In vivobioimpedance changes during haemorrhagic and ischaemic stroke in rats: towards 3D stroke imaging using electrical impedance tomography

Noise-based correction for electrical impedance tomography

Objective.Noisy measurements frequently cause noisy and inaccurate images in impedance imaging. No post-processing technique exists to calculate the propagation of measurement noise and use this to suppress noise in the image. The objectives of this work were (1) to develop a post-processing method for noise-based correction (NBC) in impedance tomography, (2) to test whether NBC improves image quality in electrical impedance tomography (EIT), (3) to determine whether it is preferable to use correlated or uncorrelated noise for NBC, (4) to test whether NBC works within vivodata and (5) to test whether NBC is stable across model and perturbation geometries.Approach.EIT was performedin silicoin a 2D homogeneous circular domain and an anatomically realistic, heterogeneous 3D human head domain for four perturbations and 25 noise levels in each case. This was validated by performing EIT for four perturbations in a circular, saline tank in 2D as well as a human head-shaped saline tank with a realistic skull-like layer in 3D. Images were assessed on the error in the weighted spatial variance (WSV) with respect to the true, target image. The effect of NBC was also tested forin vivoEIT data of lung ventilation in a human thorax and cortical activity in a rat brain.Main results.On visual inspection, NBC maintained or increased image quality for all perturbations and noise levels in 2D and 3D, both experimentally andin silico. Analysis of the WSV showed that NBC significantly improved the WSV in nearly all cases. When the WSV was inferior with NBC, this was either visually imperceptible or a transformation between noisy reconstructions. Forin vivodata, NBC improved image quality in all cases and preserved the expected shape of the reconstructed perturbation.Significance.In practice, uncorrelated NBC performed better than correlated NBC and is recommended as a general-use post-processing technique in EIT.

Early detection of acute ischemic stroke using Contrast-enhanced electrical impedance tomography perfusion

A cerebral contrast-enhanced electrical impedance tomography perfusion method is developed for acute ischemic stroke during intravenous thrombolytic therapy. Several clinical contrast agents with stable impedance characteristics and high-conductivity contrast were screened experimentally as electrical impedance contrast agent candidates. The electrical impedance tomography perfusion method was tested on rabbits with focal cerebral infarction, and its capability for early detection was verified based on perfusion images. The experimental results showed that ioversol 350 performed significantly better as an electrical impedance contrast agent than other contrast agents (p < 0.01). Additionally, perfusion images of focal cerebral infarction in rabbits confirmed that the electrical impedance tomography perfusion method could accurately detect the location and area of different cerebral infarction lesions (p < 0.001). Therefore, the cerebral contrast-enhanced electrical impedance tomography perfusion method proposed herein combines traditional, dynamic continuous imaging with rapid detection and could be applied as an early, rapid-detection, auxiliary, bedside imaging method for patients after a suspected ischemic stroke in both prehospital and in-hospital settings.

Real-time imaging of traumatic brain injury using magnetic induction tomography

Objective. Early diagnosis of traumatic brain injury (TBI) is crucial for its prognosis; however, traditional computed tomography diagnostic methods rely on large medical devices with an associated lag time to receive results. Therefore, an imaging modality is needed that provides real-time monitoring, can easily be carried out to assess the extent of TBI damage, and thus guides treatment.Approach. In the present study, an improved magnetic induction tomography (MIT) data acquisition system was used to monitor TBI in an animal model and distinguish the injury level. A pneumatically controlled cortical impactor was used to strike the parietal lobe of anesthetized rabbits two or three times under the same parameter mode to establish two different rabbit models of TBI. The MIT data acquisition system was used to record data and continuously monitor the brain for one hour without intervention.Main results. A target with increased conductivity was clearly observed in the reconstructed image. The position was relatively fixed and accurate, and the average positioning error of the image was 0.013 72 m. The normalized mean reconstruction value of all images increased with time. The slope of the regression line of the normalized mean reconstruction value differed significantly between the two models (p< 0.0001).Significance. This indicates that in the animal model, the unique features of MIT may facilitate the early monitoring of TBI and distinguish different degrees of injuries, thereby reducing the risk and mortality of associated complications.

