Near infrared spectroscopy (NIRS): a new tool to study hemodynamic changes during activation of brain function in human adults

Blood flow and oxygenation in peritendinous tissue and calf muscle during dynamic exercise in humans

1. Circulation around tendons may act as a shunt for muscle during exercise. The perfusion and oxygenation of Achilles' peritendinous tissue was measured in parallel with that of calf muscle during exercise to determine (1) whether blood flow is restricted in peritendinous tissue during exercise, and (2) whether blood flow is coupled to oxidative metabolism. 2. Seven individuals performed dynamic plantar flexion from 1 to 9 W. Radial artery and popliteal venous blood were sampled for O2, peritendinous blood flow was determined by 133Xe-washout, calf blood flow by plethysmography, cardiac output by dye dilution, arterial pressure by an arterial catheter-transducer, and muscle and peritendinous O2 saturation by spatially resolved spectroscopy (SRS). 3. Calf blood flow rose 20-fold with exercise, reaching 44 +/- 7 ml (100 g)-1 min-1 (mean +/- s.e.m. ) at 9 W, while Achilles' peritendinous flow increased (7-fold) to 14 +/- 4 ml (100 g)-1 min-1, which was 18 % of the maximal flow established during reactive hyperaemia. SRS-O2 saturation fell both in muscle (from 66 +/- 2 % at rest to 57 +/- 3 %, P < 0.05) and in peritendinous regions (58 +/- 4 to 52 +/- 4 %, P < 0.05) during exercise along with a rise in leg vascular conductance and microvascular haemoglobin volume, despite elevated systemic vascular resistance. 4. The parallel rise in calf muscle and peritendinous blood flow and fall in O2 saturation during exercise indicate that blood flow is coupled to oxidative metabolism in both tissue regions. Increased leg vascular conductance accompanied by elevated microvascular haemoglobin volume reflect vasodilatation in both muscle and peritendinous regions. However, peak exercise peritendinous blood flow reaches only approximately 20 % of its maximal blood flow capacity.

Spontaneous oscillation of oxy- and deoxy- hemoglobin changes with a phase difference throughout the occipital cortex of newborn infants observed using non-invasive optical topography

We investigated spontaneous changes in the cerebral oxygenation state of infants during quiet sleeping by using a form of multi-channel near-infrared spectroscopy: non-invasive optical topography. Eight infants born at 32-39 weeks were studied at postconceptional term age (38-43 weeks). Spatially synchronized oscillations of changes in the concentration of oxy- and deoxy- hemoglobin ([oxy-Hb] and [deoxy-Hb]) were observed throughout the occipital cortex. Time series analysis based on the theory of non-linear oscillators showed that the mean periods of the oscillation for each infant ranged from 11 to 18 s. The phase lag of [oxy-Hb] relative to [deoxy-Hb] was stable at about 3pi/4. This phase difference may result from interplay between the vasomotion and the oxygen consumption in relation to brain activity.

Noninvasive functional imaging of human brain using light

Analysis of photon transit time for low-power light passing into the head, and through both skull and brain, of human subjects allowed for tomographic imaging of cerebral hemoglobin oxygenation based on photon diffusion theory. In healthy adults, imaging of changes in hemoglobin saturation during hand movement revealed focal, contralateral increases in motor cortex oxygenation with spatial agreement to activation maps determined by functional magnetic resonance imaging; in ill neonates, imaging of hemoglobin saturation revealed focal regions of low oxygenation after acute stroke, with spatial overlap to injury location determined by computed tomography scan. Because such slow optical changes occur over seconds and co-localize with magnetic resonance imaging vascular signals whereas fast activation-related optical changes occur over milliseconds and co-localize with EEG electrical signals, optical methods offer a single modality for exploring the spatio-temporal relationship between electrical and vascular responses in the brain in vivo, as well as for mapping cortical activation and oxygenation at the bedside in real-time for clinical monitoring.

Near-infrared spectroscopy: does it function in functional activation studies of the adult brain?

Changes in optical properties of biological tissue can be examined by near-infrared spectroscopy (NIRS). The relative transparency of tissues including the skull to near-infrared light is the prerequisite to apply the method to brain research. We describe the methodology with respect to its applicability in non-invasive functional research of the adult cortex. A summary of studies establishing the 'typical' response in NIRS vascular parameters, i.e. changes in the concentration of oxygenated and deoxygenated haemoglobin, over an activated area is followed by the validation of changes in the cytochrome-oxidase redox state in response to a visual stimulus. Proceeding from these findings a rough mapping of this metabolic response over the motion-sensitive extrastriate visual area is demonstrated. NIRS measures concentration changes in deoxygenated haemoglobin [deoxy-Hb] which are assumed to be the basis of fMRI BOLD contrast (blood oxygenation level-dependent). The method is therefore an excellent tool to validate assumptions on the physiological basis underlying the fMRI signal, due to its high specificity as to the parameters measured. Questions concerning the concept of 'activation'/'deactivation' and that of the linearity of the vascular response are discussed. To challenge the method we finally present results from a complex single-trial motor paradigm study testing the hypothesis, that premotor potentials (contingent negative variation) can be examined by functional techniques relying on the vascular response. Some of the work described here has been published elsewhere.

