A 4D neonatal head model for diffuse optical imaging of pre-term to term infants

Developmental changes in neonatal hemodynamics during tactile stimulation using whole-head functional near-infrared spectroscopy

Neural-activity-associated hemodynamic changes have been used to noninvasively measure brain function in the early developmental stages. However, the temporal changes in their hemodynamics are not always consistent with adults. Studies have not evaluated developmental changes for a long period using the same stimuli; therefore, this study examined the normalized relative changes in oxygenated hemoglobin (Δ[oxy-Hb]) in full-term infants and compared them with neonates up to 10 months of age during the administration of tactile vibration stimuli to their limbs using whole-head functional near-infrared spectroscopy. The time to peak of normalized Δ[oxy-Hb] was not affected by age. The amplitude of normalized Δ[oxy-Hb] showed an effect of age in broader areas, including sensorimotor-related but excluding supplementary motor area; the amplitude of normalized Δ[oxy-Hb] decreased the most in the 1-2-month-old group and later increased with development. We hypothesized that these results may reflect developmental changes in neural activity, vasculature, and blood oxygenation.

Effects of atlas-based anatomy on modelled light transport in the neonatal head

Objective.Diffuse optical tomography (DOT) provides a relatively convenient method for imaging haemodynamic changes related to neuronal activity on the cerebral cortex. Due to practical challenges in obtaining anatomical images of neonates, an anatomical framework is often created from an age-appropriate atlas model, which is individualized to the subject based on measurements of the head geometry. This work studies the approximation error arising from using an atlas instead of the neonate's own anatomical model.Approach.We consider numerical simulations of frequency-domain (FD) DOT using two approaches, Monte Carlo simulations and diffusion approximation via finite element method, and observe the variation in (1) the logarithm of amplitude and phase shift measurements, and (2) the corresponding inner head sensitivities (Jacobians), due to varying segmented anatomy. Varying segmentations are sampled by registering 165 atlas models from a neonatal database to the head geometry of one individual selected as the reference model. Prior to the registration, we refine the segmentation of the cerebrospinal fluid (CSF) by separating the CSF into two physiologically plausible layers.Main results.In absolute measurements, a considerable change in the grey matter or extracerebral tissue absorption coefficient was found detectable over the anatomical variation. In difference measurements, a small local 10%-increase in brain absorption was clearly detectable in the simulated measurements over the approximation error in the Jacobians, despite the wide range of brain maturation among the registered models.Significance.Individual-level atlas models could potentially be selected within several weeks in gestational age in DOT difference imaging, if an exactly age-appropriate atlas is not available. The approximation error method could potentially be implemented to improve the accuracy of atlas-based imaging. The presented CSF segmentation algorithm could be useful also in other model-based imaging modalities. The computation of FD Jacobians is now available in the widely-used Monte Carlo eXtreme software.

The frontal sharp transient in newborns: An endogenous neurobiomarker concomitant to the physiological and critical transitional period around delivery?

The frontal sharp transient (FST) consists of transient electrical activity recorded around the transitional period from the in to ex utero environment. Although its positive predictive value is assumed, nothing is known about its functionality or origin. The objectives were (i) to define its characteristics and (ii) to develop functional hypothesis. The 128-channels high-resolution electroencephalograms of 20 healthy newborns (37.1-41.6 weeks) were studied. The morphological and time-frequency characteristics of 418 FSTs were analyzed. The source localization of the FSTs was obtained using a finite element head model (5 layers and fontanels) and various source localization methods (distributed and dipolar). The characteristics (duration, slopes, and amplitude) and the localization of FSTs were not modulated by the huge developmental neuronal processes that occur during the very last period of gestation. The sources were located beneath the ventral median part of the frontal lobe around the interhemispheric fissure, suggesting that the olfactory bulbs and orbitofrontal cortex, essential in olfaction and the mother-infant attachment relationship, are likely candidates for the generation of FSTs. FSTs may contribute to the implementation of the functionalities of brain structures involved in the higher-order processing necessary for survival ahead of delivery, with a genetic fingerprint.

Noninvasive hemoglobin sensing and imaging: optical tools for disease diagnosis

SIGNIFICANCE

Measurement and imaging of hemoglobin oxygenation are used extensively in the detection and diagnosis of disease; however, the applied instruments vary widely in their depth of imaging, spatiotemporal resolution, sensitivity, accuracy, complexity, physical size, and cost. The wide variation in available instrumentation can make it challenging for end users to select the appropriate tools for their application and to understand the relative limitations of different methods.

AIM

We aim to provide a systematic overview of the field of hemoglobin imaging and sensing.

APPROACH

We reviewed the sensing and imaging methods used to analyze hemoglobin oxygenation, including pulse oximetry, spectral reflectance imaging, diffuse optical imaging, spectroscopic optical coherence tomography, photoacoustic imaging, and diffuse correlation spectroscopy.

RESULTS

We compared and contrasted the ability of different methods to determine hemoglobin biomarkers such as oxygenation while considering factors that influence their practical application.

CONCLUSIONS

We highlight key limitations in the current state-of-the-art and make suggestions for routes to advance the clinical use and interpretation of hemoglobin oxygenation information.

Age-related changes in diffuse optical tomography sensitivity profiles from childhood to adulthood

SIGNIFICANCE

Diffuse optical tomography (DOT) uses near-infrared light spectroscopy to measure changes in cerebral hemoglobin concentration. Anatomical interpretations of the brain location that generates the hemodynamic signal require accurate descriptions of the DOT sensitivity to the underlying cortex. DOT sensitivity profiles are different in infants compared with adults. However, the descriptions of DOT sensitivity profiles from early childhood to adulthood are lacking despite the continuous head and brain development.