Fast Iterative Shrinkage-Thresholding Algorithm with Continuation for Brain Injury Monitoring Imaging Based on Electrical Impedance Tomography

Electrical impedance tomography (EIT) is low-cost and noninvasive and has the potential for real-time imaging and bedside monitoring of brain injury. However, brain injury monitoring by EIT imaging suffers from image noise (IN) and resolution problems, causing blurred reconstructions. To address these problems, a least absolute shrinkage and selection operator model is built, and a fast iterative shrinkage-thresholding algorithm with continuation (FISTA-C) is proposed. Results of numerical simulations and head phantom experiments indicate that FISTA-C reduces IN by 63.2%, 47.2%, and 29.9% and 54.4%, 44.7%, and 22.7%, respectively, when compared with the damped least-squares algorithm, the split Bergman, and the FISTA algorithms. When the signal-to-noise ratio of the measurements is 80-50 dB, FISTA-C can reduce IN by 83.3%, 72.3%, and 68.7% on average when compared with the three algorithms, respectively. Both simulation and phantom experiments suggest that FISTA-C produces the best image resolution and can identify the two closest targets. Moreover, FISTA-C is more practical for clinical application because it does not require excessive parameter adjustments. This technology can provide better reconstruction performance and significantly outperforms the traditional algorithms in terms of IN and resolution and is expected to offer a general algorithm for brain injury monitoring imaging via EIT.

Neurophysiology tools to lower the stroke onset to treatment time during the golden hour: microwaves, bioelectrical impedance and near infrared spectroscopy

Reperfusion therapy administration timing in acute ischaemic stroke is the main determinant of patients' mortality and long-term disability. Indeed, the first hour from the stroke onset is defined the "golden hour", in which the treatment has the highest efficacy and lowest side effects. Delayed ambulance transport, inappropriate triage and difficulty in accessing CT scans lead to delayed onset to treatment time (OTT) in clinical practice. To date brain CT scan is needed to rule out intracranial haemorrhage, which is a major contraindication to thrombolytic therapy. The availability, dimension and portability make CT suitable mainly for intrahospital use, determining further delays in the therapies administration. This review aims at evaluating portable neurophysiology technologies developed with the scope of speeding up the diagnostic phase of acute stroke and, therefore, the initiation of intravenous thrombolysis. Medline databases were explored for studies concerning near infrared spectroscopy (NIRS), bioelectrical impedance spectroscopy (BIS) and Microwave imaging (MWI) as methods for stroke diagnosis. A total of 1368 articles were found, and 12 of these fit with our criteria and were included in the review. For each technology, the following parameters were evaluated: diagnostic accuracy, ability to differentiate ischaemic and haemorrhagic stroke, diagnosis time from stroke onset, portability and technology readiness level (TRL). All the described methods seem to be able to identify acute stroke even though the number of studies is very limited. Low cost and portability make them potentially usable during ambulance transport, possibly leading to a reduction of stroke OTT along with the related huge benefits in terms of patients outcome and health care costs. In addition, unlike standard imaging techniques, neurophysiological techniques could allow continuous monitoring of patients for timely intrahospital stroke diagnosis.KEY MESSAGESFirst hour from the stroke onset is defined the "golden hour", in which the treatment has the highest efficacy and lowest side effects.The delay for stroke onset to brain imaging time is one of the major reasons why only a minority of patients with acute ischaemic stroke are eligible to reperfusion therapies.Neurophysiology techniques (NIRS, BIS and MWI) could have a potential high impact in reducing the time to treatment in stroke patients.

Detection, Diagnosis and Treatment of Acute Ischemic Stroke: Current and Future Perspectives

Stroke is one of the leading causes of disability worldwide. Early diagnosis and treatment of stroke are important for better clinical outcome. Rapid and accurate diagnosis of stroke subtypes is critical. This review discusses the advantages and disadvantages of the current diagnostic and assessment techniques used in clinical practice, particularly for diagnosing acute ischemic stroke. Alternative techniques for rapid detection of stroke utilizing blood based biomarkers and novel portable devices employing imaging methods such as volumetric impedance phase-shift spectroscopy, microwave tomography and Doppler ultrasound are also discussed. Current therapeutic approaches for treating acute ischemic stroke using thrombolytic drugs and endovascular thrombectomy are discussed, with a focus on devices and approaches recently developed to treat large cranial vessel occlusions.