Changes in cerebral blood volume with changes in position in awake and anesthetized subjects

Changes in posture affect cerebral blood volume (CBV), and moderate head-up tilt is used as a therapeutic maneuver to reduce CBV and intracranial pressure. However, CBV is rarely measured in the clinical setting. Near-infrared spectroscopy allows real-time bedside monitoring of cerebral hemodynamics, and we have used this technique to measure changes in CBV with changes in posture in 10 normal subjects and 10 propofol-anesthetized patients. In the awake subjects, changes in CBV were correlated with the degree of table tilt. CBV decreased with 18 degrees head-up tilt and increased with 18 degrees head-down tilt (P < 0.0001, r = -0.924). In anesthetized patients, there were differences between head-up and head-down tilt. In the head-down position, CBV was also correlated with the degree of table tilt (P < 0.001, r = -0.782), whereas there was a clinically insignificant reduction in CBV in the head-up position. Near-infrared spectroscopy allows continuous, real time measurement of changes in CBV at the bedside.

IMPLICATIONS

Near-infrared spectroscopy, a bedside technique, has been used to measure changes in cerebral blood volume in normal subjects. We have used the same technique in anesthetized patients and have shown that, when a patient is placed in the head up position, the decrease in cerebral blood volume is attenuated, relative to normal subjects.

On-line optical imaging of the human brain with 160-ms temporal resolution

We have developed an instrument for non-invasive optical imaging of the human brain that produces on-line images with a temporal resolution of 160 ms. The imaged quantities are the temporal changes in cerebral oxy-hemoglobin and deoxy-hemoglobin concentrations. We report real-time videos of the arterial pulsation and motor activation recorded on a 4 x 9 cm 2 area of the cerebral cortex in a healthy human subject. This approach to optical brain imaging is a powerful tool for the investigation of the spatial and temporal features of the optical signals collected on the brain.

Activation of the visual cortex imaged by 24-channel near-infrared spectroscopy

Near-infrared spectroscopy (NIRS) is a noninvasive technique for continuous monitoring of the amounts of total hemoglobin (total-Hb), oxygenated hemoglobin, (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb). The purpose of the present study was to demonstrate the utility of NIRS in functional imaging of the human visual cortex. A new NIRS imaging system enabled measurements from 24 scalp locations covering a 9 cm sq area. Topographic images were obtained from interpolations of the concentration changes between measurement points. Five healthy subjects between 25 and 49 years of age were investigated. After a resting baseline period of 50 s, the subjects were exposed to a visual stimulus for 20 s, followed by a 50 s resting period in a dimly lit, sound attenuating room. The visual stimulus was a circular, black and white, alternating checkerboard. In four of five subjects the visual cortex was the most activated area during visual stimulation. This is the first reported use of a NIRS-imaging system for assessing hemodynamic changes in the human visual cortex. The typical hemodynamic changes expected were observed; the total-Hb and oxy-Hb increased just after the start of stimulation and plateaued after 10 s of the stimulation period.

Temporal cortex activation during speech recognition: an optical topography study

Cortical activity during speech recognition was examined using optical topography (OT), a recently developed non-invasive technique. To assess relative changes in hemoglobin oxygenation, local changes in near-infrared light absorption were measured simultaneously from 44 points in both hemispheres. A dichotic listening paradigm was used in this experiment, in which target stimuli and non-target stimuli were presented to different ears. Subjects were asked to track targets and to press a button when targets shifted from one ear to the other. We compared three tasks: (i) a control task, in which a tone was used as the target; (ii) a repeat task, in which the target was one repeated sentence; (iii) a story task, in which the targets were continuous sentences of a story. The activity for the story task, compared with the repeat task, was localized in the left superior temporal cortex. Relative to the control task, we observed in this region a larger increase in oxyhemoglobin concentration and a decrease in deoxyhemoglobin concentration in the story task than those in the repeat task. These results suggest that the activity in the left temporal association area reflects the load of auditory, memory, and language information processing.

Measurement system for noninvasive dynamic optical topography

We have developed a 24-channel simultaneous measurement system for optical topography that noninvasively obtains dynamic images of brain activity using near-infrared light. To evaluate the system performance, we utilized a dynamic phantom containing a rotating absorber in a cylindrical scattering medium. In this system, eight incident and eight detecting optical fibers are arranged alternately at square lattice points on the phantom. The phantom is illuminated with light of two wavelengths (780 and 830 nm) from each incident fiber. Reflected light is received by the detecting fibers, each of which is connected to an avalanche photodiode. Multiple light intensity modulation and lock-in detection are used to enable highly sensitive measurement with negligible cross talk for multichannel measurement. In the phantom measurement, we obtained topographic dynamic images of the absorber rotating in the medium with a temporal resolution of 0.5 s over a measurement area of 90 mm×90 mm. © 1999 Society of Photo-Optical Instrumentation Engineers.

Higher-order brain function analysis by trans-cranial dynamic near-infrared spectroscopy imaging

Near-infrared spectroscopy is discussed from the viewpoint of human higher-order brain function analysis. Pioneering work in this field is reviewed; then we describe our concept of noninvasive trans-cranial dynamic optical topography and its instrumentation. Also, the validity of its functional images is assessed from both physical and physiological viewpoints. After confirming the validity of this method, we have applied it to a wide variety of fields such as clinical medicine, cognitive science, and linguistics in collaboration with researchers at several other institutes. Further application possibilities and the future of trans-cranial dynamic optical topography are also discussed. © 1999 Society of Photo-Optical Instrumentation Engineers.

