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Tsukinaga A, Yoshitani K, Ozaki T, Takahashi JC, Ogata S, Ohnishi Y. Quantitative regional cerebral blood flow measurement using near-infrared spectroscopy and indocyanine green in patients undergoing superficial temporal to middle cerebral artery bypass for moyamoya disease: a novel method using a frequency filter. J Clin Monit Comput 2022; 37:421-429. [PMID: 36167879 DOI: 10.1007/s10877-022-00916-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022]
Abstract
Measuring regional cerebral blood flow (rCBF) after revascularization for moyamoya disease, as a type of ischemic cerebrovascular disease, is crucial. This study aims to validate our novel technology that combines near-infrared spectroscopy (NIRS) with a frequency filter to extract the arterial component. We measured rCBF before and after revascularization for moyamoya disease and at the end of the surgery using NIRO-200NX (Hamamatsu Photonics, Japan) and indocyanine green (ICG). rCBF was calculated using Fick's principle, change in arterial ICG concentrations, and maximum arterial ICG concentration. rCBF measured with NIRS (rCBF_N) was compared with pre- and postoperative rCBF measured with SPECT (rCBF_S). Thirty-four procedures were analyzed. rCBF_N increased from baseline to end of the surgery (mean difference (MD), 2.99 ml/min/100 g; 95% confidence interval (CI), 0.40-5.57 ml/min/100 g on the diseased side; MD, 4.94 ml/min/100 g; 95% CI, 2.35-7.52 ml/min/100 g on the non-diseased side). Similar trends were observed for rCBF_S (MD, 3.98 ml/min/100 g; 95% CI, 2.30-5.67 ml/min/100 g on the diseased side; MD, 2.77 ml/min/100 g; 95% CI, 1.09-4.45 ml/min/100 g on the non-diseased side). Intraclass correlations 3 (ICC3s) between rCBF_N and rCBF_S were weak on the diseased side (ICC3, 0.25; 95% CI, -0.03-0.5; p = 0.07) and the non-diseased side (ICC3, 0.24; 95% CI, -0.05-0.5; p = 0.08). rCBF measurements based on this novel method were weakly correlated with rCBF measurements with SPECT.
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Affiliation(s)
- Akito Tsukinaga
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, SuitaOsaka, 564-8565, Japan
| | - Kenji Yoshitani
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, SuitaOsaka, 564-8565, Japan.
| | - Takeo Ozaki
- Systems Division, Hamamatsu Photonics K.K, Hamamatsu, Japan
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, SuitaOsaka, 564-8565, Japan
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Skow RJ, Brothers RM, Claassen JAHR, Day TA, Rickards CA, Smirl JD, Brassard P. On the use and misuse of cerebral hemodynamics terminology using Transcranial Doppler ultrasound: a call for standardization. Am J Physiol Heart Circ Physiol 2022; 323:H350-H357. [PMID: 35839156 DOI: 10.1152/ajpheart.00107.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cerebral hemodynamics (e.g., cerebral blood flow) can be measured and quantified using many different methods, with Transcranial Doppler ultrasound (TCD) being one of the most commonly utilized approaches. In human physiology, the terminology used to describe metrics of cerebral hemodynamics are inconsistent, and in some instances technically inaccurate; this is especially true when evaluating, reporting, and interpreting measures from TCD. Therefore, this perspectives article presents recommended terminology when reporting cerebral hemodynamic data. We discuss the current use and misuse of the terminology in the context of using TCD to measure and quantify cerebral hemodynamics and present our rationale and consensus on the terminology that we recommend moving forward. For example, one recommendation is to discontinue use of the term "cerebral blood flow velocity" in favor of "cerebral blood velocity" with precise indication of the vessel of interest. We also recommend clarity when differentiating between discrete cerebrovascular regulatory mechanisms, namely cerebral autoregulation, neurovascular coupling, and cerebrovascular reactivity. This will be a useful guide for investigators in the field of cerebral hemodynamics research.
