Investigation of the effect of discrete absorbers upon the measurement of blood volume with near-infrared spectroscopy

The influence of the blood vessel diameter on the full scattering profile from cylindrical tissues: experimental evidence for the shielding effect

Optical methods for detecting physiological state based on light-tissue interaction are noninvasive, inexpensive, simplistic, and thus very useful. The blood vessels in human tissue are the main cause of light absorbing and scattering. Therefore, the effect of blood vessels on light-tissue interactions is essential for optically detecting physiological tissue state, such as oxygen saturation, blood perfusion and blood pressure. We have previously suggested a new theoretical and experimental method for measuring the full scattering profile, which is the angular distribution of light intensity, of cylindrical tissues. In this work we will present experimental measurements of the full scattering profile of heterogenic cylindrical phantoms that include blood vessels. We show, for the first time that the vessel diameter influences the full scattering profile, and found higher reflection intensity for larger vessel diameters accordance to the shielding effect. For an increase of 60% in the vessel diameter the light intensity in the full scattering profile above 90° is between 9% to 40% higher, depending on the angle. By these results we claim that during respiration, when the blood-vessel diameter changes, it is essential to consider the blood-vessel diameter distribution in order to determine the optical path in tissues. A CT scan of the measured silicon-based phantoms. The phantoms contain the same blood volume in different blood-vessel diameters.

Cortico-cortical evoked hemodynamic responses in human language systems using intraoperative near-infrared spectroscopy during direct cortical stimulation

BACKGROUND

Understanding of cortico-cortical activity in eloquent areas intraoperatively is crucial for neurosurgical procedures. Here, we used intraoperative near-infrared spectroscopy (iNIRS) during direct cortical stimulation as a robust tool to better understand the cortico-cortical connectivity in language systems.

METHODS

We applied iNIRS to 3 patients who underwent epilepsy surgery due to lesions (cavernous angioma, epidermoid cyst, and low-grade glioma) located in language areas. Using iNIRS, we measured the blood concentration changes of oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) in the lateral temporal cortex during direct cortical stimulation (50Hz) at the inferior frontal area where Broca's area was probabilistically located.

RESULTS

In all patients, 50Hz stimulation elicited hemodynamic changes in the superior temporal gyrus (STG). During 0.8-4.8s after stimulation, HbO2 increased and HbR decreased in the posterior part of the STG (Wernicke's area). Similar responses were observed in the anterior part of the STG 1.3-8.0s after stimulation. Finally, these changes were disappeared in the middle temporal gyrus.

CONCLUSIONS

Our results suggest that cortical stimulation of Broca's area elicits hemodynamic responses in Wernicke's area via cortico-cortical connectivity. We demonstrated cortico-cortical evoked responses in language systems using iNIRS during direct cortical stimulation. Our iNIRS data will provide useful information about cortico-cortical networks underlying human brain functions intraoperatively and will contribute to neurosurgical treatment in eloquent areas.

Experimental system for measuring the full scattering profile of circular phantoms

Optical methods for monitoring physiological tissue state are important and useful because they are non-invasive and sensitive. Experimental measurements of the full scattering profile of circular phantoms are presented. We report, for the first time, an experimental observation of a typical reflected light intensity behavior for a circular structure characterized by the isobaric point. We previously suggested a new theoretically method for measuring the full scattering profile, which is the angular distribution of light intensity, of cylindrical tissues. In this work we present that the experimental result match the simulation results. We show the isobaric point at 105° for a cylindrical phantom with a 7mm diameter, while for a 16mm diameter phantom the isobaric point is at 125°. Furthermore, the experimental work present a new crossover point of the full scattering profiles of subjects with different diameters of the cylindrical tissues.