Near-infrared oximetry of the brain

Near-infrared (IR) light easily penetrates biological tissue, and the information offered by in vivo spectroscopy of cerebral oxygenation is detailed and comes with a high temporal resolution. Near-IR light spectroscopy (NIRS) reflects cerebral oxygenation during arterial hypotension, hypoxic hypoxaemia and hypo- and hypercapnia. As determined by dual-wavelength NIRS, the cerebral O2 saturation integrates the arterial O2 content and the cerebral perfusion, and as established for skeletal muscle, NIRS obtains information on tissue oxygenation and metabolism beyond that obtained by venous blood sampling. Caveats of cerebral NIRS include insufficient light shielding, optode displacement and a sample volume including muscle or the frontal sinus mucous membrane. The relative influence from the extracranial tissue is minimized by optode separation and correction for an extracranial sample volume, or both. The natural pigment melatonin and also water are of little influence to spectroscopic analysis of cerebral oxygenation, whereas bilirubin systematically lowers ScO2 and attenuates the detection of changes in cerebral oxygenation. By NIRS, reduction of cytochrome oxidase is demonstrated during hypoxic hypoxaemia and head-up tilt-induced arterial hypotension, but the changes are small. In the clinical setting, NIRS offers useful information in patients with both systemic and local cerebral circulatory impairment, for example, during cranial trauma, surgery on the cerebral arteries, orthostasis and acute heart failure. Whereas mapping of the brain circulation is needed for jugular venous sampling to reflect either global or local oxygenation, the determination of cerebral oxygenation by NIRS has the advantage of localized monitoring of the cerebral cortex.

Near-infrared monitoring of tissue oxygenation during application of lower body pressure at rest and during dynamical exercise in humans

During the application of a wide range of graded lower body pressures (LBP) (-50 to 50 mmHg), we examined how (1) the tissue oxygenation in the lower and upper parts of the body changes at rest, and (2) how tissue oxygenation changes in the lower extremities during dynamical leg exercise. We used near-infrared spectroscopy (NIRS) to measure the changes induced by LBP in total Hb content and Hb oxygenation in seven subjects. At rest, total Hb increased and Hb oxygenation decreased in the thigh muscles during -25 and -50 mmHg LBP, while both decreased during +25 and +50 mmHg LBP. However, in the forearm muscles during graded LBP, the pattern of change in total Hb was the reverse of that in the thigh. Measurements from the forehead showed changes only during +50 mmHg LBP. These results demonstrated that the pattern of change in total Hb and Hb oxygenation differed between upper and lower parts with graded LBP at rest. During dynamical leg exercise, total Hb and Hb oxygenation in the thigh muscles decreased during stepwise increases in LBP above -25 mmHg, Hb oxygenation decreasing markedly during +50 mmHg LBP. These results suggest that during dynamical exercise (i) LBP at +25 mmHg or more causes a graded decline in blood volume and/or flow in the thigh muscles, and (ii) especially at +50 mmHg LBP, the O2 content may decrease markedly in active muscles. Our results suggest that NIRS can be used to monitor in a non-invasive and continuous fashion the changes in oxygenation occurring in human skeletal muscles and head during the graded changes in blood flow and/or volume caused by changes in external pressure and secondary reflexes both at rest and during dynamical exercise.

Exploring brain function with magnetic resonance imaging

Since its invention in the early 1990s, functional magnetic resonance imaging (fMRI) has rapidly assumed a leading role among the techniques used to localize brain activity. The spatial and temporal resolution provided by state-of-the-art MR technology and its non-invasive character, which allows multiple studies of the same subject, are some of the main advantages of fMRI over the other functional neuroimaging modalities that are based on changes in blood flow and cortical metabolism. This paper describes the basic principles and methodology of fMRI and some aspects of its application to functional activation studies. Attention is focused on the physiology of the blood oxygenation level-dependent (BOLD) contrast mechanism and on the acquisition of functional time-series with echo planar imaging (EPI). We also provide an introduction to the current strategies for the correction of signal artefacts and other image processing techniques. In order to convey an idea of the numerous applications of fMRI, we will review some of the recent results in the fields of cognitive and sensorimotor psychology and physiology.

Continuous measurement of cerebral oxygenation by near infrared spectroscopy during induction of anesthesia

Near infrared spectroscopy (NIRS) measures tissue oxygenation continuously at the bedside. Major disturbances of cerebral oxygenation can be detected by using NIRS, but the ability to observe smaller changes is poorly documented. Although anesthetics generally depress cerebral metabolism and enhance oxygen delivery, the administration of etomidate has been associated with cerebral desaturation. We used this difference to study the ability of NIRS to detect the small changes associated with the onset of anesthesia. Thirty-six healthy patients were randomly allocated to have anesthesia induced with either etomidate, propofol, or thiopental. We found that there was a temporal association between the onset of anesthesia and NIRS-derived indices of cerebral oxygenation. Etomidate was associated with a decrease in cerebral oxygenation, whereas propofol and thiopental were associated with an increase in cerebral oxygenation. We conclude that NIRS is capable of detecting the small changes in cerebral oxygenation associated with the induction of general anesthesia and shows promise as a bedside investigational tool for the noninvasive assessment of cerebral oxygenation.

IMPLICATIONS

We conclude that near infrared spectroscopy is capable of detecting the small changes in cerebral oxygenation associated with the induction of general anesthesia and shows promise as a bedside investigational tool for the noninvasive assessment of cerebral oxygenation.