AIM

We aim to investigate age-related differences in DOT sensitivity profiles in individuals aged from 2 to 34 years with narrow age ranges of 0.5 or 1 year.

APPROACH

We implemented existing photon migration simulation methods and computed source-detector channel DOT sensitivity using age-appropriate, realistic head models.

RESULTS

DOT sensitivity profiles change systematically as a function of source-detector separation distance for all age groups. Children displayed distinctive DOT sensitivity profiles compared to older individuals, and the differences were enhanced at larger separation distances.

CONCLUSIONS

The findings have important implications for the design of source-detector placement and image reconstruction. Age-appropriate realistic head models should be used to provide anatomical guidance for standalone DOT data. Using age-inappropriate head models will have more negative impacts on estimation accuracy in younger children.

Rapid learning of a phonemic discrimination in the first hours of life

Human neonates can discriminate phonemes, but the neural mechanism underlying this ability is poorly understood. Here we show that the neonatal brain can learn to discriminate natural vowels from backward vowels, a contrast unlikely to have been learnt in the womb. Using functional near-infrared spectroscopy, we examined the neuroplastic changes caused by 5 h of postnatal exposure to random sequences of natural and reversed (backward) vowels (T1), and again 2 h later (T2). Neonates in the experimental group were trained with the same stimuli as those used at T1 and T2. Compared with controls, infants in the experimental group showed shorter haemodynamic response latencies for forward vs backward vowels at T1, maximally over the inferior frontal region. At T2, neural activity differentially increased, maximally over superior temporal regions and the left inferior parietal region. Neonates thus exhibit ultra-fast tuning to natural phonemes in the first hours after birth.

Widespread nociceptive maps in the human neonatal somatosensory cortex

Topographic cortical maps are essential for spatial localisation of sensory stimulation and generation of appropriate task-related motor responses. Somatosensation and nociception are finely mapped and aligned in the adult somatosensory (S1) cortex, but in infancy, when pain behaviour is disorganised and poorly directed, nociceptive maps may be less refined. We compared the topographic pattern of S1 activation following noxious (clinically required heel lance) and innocuous (touch) mechanical stimulation of the same skin region in newborn infants (n = 32) using multioptode functional near-infrared spectroscopy (fNIRS). Within S1 cortex, touch and lance of the heel elicit localised, partially overlapping increases in oxygenated haemoglobin concentration (Δ[HbO]), but while touch activation was restricted to the heel area, lance activation extended into cortical hand regions. The data reveals a widespread cortical nociceptive map in infant S1, consistent with their poorly directed pain behaviour.

Wavelength and pulse energy optimization for detecting hypoxia in photoacoustic imaging of the neonatal brain: a simulation study

Cerebral hypoxia is a severe injury caused by oxygen deprivation to the brain. Hypoxia in the neonatal period increases the risk for the development of neurological disorders, including hypoxic-ischemic encephalopathy, cerebral palsy, periventricular leukomalacia, and hydrocephalus. It is crucial to recognize hypoxia as soon as possible because early intervention improves outcomes. Photoacoustic imaging, using at least two wavelengths, through a spectroscopic analysis, can measure brain oxygen saturation. Due to the spectral coloring effect arising from the dependency of optical properties of biological tissues to the wavelength of light, choosing the right wavelength-pair for efficient and most accurate oxygen saturation measurement and consequently quantifying hypoxia at a specific depth is critical. Using a realistic neonate head model and Monte Carlo simulations, we found practical wavelength-pairs that quantified regions with hypoxia most accurately at different depths down to 22 mm into the cortex neighboring the lateral ventricle. We also demonstrated, for the first time, that the accuracy of the sO₂ measurement can be increased by adjusting the level of light energy for each wavelength-pair. Considering the growing interest in photoacoustic imaging of the brain, this work will assist in a more accurate use of photoacoustic spectroscopy and help in the clinical translation of this promising imaging modality. Please note that explaining the effect of acoustic aberration of the skull is not in the scope of this study.

Investigating developmental changes in scalp-to-cortex correspondence using diffuse optical tomography sensitivity in infancy

Significance: Diffuse optical tomography (DOT) uses near-infrared light spectroscopy (NIRS) to measure changes in cerebral hemoglobin concentration. Anatomical interpretations of NIRS data require accurate descriptions of the cranio-cerebral relations and DOT sensitivity to the underlying cortical structures. Such information is limited for pediatric populations because they undergo rapid head and brain development. Aim: We aim to investigate age-related differences in scalp-to-cortex distance and mapping between scalp locations and cortical regions of interest (ROIs) among infants (2 weeks to 24 months with narrow age bins), children (4 and 12 years), and adults (20 to 24 years). Approach: We used spatial scalp projection and photon propagation simulation methods with age-matched realistic head models based on MRIs. Results: There were age-group differences in the scalp-to-cortex distances in infancy. The developmental increase was magnified in children and adults. There were systematic age-related differences in the probabilistic mappings between scalp locations and cortical ROIs. Conclusions: Our findings have important implications in the design of sensor placement and making anatomical interpretations in NIRS and fNIRS research. Age-appropriate, realistic head models should be used to provide anatomical guidance for standalone DOT data in infants.