Advances in electrical impedance tomography-based brain imaging

Novel advances in the field of brain imaging have enabled the unprecedented clinical application of various imaging modalities to facilitate disease diagnosis and treatment. Electrical impedance tomography (EIT) is a functional imaging technique that measures the transfer impedances between electrodes on the body surface to estimate the spatial distribution of electrical properties of tissues. EIT offers many advantages over other neuroimaging technologies, which has led to its potential clinical use. This qualitative review provides an overview of the basic principles, algorithms, and system composition of EIT. Recent advances in the field of EIT are discussed in the context of epilepsy, stroke, brain injuries and edema, and other brain diseases. Further, we summarize factors limiting the development of brain EIT and highlight prospects for the field. In epilepsy imaging, there have been advances in EIT imaging depth, from cortical to subcortical regions. In stroke research, a bedside EIT stroke monitoring system has been developed for clinical practice, and data support the role of EIT in multi-modal imaging for diagnosing stroke. Additionally, EIT has been applied to monitor the changes in brain water content associated with cerebral edema, enabling the early identification of brain edema and the evaluation of mannitol dehydration. However, anatomically realistic geometry, inhomogeneity, cranium completeness, anisotropy and skull type, etc., must be considered to improve the accuracy of EIT modeling. Thus, the further establishment of EIT as a mature and routine diagnostic technique will necessitate the accumulation of more supporting evidence.

Anatomical atlas of the upper part of the human head for electroencephalography and bioimpedance applications

Objective.The objective of this work is to develop a 4D (3D+T) statistical anatomical atlas of the electrical properties of the upper part of the human head for cerebral electrophysiology and bioimpedance applications.Approach.The atlas was constructed based on 3D magnetic resonance images (MRI) of 107 human individuals and comprises the electrical properties of the main internal structures and can be adjusted for specific electrical frequencies. T1w+T2w MRI images were used to segment the main structures of the head while angiography MRI was used to segment the main arteries. The proposed atlas also comprises a time-varying model of arterial brain circulation, based on the solution of the Navier-Stokes equation in the main arteries and their vascular territories.Main results.High-resolution, multi-frequency and time-varying anatomical atlases of resistivity, conductivity and relative permittivity were created and evaluated using a forward problem solver for EIT. The atlas was successfully used to simulate electrical impedance tomography measurements indicating the necessity of signal-to-noise between 100 and 125 dB to identify vascular changes due to the cardiac cycle, corroborating previous studies. The source code of the atlas and solver are freely available to download.Significance.Volume conductor problems in cerebral electrophysiology and bioimpedance do not have analytical solutions for nontrivial geometries and require a 3D model of the head and its electrical properties for solving the associated PDEs numerically. Ideally, the model should be made with patient-specific information. In clinical practice, this is not always the case and an average head model is often used. Also, the electrical properties of the tissues might not be completely known due to natural variability. Anatomical atlases are important tools forin silicostudies on cerebral circulation and electrophysiology that require statistically consistent data, e.g. machine learning, sensitivity analyses, and as a benchmark to test inverse problem solvers.

A bioimpedance-based monitor for real-time detection and identification of secondary brain injury

Secondary brain injury impacts patient prognosis and can lead to long-term morbidity and mortality in cases of trauma. Continuous monitoring of secondary injury in acute clinical settings is primarily limited to intracranial pressure (ICP); however, ICP is unable to identify essential underlying etiologies of injury needed to guide treatment (e.g. immediate surgical intervention vs medical management). Here we show that a novel intracranial bioimpedance monitor (BIM) can detect onset of secondary injury, differentiate focal (e.g. hemorrhage) from global (e.g. edema) events, identify underlying etiology and provide localization of an intracranial mass effect. We found in an in vivo porcine model that the BIM detected changes in intracranial volume down to 0.38 mL, differentiated high impedance (e.g. ischemic) from low impedance (e.g. hemorrhagic) injuries (p < 0.001), separated focal from global events (p < 0.001) and provided coarse 'imaging' through localization of the mass effect. This work presents for the first time the full design, development, characterization and successful implementation of an intracranial bioimpedance monitor. This BIM technology could be further translated to clinical pathologies including but not limited to traumatic brain injury, intracerebral hemorrhage, stroke, hydrocephalus and post-surgical monitoring.