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Affiliation(s)
- Rachel J Skow
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
| | - R Matthew Brothers
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
| | - Jurgen A H R Claassen
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Caroline A Rickards
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Canada
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Barud M, Dabrowski W, Siwicka-Gieroba D, Robba C, Bielacz M, Badenes R. Usefulness of Cerebral Oximetry in TBI by NIRS. J Clin Med 2021; 10:2938. [PMID: 34209017 PMCID: PMC8268432 DOI: 10.3390/jcm10132938] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 12/14/2022] Open
Abstract
Measurement of cerebral oximetry by near-infrared spectroscopy provides continuous and non-invasive information about the oxygen saturation of haemoglobin in the central nervous system. This is especially important in the case of patients with traumatic brain injuries. Monitoring of cerebral oximetry in these patients could allow for the diagnosis of inadequate cerebral oxygenation caused by disturbances in cerebral blood flow. It could enable identification of episodes of hypoxia and cerebral ischemia. Continuous bedside measurement could facilitate the rapid diagnosis of intracranial bleeding or cerebrovascular autoregulation disorders and accelerate the implementation of treatment. However, it should be remembered that the method of monitoring cerebral oximetry by means of near-infrared spectroscopy also has its numerous limitations, resulting mainly from its physical properties. This paper summarizes the usefulness of monitoring cerebral oximetry by near-infrared spectroscopy in patients with traumatic brain injury, taking into account the advantages and the disadvantages of this technique.
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Affiliation(s)
- Małgorzata Barud
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland; (W.D.); (D.S.-G.)
| | - Wojciech Dabrowski
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland; (W.D.); (D.S.-G.)
| | - Dorota Siwicka-Gieroba
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland; (W.D.); (D.S.-G.)
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino, 16100 Genova, Italy;
| | - Magdalena Bielacz
- Institute of Tourism and Recreation, State Vocational College of Szymon Szymonowicz, 22-400 Zamosc, Poland;
| | - Rafael Badenes
- Department of Anaesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, 46010 Valencia, Spain;
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4
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Forcione M, Yakoub KM, Chiarelli AM, Perpetuini D, Merla A, Sun R, Sawosz P, Belli A, Davies DJ. Dynamic contrast-enhanced near-infrared spectroscopy using indocyanine green on moderate and severe traumatic brain injury: a prospective observational study. Quant Imaging Med Surg 2020; 10:2085-2097. [PMID: 33139989 PMCID: PMC7547258 DOI: 10.21037/qims-20-742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The care given to moderate and severe traumatic brain injury (TBI) patients may be hampered by the inability to tailor their treatments according to their neurological status. Contrast-enhanced near-infrared spectroscopy (NIRS) with indocyanine green (ICG) could be a suitable neuromonitoring tool. METHODS Monitoring the effective attenuation coefficients (EAC), we compared the ICG kinetics between five TBI and five extracranial trauma patients, following a venous-injection of 5 mL of 1 mg/mL ICG, using two commercially available NIRS devices. RESULTS A significantly slower passage of the dye through the brain of the TBI group was observed in two parameters related to the first ICG inflow into the brain (P=0.04; P=0.01). This is likely related to the reduction of cerebral perfusion following TBI. Significant changes in ICG optical properties minutes after injection (P=0.04) were registered. The acquisition of valid optical data in a clinical environment was challenging. CONCLUSIONS Future research should analyze abnormalities in the ICG kinetic following brain trauma, test how these values can enhance care in TBI, and adapt the current optical devices to clinical settings. Also, studies on the pattern in changes of ICG optical properties after venous injection can improve the accuracy of the values detected.