Age-related changes in diffuse optical tomography sensitivity profiles in infancy

Diffuse optical tomography uses near-infrared light spectroscopy to measure changes in cerebral hemoglobin concentration. Anatomical interpretations of the location that generates the hemodynamic signal requires accurate descriptions of diffuse optical tomography sensitivity to the underlying cortical structures. Such information is limited for pediatric populations because they undergo rapid head and brain development. The present study used photon propagation simulation methods to examine diffuse optical tomography sensitivity profiles in realistic head models among infants ranging from 2 weeks to 24 months with narrow age bins, children (4 and 12 years) and adults (20 to 24 years). The sensitivity profiles changed systematically with the source-detector separation distance. The peak of the sensitivity function in the head was largest at the smallest separation distance and decreased as separation distance increased. The fluence value dissipated more quickly with sampling depth at the shorter source-detector separations than the longer separation distances. There were age-related differences in the shape and variance of sensitivity profiles across a wide range of source-detector separation distances. Our findings have important implications in the design of sensor placement and diffuse optical tomography image reconstruction in (functional) near-infrared light spectroscopy research. Age-appropriate realistic head models should be used to provide anatomical guidance for standalone near-infrared light spectroscopy data in infants.

Accuracy of homogeneous models for photon diffusion in estimating neonatal cerebral hemodynamics by TD-NIRS

We assessed the accuracy of homogenous (semi-infinite, spherical) photon diffusion models in estimating absolute hemodynamic parameters of the neonatal brain in realistic scenarios (ischemia, hyperoxygenation, and hypoventilation) from 1.5 cm interfiber distance TD NIRS measurements. Time-point-spread-functions in 29- and 44-weeks postmenstrual age head meshes were simulated by the Monte Carlo method, convoluted with a real instrument response function, and then fitted with photon diffusion models. The results show good accuracy in retrieving brain oxygen saturation, and severe underestimation of total cerebral hemoglobin, suggesting the need for more complex models of analysis or of larger interfiber distances to precisely monitor all hemodynamic parameters.

Correlating functional near-infrared spectroscopy with underlying cortical regions of 0-, 1-, and 2-year-olds using theoretical light propagation analysis

Significance: The establishment of a light propagation analysis-based scalp-cortex correlation (SCC) between the scalp location of the source-detector (SD) pair and brain regions is essential for measuring functional brain development in the first 2 years of life using functional near-infrared spectroscopy (fNIRS). Aim: We aimed to reveal the optics-based SCC of 0-, 1-, and 2-year-olds (yo) and the suitable SD distance for this age period. Approach: Light propagation analyses using age-appropriate head models were conducted on SD pairs at 10-10 fiducial points on the scalp to obtain optics-based SCC and its metrics: the number of corresponding brain regions ( N C B R ), selectivity and sensitivity of the most likely corresponding brain region (MLCBR), and consistency of the MLCBR across developmental ages. Moreover, we assessed the suitable SD distances for 0-, 1-, and 2-yo by simultaneously considering the selectivity and sensitivity of the MLCBR. Results: Age-related changes in the SCC metrics were observed. For instance, the N C B R of 0-yo was larger than that of 1- and 2-yo. Conversely, the selectivity of 0-yo was lower than that of 1- and 2-yo. The sensitivity of 1-yo was higher than that of 0-yo at 15- to 30-mm SD distances and higher than that of 2-yo at 10-mm SD distance. Notably, the MLCBR of the fiducial points around the longitudinal fissure was inconsistent across age groups. An SD distance between 15 and 25 mm was found to be appropriate for satisfying both sensitivity and selectivity requirements. In addition, this work provides reference tables of optics-based SCC for 0-, 1-, and 2-yo. Conclusions: Optics-based SCC will be informative in designing and explaining child developmental studies using fNIRS. The suitable SD distances were between 15 and 25 mm for the first 2 years of life.

Absolute quantification of cerebral tissue oxygen saturation with multidistance broadband NIRS in newborn brain

Tissue oximetry with near-infrared spectroscopy (NIRS) is a technique for the measurement of absolute tissue oxygen saturation (StO2). Offering a real-time and non-invasive assessment of brain oxygenation and haemodynamics, StO2 has potential to be used for the assessment of newborn brain injury. Multiple algorithms have been developed to measure StO2, however, issues with low measurement accuracy or extracranial tissue signal contamination remain. In this work, we present a novel algorithm to recover StO2 in the neonate, broadband multidistance oximetry (BRUNO), based on a measurement of the gradient of attenuation against distance measured with broadband NIRS. The performance of the algorithm was compared to two other published algorithms, broadband fitting (BF) and spatially resolved spectroscopy (SRS). The median error when recovering StO2 in light transport simulations on a neonatal head mesh was 0.4% with BRUNO, 4.2% with BF and 9.5% with SRS. BRUNO was more sensitive to brain tissue oxygenation changes, shown in layered head model simulations. Comparison of algorithm performance during full oxygenation-deoxygenation cycles in a homogeneous dynamic blood phantom showed significant differences in the dynamic range of the algorithms; BRUNO recovered StO2 over 0-100%, BF over 0-90% and SRS over 39-80%. Recovering StO2 from data collected in a neonate treated at the neonatal intensive care showed different baseline values; mean StO2 was 64.9% with BRUNO, 67.2% with BF and 73.2% with SRS. These findings highlight the effect of StO2 algorithm selection on oxygenation recovery; applying BRUNO in the clinical care setting could reveal further insight into complex haemodynamic processes occurring during neonatal brain injury.