Arrangement of boundary electrodes for detection of frontal lobe disease with electrical impedance tomography

Purpose: Caused by brain trauma or blood vessel abnormality, intracerebral hemorrhage and secondary ischemia have become prevalent and severe neurological diseases. The timely and accurate detection of disease is essential for the recovery of patients. As an emerging visualization technique, electrical impedance tomography (EIT) offers an alternative. It is able to reconstruct the conductivity distribution that reflects the pathological variation of human tissue. Approach: In the EIT-based detection, electrodes are usually in uniform arrangement, which may be not suitable in some conditions. To enhance sensitivity in the region of interest, EIT with a novel offset arrangement of boundary electrodes is proposed to image a simulated frontal lobe hemorrhage and secondary ischemia. To cope with the ill-posed inverse problem, the L1 regularization method is developed during the reconstruction. In addition, the impact of noise with a signal-to-noise ratio of 56 dB is studied. Results: Compared with the traditional uniform electrode arrangement, the results demonstrate that EIT with the proposed offset arrangement of electrodes is more advantageous for imaging frontal lobe disease. Conclusions: The proposed offset arrangement of electrodes is superior to the traditional uniform arrangement in imaging frontal lobe disease, especially under the impact of noise.

A New Method of Haemorrhagic Stroke Detection Via Deep Magnetic Induction Tomography

Hemorrhage imaging is one of the most common applications of magnetic induction tomography (MIT). Depth and the mass of stroke stimulated (MSS) are the most important issues that need to be solved for this application. Transcranial magnetic stimulation (TMS) is a technique belonging to the deep brain stimulation (DBS) field, which aims at overcoming human diseases such as depression. TMS coils, namely, circular, figure-8, and H-coils, play an important role in TMS. Among these, H-coils individually focus on the issues of achieving effective stimulation of deep region. MIT and TMS mechanisms are similar. Herein, for the first time, improved TMS coils, including figure-8 and H-coils, are applied as MIT excitation coils to study the possibility of achieving the mass of stroke stimulated and deep detection through MIT. In addition, the configurations of the detection coils are varied to analyze their influence and determine the optimal coils array. Finally, MIT is used to detect haemorrhagic stroke occurring in humans, and the application of deep MIT to the haemorrhagic stroke problem is computationally explored. Results show that among the various coils, the improved H-coils have MSS and depth characteristics that enable the detection of deep strokes through MIT. Although the detecting depth of the figure-8 coil is weaker, its surface signal is good. The deep MIT technique can be applied to haemorrhagic detection, providing a critical base for deeper research.

Evaluation of the effectiveness of electrical muscle stimulation on human calf muscles via frequency difference electrical impedance tomography