Dynamic model for the tissue concentration and oxygen saturation of hemoglobin in relation to blood volume, flow velocity, and oxygen consumption: Implications for functional neuroimaging and coherent hemodynamics spectroscopy (CHS)

This article presents a dynamic model that quantifies the temporal evolution of the concentration and oxygen saturation of hemoglobin in tissue, as determined by time-varying hemodynamic and metabolic parameters: blood volume, flow velocity, and oxygen consumption. This multi-compartment model determines separate contributions from arterioles, capillaries, and venules that comprise the tissue microvasculature, and treats them as a complete network, without making assumptions on the details of the architecture and morphology of the microvascular bed. A key parameter in the model is the effective blood transit time through the capillaries and its associated probability of oxygen release from hemoglobin to tissue, as described by a rate constant for oxygen diffusion. The solution of the model in the time domain predicts the signals measured by hemodynamic-based neuroimaging techniques such as functional near-infrared spectroscopy (fNIRS) and functional magnetic resonance imaging (fMRI) in response to brain activation. In the frequency domain, the model yields an analytical solution based on a phasor representation that provides a framework for quantitative spectroscopy of coherent hemodynamic oscillations. I term this novel technique coherent hemodynamics spectroscopy (CHS), and this article describes how it can be used for the assessment of cerebral autoregulation and the study of hemodynamic oscillations resulting from a variety of periodic physiological challenges, brain activation protocols, or physical maneuvers.

Multispectral reflectance imaging of brain activation in rodents: methodological study of the differential path length estimations and first in vivo recordings in the rat olfactory bulb

Dynamic maps of relative changes in blood volume and oxygenation following brain activation are obtained using multispectral reflectance imaging. The technique relies on optical absorption modifications linked to hemodynamic changes. The relative variation of hemodynamic parameters can be quantified using the modified Beer-Lambert Law if changes in reflected light intensities are recorded at two wavelengths or more and the differential path length (DP) is known. The DP is the mean path length in tissues of backscattered photons and varies with wavelength. It is usually estimated using Monte Carlo simulations in simplified semi-infinite homogeneous geometries. Here we consider the use of multilayered models of the somatosensory cortex (SsC) and olfactory bulb (OB), which are common physiological models of brain activation. Simulations demonstrate that specific DP estimation is required for SsC and OB, specifically for wavelengths above 600 nm. They validate the hypothesis of a constant path length during activation and show the need for specific DP if imaging is performed in a thinned-skull preparation. The first multispectral reflectance imaging data recorded in vivo during OB activation are presented, and the influence of DP on the hemodynamic parameters and the pattern of oxymetric changes in the activated OB are discussed.

Detecting angiogenesis in breast tumors: comparison of color Doppler flow imaging with ultrasound-guided diffuse optical tomography

We investigated the correlation between color Doppler flow imaging (CDFI) and ultrasound (US)-guided diffuse optical tomography (DOT) for detection of breast tumor angiogenesis. Both CDFI and DOT were performed in 214 breast lesions scheduled for biopsy. The lesions were classified as vascular or nonvascular on CDFI and total hemoglobin concentration (THC) was measured by DOT. Sonographic results were correlated with the THC measurements. Pathologic examination showed 118 breast cancers and 96 benign breast masses. When vascularization on CDFI as a sign of malignancy and a cutoff of 140 μmol/L was used, the sensitivity, specificity and accuracy were 83.9, 50.0 and 68.7% for CDFI and 83.9, 66.7 and 76.2% for DOT, respectively. Thirteen (11.0%) nonvascular breast cancers presented high THC levels. Twenty-five (52.1%) vascular benign tumors demonstrated low THC levels. Mean THC did not differ significantly in malignancies with vascular or without vascular (228.14 ± 85.37 μmol/L vs. 191.42 ± 92.59 μmol/L; p > 0.05). Likewise, for benign lesions, the difference between THC values in vascular lesions and nonvascular lesions was not statistically significant (140.86 ± 79.63 μmol/L vs. 110.13 ± 85.05 μmol/L; p > 0.05). Our results suggest that the addition of DOT to CDFI could be helpful for characterizing CDFI nonvascular lesions that are suspicious for malignancy or vascular lesions that are probably benign.