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Affiliation(s)
- Mario Forcione
- University Hospitals Birmingham NHS Foundation Trust, National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), Mindelsohn Way, Birmingham, UK
- University of Birmingham, Neuroscience & Ophthalmology Research Group, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, Edgbaston, Birmingham, UK
| | - Kamal Makram Yakoub
- University Hospitals Birmingham NHS Foundation Trust, National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), Mindelsohn Way, Birmingham, UK
| | - Antonio Maria Chiarelli
- University G. D’Annunzio of Chieti-Pescara, Institute for Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
| | - David Perpetuini
- University G. D’Annunzio of Chieti-Pescara, Institute for Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
| | - Arcangelo Merla
- University G. D’Annunzio of Chieti-Pescara, Institute for Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
| | - Rosa Sun
- University Hospitals Birmingham NHS Foundation Trust, National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), Mindelsohn Way, Birmingham, UK
| | - Piotr Sawosz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4, Warsaw, Poland
| | - Antonio Belli
- University Hospitals Birmingham NHS Foundation Trust, National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), Mindelsohn Way, Birmingham, UK
- University of Birmingham, Neuroscience & Ophthalmology Research Group, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, Edgbaston, Birmingham, UK
| | - David James Davies
- University Hospitals Birmingham NHS Foundation Trust, National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), Mindelsohn Way, Birmingham, UK
- University of Birmingham, Neuroscience & Ophthalmology Research Group, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, Edgbaston, Birmingham, UK
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5
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Forcione M, Chiarelli AM, Davies DJ, Perpetuini D, Sawosz P, Merla A, Belli A. Cerebral perfusion and blood-brain barrier assessment in brain trauma using contrast-enhanced near-infrared spectroscopy with indocyanine green: A review. J Cereb Blood Flow Metab 2020; 40:1586-1598. [PMID: 32345103 PMCID: PMC7370372 DOI: 10.1177/0271678x20921973] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Contrast-enhanced near-infrared spectroscopy (NIRS) with indocyanine green (ICG) can be a valid non-invasive, continuous, bedside neuromonitoring tool. However, its usage in moderate and severe traumatic brain injury (TBI) patients can be unprecise due to their clinical status. This review is targeted at researchers and clinicians involved in the development and application of contrast-enhanced NIRS for the care of TBI patients and can be used to design future studies. This review describes the methods developed to monitor the brain perfusion and the blood-brain barrier integrity using the changes of diffuse reflectance during the ICG passage and the results on studies in animals and humans. The limitations in accuracy of these methods when applied on TBI patients and the proposed solutions to overcome them are discussed. Finally, the analysis of relative parameters is proposed as a valid alternative over absolute values to address some current clinical needs in brain trauma care. In conclusion, care should be taken in the translation of the optical signal into absolute physiological parameters of TBI patients, as their clinical status must be taken into consideration. Discussion on where and how future studies should be directed to effectively incorporate contrast-enhanced NIRS into brain trauma care is given.
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Affiliation(s)
- Mario Forcione
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Neuroscience & Ophthalmology Research Group, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Antonio M Chiarelli
- Department of Neuroscience Imaging and Clinical Science, Institute for Advanced Biomedical Technologies, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - David J Davies
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Neuroscience & Ophthalmology Research Group, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - David Perpetuini
- Department of Neuroscience Imaging and Clinical Science, Institute for Advanced Biomedical Technologies, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Piotr Sawosz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Arcangelo Merla
- Department of Neuroscience Imaging and Clinical Science, Institute for Advanced Biomedical Technologies, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Antonio Belli
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Neuroscience & Ophthalmology Research Group, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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6
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Gerega A, Milej D, Weigl W, Kacprzak M, Liebert A. Multiwavelength time-resolved near-infrared spectroscopy of the adult head: assessment of intracerebral and extracerebral absorption changes. BIOMEDICAL OPTICS EXPRESS 2018; 9:2974-2993. [PMID: 29984079 PMCID: PMC6033559 DOI: 10.1364/boe.9.002974] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/27/2018] [Accepted: 05/17/2018] [Indexed: 05/23/2023]
Abstract
An optical technique based on diffuse reflectance measurement combined with indocyanine green (ICG) bolus tracking is extensively tested as a method for the clinical assessment of brain perfusion at the bedside. We report on multiwavelength time-resolved diffuse reflectance spectroscopy measurements carried out on the head of a healthy adult during the intravenous administration of a bolus of ICG. Intracerebral and extracerebral changes in absorption were estimated from an analysis of changes in statistical moments (total number of photons, mean time of flight and variance) of the distributions of times of flight (DTOF) of photons recorded simultaneously at 16 wavelengths from the range of 650-850 nm using sensitivity factors estimated by diffusion approximation based on a layered model of the studied medium. We validated the proposed method in a series of phantom experiments and in-vivo measurements. The results obtained show that changes in the concentration of the ICG can be assessed as a function of time of the experiment and depth in the tissue. Thus, the separation of changes in ICG concentration appearing in intra- and extracerebral tissues can be estimated from optical data acquired at a single source-detector pair of fibers/fiber bundles positioned on the surface of the head.