Objectives. The human skeletal muscle responds immediately under electrical muscle stimulation (EMS), and there is an immediate physiological response in human skeletal muscle. Non-invasive quantitative analysis is at the heart of our understanding of the physiological significance of human muscle changes under EMS. Response muscle areas of human calf muscles under EMS have been detected by frequency difference electrical impedance tomography (fd-EIT).Approach. The experimental protocol consists of four parts: pre-training (pre), training (tra), post-training (post), and relaxation (relax) parts. The relaxation part has three relaxation conditions, which are massage relaxation (MR), cold pack relaxation (CR), and hot pack relaxation (HR).Main results. From the experimental results, conductivity distribution imagesσ^p(pmeans protocol = pre,tra,post,or relax) are clearly reconstructed byfd-EIT as response muscle areas, which are called theM₁response area (composed of gastrocnemius muscle) and theM₂response area (composed of the tibialis anterior muscle, extensor digitorum longus muscle, and peroneus longus muscle). A paired samplest-test was conducted to elucidate the statistical significance of spatial-mean conductivities 〈σ^p〉_M1and 〈σ^p〉_M2inM₁andM₂with reference to the conventional extracellular water ratioβ^pby bioelectrical impedance analysis. Significance. From thet-test results, 〈σ^p〉_M1and〈σ^p〉_M2have good correlation withβ^p. In the post-training part, 〈σ^post〉 andβ^postwere significantly higher than in the pre-training part (n = 24,p < 0.001). The relax-pre difference ratios of spatial-mean conductivity Δ〈σ^relax-pre〉 and the relax-pre difference ratios of extracellular water ratio Δβ^relax-prein both MR and CR were lower; on the contrary, the Δ〈σ^relax-pre〉 and Δβ^relax-prein HR were significantly higher than those in post-pre difference ratios of spatial-mean conductivity Δ〈σ^post-pre〉 (n = 8,p < 0.05). The reason for the changes in 〈σ^p〉_M1and 〈σ^p〉_M2are caused by the changes in muscle extracellular volumes. In conclusion,fd-EIT satisfactorily evaluates the effectiveness of human calf muscles under EMS.

Real-time monitoring hypoxia at high altitudes using electrical bioimpedance technique: an animal experiment

Hypoxia poses a serious threat to pilots. The aim of this study was to examine the efficacy of electrical bioimpedance (EBI) in detecting the onset of hypoxia in real time in a rabbit hypoxia model. Thirty-two New Zealand rabbits were divided equally into four groups (control group and three hypoxia groups, i.e., mild, moderate, and severe). Hypoxia was induced by simulating various altitudes in the hypobaric oxygen chamber (3,000 m, 5,000 m, and 8,000 m). Both cerebral impedance and blood oxygen (Sp_O2) were monitored continuously. Results showed that the cerebral impedance increased immediately during the period of increasing altitude and decreased quickly to the initial baseline at the phase of descending altitude. Moreover, the change of cerebral impedance in the mild hypoxia group (3,000 m) was significantly smaller than those in the other two groups (5,000 m and 8,000 m, P < 0.05). The changes in cerebral impedance and Sp_O2 were significantly correlated based on the total of measurement data (r² = 0.628, P < 0.001). Furthermore, the agreement analysis performed with Bland-Altman and standardized residual plots exhibited high concordance between cerebral impedance and Sp_O2. Receiver operator characteristic analysis manifested that the sensitivity, specificity, and area under the curve using cerebral impedance for changes in Sp_O2 >10% were 0.735, 0.826, and 0.845, respectively. These findings demonstrated that EBI could sensitively and accurately monitor changes of cerebral impedance induced by hypoxia, which might provide a potential tool for the real-time and noninvasive monitoring of hypoxic condition of pilots in flight for early identification of hypoxia.NEW & NOTEWORTHY This study is the first to examine the efficacy of electrical bioimpedance (EBI) in detecting the onset of high-altitude hypoxia in real time. The novelty of this research includes three aspects. First, the cerebral impedance of rabbits increased immediately during the rising of altitude and decreased quickly to the initial baseline at the phase of descending altitude. Second, there was a significant correlation and high concordance between cerebral impedance and Sp_O2. Third, cerebral impedance could determine the change of Sp_O2 resulting from hypoxia.

Imaging fascicular organization of rat sciatic nerves with fast neural electrical impedance tomography

Imaging compound action potentials (CAPs) in peripheral nerves could help avoid side effects in neuromodulation by selective stimulation of identified fascicles. Existing methods have low resolution, limited imaging depth, or are invasive. Fast neural electrical impedance tomography (EIT) allows fascicular CAP imaging with a resolution of <200 µm, <1 ms using a non-penetrating flexible nerve cuff electrode array. Here, we validate EIT imaging in rat sciatic nerve by comparison to micro-computed tomography (microCT) and histology with fluorescent dextran tracers. With EIT, there are reproducible localized changes in tissue impedance in response to stimulation of individual fascicles (tibial, peroneal and sural). The reconstructed EIT images correspond to microCT scans and histology, with significant separation between the fascicles (p < 0.01). The mean fascicle position is identified with an accuracy of 6% of nerve diameter. This suggests fast neural EIT can reliably image the functional fascicular anatomy of the nerves and so aid selective neuromodulation.