Use of mitochondrial inhibitors to demonstrate that cytochrome oxidase near-infrared spectroscopy can measure mitochondrial dysfunction noninvasively in the brain

The use of near-infrared spectroscopy to measure noninvasively changes in the redox state of cerebral cytochrome oxidase in vivo is controversial. We therefore tested these measurements using a multiwavelength detector in the neonatal pig brain. Exchange transfusion with perfluorocarbons revealed that the spectrum of cytochrome oxidase in the near-infrared was identical in the neonatal pig, the adult rat, and in the purified enzyme. Under normoxic conditions, the neonatal pig brain contained 15 micromol/L deoxyhemoglobin, 29 micromol/L oxyhemoglobin, and 1.2 micromol/L oxidized cytochrome oxidase. The mitochondrial inhibitor cyanide was used to determine whether redox changes in cytochrome oxidase could be detected in the presence of the larger cerebral hemoglobin concentration. Addition of cyanide induced full reduction of cytochrome oxidase in both blooded and bloodless animals. In the blooded animals, subsequent anoxia caused large changes in hemoglobin oxygenation and concentration but did not affect the cytochrome oxidase near-infrared signal. Simultaneous blood oxygenation level-dependent magnetic resonance imaging measurements showed a good correlation with near-infrared measurements of deoxyhemoglobin concentration. Possible interference in the near-infrared measurements from light scattering changes was discounted by simultaneous measurements of the optical pathlength using the cerebral water absorbance as a standard chromophore. We conclude that, under these conditions, near-infrared spectroscopy can accurately measure changes in the cerebral cytochrome oxidase redox state.

Non-invasive assessment of language dominance with near-infrared spectroscopic mapping

Hemispheric dominance for language is usually assessed by means of the Wada test where amobarbital is injected into the carotid artery. Recently, positron emission tomography and functional MRI have been used as non-invasive alternatives to this method. We have applied 24-channel near-infrared spectroscopic topography (NIRS) as another non-invasive method to detect the unilateral cerebral activation during a language task. We used 11 healthy volunteers and six patients with intractable epilepsy. A word-generation task was applied for 17 s, followed by an extinction/resting period of 60 s. In healthy volunteers, the inferior frontal region was activated on the side opposite to the subject's handedness in infancy. In the epilepsy cases, the activated side agreed with the dominance determined by the Wada test. Our results demonstrate that NIRS is a feasible non-invasive alternative to the Wada test.

Refractory periods observed by intrinsic signal and fluorescent dye imaging

All perfusion-based imaging modalities depend on the relationship between neuronal and vascular activity. However, the relationship between stimulus and response was never fully characterized. With the use of optical imaging (intrinsic signals and intravascular fluorescent dyes) during repetitive stimulation paradigms, we observed reduced responses with temporally close stimuli. Cortical evoked potentials, however, did not produce the same reduced responsiveness. We therefore termed these intervals of reduced responsiveness "refractory periods." During these refractory periods an ability to respond was retained, but at a near 60% reduction in the initial magnitude. Although increasing the initial stimulus duration lengthened the observed refractory periods, significantly novel or temporally spaced stimuli overcame them. We observed this phenomenon in both rodent and human subjects in somatosensory and auditory cortices. These results have significant implications for understanding the capacities, mechanisms, and distributions of neurovascular coupling and thereby possess relevance to all perfusion-dependent functional imaging techniques.

A model for the regulation of cerebral oxygen delivery

On the basis of the assumption that oxygen delivery across the endothelium is proportional to capillary plasma PO2, a model is presented that links cerebral metabolic rate of oxygen utilization (CMRO2) to cerebral blood flow (CBF) through an effective diffusivity for oxygen (D) of the capillary bed. On the basis of in vivo evidence that the oxygen diffusivity properties of the capillary bed may be altered by changes in capillary PO2, hematocrit, and/or blood volume, the model allows changes in D with changes in CBF. Choice in the model of the appropriate ratio of Omega identical with (DeltaD/D)/(DeltaCBF/CBF) determines the dependence of tissue oxygen delivery on perfusion. Buxton and Frank (J. Cereb. Blood Flow. Metab. 17: 64-72, 1997) recently presented a limiting case of the present model in which Omega = 0. In contrast to the trends predicted by the model of Buxton and Frank, in the current model when Omega > 0, the proportionality between changes in CBF and CMRO2 becomes more linear, and similar degrees of proportionality can exist at different basal values of oxygen extraction fraction. The model is able to fit the observed proportionalities between CBF and CMRO2 for a large range of physiological data. Although the model does not validate any particular observed proportionality between CBF and CMRO2, generally values of (DeltaCMRO2/CMRO2)/(DeltaCBF/CBF) close to unity have been observed across ranges of graded anesthesia in rats and humans and for particular functional activations in humans. The model's capacity to fit the wide range of data indicates that the oxygen diffusivity properties of the capillary bed, which can be modified in relation to perfusion, play an important role in regulating cerebral oxygen delivery in vivo.

Age correlation of the time lag in signal change on EPI-fMRI

PURPOSE

We measured the time lags between the start or end of tasks and signal changes in functional MRI (fMRI) for various age groups and evaluated the age correlation of the time lags.

METHODS

Forty subjects, 20-76 years old, were evaluated. fMRI was performed with and echo planar imaging sequence at 0.5 s intervals. We measured the time for the signal of the precentral gyrus to make a half-maximal increase after starting the task (T-inc) and the time to reach the initial level after ceasing the task (T-dec).

RESULTS

Average T-inc was 3.09 s and T-dec was 6.63 s. The values of T-inc could be correlated to age. T-dec had no age correlation.

CONCLUSION

The time lag in fMRI was revealed to be prolonged with increasing age. Our results suggest that the time lag in fMRI is influenced by some factors associated with aging.

Sensitivity of near infrared spectroscopy to cerebral and extra-cerebral oxygenation changes is determined by emitter-detector separation

OBJECTIVE

To examine the effect of two emitter-detector separations (2.7 and 5.5 cm) on the detection of changes in cerebral and extra-cerebral tissue oxygenation using near infrared spectroscopy (NIRS).

METHODS

Two NIR detectors were placed on the scalp 2.7 and 5.5 cm from a single NIR emitter. Changes in deoxyhaemoglobin (HHb), oxyhaemoglobin (O2Hb),oxidised cytochrome C oxidase (Cyt) and total haemoglobin (tHb) were recorded from each detector during the induction of cerebral oligaemia (transition from hypercapnia to hypocapnia) and scalp hyperaemia (following release of a scalp tourniquet).