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Affiliation(s)
- Anna Gerega
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences Trojdena 4, 02-109 Warsaw, Poland
| | - Daniel Milej
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences Trojdena 4, 02-109 Warsaw, Poland
- Department of Medical Biophysics, Western University, London, Ontario N6A 5C1, Canada
- Imaging Division, Lawson Health Research Institute, London, Ontario N6A 4V2, Canada
| | - Wojciech Weigl
- Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Akademiska Hospital, 751 85 Uppsala, Sweden
| | - Michal Kacprzak
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences Trojdena 4, 02-109 Warsaw, Poland
| | - Adam Liebert
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences Trojdena 4, 02-109 Warsaw, Poland
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7
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An Y, Kang Y, Lee J, Ahn C, Kwon K, Choi C. Blood flow characteristics of diabetic patients with complications detected by optical measurement. Biomed Eng Online 2018; 17:25. [PMID: 29466988 PMCID: PMC5822764 DOI: 10.1186/s12938-018-0457-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/16/2018] [Indexed: 12/12/2022] Open
Abstract
Background Diabetes mellitus (DM) is one of the most common diseases worldwide. Uncontrolled and prolonged hyperglycemia can cause diabetic complications, which reduce the quality of life of patients. Diabetic complications are common in DM patients. Because it is impossible to completely recover from diabetic complications, it is important for early detection. In this study, we suggest a novel method of determining blood flow characteristics based on fluorescence image analysis with indocyanine green and report that diabetic complications have unique blood flow characteristics. Methods We analyzed time-series fluorescence images obtained from controls, DM patients, and DM patients with complications. The images were segmented into the digits and the dorsum of the feet and hands, and each part has been considered as arterial and capillary flow. We compared the blood flow parameters in each region among the three groups. Results The DM patients with complications showed similar blood flow parameters to the controls, except the area under the curve and the maximum intensity, which indicate the blood flow volume. These parameters were significantly decreased in DM patients with complications. Although some blood flow parameters in the feet of DM patients with complications were close to normal blood flow, the vascular response of the macrovessels and microvessels to stimulation of the hands was significantly reduced, which indicates less reactivity in DM patients with complications. Conclusions Our results suggest that DM patients, and DM patients with complications, have unique peripheral blood flow characteristics.
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Affiliation(s)
- Yuri An
- Department of Bio and Brain Engineering, KAIST, Daejeon, Republic of Korea
| | - Yujung Kang
- R&D Center, Vieworks Co., Anyang-si, Gyeonggi-do, Republic of Korea
| | - Jungsul Lee
- Cellex Life Sciences, Inc, Daejeon, Republic of Korea
| | - Chulwoo Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kihwan Kwon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Chulhee Choi
- Department of Bio and Brain Engineering, KAIST, Daejeon, Republic of Korea. .,Cellex Life Sciences, Inc, Daejeon, Republic of Korea.