Experimental investigation of NIRS spatial sensitivity

Near infrared spectroscopy (NIRS) is regarded as a potential medical diagnostic technique for investigation of hemodynamic changes. However, uncertainties pertaining to the origin of NIRS signals have hampered its clinical interpretation. The uncertainities in NIRS measurements especially in case of living tissues are due to lack of rigorous combined theoretical-experimental studies resulting in clear understanding of the origin of NIRS signals. For their reliable interpretation it is important to understand the relationship between spatial changes in optical properties and corresponding changes in the NIRS signal. We investigated spatial sensitivity of near infrared optical measurements using an experimental approach. It uses a liquid optical phantom as tissue equivalent, which is explored under robot-control by a small, approximately point like perturbation of desired optical properties, and a NIRS instrument for trans-illumination/reflection measurements. The experimentally obtained sensitivity has been analyzed and compared with numerical simulations. In preliminary experiments we investigated the influence of various optical properties of the medium and of source/detector distances on the spatial sensitivity distribution. The acquired sensitivity maps can be used to define characteristic parameters. As an example, we used a 25% threshold to define a penetration depth measure which provides values in good accordance with published ones. To the best of our knowledge this is the first experimental study of NIRS spatial sensitivity. The presented method will allow in depth experimental investigation of the influence of various conditions pertaining to medium such as optical properties of tissue (scattering and absorption) and of the source/detector configuration.

Multiscale modeling of light absorption in tissues: limitations of classical homogenization approach

In biophotonics, the light absorption in a tissue is usually modeled by the Helmholtz equation with two constant parameters, the scattering coefficient and the absorption coefficient. This classic approximation of “haemoglobin diluted everywhere” (constant absorption coefficient) corresponds to the classical homogenization approach. The paper discusses the limitations of this approach. The scattering coefficient is supposed to be constant (equal to one) while the absorption coefficient is equal to zero everywhere except for a periodic set of thin parallel strips simulating the blood vessels, where it is a large parameter The problem contains two other parameters which are small: , the ratio of the distance between the axes of vessels to the characteristic macroscopic size, and , the ratio of the thickness of thin vessels and the period. We construct asymptotic expansion in two cases: and and prove that in the first case the classical homogenization (averaging) of the differential equation is true while in the second case it is wrong. This result may be applied in the biomedical optics, for instance, in the modeling of the skin and cosmetics.

Acute intermittent hypoxia exposures enhance arterial oxygen delivery

Physiological adaptations to intermittent hypoxia (IH) conditioning are based on the cumulative effect of repeated IH exposures. The present study sought to test the hypothesis that acute IH exposures would promote arterial O2 delivery and regional tissue oxygenation. Changes in arterial O2 saturation (SaO2, oximeter), forearm muscle and cerebral tissue oxygenations (SmO2 and ScO2, near-infrared spectroscopy) were compared during five repeated hypoxia exposures (10 ± 0.2% O2 for 5-min each) interposed with four-minute inhalation of room air in 11 healthy subjects (24 ± 0.9 y). Baseline, prehypoxia partial pressure of end-tidal O2 (PETO2, mass spectrometer) and SaO2 (107 ± 2 mmHg and 97.3 ± 0.3%) were decreased ( P < 0.05) after the first bout as compared with those during normoxia prior to the second (94 ± 2 mmHg and 96.2 ± 0.4%) and the fifth (92 ± 3 mmHg and 95.7 ± 0.7%) episodes of IH exposures, whereas partial pressure of end-tidal CO2, tidal volume and breathing frequency were similar. Arterial O2 dissociation in terms of per unit decrease in PETO2 during hypoxia, i.e. the slope of SaO2/PETO2, was augmented ( P = 0.0025) from 0.71 ± 0.09%/mmHg during the first hypoxia bout to 1.39 ± 0.15%/mmHg and 1.47 ± 0.16%/mmHg during the second and the fifth bouts, respectively. Fractional muscle tissue O2 extraction rate (SmO2D, i.e. normalized difference between SaO2 and SmO2) progressively decreased ( P < 0.01) during IH; however, fractional cerebral tissue O2 extraction rate (ScO2D, i.e. normalized difference between SaO2 and ScO2) did not decrease during hypoxia ( P = 0.94). ScO2D during normoxia tended to increase ( P = 0.089) following repeated IH exposures. We conclude that enhanced arterial O2 delivery with repeated IH exposures serves as a compensatory mechanism to potentiate O2 availability during hypoxia.