RESULTS

Cerebral oligaemia (mean decrease in middle cerebral artery blood flow velocity of 44%) induced by a mean reduction in end tidal CO2 of 18 mmHg was accompanied by a significant increase in the spectroscopic signal for HHb and a decrease in the O2Hb signal. The signal change per unit photon path length detected at 5.5 cm was significantly greater for HHb (p = 0.007) than that detected at 2.7 cm. In contrast, the increase in all chromophores detected at 5.5 cm during scalp hyperaemia was significantly less than that detected at 2.7 cm (p<0.001).

CONCLUSIONS

The differing sensitivity of the proximal and distal channels to changes in cerebral and extracerebral oxygenation is compatible with theoretical models of NIR light transmission in the adult head and may provide a basis for spatially resolving these changes. The optimal emitter-detector separation for adult NIRS requires further investigation and may differ between individuals.

A theoretical study of the signal contribution of regions of the adult head to near-infrared spectroscopy studies of visual evoked responses

Near-infrared (NIR) spectroscopy has been used in studies of the cerebral hemodynamic response to visual processing. In this paper, we present theoretical results from finite element and Monte Carlo modeling in order to help understand the contribution to the NIR signal from different parts of the head. The results from the models show that at the typical optode spacings used in these studies, an infrared spectroscopy measurement of intensity is sensitive to the outer 1-2 mm of the cortical gray matter and the partial optical path length in the gray matter is approximately 10 mm, compared with a total optical path length of 400 mm. When the NIR measurement is of change in mean photon arrival time (or phase shift), the signal comes from the upper 2-4 mm of the cortical surface and there is an increased lateral spread of the contributing tissue. We predict that for a 4-cm separation of input and detection optodes at 800 nm, a 1 microM change in hemoglobin concentration in the cortex corresponds to an attenuation change of approximately 0.001 OD (optical density) or 1 ps mean time change. Movement of the brain caused by this increase in volume will cause an absorption change of approximately half this magnitude, but does not affect the photon arrival time at 4-cm spacing. A discrepancy between the predicted and the experimentally measured intensities may support the supposition that the NIR signal is actually very sensitive to changes occurring in the pial cerebral vessels lying on the brain surface.

On the characteristics of functional magnetic resonance imaging of the brain

In this review we discuss various recent topics that characterize functional magnetic resonance imaging (fMRI). These topics include a brief description of MRI image acquisition, how to cope with noise or signal fluctuation, the basis of fMRI signal changes, and the relation of MRI signal to neuronal events. Several observations of fMRI that show good correlation to the neurofunction are referred to. Temporal characteristics of fMRI signals and examples of how the feature of real time measurement is utilized are then described. The question of spatial resolution of fMRI, which must be dictated by the vascular structure serving the functional system, is discussed based on various fMRI observations. Finally, the advantage of fMRI mapping is shown in a few examples. Reviewing the vast number of recent fMRI application that have now been reported is beyond the scope of this article.

Regional hemodynamic responses to visual stimulation in awake infants

This study presents the first measurements using near infrared spectroscopy of changes in regional hemodynamics as a response to a visual stimulus in awake infants. Ten infants aged 3 d to 14 wk viewed a checkerboard with a 5-Hz pattern reversal. The emitter and detector (optodes) of a near infrared spectrophotometer were placed over the occipital region of the head. Changes in concentration of oxy- and deoxyhemoglobin (Hbo2 and Hb) were measured and compared during 10-s epochs of stimulus on and off. A control group of 10 infants aged 18 d to 13 wk were examined with the same setup, but with the optodes over the frontoparietal region. In the test group the total hemoglobin concentration (Hbo2 + Hb) increased while the stimulus was on by a mean (+/-SD) of 2.51 (+/-1.48) micromol x L(-1). Nine out of 10 infants showed an Hbo2 increase, and 9 out of 10 an Hb increase related to the stimulus. There was no significant change in any of these parameters in the control group. The results imply that there is increased cerebral blood flow due to stimulation that is specific to the visual cortex and that infants, unlike adults, show increased cerebral oxygen utilization during activation that outstrips this hemodynamic effect. The study demonstrates that near infrared spectroscopy can be used as a practical and noninvasive method of measuring visual functional activation and its hemodynamic correlates in the awake infant.