Real-Time Detection of Hemothorax and Monitoring its Progression in a Piglet Model by Electrical Impedance Tomography: A Feasibility Study

Hemothorax is a serious medical condition that can be life-threatening if left untreated. Early diagnosis and timely treatment are of great importance to produce favorable outcome. Although currently available diagnostic techniques, e.g., chest radiography, ultrasonography, and CT, can accurately detect hemothorax, delayed hemothorax cannot be identified early because these examinations are often performed on patients until noticeable symptoms manifest. Therefore, for early detection of delayed hemothorax, real-time monitoring by means of a portable and noninvasive imaging technique is needed. In this study, we employed electrical impedance tomography (EIT) to detect the onset of hemothorax in real time on eight piglet hemothorax models. The models were established by injection of 60 ml fresh autologous blood into the pleural cavity, and the subsequent development of hemothorax was monitored continuously. The results showed that EIT was able to sensitively detect hemothorax as small as 10 ml in volume, as well as its location. Also, the development of hemothorax over a range of 10 ml up to 60 ml was well monitored in real time, with a favorable linear relationship between the impedance change in EIT images and the volume of blood injected. These findings demonstrated that EIT has a unique potential for early diagnosis and continuous monitoring of hemothorax in clinical practice, providing medical staff valuable information for prompt identification and treatment of delayed hemothorax.

Real-time imaging of infarction deterioration after ischemic stroke in rats using electrical impedance tomography

OBJECTIVE

This study investigated the feasibility of electrical impedance tomography (EIT) for monitoring the deterioration of ischemic lesion after the onset of stroke.

APPROACH

Fifteen rats were randomly distributed into two groups: rats operated to establish a right middle cerebral artery occlusion (MCAO) (n  =  10), and sham-operated rats (n  =  5). Then, the operated rats were kept 2 h under anesthesia for EIT monitoring. Subsequently, descriptive statistical analysis was performed on whole-brain resistivity changes, and repeated-measures analysis of variance (ANOVA) on the average resistivity variation index. Additionally, pathological examinations were performed after 6 h of infarction.

MAIN RESULTS

The results obtained showed that ischemic damage developed in the right corpus striatum of the rats with MCAO, whereas the brains of the sham group showed no anomalies. The descriptive statistical analysis revealed that the whole-brain resistivity changes after 30, 60, 90, and 120 min of infarction were 0.063  ±  0.038, 0.097  ±  0.046, 0.141  ±  0.062, and 0.204  ±  0.092 for the rats with MCAO and 0.029  ±  0.021, 0.002  ±  0.002, 0.017  ±  0.011, and  -0.001  ±  0.011 for the sham-operated rats, respectively. The repeated-measures ANOVA revealed that the right MCAO model resulted in a significant impedance increase in the right hemisphere, which continued to increase over time after infarction.

SIGNIFICANCE

The overall study results indicate that EIT facilitates monitoring of local impedance variations caused by MCAO and may be a solution for real-time monitoring of intracranial pathological changes in ischemic stroke patients.

An iterative damped least-squares algorithm for simultaneously monitoring the development of hemorrhagic and secondary ischemic lesions in brain injuries