The impact of morphology on light transport in cancellous bone

In recent years, optical techniques based on diffusion approximation have demonstrated their ability to gain rich spectral information about bone. However, these methods normally assume homogeneity, while cancellous bone and marrow form a highly heterogeneous two-phase medium. This paper studies the limitations of this assumption, and quantifies the role of microstructure on long-range transport properties. The propagation of light pulses through trabecular bone is calculated by Monte Carlo simulation of the scattering and absorption in reconstructions of bone samples obtained from x-ray micro tomographic scans. The time-resolved responses are then fitted with the analytical response of a homogeneous material to obtain the apparent transport properties. These properties are used to test different homogenization equations that have been postulated in the past for heterogeneous tissues and to check their accuracy. The results show that nonlinearity and crosstalk between absorption and scattering are statistically significant, although their impact is relatively small. More importantly, we found that the weight of the components is not only affected by their volume fractions, but need to be corrected by other morphologic measures like trabecular spacing or connectivity density. These deviations from the homogeneous assumption are stronger for scattering than for absorption. In conclusion, the average optical properties of cancellous bone are strongly determined by its microstructure, meaning that optical techniques are a valid method for tissue evaluation, but careful consideration of structure-related perturbation sources is required.

Optical assessment of cutaneous blood volume depends on the vessel size distribution: a computer simulation study

A Monte Carlo simulation was adapted to specify a skin model with pigmented epidermis, dermis with low baseline blood content, and vessels of a vascular lesion with an average added blood volume fraction of 5%. In the study, the lesion vessel diameters were increased and the number of lesion vessels decreased, such that the total lesion blood content was constant. The results show that reflectance (R) increases as vessel size increases, even though the blood content is constant. Light cannot penetrate effectively into larger blood vessels, so the interior of the vessel becomes less visible to the light - a result known in the literature. This study did repeated random placement of vessels to learn the variation in R due to variable vessel placement. The coefficient of variation was about 10% due to random placement. R varies with size, even with small vessels, and does not simply apply to large vessels.

Illuminating the BOLD signal: combined fMRI–fNIRS studies

Functional magnetic resonance imaging (fMRI) is currently combined with electrophysiological methods to identify the relationship between neuronal activity and the blood oxygenation level-dependent (BOLD) signal. Several processes like neuronal activity, synaptic activity, vascular dilation, blood volume and oxygenation changes underlie both response modalities, that is, the electrophysiological signal and the vascular response. However, accessing single process relationships is absolutely mandatory when aiming at a deeper understanding of neurovascular coupling and necessitates studies on the individual building blocks of the vascular response. Combined fMRI and functional near-infrared spectroscopy studies have been performed to validate the correlation of the BOLD signal to the hemodynamic changes in the brain. Here we review the current status of the integration of both technologies and judge these studies in the light of recent findings on neurovascular coupling.

Cerebral autoregulation is preserved during orthostatic stress superimposed with systemic hypotension

We sought to determine whether cerebral autoregulation (CA) is compromised during orthostatic stress superimposed with systemic hypotension. Transient systemic hypotension was produced by deflation of thigh cuffs previously inflated to suprasystolic pressure, combined with or without lower body negative pressure (LBNP). Cardiac output (CO) decreased from a baseline of 5.0+/-0.5 l/min by -8.3+/-1.7, -19.2+/-2.0, and -30.6+/-3.4% during LBNP of -15, -30, and -50 Torr, respectively. Mean arterial pressure (MAP) was maintained during LBNP, despite decreases in systolic and pulse pressures. Middle cerebral arterial blood flow velocity (VMCA) decreased significantly from a baseline of 64+/-3 to 58+/-4 cm/s (-9.7+/-2.4%) at -50 Torr of LBNP. The reduction in VMCA was associated with a decrease in regional cerebral O2 saturation. However, the percent decrease in VMCA was markedly less than that of CO. This suggests that the magnitude of the change in VMCA (an index of cerebral blood flow) is less than would be predicted, given the decrease in CO. Transient systemic hypotension decreased MAP by -21+/-2, -24+/-2, -28+/-3, and -26+/-3% at rest and during LBNP of -15, -30, and -50 Torr, respectively. Likewise, this acute hypotension resulted in decreases in VMCA of -20+/-2, -21+/-2, -24+/-25, and -19+/-2% and regional cerebral O2 saturation of -5+/-1, -6+/-1, -6+/-1, and -7+/-2% at rest and during LBNP of -15, -30, and -50 Torr, respectively. Complete recovery of VMCA to baseline values following transient hypotension (ranging from 5 to 8 s) occurred significantly earlier compared with MAP (from 10 to 12 s). No subjects experienced syncope during acute hypotension. We conclude that CA is preserved during LBNP, superimposed with transient systemic hypotension, despite the decrease in VMCA associated with sustained central hypovolemia in normal healthy individuals. This preserved CA is vital for the prevention of orthostatic syncope.