Best practices for fNIRS publications

The application of functional near-infrared spectroscopy (fNIRS) in the neurosciences has been expanding over the last 40 years. Today, it is addressing a wide range of applications within different populations and utilizes a great variety of experimental paradigms. With the rapid growth and the diversification of research methods, some inconsistencies are appearing in the way in which methods are presented, which can make the interpretation and replication of studies unnecessarily challenging. The Society for Functional Near-Infrared Spectroscopy has thus been motivated to organize a representative (but not exhaustive) group of leaders in the field to build a consensus on the best practices for describing the methods utilized in fNIRS studies. Our paper has been designed to provide guidelines to help enhance the reliability, repeatability, and traceability of reported fNIRS studies and encourage best practices throughout the community. A checklist is provided to guide authors in the preparation of their manuscripts and to assist reviewers when evaluating fNIRS papers.

Design and validation of a mechanically flexible and ultra-lightweight high-density diffuse optical tomography system for functional neuroimaging of newborns

Significance: Neonates are a highly vulnerable population. The risk of brain injury is greater during the first days and weeks after birth than at any other time of life. Functional neuroimaging that can be performed longitudinally and at the cot-side has the potential to improve our understanding of the evolution of multiple forms of neurological injury over the perinatal period. However, existing technologies make it very difficult to perform repeated and/or long-duration functional neuroimaging experiments at the cot-side. Aim: We aimed to create a modular, high-density diffuse optical tomography (HD-DOT) technology specifically for neonatal applications that is ultra-lightweight, low profile and provides high mechanical flexibility. We then sought to validate this technology using an anatomically accurate dynamic phantom. Approach: An advanced 10-layer rigid-flexible printed circuit board technology was adopted as the basis for the DOT modules, which allows for a compact module design that also provides the flexibility needed to conform to the curved infant scalp. Two module layouts were implemented: dual-hexagon and triple-hexagon. Using in-built board-to-board connectors, the system can be configured to provide a vast range of possible layouts. Using epoxy resin, thermochromic dyes, and MRI-derived 3D-printed moulds, we constructed an electrically switchable, anatomically accurate dynamic phantom. This phantom was used to quantify the imaging performance of our flexible, modular HD-DOT system. Results: Using one particular module configuration designed to cover the infant sensorimotor system, the device provided 36 source and 48 detector positions, and over 700 viable DOT channels per wavelength, ranging from 10 to ∼ 45    mm over an area of approximately 60    cm 2 . The total weight of this system is only 70 g. The signal changes from the dynamic phantom, while slow, closely simulated real hemodynamic response functions. Using difference images obtained from the phantom, the measured 3D localization error provided by the system at the depth of the cortex was in the of range 3 to 6 mm, and the lateral image resolution at the depth of the neonatal cortex is estimated to be as good as 10 to 12 mm. Conclusions: The HD-DOT system described is ultra-low weight, low profile, can conform to the infant scalp, and provides excellent imaging performance. It is expected that this device will make functional neuroimaging of the neonatal brain at the cot-side significantly more practical and effective.

Construction and validation of a database of head models for functional imaging of the neonatal brain

The neonatal brain undergoes dramatic structural and functional changes over the last trimester of gestation. The accuracy of source localisation of brain activity recorded from the scalp therefore relies on accurate age-specific head models. Although an age-appropriate population-level atlas could be used, detail is lost in the construction of such atlases, in particular with regard to the smoothing of the cortical surface, and so such a model is not representative of anatomy at an individual level. In this work, we describe the construction of a database of individual structural priors of the neonatal head using 215 individual-level datasets at ages 29-44 weeks postmenstrual age from the Developing Human Connectome Project. We have validated a method to segment the extra-cerebral tissue against manual segmentation. We have also conducted a leave-one-out analysis to quantify the expected spatial error incurred with regard to localising functional activation when using a best-matching individual from the database in place of a subject-specific model; the median error was calculated to be 8.3 mm (median absolute deviation 3.8 mm). The database can be applied for any functional neuroimaging modality which requires structural data whereby the physical parameters associated with that modality vary with tissue type and is freely available at www.ucl.ac.uk/dot-hub.

Sleep State Modulates Resting-State Functional Connectivity in Neonates

The spontaneous cerebral activity that gives rise to resting-state networks (RSNs) has been extensively studied in infants in recent years. However, the influence of sleep state on the presence of observable RSNs has yet to be formally investigated in the infant population, despite evidence that sleep modulates resting-state functional connectivity in adults. This effect could be extremely important, as most infant neuroimaging studies rely on the neonate to remain asleep throughout data acquisition. In this study, we combine functional near-infrared spectroscopy with electroencephalography to simultaneously monitor sleep state and investigate RSNs in a cohort of healthy term born neonates. During active sleep (AS) and quiet sleep (QS) our newborn neonates show functional connectivity patterns spatially consistent with previously reported RSN structures. Our three independent functional connectivity analyses revealed stronger interhemispheric connectivity during AS than during QS. In turn, within hemisphere short-range functional connectivity seems to be enhanced during QS. These findings underline the importance of sleep state monitoring in the investigation of RSNs.

Transcranial photobiomodulation with near-infrared light from childhood to elderliness: simulation of dosimetry

Significance: Major depressive disorder (MDD) affects over 40 million U.S. adults in their lifetime. Transcranial photobiomodulation (t-PBM) has been shown to be effective in treating MDD, but the current treatment dosage does not account for head and brain anatomical changes due to aging. Aim: We study effective t-PBM dosage and its variations across age groups using state-of-the-art Monte Carlo simulations and age-dependent brain atlases ranging between 5 and 85 years of age. Approach: Age-dependent brain models are derived from 18 MRI brain atlases. Two extracranial source positions, F3-F4 and Fp1-Fpz-Fp2 in the EEG 10-20 system, are simulated at five selected wavelengths and energy depositions at two MDD-relevant cortical regions-dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC)-are quantified. Results: An overall decrease of energy deposition was found with increasing age. A strong negative correlation between the thickness of extracerebral tissues (ECT) and energy deposition was observed, suggesting that increasing ECT thickness over age is primarily responsible for reduced energy delivery. The F3-F4 position appears to be more efficient in reaching dlPFC compared to treating vmPFC via the Fp1-Fpz-Fp2 position. Conclusions: Quantitative simulations revealed age-dependent light delivery across the lifespan of human brains, suggesting the need for personalized and age-adaptive t-PBM treatment planning.