Functional activation of cerebral blood flow after cardiac arrest in rat

After a period of global cerebral ischemia, CO2 reactivity and the hemodynamic-metabolic activation to functional stimulation are transiently suppressed. This raises the question of whether the impaired functional coupling reflects disturbances of functional integrity of the brain or an impaired cerebrovascular reactivity. We, therefore, compared the recovery of CO2 reactivity with that of somatosensory evoked potentials, functional flow activation and neurologic deficits in a rodent model of cardiac arrest-induced cerebral ischemia, followed by up to 7 days of reperfusion. Cardiac arrest of 10 minutes' duration was produced in 24 animals by electrical fibrillation of the heart. Five animals were sham-operated controls. Resuscitation was performed by external cardiac massage, using standard resuscitation procedures. Functional activation was carried out under chloralose anesthesia by electrical stimulation of forepaws. CO2 reactivity was tested by ventilation of animals with 6% CO2. During functional and hypercapnic stimulation CBF was measured in the somatosensory cortex using laser-Doppler flowmetry, and at the end of the experiment by 14C-iodoantipyrine autoradiography. Neurologic deficits were scored by evaluating consciousness and various sensory and motor functions. In control animals 6% CO2 increased CBF measured by laser-Doppler flowmetry by 28.8% +/- 8.7%. Forepaw stimulation generated somatosensory evoked potentials with an amplitude of 750 +/- 217 microV and increased CBF measured by laser-Doppler flowmetry by 86.0% +/- 18.1%. After return of spontaneous circulation, CO2 reactivity was transiently reduced to about 30% of control at 1 hour of reperfusion (P < 0.05) but returned to near control at 5 hours. Somatosensory evoked potential amplitudes were reduced to 15% of control at 45 minutes of reperfusion and returned to only 50% to 60% at 3 and 7 days after return of spontaneous circulation (P < 0.05). Functional activation of blood flow was completely suppressed during the first hour after return of spontaneous circulation but also recovered to 50% to 60% of control at 3 days after return of spontaneous circulation (P < 0.05). Linear regression analysis revealed a significant correlation between recovery of functional activation of blood flow and both recovery of the amplitude of somatosensory evoked potentials (P = 0.03) and the neurologic deficit score (P = 0.02), but not between neurologic deficit score and recovery of CO2 reactivity or somatosensory evoked potential amplitudes. These data demonstrate that the suppression of functional activation of blood flow after 10 minutes cardiac arrest is not related to impairment of coupling mechanisms but reflects ongoing disturbances of the functional integrity of the brain. Assessment of functional flow coupling is a reliable way to study postischemic recovery of the brain.

Fast and localized event-related optical signals (EROS) in the human occipital cortex: comparisons with the visual evoked potential and fMRI

Localized evoked activity of the human cortex produces fast changes in optical properties that can be detected noninvasively (event-related optical signal, or EROS). In the present study a fast EROS response (latency approximately 100 ms) elicited in the occipital cortex by visual stimuli showed spatial congruence with fMRI signals and temporal correspondence with VEPs, thus combining subcentimeter spatial localization with subsecond temporal resolution. fMRI signals were recorded from striate and extrastriate cortex. Both areas showed EROS peaks, but at different latencies after stimulation (100 and 200-300 ms, respectively). These results suggest that EROS manifests localized neuronal activity associated with information processing. The temporal resolution and spatial localization of this signal make it a promising tool for studying the time course of activity in localized brain areas and for bridging the gap between electrical and hemodynamic imaging methods.

Non-invasive optical spectroscopy and imaging of human brain function

Brain activity is associated with changes in optical properties of brain tissue. Optical measurements during brain activation can assess haemoglobin oxygenation, cytochrome-c-oxidase redox state, and two types of changes in light scattering reflecting either membrane potential (fast signal) or cell swelling (slow signal), respectively. In previous studies of exposed brain tissue, optical imaging of brain activity has been achieved at high temporal and microscopical spatial resolution. Now, using near-infrared light that can penetrate biological tissue reasonably well, it has become possible to assess brain activity in human subjects through the intact skull non-invasively. After early studies employing single-site near-infrared spectroscopy, first near-infrared imaging devices are being applied successfully for low-resolution functional brain imaging. Advantages of the optical methods include biochemical specificity, a temporal resolution in the millisecond range, the potential of measuring intracellular and intravascular events simultaneously and the portability of the devices enabling bedside examinations.

Noninvasive near infrared spectroscopy monitoring of regional cerebral blood oxygenation changes during peri-infarct depolarizations in focal cerebral ischemia in the rat

Intermittent peri-infarct depolarizations (PID), which spread from the vicinity of the infarction over the cortex, have been reported in focal ischemia. These depolarizations resemble cortical spreading depression except that they damage the cortex and enlarge the infarct volume possibly because of compromised oxygen delivery. The main purpose of this study was to evaluate the noninvasive technique of near-infrared spectroscopy (NIRS) for the identification of PID and to evaluate its capability for further pathophysiological studies. We used male barbiturate-anesthetized Wistar rats (n = 10) in which middle cerebral artery occlusion had been performed with a surgical thread. Middle cerebral artery occlusion resulted in a drop in parietally measured regional cerebral blood flow (laser Doppler flowmetry) to 31 +/- 8% of baseline flow. Six +/- 4 minutes after the induction of focal ischemia, 5 +/- 2 direct current deflections were recorded during a one-hour measurement period which may be regarded as PID. Measuring regional cerebral blood oxygenation changes with a NIRO 500 revealed dynamic concentration changes in the three chromophores oxyhemoglobin [HbO2], deoxyhemoglobin [Hb], and the oxidized form of cytochrome aa3 [CytO] during PID. Typically, an initial slight decrease of [HbO2] (-6.1 +/- 1.7 arbitrary units [AU] and an increase of [Hb] (+11.5 +/- 7.7 AU) were followed by an increase of [HbO2] (+10.8 +/- 4.7 AU) and a decrease of [Hb] (-4.7 +/- 5.5 AU); [CytO] decreased during the depolarizations (-2.0 +/- 1.2 AU). We conclude that NIRS can detect typical PID-associated changes in blood oxygenation. We hypothesize that during the course of PID, unlike "normal" spreading depression, hypoxygenation precedes hyperoxygenation of the microcirculation in a given cortex volume as the depolarization wave propagates through hemodynamically compromised to intact tissue. This would accord with the known damaging effect of PID. The NIRS "fingerprint" of PID encourages the search for PID during early stroke in patients.

Monte Carlo simulations and laser Doppler flow measurements with high penetration depth in biological tissuelike head phantoms

Laser Doppler flow measurements on biological tissuelike phantoms have shown that penetration depths of 30 mm could be obtained, thus exceeding the penetration depth of commercial instruments for the measurement of skin perfusion by more than an order of magnitude. Monte Carlo simulations were performed and compared with measurement results obtained on a headlike tissue model to quantify the influence of perfusion of the scalp on the cortex perfusion results. We found Doppler frequency spectra to be independent of the mean scattering angle and could be fitted with a sum of Gaussian functions, using a simple analytical model.