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8
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Nakagawa I, Park HS, Yokoyama S, Yamada S, Motoyama Y, Park YS, Wada T, Kichikawa K, Nakase H. Indocyanine green kinetics with near-infrared spectroscopy predicts cerebral hyperperfusion syndrome after carotid artery stenting. PLoS One 2017; 12:e0180684. [PMID: 28704454 PMCID: PMC5507521 DOI: 10.1371/journal.pone.0180684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/19/2017] [Indexed: 11/19/2022] Open
Abstract
Background Cerebral hyperperfusion syndrome (HPS) is a potentially life-threatening complication following carotid artery stenting (CAS) and carotid endoarterectomy (CEA). Early prediction and treatment of patients at risk for HPS are required in patients undergoing CAS because HPS occurs significantly earlier after CAS than CEA. Near-infrared spectroscopy (NIRS) is often used for monitoring, and indocyanine green (ICG) kinetics by NIRS (ICG-NIRS) can detect reductions in cerebral perfusion in patients with acute stroke. However, whether ICG-NIRS can predict postoperative hyperperfusion phenomenon (HP) after carotid revascularization is unclear. Objective Here, we evaluated whether the blood flow index (BFI) ratio calculated from a time-intensity curve from ICG-NIRS monitoring can predict HPS after CAS. Methods The BFI ratio was prospectively monitored using ICG-NIRS in 135 patients undergoing CAS. Preoperative cerebrovascular reactivity (CVR) and the postoperative asymmetry index (AI) were also assessed with single-photon emission computed tomography before and after CAS, and the correlation was evaluated. In addition, patients were divided into two groups, a non-HP group (n = 113) and an HP group (n = 22), and we evaluated the correlation with hemodynamic impairment in the ipsilateral hemisphere and clinical results. Results Twenty-two cases (16%) showed HP, and four (3%) showed HPS after CAS. The BFI ratio calculated from ICG-NIRS showed a significant linear correlation with preoperative CVR and postoperative AI (r = −0.568, 0.538, P < 0.001, <0.001, respectively). The degree of stenosis, the rate of no cross flow, preoperative CVR, and the incidence of HPS were significantly different between the groups. Conclusions Measurement of ICG kinetics by NIRS is useful for detection of HPS in patients who underwent CAS.
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Affiliation(s)
- Ichiro Nakagawa
- Departments of Neurosurgery Nara Medical University, Nara, Japan
- * E-mail:
| | - Hun Soo Park
- Departments of Neurosurgery Nara Medical University, Nara, Japan
| | - Shohei Yokoyama
- Departments of Neurosurgery Nara Medical University, Nara, Japan
| | - Shuichi Yamada
- Departments of Neurosurgery Nara Medical University, Nara, Japan
| | - Yasushi Motoyama
- Departments of Neurosurgery Nara Medical University, Nara, Japan
| | - Young Su Park
- Departments of Neurosurgery Nara Medical University, Nara, Japan
| | - Takeshi Wada
- Departments of Radiology, Nara Medical University, Nara, Japan
| | | | - Hiroyuki Nakase
- Departments of Neurosurgery Nara Medical University, Nara, Japan
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9
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Liebert A, Milej D, Weigl W, Gerega A, Kacprzak M, Maniewski R. Fluorescence-based method for assessment of blood-brain barrier disruption. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:3040-2. [PMID: 24110368 DOI: 10.1109/embc.2013.6610181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report on a fluorescence-based optical method for assessment of blood-brain barrier in humans. The technique is based on monitoring of fluorescence light excited in the dye circulating in the brain. Measurements were carried out in healthy volunteers and in patients with disruption of the blood-brain barrier with the use of time-resolved method during inflow and washout of indocyanine green after its intravenous injection. We show large differences in the fluorescence signals - in healthy subjects a fast washout of the dye can be observed whereas in patients the washout is significantly prolonged. We conclude that the monitoring of the fluorescence signals during injection of exogenous optical contrast agent can be used for the assessment of the condition of blood-brain barrier at the bedside. The technique may be of benefit for diagnosis of the patients suffering from damage of the blood-brain barrier and in monitoring of therapies used in such patients.
