACRIN 6691 study

Background: DOSI is an experimental imaging technique that employs risk-free near-infrared light for quantitative measurements of breast tissue perfusion, metabolism, and composition without exogenous contrast. A multi-center ACRIN 6691 study was designed to evaluate whether changes from baseline to mid-therapy in a DOSI-derived Tissue Optical Index (TOI) could predict pathologic complete response (pCR) in breast cancer neoadjuvant chemotherapy (NAC).

Methods: DOSI instruments were constructed at the University of California, Irvine and delivered to 6 participating sites. Bedside measurements were conducted by scanning a handheld probe over a region of interest (up to ∼10 x 10 cm2) on both breasts. Instruments were standardized and validated using a common set of tissue simulating phantoms and protocols. DOSI-derived near-infrared absorption and scattering spectra (650-1000 nm) were used to calculate the tissue concentration of oxy- and deoxyhemoglobin (ctO2Hb, ctHHb), water (ctH2O), %lipid and the tissue optical index (TOI=ctHHb x ctH2O/%lipid) in each probe location. Baseline to mid-therapy changes in the tumor to normal (T/N) TOI ratio were evaluated from DOSI images as the primary imaging endpoint for predicting clinical outcome (pCR). 60 female breast cancer patients (ages 28-69 years, mean 48.9±11), with locally advanced disease (tumors &gt;2cm) were enrolled across the 6 institutions. DOSI measurements were performed at baseline, during the first week of therapy, at midpoint, and at the completion of NAC. Logistic regression was used to assess the association between pathologic complete response (pCR) and % change in T/N TOI from baseline to mid-therapy. In addition, area under the receiver operating characteristic curve (ROC AUC) and its corresponding 95% confidence interval were calculated.

Results: Of the 34 participants (mean age 48.4 ± 10.7) with complete and evaluable data, 10 (29%) achieved pCR as determined by central pathology review. The % change in TOI ratio ranged from -82% to 321%, with a median of -36%. Using -40% as a threshold, we found that subjects in the group with a 40% or more decrease in T/N TOI were more likely to be pCR (p=0.0586, OR=4.667, 95% CI: 0.945 to 23.038). The % change in TOI ratio from baseline to mid-therapy has an AUC of 0.604 (95% CI: 0.394 to 0.814) to distinguish pCR from non-pCR.

Conclusions: DOSI has been successfully implemented in a multi-center setting and changes in T/N TOI are a promising predictor of NAC clinical outcome (pCR). A larger study population is needed to fully assess the utility of TOI and other DOSI imaging endpoints for guiding therapies and predicting NAC response in individual subjects.

ACRIN receives funding from the NCI through U01 CA079778 and U01 CA080098.

Citation Format: Bruce J Tromberg, Zheng Zhang, Anais Leproux, Thomas D O'Sullivan, Albert E Cerussi, Philip Carpenter, Rita Mehta, Darren Roblyer, Wei Yang, Keith D Paulsen, Brian W Pogue, Shudong Jiang, Peter Kaufman, Arjun G Yodh, So-Hyun Chung, Mitchell Schnall, Brad Snyder, Nola Hylton, David A Boas, Stefan A Carp, Steven J Isakoff, David Mankoff. Predicting pre-surgical neoadjuvant chemotherapy response in breast cancer using diffuse optical spectroscopic imaging (DOSI): Results from the ACRIN 6691 study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr S4-04.

Anatomical guidance for functional near-infrared spectroscopy: AtlasViewer tutorial

Functional near-infrared spectroscopy (fNIRS) is an optical imaging method that is used to noninvasively measure cerebral hemoglobin concentration changes induced by brain activation. Using structural guidance in fNIRS research enhances interpretation of results and facilitates making comparisons between studies. AtlasViewer is an open-source software package we have developed that incorporates multiple spatial registration tools to enable structural guidance in the interpretation of fNIRS studies. We introduce the reader to the layout of the AtlasViewer graphical user interface, the folder structure, and user files required in the creation of fNIRS probes containing sources and detectors registered to desired locations on the head, evaluating probe fabrication error and intersubject probe placement variability, and different procedures for estimating measurement sensitivity to different brain regions as well as image reconstruction performance. Further, we detail how AtlasViewer provides a generic head atlas for guiding interpretation of fNIRS results, but also permits users to provide subject-specific head anatomies to interpret their results. We anticipate that AtlasViewer will be a valuable tool in improving the anatomical interpretation of fNIRS studies.

Optical coherence tomography visualizes neurons in human entorhinal cortex

The cytoarchitecture of the human brain is of great interest in diverse fields: neuroanatomy, neurology, neuroscience, and neuropathology. Traditional histology is a method that has been historically used to assess cell and fiber content in the ex vivo human brain. However, this technique suffers from significant distortions. We used a previously demonstrated optical coherence microscopy technique to image individual neurons in several square millimeters of en-face tissue blocks from layer II of the human entorhinal cortex, over 50 µm in depth. The same slices were then sectioned and stained for Nissl substance. We registered the optical coherence tomography (OCT) images with the corresponding Nissl stained slices using a nonlinear transformation. The neurons were then segmented in both images and we quantified the overlap. We show that OCT images contain information about neurons that is comparable to what can be obtained from Nissl staining, and thus can be used to assess the cytoarchitecture of the ex vivo human brain with minimal distortion. With the future integration of a vibratome into the OCT imaging rig, this technique can be scaled up to obtain undistorted volumetric data of centimeter cube tissue blocks in the near term, and entire human hemispheres in the future.