Mapping human skeletal muscle perforator vessels using a quantum well infrared photodetector (QWIP) might explain the variability of NIRS and LDF measurements

Near-infrared spectroscopy (NIRS) and laser Doppler flowmetry (LDF) have become the techniques of choice allowing the non-invasive study of local human skeletal muscle metabolism and blood perfusion on a small tissue volume (a few cm3). However, it has been shown that both NIRS and LDF measurements may show a large spatial variability depending on the position of the optodes over the investigated muscle. This variability may be due to local morphologic and/or metabolic characteristics of the muscle and makes the data interpretation and comparison difficult. In the present work, we use a third method to investigate this problem which permits fast, non-invasive mapping of the intramuscular vessel distribution in the human vastus latelralis muscle. This method uses an advanced, passive, infrared imaging sensor called a QWIP (quantum well infrared photodetector). We demonstrate, using a recovery-enhanced infrared imaging technique, that there is a significant presence of perforator vessels in the region of interest of approximately 30 x 18 cm (the number of vessels being: 14, 9, 8, 33, 17 and 18 for each subject, respectively). The presence of these vessels makes the skeletal muscle highly inhomogeneous, and may explain the observed NIRS and LDF spatial variability. We conclude that accurate comparison of the metabolic activity of two different muscle regions is not possible without reliable maps of vascular 'singularities' such as the perforator vessels, and that the QWIP-based imaging system is one method to obtain this information.

Investigation of TRAM Flap Oxygenation and Perfusion by Near-Infrared Reflection Spectroscopy and Color-Coded Duplex Sonography

Near-infrared reflection spectroscopy, used experimentally for investigation of tissue hemoglobin content and oxygenation in various flaps, was tested in the pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, chosen as a simple clinical model because of its well-known vascular anatomy and clinical relevance. The study intended to answer the following questions: Does the near-infrared reflection spectroscopy system used in this study measure tissue hemoglobin content and oxygenation in the superficial skin layers only, as proposed by the manufacturer? Is near-infrared reflection spectroscopy able to detect differences of tissue hemoglobin content and oxygenation in distinct zones of the TRAM flap skin before, early, and late after surgery? Does tissue hemoglobin content and oxygenation correspond to blood flow in the supplying superior epigastric artery and to clinical signs of TRAM flap perfusion and viability? In 11 patients, tissue hemoglobin content and oxygenation in the lower abdomen/TRAM flap, mastectomy skin flap, and contralateral breast were measured by a new near-infrared reflection spectroscopy system preoperatively, early postoperatively, and late postoperatively. Simultaneously, systolic peak flow in the ipsilateral superior epigastric artery was obtained by color-coded duplex sonography. Routine clinical monitoring was performed throughout the early postoperative period. Tissue hemoglobin content and oxygenation in the lower abdomen, mastectomy skin flap, and contralateral breast were similar before surgery but varied considerably between different patients. There were no significant differences among preoperative, early postoperative, and late postoperative values of tissue hemoglobin content and oxygenation in the mastectomy skin flap and contralateral breast. However, near-infrared reflection spectroscopy measurements of the TRAM flap revealed significant differences between preoperative and early postoperative values of tissue hemoglobin content and oxygenation and among zones I, II, and III early after surgery. Tissue hemoglobin content in the TRAM flap skin increased and oxygenation decreased early after surgery. Near-infrared reflection spectroscopy values corresponded to clinical signs of venous congestion predominantly in zone III. Late postoperative return of hemoglobin content and oxygenation in the TRAM flap toward preoperative values can be attributed to improved venous return by reversed flow across regurgitant valves and development of collateral circulation. Finally, there was a significant increase of systolic peak flow in the ipsilateral superior epigastric artery early after surgery. This could be related to the opening of small-caliber choke arteries between the superior and deep inferior epigastric arteries following ligation of the dominant deep inferior epigastric artery and TRAM flap transfer to the chest. Systolic peak flow returned to preoperative values late after surgery. The near-infrared reflection spectroscopy system used in this study appeared to measure hemoglobin content and oxygenation in the superficial skin layers only. Near-infrared reflection spectroscopy was able to detect differences of tissue hemoglobin content and oxygenation in the TRAM flap between preoperative and postoperative measurements and between distinct zones of the TRAM flap early postoperatively. Postoperative changes in near-infrared reflection spectroscopy values corresponded to clinical observations and blood flow in the superior epigastric artery measured by color-coded duplex sonography. Further experience is needed before near-infrared reflection spectroscopy can be advocated for routine clinical flap monitoring.