Improving model-based functional near-infrared spectroscopy analysis using mesh-based anatomical and light-transport models

Significance: Functional near-infrared spectroscopy (fNIRS) has become an important research tool in studying human brains. Accurate quantification of brain activities via fNIRS relies upon solving computational models that simulate the transport of photons through complex anatomy. Aim: We aim to highlight the importance of accurate anatomical modeling in the context of fNIRS and propose a robust method for creating high-quality brain/full-head tetrahedral mesh models for neuroimaging analysis. Approach: We have developed a surface-based brain meshing pipeline that can produce significantly better brain mesh models, compared to conventional meshing techniques. It can convert segmented volumetric brain scans into multilayered surfaces and tetrahedral mesh models, with typical processing times of only a few minutes and broad utilities, such as in Monte Carlo or finite-element-based photon simulations for fNIRS studies. Results: A variety of high-quality brain mesh models have been successfully generated by processing publicly available brain atlases. In addition, we compare three brain anatomical models-the voxel-based brain segmentation, tetrahedral brain mesh, and layered-slab brain model-and demonstrate noticeable discrepancies in brain partial pathlengths when using approximated brain anatomies, ranging between - 1.5 % to 23% with the voxelated brain and 36% to 166% with the layered-slab brain. Conclusion: The generation and utility of high-quality brain meshes can lead to more accurate brain quantification in fNIRS studies. Our open-source meshing toolboxes "Brain2Mesh" and "Iso2Mesh" are freely available at http://mcx.space/brain2mesh.

fNIRS for Tracking Brain Development in the Context of Global Health Projects

Over the past 25 years, functional near-infrared spectroscopy (fNIRS) has emerged as a valuable tool to study brain function, and it is in younger participants where it has found, arguably, its most successful application. Thanks to its infant-friendly features, the technology has helped shape research in the neurocognitive development field by contributing to our understanding of the neural underpinnings of sensory perception and socio-cognitive skills. Furthermore, it has provided avenues of exploration for markers of compromised brain development. Advances in fNIRS instrumentation and methods have enabled the next step in the evolution of its applications including the investigation of the effects of complex and interacting socio-economic and environmental adversities on brain development. To do this, it is necessary to take fNIRS out of well-resourced research labs (the majority located in high-income countries) to study at-risk populations in resource-poor settings in low- and middle-income countries (LMICs). Here we review the use of this technology in global health studies, we discuss the implementation of fNIRS studies in LMICs with a particular emphasis on the Brain Imaging for Global Health (BRIGHT) project, and we consider its potential in this emerging field.

Changes of functional response in sensorimotor cortex of preterm and full-term infants during the first year: An fNIRS study

BACKGROUND

Motor impairments are frequently associated with preterm birth and interfere in acquisition of essential skills to global development. Using Near Infrared Spectroscopy (NIRS), the study of neural correlates of motor development in early stages of life are feasible in an ecological assessment.

AIMS

To evaluate changes in cortical activity in response to a sensorimotor stimulation in preterm and full-term infants at 6 and 12 months of age.

STUDY DESIGN

A longitudinal study was conducted with 22 infants (12 preterm and 10 full-term). Hemodynamic activity during sensorimotor task (8 blocks of 8 s of vibration applied to infant's right hand) was measured by Functional Near Infrared Spectroscopy (fNIRS). The optical probe consisted of 84 channels positioned according to the international 10-20 system coordinates, covering the frontal (38 channels), parietal (16 channels), temporal (22 channels) and occipital (8 channels) lobes of both hemispheres.

RESULTS

Preterm and full-term infants exhibited differences of location of the activation as well on the hemodynamic response in both the evaluated age groups.

CONCLUSIONS

Group differences in activation of sensorimotor cortex observed in this study demonstrate the potential of fNIRS application for preterm evaluation of motor development in children. Overall, the present work contributes to our understanding of cortical activation of cerebral motor skills spanning early ages in preterm-born children.

High-density diffuse optical tomography for imaging human brain function

This review describes the unique opportunities and challenges for noninvasive optical mapping of human brain function. Diffuse optical methods offer safe, portable, and radiation free alternatives to traditional technologies like positron emission tomography or functional magnetic resonance imaging (fMRI). Recent developments in high-density diffuse optical tomography (HD-DOT) have demonstrated capabilities for mapping human cortical brain function over an extended field of view with image quality approaching that of fMRI. In this review, we cover fundamental principles of the diffusion of near infrared light in biological tissue. We discuss the challenges involved in the HD-DOT system design and implementation that must be overcome to acquire the signal-to-noise necessary to measure and locate brain function at the depth of the cortex. We discuss strategies for validation of the sensitivity, specificity, and reliability of HD-DOT acquired maps of cortical brain function. We then provide a brief overview of some clinical applications of HD-DOT. Though diffuse optical measurements of neurophysiology have existed for several decades, tremendous opportunity remains to advance optical imaging of brain function to address a crucial niche in basic and clinical neuroscience: that of bedside and minimally constrained high fidelity imaging of brain function.