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10
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Keller E, Froehlich J, Baumann D, Böcklin C, Sikorski C, Oberle M, Muser M. Detection of delayed cerebral ischemia (DCI) in subarachnoid haemorrhage applying near-infrared spectroscopy: elimination of the extracerebral signal by transcutaneous and intraparenchymatous measurements in parallel. ACTA NEUROCHIRURGICA. SUPPLEMENT 2015; 120:243-7. [PMID: 25366631 DOI: 10.1007/978-3-319-04981-6_41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Detection of delayed cerebral ischemia (DCI) in high-grade subarachnoid haemorrhage (SAH) is an unsolved issue. Conventional near-infrared spectroscopy (NIRS) with optodes applied over the skin is controversial because the NIRS signal is contaminated by extracerebral tissue. The objective is to quantify and subtract the contribution from extracerebral tissue from the signal by using measurements in parallel with a NIRS brain tissue probe and conventional NIRS. METHODS In a patient with high-grade SAH, two approaches for NIRS were applied. First, a conventional brain tissue probe for intracranial pressure (ICP) monitoring, supplied by optical fibres, was placed into the brain tissue 2 cm deep from the dura. Second, for conventional NIRS, a plaster-based patch carrying optodes (one emitter, two detectors) was attached to the skin. Central venous injections of 0.3 mg/kg body weight (bw) indocyanine green (ICG) were performed. ICG dye dilution curves obtained with the probe and patch were collected simultaneously and analysed for blood flow values. RESULTS Twelve measurements in parallel with the probe and patch were performed. Mean cerebral blood flow (CBF) for the probe was higher (24.8 ± 9.1 ml/100 g/min) compared with the values obtained with the patch (for detector 1, extra-cerebral blood flow [ECBF] mean 5.1 ± 1.8 ml/100 g/min; p = 0.002; for detector 2, 6.6 ± 2.1 ml/100 g/min; p = 0.002). CBF values obtained with the probe correlated with blood flow values obtained with the patch (for CBF vs. ECBF detector 1, r = 0.72 [p = 0.008]; ECBF detector 2, r = 0.79 [p = 0.002]). CONCLUSIONS Blood flow values obtained with conventional NIRS correlated significantly with absolute CBF values obtained directly within the brain tissue. Simultaneous measurements with the NeMo Probe and NeMo Patch allow quantification and subtraction of the contribution from extracerebral tissues from the signal obtained with conventional NIRS.
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Affiliation(s)
- Emanuela Keller
- Neurocritical Care Unit, Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, Zuerich, CH-8091, Switzerland,
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11
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Ishii H, Takami T, Fujioka T, Mizukaki N, Kondo A, Sunohara D, Hoshika A, Akutagawa O, Isaka K. Comparison of changes in cerebral and systemic perfusion between appropriate- and small-for-gestational-age infants during the first three days after birth. Brain Dev 2014; 36:380-7. [PMID: 23838311 DOI: 10.1016/j.braindev.2013.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 06/07/2013] [Accepted: 06/10/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The aims of the current study were to compare changes in cerebral and systemic perfusion in appropriate-for-gestational-age (AGA) and small-for-gestational-age (SGA) infants immediately after birth. METHODS Cerebral blood volume (CBV), cerebral Hb oxygen saturation (cSO2) and cerebral fractional tissue oxygen extraction (cFTOE) among 57 AGA infants and 30 SGA infants were monitored using a newly developed time-resolved spectroscopy system during the first 3days of life. The left ventricular ejection fraction (LVEF), left ventricular cardiac output (LVCO) and E/e' values were determined by three-dimensional echocardiography and tissue Doppler imaging performed simultaneously. RESULTS There were significant differences between the body weights of both the AGA and SGA infants, but not between the gestational age and head circumferences in both groups. Although CBV showed no significant difference between the groups, cSO2 was significantly higher and cFTOE was lower in SGA infants than in AGA infants. Hematocrit (Ht) levels were significantly higher and LVEF and LVCO were lower in SGA infants than in AGA infants. Negative correlation was observed between CBV and Ht levels in AGA infants, but not in SGA infants. CONCLUSIONS The high Ht levels and vasoreactivity in SGA infants might be a compensatory mechanism in order to maintain oxygen delivery to the brain, which reflects the condition of chronic hypoxia during the fetal period and also reflects the weak contraction and low cardiac output of the left ventricle sustaining the relatively large brain from the fetal period to after birth.