Excessive oxygen or glucose supply does not alter the blood flow response to somatosensory stimulation or spreading depression in rats

We investigated the influence of hyperoxia (arterial pO2 446 +/- 43 mmHg) and hyperglycemia (blood glucose 19.4 mmol/l) on somatosensory stimulation (whisker deflection) employing laser Doppler flowmetry (LDF). Our aim was to test the hypothesis that a possible substrate-sensing mechanism for glucose and oxygen contributes to the coupling between cortical activity and regional cerebral blood flow (rCBF) in order to match increased demand with substrates. In addition, we looked at the influence of hyperglycemia (blood glucose 17.9 mmol/l) and hypercapnia (arterial pCO2 62 mmHg) on rCBF (LDF) and regional cerebral blood oxygenation changes (rCBO) in the even stronger metabolic stimulus of cortical spreading depression (CSD). For the latter we employed the new non-invasive technique of near infrared spectroscopy (NIRS). All experiments were done using chloralose/urethane-anesthetized rats. Somatosensory stimulation increased rCBF by about 20% of baseline, in the case of both norm- and hyperoxia as well as both normo- and hyperglycemia. The blood-flow response to CSD consisted of a temporary sharp increase in rCBF to more than 400%. At the same time, the concentration of oxyhemoglobin [HbO2] increased, while deoxyhemoglobin [Hb] decreased, indicating excessive oxygenation. Hyperglycemia altered neither the rCBF nor the rCBO response. Preexisting hypercapnia, however, produced reductions in both hyperperfusion (rCBF) and hyperoxygenation (rCBO) during CSD. We found that, for experimental hyperglycemia, i.v. may be superior to i.p. application of glucose because of the latter's side effects in connection with blood flow. Our findings cannot support the hypothesis of a substrate sensing mechanism in coupling.

Loss of functional hemispheric asymmetry in Alzheimer's dementia assessed with near-infrared spectroscopy

In a total of 10 patients with dementia of the Alzheimer-type (DAT) and in 10 healthy controls near-infrared spectroscopy (NIRS), a new non-invasive optical method, was used to measure the changes of concentrations of oxy- (O2HB) and deoxyhemoglobin (HHB) in left and right hemispheric prefrontal brain tissue areas during performance of the Verbal Fluency Test (VFT). On a neuropsychological level, the healthy subjects performed better in the VFT than patients with DAT. Statistical analysis of the relative concentrations of O2HB and HHB measured with NIRS during performance of the VFT revealed a significant interaction of the hemispheric effects with the diagnosis. A possible interpretation of this finding is that a good performance in the VFT relies on a predominantly left hemispheric activation observed in controls, whereas a low number of correct responses is associated with a loss of this asymmetric activation in patients with DAT. Although both, patients and controls, performed better in the category version of the VFT, the metabolic effects of this task were significantly less pronounced than in the letter version. This indicates that different energy demands, according to the type of access to the memory stores, may be interpreted as the result of a less energy-demanding access to categorically stored information and adds further evidence to the view that memory departments in humans are organized according to categorical principles.

Fluctuations in the cerebral oxygenation state during the resting period in functional mapping studies of the human brain

Functional mapping studies using near-infrared spectroscopy have detected for the first time the existence of significant fluctuations in the concentration of cerebral oxygenated [oxy-Hb], and deoxygenated haemoglobin, [deoxy-Hb], during the resting period. The fluctuations are not related to alterations in the systemic circulatory system. The temporal pattern varies with each brain region. In some instances, the degrees of change in [oxy-Hb] and [deoxy-Hb] caused by highly integrated tasks are within this resting variation range. Thus, taking account of these fluctuations is essential to the interpretation of distribution patterns of cerebral activity.

Localized near-infrared spectroscopy and functional optical imaging of brain activity

Changes in cerebral blood flow (CBF) and cerebral metabolic rates (CMRO2) have been used as indices for changes in neuronal activity. Near-infrared spectroscopy (NIRS) can also measure cerebral haemodynamics and metabolic changes, enabling the possible use of multichannel recording of NIRS for functional optical imaging of human brain activity. Spatio-temporal variations of brain regions were demonstrated during various mental tasks. Non-synchronous behaviour of cerebral haemodynamics during the neuronal activation was observed. Gender- and handedness-dependent lateralization of the function between right and left hemispheres was demonstrated by simultaneous measurement using two NIR instruments during the mirror-drawing task. A lack of interhemispheric integration was observed with schizophrenic patients. These observations suggest an application for NIRS in psychiatric disease management, as an addition to clinical monitoring at the bedside. A time resolved 64-channel optical imaging system was constructed. This consisted of three picosecond laser diodes and 64 channels of TAC and CFD systems. Image reconstruction for phantom model systems was performed. Time-resolved quantitative optical imaging will become real in the very near future.