Noninvasive determination of the optical properties of adult brain: near-infrared spectroscopy approach

The basic parameters for physiological measurements provided by near-infrared spectroscopy are the local absorption and scattering coefficients. For the adult human head, they have been difficult to measure noninvasively because of the layered structure of the head. The results of measurements of absorption and reduced scattering coefficients through the forehead on 30 adult volunteers using a multidistance frequency domain method are reported. The optode separation distance ranged from 10 to 80 mm and measurements were recorded at 758 and 830 nm. The measured absorption and reduced scattering coefficients of the forehead were used to evaluate the hemoglobin content in the scalp and brain as well as cerebral oxygen saturation. We found that cerebral oxygenation was relatively narrowly distributed within the subject group (the standard deviation was about 3% for scalp and 6% for brain, respectively), whereas hemoglobin concentrations had a relatively broader distribution. We found that as the optode distance increased, the absorption coefficients increased and the scattering coefficients decreased, retrieving the optical values of scalp and brain for shorter and longer optode distances, respectively. We present the transition curves of the absorption and reduced scattering coefficients as functions of the optode distance. In order to verify the values for each layer, a comparison between the experimental data and a prediction based on the two-layer model of the adult head was carried out. The thicknesses of scalp and skull for the two-layer model were obtained by magnetic resonance imaging of a subject's head. The optical parameters obtained from the two-layer model agreed very well with those measured by the multidistance method.

Interpreting hemoglobin and water concentration, oxygen saturation, and scattering measured in vivo by near-infrared breast tomography

Near-infrared spectroscopic tomography was used to measure the properties of 24 mammographically normal breasts to quantify whole-breast absorption and scattering spectra and to evaluate which tissue composition characteristics can be determined from these spectra. The absorption spectrum of breast tissue allows quantification of (i) total hemoglobin concentration, (ii) hemoglobin oxygen saturation, and (iii) water concentration, whereas the scattering spectrum provides information about the size and number density of cellular components and structural matrix elements. These property data were tested for correlation to demographic information, including subject age, body mass index, breast size, and radiographic density. Total hemoglobin concentration correlated inversely to body mass index, likely because lower body mass indicates proportionately less fat and more glandular tissue, and glandular tissue contains greater vascularity, hence, more total hemoglobin. Optical scattering was correlated to breast diameter, subject age, and radiographic density. In the radiographic density, fatty breasts had low scattering power and extremely dense breasts had higher values. This observation is consistent with low attenuation of conventional x-rays with fat and higher attenuation in glandular tissues. Optically, fatty tissues have large scatterers leading to a low scattering power, whereas glandular or fibrous tissues have more cellular and collagen-based structures that lead to high scattering power. The study presents correlative data supporting the hypothesis that optical measurements of absorption and scattering can provide physiologically relevant information about breast tissue composition. These breast constituents vary significantly between individuals and can be altered because of changes in breast physiology or pathological state.

Tissue oxygenation and perfusion in inferior pedicle reduction mammaplasty by near-infrared reflection spectroscopy and color-coded duplex sonography