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Affiliation(s)
- Hiroki Ishii
- Department of Pediatrics, Tokyo Medical University, Japan.
| | - Takeshi Takami
- Department of Pediatrics, Tokyo Medical University, Japan
| | - Tao Fujioka
- Department of Pediatrics, Tokyo Medical University, Japan
| | - Norio Mizukaki
- Department of Pediatrics, Tokyo Medical University, Japan
| | - Atsushi Kondo
- Department of Pediatrics, Tokyo Medical University, Japan
| | | | | | - Osamu Akutagawa
- Department of Obstetrics and Gynecology, Tokyo Medical University, Japan
| | - Keiichi Isaka
- Department of Obstetrics and Gynecology, Tokyo Medical University, Japan
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12
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Toczylowska B, Zieminska E, Goch G, Milej D, Gerega A, Liebert A. Neurotoxic effects of indocyanine green -cerebellar granule cell culture viability study. BIOMEDICAL OPTICS EXPRESS 2014; 5:800-16. [PMID: 24688815 PMCID: PMC3959834 DOI: 10.1364/boe.5.000800] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/08/2014] [Accepted: 02/10/2014] [Indexed: 05/05/2023]
Abstract
The aim of this study was to examine neurotoxicity indocyanine green (ICG). We assessed viability of primary cerebellar granule cell culture (CGC) exposed to ICG to test two mechanisms that could be the first triggers causing neuronal toxicity: imbalance in calcium homeostasis and the degree of oligomerization of ICG molecules. We have observed this imbalance in CGC after exposure to 75-125μΜ ICG and dose and application sequence dependent protective effect of Gadovist on surviving neurons in vitro when used with ICG. Spectroscopic studies suggest the major cause of toxicity of the ICG is connected with oligomers formation. ICG at concentration of 25 μM (which is about 4 times higher than the highest concentration of ICG in the brain applied in in-vivo human studies) is not neurotoxic in the cell culture.
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Affiliation(s)
- Beata Toczylowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Trojdena Str. 02-109 Warsaw, Poland
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 5A Pawinskiego Str., 02-106 Warsaw, Poland
| | - Elzbieta Zieminska
- Mossakowski Medical Research Centre, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland
| | - Grazyna Goch
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 5A Pawinskiego Str., 02-106 Warsaw, Poland
| | - Daniel Milej
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Trojdena Str. 02-109 Warsaw, Poland
| | - Anna Gerega
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Trojdena Str. 02-109 Warsaw, Poland
| | - Adam Liebert
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Trojdena Str. 02-109 Warsaw, Poland
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13
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Calderon-Arnulphi M, Alaraj A, Slavin KV. Near infrared technology in neuroscience: past, present and future. Neurol Res 2013; 31:605-14. [DOI: 10.1179/174313209x383286] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Weigl W, Milej D, Gerega A, Toczylowska B, Kacprzak M, Sawosz P, Botwicz M, Maniewski R, Mayzner-Zawadzka E, Liebert A. Assessment of cerebral perfusion in post-traumatic brain injury patients with the use of ICG-bolus tracking method. Neuroimage 2013; 85 Pt 1:555-65. [PMID: 23831529 DOI: 10.1016/j.neuroimage.2013.06.065] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 06/15/2013] [Accepted: 06/20/2013] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to verify the usefulness of the time-resolved optical method utilizing diffusely reflected photons and fluorescence signals combined with intravenous injection of indocyanine green (ICG) in the assessment of brain perfusion in post-traumatic brain injury patients. The distributions of times of flight (DTOFs) of diffusely reflected photons were acquired together with the distributions of times of arrival (DTAs) of fluorescence photons. The data analysis methodology was based on the observation of delays between the signals of statistical moments (number of photons, mean time of flight and variance) of DTOFs and DTAs related to the inflow of ICG to the extra- and intracerebral tissue compartments. Eleven patients with brain hematoma, 15 patients with brain edema and a group of 9 healthy subjects were included in this study. Statistically significant differences between parameters obtained in healthy subjects and patients with brain hematoma and brain edema were observed. The best optical parameter to differentiate patients and control group was variance of the DTOFs or DTAs. Results of the study suggest that time-resolved optical monitoring of inflow of the ICG seems to be a promising tool for detecting cerebral perfusion insufficiencies in critically ill patients.
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Affiliation(s)
- W Weigl
- Medical University of Warsaw, I Department of Anesthesiology and Intensive Care, Warsaw, Poland; Warsaw Praski Hospital, Department of Intensive Care and Anesthesiology, Warsaw, Poland.