Near-infrared spectroscopy reveals neural perception of vocal emotions in human neonates

Processing affective prosody, that is the emotional tone of a speaker, is fundamental to human communication and adaptive behaviors. Previous studies have mainly focused on adults and infants; thus the neural mechanisms underlying the processing of affective prosody in newborns remain unclear. Here, we used near-infrared spectroscopy to examine the ability of 0-to-4-day-old neonates to discriminate emotions conveyed by speech prosody in their maternal language and a foreign language. Happy, fearful, and angry prosodies enhanced neural activation in the right superior temporal gyrus relative to neutral prosody in the maternal but not the foreign language. Happy prosody elicited greater activation than negative prosody in the left superior frontal gyrus and the left angular gyrus, regions that have not been associated with affective prosody processing in infants or adults. These findings suggest that sensitivity to affective prosody is formed through prenatal exposure to vocal stimuli of the maternal language. Furthermore, the sensitive neural correlates appeared more distributed in neonates than infants, indicating a high-level of neural specialization between the neonatal stage and early infancy. Finally, neonates showed preferential neural responses to positive over negative prosody, which is contrary to the "negativity bias" phenomenon established in adult and infant studies.

Diffuse optical tomography for the detection of perinatal stroke at the cot side: a pilot study

BACKGROUND

Perinatal stroke is a potentially debilitating injury, often under-diagnosed in the neonatal period. We conducted a pilot study investigating the role of the portable, non-invasive brain monitoring technique, diffuse optical tomography (DOT), as an early detection tool for infants with perinatal stroke.

METHODS

Four stroke-affected infants were scanned with a DOT system within the first 3 days of life and compared to four healthy control subjects. Spectral power, correlation, and phase lag between interhemispheric low frequency (0.0055-0.3 Hz) hemoglobin signals were assessed. Optical data analyses were conducted with and without magnetic resonance imaging (MRI)-guided stroke localization to assess the efficacy of DOT when used without stroke anatomical information.

RESULTS

Interhemispheric correlations of both oxyhemoglobin and deoxyhemoglobin concentration were significantly reduced in the stroke-affected group within the very low (0.0055-0.0095 Hz) and resting state (0.01-0.08 Hz) frequencies (p < 0.003). There were no interhemispheric differences for spectral power. These results were observed even without MRI stroke localization.

CONCLUSION

This suggests that DOT and correlation-based analyses in the low-frequency range can potentially aid the early detection of perinatal stroke, prior to MRI acquisition. Additional methodological advances are required to increase the sensitivity and specificity of this technique.

Array Designer: automated optimized array design for functional near-infrared spectroscopy

The position of each source and detector "optode" on the scalp, and their relative separations, determines the sensitivity of each functional near-infrared spectroscopy (fNIRS) channel to the underlying cortex. As a result, selecting appropriate scalp locations for the available sources and detectors is critical to every fNIRS experiment. At present, it is standard practice for the user to undertake this task manually; to select what they believe are the best locations on the scalp to place their optodes so as to sample a given cortical region-of-interest (ROI). This process is difficult, time-consuming, and highly subjective. Here, we propose a tool, Array Designer, that is able to automatically design optimized fNIRS arrays given a user-defined ROI and certain features of the available fNIRS device. Critically, the Array Designer methodology is generalizable and will be applicable to almost any subject population or fNIRS device. We describe and validate the algorithmic methodology that underpins Array Designer by running multiple simulations of array design problems in a realistic anatomical model. We believe that Array Designer has the potential to end the need for manual array design, and in doing so save researchers time, improve fNIRS data quality, and promote standardization across the field.

fNIRS Optodes' Location Decider (fOLD): a toolbox for probe arrangement guided by brain regions-of-interest

The employment of functional near-infrared spectroscopy (fNIRS) as a method of brain imaging has increased over the last few years due to its portability, low-cost and robustness to subject movement. Experiments with fNIRS are designed in the face of a limited number of sources and detectors (optodes) to be positioned on selected portion(s) of the scalp. The optodes locations represent an expectation of assessing cortical regions relevant to the experiment’s hypothesis. However, this translation process remains a challenge for fNIRS experimental design. In the present study, we propose an approach that automatically decides the location of fNIRS optodes from a set of predefined positions with the aim of maximizing the anatomical specificity to brain regions-of-interest. The implemented method is based on photon transport simulations on two head atlases. The results are compiled into the publicly available “fNIRS Optodes’ Location Decider” (fOLD). This toolbox is a first-order approach to bring the achieved advancements of parcellation methods and meta-analyses from functional magnetic resonance imaging to more precisely guide the selection of optode positions for fNIRS experiments.

Functional Near Infrared Spectroscopy: Enabling Routine Functional Brain Imaging

Functional Near-Infrared Spectroscopy (fNIRS) maps human brain function by measuring and imaging local changes in hemoglobin concentrations in the brain that arise from the modulation of cerebral blood flow and oxygen metabolism by neural activity. Since its advent over 20 years ago, researchers have exploited and continuously advanced the ability of near infrared light to penetrate through the scalp and skull in order to non-invasively monitor changes in cerebral hemoglobin concentrations that reflect brain activity. We review recent advances in signal processing and hardware that significantly improve the capabilities of fNIRS by reducing the impact of confounding signals to improve statistical robustness of the brain signals and by enhancing the density, spatial coverage, and wearability of measuring devices respectively. We then summarize the application areas that are experiencing rapid growth as fNIRS begins to enable routine functional brain imaging.