Near-infrared reflection spectroscopy has been used in various experimental and clinical settings to investigate tissue perfusion and oxygenation noninvasively. Its application in plastic surgery has only recently been reported. The current study used near-infrared reflection spectroscopy to monitor cutaneous microcirculation in breast skin flaps after inferior pedicle reduction mammaplasty. Thirty patients underwent bilateral reduction mammaplasty by a modified Robbins technique. Near-infrared reflection spectroscopy measurements were performed preoperatively and postoperatively at several defined positions of the breast. The reflection spectroscopy system was capable of detecting absolute values of total hemoglobin in milligrams per milliliter of tissue and tissue hemoglobin oxygen saturation in percent. Color-coded duplex sonography was used to visualize nutrient vessels of the inferior dermoglandular pedicle and to measure systolic peak flow in the arteries supplying the nipple-areola complex. Reflection spectroscopy values were examined for changes during the postoperative course. Reflection spectroscopy and duplex sonography values were analyzed for differences between patients with normal and compromised skin flap perfusion and wound healing, which was assessed clinically and by ultrasound. Preoperative reflection spectroscopy values demonstrated local, regional, and interindividual variations. Postoperatively, characteristic changes of tissue hemoglobin oxygen saturation and total hemoglobin were observed in all patients during the 2-week follow-up. Reflection spectroscopy values differed significantly between breast and nipple-areola skin. Tissue hemoglobin oxygen saturation was significantly lower, and total hemoglobin significantly higher, in patients with impaired wound healing compared with patients having normal wound healing. However, systolic peak flow in arteries of the inferior dermoglandular pedicle did not reveal differences between patients with impaired or normal wound healing of the nipple-areola complex. Near-infrared reflection spectroscopy allows the detection of hemoglobin content and oxygenation in skin flaps. Changes in tissue hemoglobin oxygen saturation and total hemoglobin reflect hemodynamic changes in skin flaps during normal and pathological wound healing. Because of considerable intraindividual and interindividual variations, trend values seem to be superior to single measurements. Although in this study, near-infrared reflection spectroscopy was capable of distinguishing between normal and impaired perfusion in skin flaps in a clinical model, its future implication may be the early detection of vascular compromise in free flaps.

Diffuse-reflectance spectroscopy from 500 to 1060 nm by correction for inhomogeneously distributed absorbers

Diffuse-reflectance spectroscopy for measurement of the absorption and scattering coefficients of biological tissue produces reliable results for wavelengths from 650 to 1050 nm. Implicitly, this approach assumes homogeneously distributed absorbers. A correction factor is introduced for inhomogeneous distribution of blood concentrated in discrete cylindrical vessels. This factor extends the applicability of diffusion theory to lower wavelengths. We present measurements of in vivo optical properties in the wavelength range 500-1060 nm.

Absorbance of opaque microstructures in optically diffuse media

In this study experimental measurements are used to determine that the observed absorbance of opaque microstructures in optically diffuse media correlates with the total surface area rather than the attenuation as calculated in a nonscattering environment. The data suggest that it may be possible to use remote measurements of optical diffuse transmission to quantify surface areas of microcapillaries that are highly absorbing or larger blood vessels that can have high intrinsic attenuation because of hematocrit alone. Results obtained in a transmission geometry are insensitive to the position of the microstructure along the line between source and detector, whereas those collected in a remission geometry are highly sensitive to the depth at which the structure is located. These types of measurement involving microscopic structures embedded in diffuse media have potential application in quantifying blood vessel surface areas that contain contrast agents or other microparticles within tissue.

Precise measurement of cerebral blood flow in newborn piglets from the bolus passage of indocyanine green

Indocyanine green (ICG) is a near-infrared dye that has the potential to be used as a tracer for the minimally invasive measurement of cerebral blood flow (CBF). In order to examine the technique, the arterial and cerebral concentrations of ICG were measured in newborn piglets during the bolus passage of ICG at normocapnia and two levels of mild hypercapnia. The results were analysed by applying the Fick principle in both integral and differential forms using a linear regression technique to improve the precision of calculated values of CBF. It was found that the integral method, which has been used previously, is particularly sensitive to errors in the time registration between the arterial and tissue signals whereas the differential method is less so. In addition, the differential method allows the venous outflow to be calculated which gives further information on the state of the capillary bed. CBF was 39.7 +/- 4.6 ml 100 g(-1) min(-1) at an arterial carbon dioxide tension (PaCO2) of 33.0+/-2.2 mmHg and increased to 53.7+/-9.1 and 75.4+/-15.2 ml 100 g(-1) min(-1) at a PaCO2 of 42.1 +/- 2.6 and 54.2 +/- 3.1 mmHg respectively (mean +/- SD, n = 7). There was no significant change in cerebral metabolic rate for oxygen, validating the value of blood flow to an arbitrary scaling factor. When the inspired CO2 fraction was returned to zero, calculated CBF returned to baseline with a variation of 7% of the mean, indicating that this technique is highly precise.