Electrical impedance tomography (EIT) is a non-invasive and real-time imaging method that has the potential to be used for monitoring intracerebral hemorrhage (ICH). Recent studies have proposed that ischemia secondary to ICH occurs simultaneously in the brain. Real-time monitoring of the development of hemorrhage and risk of secondary ischemia is crucial for clinical intervention. However, few studies have explored the performance of EIT monitoring in cases where hemorrhage and secondary ischemia exist. When these lesions get close to each other, or their conductivity and volume changes differ greatly, it becomes challenging for dynamic EIT algorithms to simultaneously reconstruct subtle injuries. To address this, an iterative damped least-squares (IDLS) algorithm is proposed in this study. The quality of the IDLS algorithm was assessed using blur radius and temporal response during computer simulation and a phantom 3D head-shaped model where bidirectional disturbance targets were simulated. The results showed that the IDLS algorithm enhanced contrast and concurrently reconstructed bidirectional disturbance targets in images. Moreover, it showed superior performance in decreasing the blur radius and was time cost-effective. With further improvement, the IDLS algorithm has the potential to be used for monitoring the development of hemorrhage and risk of ischemia secondary to ICH. Graphical abstract (a) and (b) are simulation images of bidirectional disturbance targets with different change ratios of volume (Vr) and conductivity (σ_r) based on the damped least-squares (DLS) algorithm and iterative damped least-squared (IDLS) algorithm, respectively. (c) shows the performance metrics of blur radius and temporal response with different volume ratio (corresponding to Vr). (d) shows the performance metrics of blur radius and temporal response with different conductivity change percentage (corresponding to σ_r).

EIT Imaging of Intracranial Hemorrhage in Rabbit Models Is Influenced by the Intactness of Cranium

Electrical impedance tomography (EIT) has been shown to be a promising, bedside imaging method to monitor the progression of intracranial hemorrhage (ICH). However, the observed impedance changes within brain related to ICH differed among groups, and we hypothesized that the cranium intactness (open or closed) may be the one of potential reasons leading to the difference. Therefore, the aim of this study was to investigate this effect of open or closed cranium on impedance changes within brain in the rabbit ICH model. In this study, we first established the ICH model in 12 rabbits with the open cranium and in 12 rabbits with the closed cranium. Simultaneously, EIT measurements on the rabbits' heads were performed to record the impedance changes caused by injecting the autologous nonheparinized blood into cerebral parenchyma. Finally, the regional impedance changes on EIT images and the whole impedance changes were analyzed. It was surprisingly found that when the cranium was open, the impedance of the area where the blood was injected, as well as the whole brain impedance, decreased with the amount of blood being injected; when the cranium was closed, while the impedance of the area where blood was not injected continued to increase, the impedance of the area where blood was injected decreased within 20s of the blood being injected and then remained almost unchanged, and the whole brain impedance had a small fall and then notably increased. The results have validated that the cranium completeness (open or closed) has influences on impedance changes within brain when using EIT to monitor ICH. In future study on application of EIT to monitor ICH, the cranium completeness should be taken into account for establishing an ICH model and analyzing the corresponding EIT results.

Optimal combination of electrodes and conductive gels for brain electrical impedance tomography

BACKGROUND

Electrical impedance tomography (EIT) is an emerging imaging technology that has been used to monitor brain injury and detect acute stroke. The time and frequency properties of electrode-skin contact impedance are important for brain EIT because brain EIT measurement is performed over a long period when used to monitor brain injury, and is carried out across a wide range of frequencies when used to detect stroke. To our knowledge, no study has simultaneously investigated the time and frequency properties of both electrode and conductive gel for brain EIT.

METHODS

In this study, the contact impedance of 16 combinations consisting of 4 kinds of clinical electrode and five types of commonly used conductive gel was measured on ten volunteers' scalp for a period of 1 h at frequencies from 100 Hz to 1 MHz using the two-electrode method. And then the performance of each combination was systematically evaluated in terms of the magnitude of contact impedance, and changes in contact impedance with time and frequency.

RESULTS

Results showed that combination of Ag⁺/Ag⁺Cl^- powder electrode and low viscosity conductive gel performed best overall (Ten 20^® in this study); it had a relatively low magnitude of contact impedance and superior performance regarding contact impedance with time (p < 0.05) and frequency (p < 0.05).

CONCLUSIONS

Experimental results indicates that the combination of Ag⁺/Ag⁺Cl^- powder electrode and low viscosity conductive gel may be the best choice for brain EIT.