Investigating the effects of cerebrospinal fluid removal on cerebral blood flow and oxidative metabolism in infants with post-hemorrhagic ventricular dilatation

BackgroundPost-hemorrhagic ventricular dilatation (PHVD) is predictive of mortality and morbidity among very-low-birth-weight preterm infants. Impaired cerebral blood flow (CBF) due to elevated intracranial pressure (ICP) is believed to be a contributing factor.MethodsA hyperspectral near-infrared spectroscopy (NIRS) method of measuring CBF and the cerebral metabolic rate of oxygen (CMRO₂) was used to investigate perfusion and metabolism changes in patients receiving a ventricular tap (VT) based on clinical management. To improve measurement accuracy, the spectral analysis was modified to account for compression of the cortical mantle caused by PHVD and the possible presence of blood breakdown products.ResultsFrom nine patients (27 VTs), a significant CBF increase was measured (15.6%) following VT (14.6±4.2 to 16.9±6.6 ml/100 g/min), but with no corresponding change in CMRO₂ (1.02±0.41 ml O₂/100 g/min). Post-VT CBF was in good agreement with a control group of 13 patients with patent ductus arteriosus but no major cerebral pathology (16.5±7.7 ml/100 g/min), whereas tissue oxygen saturation (StO₂) was significantly lower (58.9±12.1% vs. 70.5±9.1% for controls).ConclusionCBF was impeded in PHVD infants requiring a clinical intervention, but the effect is not large enough to alter CMRO₂.

Diffuse optical tomography to investigate the newborn brain

Over the past 15 years, functional near-infrared spectroscopy (fNIRS) has emerged as a powerful technology for studying the developing brain. Diffuse optical tomography (DOT) is an extension of fNIRS that combines hemodynamic information from dense optical sensor arrays over a wide field of view. Using image reconstruction techniques, DOT can provide images of the hemodynamic correlates to neural function that are comparable to those produced by functional magnetic resonance imaging. This review article explains the principles of DOT, and highlights the growing literature on the use of DOT in the study of healthy development of the infant brain, and the study of novel pathophysiology in infants with brain injury. Current challenges, particularly around instrumentation and image reconstruction, will be discussed, as will the future of this growing field, with particular focus on whole-brain, time-resolved DOT.

Advances in Monte Carlo Simulation for Light Propagation in Tissue

Monte Carlo (MC) simulation for light propagation in tissue is the gold standard for studying the light propagation in biological tissue and has been used for years. Interaction of photons with a medium is simulated based on its optical properties. New simulation geometries, tissue-light interaction methods, and recording techniques recently have been designed. Applications, such as whole mouse body simulations for fluorescence imaging, eye modeling for blood vessel imaging, skin modeling for terahertz imaging, and human head modeling for sinus imaging, have emerged. Here, we review the technical advances and recent applications of MC simulation.

Geometrically complex 3D-printed phantoms for diffuse optical imaging

Tissue-equivalent phantoms that mimic the optical properties of human and animal tissues are commonly used in diffuse optical imaging research to characterize instrumentation or evaluate an image reconstruction method. Although many recipes have been produced for generating solid phantoms with specified absorption and transport scattering coefficients at visible and near-infrared wavelengths, the construction methods are generally time-consuming and are unable to create complex geometries. We present a method of generating phantoms using a standard 3D printer. A simple recipe was devised which enables printed phantoms to be produced with precisely known optical properties. To illustrate the capability of the method, we describe the creation of an anatomically accurate, tissue-equivalent premature infant head optical phantom with a hollow brain space based on MRI atlas data. A diffuse optical image of the phantom is acquired when a high contrast target is inserted into the hollow space filled with an aqueous scattering solution.

Functional imaging of the human brain using a modular, fibre-less, high-density diffuse optical tomography system

We present the first three-dimensional, functional images of the human brain to be obtained using a fibre-less, high-density diffuse optical tomography system. Our technology consists of independent, miniaturized, silicone-encapsulated DOT modules that can be placed directly on the scalp. Four of these modules were arranged to provide up to 128, dual-wavelength measurement channels over a scalp area of approximately 60 × 65 mm². Using a series of motor-cortex stimulation experiments, we demonstrate that this system can obtain high-quality, continuous-wave measurements at source-detector separations ranging from 14 to 55 mm in adults, in the presence of hair. We identify robust haemodynamic response functions in 5 out of 5 subjects, and present diffuse optical tomography images that depict functional haemodynamic responses that are well-localized in all three dimensions at both the individual and group levels. This prototype modular system paves the way for a new generation of wearable, wireless, high-density optical neuroimaging technologies.

Hemodynamic response to burst-suppressed and discontinuous electroencephalography activity in infants with hypoxic ischemic encephalopathy

Burst suppression (BS) is an electroencephalographic state associated with a profound inactivation of the brain. BS and pathological discontinuous electroencephalography (EEG) are often observed in term-age infants with neurological injury and can be indicative of a poor outcome and lifelong disability. Little is known about the neurophysiological mechanisms of BS or how the condition relates to the functional state of the neonatal brain. We used simultaneous EEG and diffuse optical tomography (DOT) to investigate whether bursts of EEG activity in infants with hypoxic ischemic encephalopathy are associated with an observable cerebral hemodynamic response. We were able to identify significant changes in concentration of both oxy and deoxyhemoglobin that are temporally correlated with EEG bursts and present a relatively consistent morphology across six infants. Furthermore, DOT reveals patient-specific spatial distributions of this hemodynamic response that may be indicative of a complex pattern of cortical activation underlying discontinuous EEG activity that is not readily apparent in scalp EEG.