Corrections for inhomogeneities in biological tissue caused by blood vessels

In tissue optics, the assumption that blood is homogeneously distributed in tissue can give rise to miscalculations because blood is found only in blood vessels. In our paper randomly oriented blood vessels are treated as particles for which we obtained apparent absorption and scattering coefficients by means of the Monte Carlo method. Apart from this correction for the contribution of blood properties in tissue, a correction for the contribution of the surrounding tissue proved to be needed as well. The results found with our model were compared with available results from the literature.

Measurement of cerebral blood volume using near-infrared spectroscopy and indocyanine green elimination

Methods for measuring cerebral blood volume (CBV) have traditionally used radioisotopes. More recently, near-infrared spectroscopy (NIRS) has been used to measure CBV by using a technique involving O(2) desaturation of cerebral tissue, where the observed change in the concentration of oxygenated hemoglobin is a marker of the volume of blood contained within the brain. A new integration method employing NIRS is described by using indocyanine green (ICG) as the intravascular marker. After bolus injection, concentration-time integrals of cerebral tissue ICG concentration ([ICG](tissue)) measured by NIRS are compared with corresponding integrals of the cerebral blood ICG concentrations ([ICG](blood)) estimated by high-performance liquid chromatography of peripheral blood samples with allowance for cerebral-to-large-vessel hematocrit ratio. It is shown that CBV = integral [ICG]tissue/[ICG]blood. Measurements in 10 adult volunteers gave a mean value of 1.1 +/- 0.39 (SD) ml/100 g illuminated tissue. This result, although lower than previous NIRS estimations, is consistent with the long extracerebral path of light in the adult head. Scaling of results is required to take into account this component of the optical pathlength.

Experimental and theoretical comparison of NIR spectroscopy measurements of cerebral hemoglobin changes

Two near-infrared spectroscopy (NIRS) methods are available for measuring changes (Delta) in total cerebral hemoglobin concentration (CHC): 1) a continuous measurement of the changes in total hemoglobin concentration (Delta[Hb]tot) and 2) the difference between two absolute measurements of CHC, each derived from a small, controlled change in inspired O2 fraction. This paper investigates the internal consistency of these two methods by using an experimental and theoretical comparison. NIRS was used to measure [Hb]tot in five newborn piglets before and after a change in arterial PCO2. Delta[Hb]tot demonstrated a low coefficient of variation of 2.8 +/- 2.8 (SD) % which allowed changes in CO2-cerebral blood volume reactivity to be clearly discriminated. However, a high coefficient of variation of 22.8 +/- 3.5% on the DeltaCHC measurements obscured any CO2 reactivity changes. A theoretical analysis demonstrates the effects of optical pathlength, background absorption, scatter, and blood vessel diameter on both methods. For more accurate monitoring of CHC, individual measurements of optical pathlength and more accurate pulse oximetry are required.

The relationship of oxygen delivery to absolute haemoglobin oxygenation and mitochondrial cytochrome oxidase redox state in the adult brain: a near-infrared spectroscopy study

Near-infrared spectroscopy was used to determine the effect of changes in the rate of oxygen delivery to the adult rat brain on the absolute concentrations of oxyhaemoglobin, deoxyhaemoglobin and the redox state of the CuA centre in mitochondrial cytochrome oxidase. The cytochrome oxidase detection algorithm was determined to be robust to large changes in haemoglobin oxygenation and concentration. By assuming complete haemoglobin deoxygenation and CuA reduction following mechanical ventilation on 100% N2O, the absolute concentration of oxyhaemoglobin (35 microM), deoxyhaemoglobin (27 microM) and the redox state of CuA (82% oxidized) were calculated in the normal adult brain. The mean arterial blood pressure was decreased by exsanguination. When the pressure reached 100 mmHg, haemoglobin oxygenation started to fall, but the total haemoglobin concentration and oxidized CuA levels only fell when cerebral blood volume autoregulation mechanisms failed at 50 mmHg. Haemoglobin oxygenation fell linearly with decreases in the rate of oxygen delivery to the brain, but the oxidized CuA concentration did not start to fall until this rate was 50% of normal. The results suggest that the brain maintains more than adequate oxygen delivery to mitochondria and that near-infrared spectroscopy may be a good measure of oxygen insufficiency in vivo.