Phase division multiplexed EIT for enhanced temporal resolution

OBJECTIVE

The most commonly used EIT paradigm (time division multiplexing) limits the temporal resolution of impedance images due to the need to switch between injection electrodes. Advances have previously been made using frequency division multiplexing (FDM) to increase temporal resolution, but in cases where a fixed range of frequencies is available, such as imaging fast neural activity, an upper limit is placed on the total number of simultaneous injections. The use of phase division multiplexing (PDM) where multiple out of phase signals can be injected at each frequency is investigated to increase temporal resolution.

APPROACH

TDM, FDM and PDM were compared in head tank experiments, to compare transfer impedance measurements and spatial resolution between the three techniques. A resistor phantom paradigm was established to investigate the imaging of one-off impedance changes, of magnitude 1% and with durations as low as 500 µs (similar to those seen in nerve bundles), using both PDM and TDM approaches.

MAIN RESULTS

In head tank experiments, a strong correlation (r  >  0.85 and p  <  0.001) was present between the three sets of measured transfer impedances, and no statistically significant difference was found in reconstructed image quality. PDM was able to image impedance changes down to 500 µs in the phantom experiments, while the minimum duration imaged using TDM was 5 ms.

SIGNIFICANCE

PDM offers a possible solution to the imaging of fast moving impedance changes (such as in nerves), where the use of triggering or coherent averaging is not possible. The temporal resolution presents an order of magnitude improvement of the TDM approach, and the approach addresses the limited spatial resolution of FDM by increasing the number of simultaneous EIT injections.

In Vivo Bioimpedance Spectroscopy Characterization of Healthy, Hemorrhagic and Ischemic Rabbit Brain within 10 Hz-1 MHz

Acute stroke is a serious cerebrovascular disease and has been the second leading cause of death worldwide. Conventional diagnostic modalities for stroke, such as CT and MRI, may not be available in emergency settings. Hence, it is imperative to develop a portable tool to diagnose stroke in a timely manner. Since there are differences in impedance spectra between normal, hemorrhagic and ischemic brain tissues, multi-frequency electrical impedance tomography (MFEIT) shows great promise in detecting stroke. Measuring the impedance spectra of healthy, hemorrhagic and ischemic brain in vivo is crucial to the success of MFEIT. To our knowledge, no research has established hemorrhagic and ischemic brain models in the same animal and comprehensively measured the in vivo impedance spectra of healthy, hemorrhagic and ischemic brain within 10 Hz–1 MHz. In this study, the intracerebral hemorrhage and ischemic models were established in rabbits, and then the impedance spectra of healthy, hemorrhagic and ischemic brain were measured in vivo and compared. The results demonstrated that the impedance spectra differed significantly between healthy and stroke-affected brain (i.e., hemorrhagic or ischemic brain). Moreover, the rate of change in brain impedance following hemorrhagic and ischemic stroke with regard to frequency was distinct. These findings further validate the feasibility of using MFEIT to detect stroke and differentiate stroke types, and provide data supporting for future research.

A Versatile and Reproducible Multi-Frequency Electrical Impedance Tomography System

A highly versatile Electrical Impedance Tomography (EIT) system, nicknamed the ScouseTom, has been developed. The system allows control over current amplitude, frequency, number of electrodes, injection protocol and data processing. Current is injected using a Keithley 6221 current source, and voltages are recorded with a 24-bit EEG system with minimum bandwidth of 3.2 kHz. Custom PCBs interface with a PC to control the measurement process, electrode addressing and triggering of external stimuli. The performance of the system was characterised using resistor phantoms to represent human scalp recordings, with an SNR of 77.5 dB, stable across a four hour recording and 20 Hz to 20 kHz. In studies of both haeomorrhage using scalp electrodes, and evoked activity using epicortical electrode mats in rats, it was possible to reconstruct images matching established literature at known areas of onset. Data collected using scalp electrode in humans matched known tissue impedance spectra and was stable over frequency. The experimental procedure is software controlled and is readily adaptable to new paradigms. Where possible, commercial or open-source components were used, to minimise the complexity in reproduction. The hardware designs and software for the system have been released under an open source licence, encouraging contributions and allowing for rapid replication.