Mapping Cortical Responses to Somatosensory Stimuli in Human Infants with Simultaneous Near-Infrared Spectroscopy and Event-Related Potential Recording

Near-infrared spectroscopy (NIRS) and electroencephalography (EEG) have recently provided fundamental new information about how the newborn brain processes innocuous and noxious somatosensory information. However, results derived independently from these two techniques are not entirely consistent, raising questions about the relationship between hemodynamic and electrophysiological responses in the study of touch and pain processing in the newborn. To address this, we have recorded NIRS and EEG responses simultaneously for the first time in the human infant following noxious (time-locked clinically required heel lances) and innocuous tactile cutaneous stimulation in 30 newborn infants. The results show that both techniques can be used to record quantifiable and distinct innocuous and noxious evoked activity at a group level in the newborn cortex. Noxious stimulation elicits a peak hemodynamic response that is 10-fold larger than that elicited by an innocuous stimulus (HbO2: 2.0 vs 0.3 µM) and a distinct nociceptive-specific N3P3 waveform in electrophysiological recordings. However, a novel single-trial analysis revealed that hemodynamic and electrophysiological responses do not always co-occur at an individual level, although when they do (64% of noxious test occasions), they are significantly correlated in magnitude. These data show that, while hemodynamic and electrophysiological touch and pain brain activity in newborn infants are comparable in group analyses, important individual differences remain. These data indicate that integrated and multimodal brain monitoring is required to understand central touch and pain processing in the newborn.

Neurovascular Interactions in the Neurologically Compromised Neonatal Brain

Neurological brain injuries such as hypoxic ischaemic encephalopathy (HIE) and associated conditions such as seizures have been associated with poor developmental outcome in neonates. Our limited knowledge of the neurological and cerebrovascular processes underlying seizures limits their diagnosis and timely treatment. Diffuse optical tomography (DOT) provides haemodynamic information in the form of changes in concentration of de/oxygenated haemoglobin, which can improve our understanding of seizures and the relationship between neural and vascular processes. Using simultaneous EEG-DOT, we observed distinct haemodynamic changes which are temporally correlated with electrographic seizures. Here, we present DOT-EEG data from two neonates clinically diagnosed as HIE. Our results highlight the wealth of mutually-informative data that can be obtained using DOT-EEG techniques to understand neurovascular coupling in HIE neonates.

How short is short? Optimum source-detector distance for short-separation channels in functional near-infrared spectroscopy

In recent years, it has been demonstrated that using functional near-infrared spectroscopy (fNIRS) channels with short separations to explicitly sample extra-cerebral tissues can provide a significant improvement in the accuracy and reliability of fNIRS measurements. The aim of these short-separation channels is to measure the same superficial hemodynamics observed by standard fNIRS channels while also being insensitive to the brain. We use Monte Carlo simulations of photon transport in anatomically informed multilayer models to determine the optimum source-detector distance for short-separation channels in adult and newborn populations. We present a look-up plot that provides (for an acceptable value of short-separation channel brain sensitivity relative to standard channel brain sensitivity) the optimum short-separation distance. Though values vary across the scalp, when the acceptable ratio of the short-separation channel brain sensitivity to standard channel brain sensitivity is set at 5%, the optimum short-separation distance is 8.4 mm in the typical adult and 2.15 mm in the term-age infant.

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.

Functional Imaging of the Developing Brain at the Bedside Using Diffuse Optical Tomography

While histological studies and conventional magnetic resonance imaging (MRI) investigations have elucidated the trajectory of structural changes in the developing brain, less is known regarding early functional cerebral development. Recent investigations have demonstrated that resting-state functional connectivity MRI (fcMRI) can identify networks of functional cerebral connections in infants. However, technical and logistical challenges frequently limit the ability to perform MRI scans early or repeatedly in neonates, particularly in those at greatest risk for adverse neurodevelopmental outcomes. High-density diffuse optical tomography (HD-DOT), a portable imaging modality, potentially enables early continuous and quantitative monitoring of brain function in infants. We introduce an HD-DOT imaging system that combines advancements in cap design, ergonomics, and data analysis methods to allow bedside mapping of functional brain development in infants. In a cohort of healthy, full-term neonates scanned within the first days of life, HD-DOT results demonstrate strong congruence with those obtained using co-registered, subject-matched fcMRI and reflect patterns of typical brain development. These findings represent a transformative advance in functional neuroimaging in infants, and introduce HD-DOT as a powerful and practical method for quantitative mapping of early functional brain development in normal and high-risk neonates.

Mapping cortical haemodynamics during neonatal seizures using diffuse optical tomography: a case study

Seizures in the newborn brain represent a major challenge to neonatal medicine. Neonatal seizures are poorly classified, under-diagnosed, difficult to treat and are associated with poor neurodevelopmental outcome. Video-EEG is the current gold-standard approach for seizure detection and monitoring. Interpreting neonatal EEG requires expertise and the impact of seizures on the developing brain remains poorly understood. In this case study we present the first ever images of the haemodynamic impact of seizures on the human infant brain, obtained using simultaneous diffuse optical tomography (DOT) and video-EEG with whole-scalp coverage. Seven discrete periods of ictal electrographic activity were observed during a 60 minute recording of an infant with hypoxic-ischaemic encephalopathy. The resulting DOT images show a remarkably consistent, high-amplitude, biphasic pattern of changes in cortical blood volume and oxygenation in response to each electrographic event. While there is spatial variation across the cortex, the dominant haemodynamic response to seizure activity consists of an initial increase in cortical blood volume prior to a large and extended decrease typically lasting several minutes. This case study demonstrates the wealth of physiologically and clinically relevant information that DOT-EEG techniques can yield. The consistency and scale of the haemodynamic responses observed here also suggest that DOT-EEG has the potential to provide improved detection of neonatal seizures.