Cerebral haemoglobin oxygenation during sustained visual stimulation--a near-infrared spectroscopy study

Using near-infrared spectroscopy, we investigated the time-course of the concentrations of oxygenated haemoglobin, [oxy-Hb], and deoxygenated haemoglobin [deoxy-Hb], in the occipital cortex of healthy human adults during standard sustained visual stimulation. Within a few seconds after stimulation (by coloured dodecahedron), we observed a decrease in [deoxy-Hb], peaking after 13 s ('initial undershoot'). In the subsequent 1-2 min, in seven out of ten subjects, [deoxy-Hb] gradually returned to a plateau closer to the baseline level. After cessation of stimulation, there was a 'post-stimulus overshoot' in [deoxy-Hb]. There was a statistically significant correlation between the size of the 'initial undershoot' and the post-stimulus overshoot'. The concentration of oxyhaemoglobin increased upon functional activation. However, in the mean across all subjects there was no 'initial overshoot'. After approximately 19 s it reached a plateau and remained constantly elevated throughout the activation period. After cessation of activation there was a 'post-stimulus undershoot' of oxyhaemoglobin. It is important to consider the time-course of haemoglobin oxygenation when interpreting functional activation data, especially those data obtained with oxygenation-sensitive methods, such as BOLD-contrast fMRI.

A hypercapnia-based normalization method for improved spatial localization of human brain activation with fMRI

An issue in blood oxygenation level dependent contrast-based functional MRI is the accurate interpretation of the activation-induced signal changes. Hemodynamic factors other than activation-induced changes in blood oxygenation are known to contribute to the signal change magnitudes and dynamics, and therefore need to be accounted for or removed. In this paper, a general method for removal of effects other than activation-induced blood oxygenation changes from fMRI brain activation maps by the use of hypercapnic stress normalization is introduced. First, the effects of resting blood volume distribution across voxels on activation-induced BOLD-based fMRI signal changes are shown to be significant. Second, the effects of hypercapnia and hypoxia on resting and activation-induced signal changes are demonstrated. These results suggest that global hemodynamic stresses may be useful for non-invasive mapping of blood volume. Third, the normalization technique is demonstrated.

Decrease in parietal cerebral hemoglobin oxygenation during performance of a verbal fluency task in patients with Alzheimer's disease monitored by means of near-infrared spectroscopy (NIRS)--correlation with simultaneous rCBF-PET measurements

We used near-infrared spectroscopy (NIRS) to study non-invasively changes in cerebral hemoglobin oxygenation in the frontal and parietal cortex during performance of a verbal fluency task in patients with Alzheimer's disease (AD). Whereas healthy elderly subjects (n = 19, age 67 +/- 10 years) showed increases in concentrations of oxygenated hemoglobin [HbO2] (mean (arbitrary units) +/- S.E.M., 1.44 +/- 0.59) and total hemoglobin [HbT] (0.92 +/- 0.81) over the left superior parietal cortex, patients with AD (n = 19, age 71 +/- 10 years) showed significant decreases in [HbO2] (-3.26 +/- 1.30, P < 0.01) as well as [HbT] (-4.45 +/- 1.57, P < 0.01). [HbR] decreased slightly in both groups (-0.62 +/- 0.29 and - 1.18 +/- 0.40, respectively). Using two pairs of NIRS optodes placed on the left superior partietal cortex and on the left prefrontal cortex simultaneous increases in [HbO2] as well as [HbT] in both cortical regions in the healthy elderly subjects (n = 8, age 60 +/- 15) were demonstrated during performance of the task. AD patients (n = 10, age 65 +/- 13 years) showed decreases in [HbO2] and [HbT] in the parietal cortex and, at the same time, increases in [HbO2] and [HbT] in the frontal cortex. Simultaneous NIRS-[HbT] and PET-rCBF measurements showed a significant correlation both when calculated in a 'banana' shaped volume approximated by using cortical thresholds as well as when calculated in a semisphere volume of brain tissue beneath the optodes placed on the head surface (patients with AD, n = 10). The correlation was dependent on the assumed penetration depth of the near-infrared light and was best for all three NIRS variables ([HbO2], [HbR] and [HbT]) when calculated using a semisphere radius of 0.45 cm to 1.35 cm. In conclusion, in Alzheimer's disease a marked reduction of regional cerebral blood flow and cerebral hemoglobin oxygenation may occur during activation of brain function, probably mainly in degenerating brain areas, such as the parietal cortex.

Near-infrared optical detection of sequential brain activation in the prefrontal cortex during mental tasks

To examine the spatiotemporal differences of brain activation during mental tasks, changes in the oxygenation and hemodynamics in two regions of the prefrontal cortex were measured simultaneously by near-infrared spectroscopy (NIRS). Subjects were eight healthy adults who attempted to solve three different mathematical problems. The behavior of concentration changes in oxy-, deoxy-, and total hemoglobin in one brain region varied with the time course (more than 10 min). This suggested that regional brain activity varied during the performance of the mental task. In each single subject, the pattern of these changes varied with each problem, and this variation differed from subject to subject. When NIRS traces in two regions were compared, it was seen that activated regions moved alternatively: when in one region total hemoglobin that had first increased returned to the resting level, in the other it started to increase. These region-dependent temporal variations of brain activity might reflect mental processes. It is thus concluded that NIRS has the potential for imaging the sequence of brain activation.

Right frontal activation during the continuous performance test assessed with near-infrared spectroscopy in healthy subjects

Near-infrared spectroscopy (NIRS) is a non-invasive optical technique which has been successfully used to register substantial cerebral ischemia. There are indications that NIRS is sensible enough to detect also small metabolic changes during the performance of cognitive tasks. In the present study, two-channel NIRS of left and right anterior frontal brain areas was applied to investigate brain oxygenation of 10 healthy subjects carrying out the continuous performance test (CPT). Significant differences between the left and right hemisphere were found. These consisted of different changes in deoxyhaemoglobin (HHB), but not in oxyhaemoglobin (O2HB) in right frontal brain areas compared to baseline during the test. Despite of some methodological restrictions, the findings suggest that the sensitivity of the NIRS-method is sufficient to detect brain oxygenation changes during cognitive activation. Furthermore, the results support the view that execution of the CPT is associated with prevalently right frontal activation.