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15
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Milej D, Gerega A, Żołek N, Weigl W, Kacprzak M, Sawosz P, Mączewska J, Fronczewska K, Mayzner-Zawadzka E, Królicki L, Maniewski R, Liebert A. Time-resolved detection of fluorescent light during inflow of ICG to the brain—a methodological study. Phys Med Biol 2012; 57:6725-42. [DOI: 10.1088/0031-9155/57/20/6725] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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16
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Gerega A, Milej D, Weigl W, Botwicz M, Zolek N, Kacprzak M, Wierzejski W, Toczylowska B, Mayzner-Zawadzka E, Maniewski R, Liebert A. Multiwavelength time-resolved detection of fluorescence during the inflow of indocyanine green into the adult's brain. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:087001. [PMID: 23224200 DOI: 10.1117/1.jbo.17.8.087001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Optical technique based on diffuse reflectance measurement combined with indocyanine green (ICG) bolus tracking is extensively tested as a method for clinical assessment of brain perfusion in adults at the bedside. Methodology of multiwavelength and time-resolved detection of fluorescence light excited in the ICG is presented and advantages of measurements at multiple wavelengths are discussed. Measurements were carried out: 1. on a physical homogeneous phantom to study the concentration dependence of the fluorescence signal, 2. on the phantom to simulate the dynamic inflow of ICG at different depths, and 3. in vivo on surface of the human head. Pattern of inflow and washout of ICG in the head of healthy volunteers after intravenous injection of the dye was observed for the first time with time-resolved instrumentation at multiple emission wavelengths. The multiwavelength detection of fluorescence signal confirms that at longer emission wavelengths, probability of reabsorption of the fluorescence light by the dye itself is reduced. Considering different light penetration depths at different wavelengths, and the pronounced reabsorption at longer wavelengths, the time-resolved multiwavelength technique may be useful in signal decomposition, leading to evaluation of extra- and intracerebral components of the measured signals.
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Affiliation(s)
- Anna Gerega
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Trojdena 4, 02-109 Warsaw, Poland.
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17
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Habermehl C, Schmitz CH, Steinbrink J. Contrast enhanced high-resolution diffuse optical tomography of the human brain using ICG. OPTICS EXPRESS 2011; 19:18636-44. [PMID: 21935232 PMCID: PMC3482886 DOI: 10.1364/oe.19.018636] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 08/31/2011] [Indexed: 05/19/2023]
Abstract
Non-invasive diffuse optical tomography (DOT) of the adult brain has recently been shown to improve the spatial resolution for functional brain imaging applications. Here we show that high-resolution (HR) DOT is also advantageous for clinical perfusion imaging using an optical contrast agent. We present the first HR-DOT results with a continuous wave near infrared spectroscopy setup using a dense grid of optical fibers and indocyanine green (ICG) as an exogenic contrast agent. We find an early arrival of the ICG bolus in the intracerebral tissue and a delayed arrival of the bolus in the extracerebral tissue, achieving the separation of both layers. This demonstrates the method's potential for brain perfusion monitoring in neurointensive care patients.
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Affiliation(s)
- Christina Habermehl
- Berlin NeuroImaging Center, Charité University Hospital, Department of Neurology, Berlin, Germany.
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18
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Gerega A, Zolek N, Soltysinski T, Milej D, Sawosz P, Toczylowska B, Liebert A. Wavelength-resolved measurements of fluorescence lifetime of indocyanine green. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:067010. [PMID: 21721831 DOI: 10.1117/1.3593386] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We study fluorescence lifetime of indocyanine green (ICG) using femtosecond laser and sensitive detection based on time-correlated single-photon counting. A time-resolved multichannel spectral system is constructed and applied for determination of the fluorescence lifetime of the ICG in different solvents. Emission properties of ICG in water, milk, and 1% intralipid solution are investigated. Fluorescence of the fluorophore of different concentrations (in a range of 1.7-160 μM) dissolved in different solutions is excited by femtosecond pulses generated with the use of Ti:Sa laser tuned within the range of 740-790 nm. It is observed that fluorescence lifetime of ICG in water is 0.166 ± 0.02 ns and does not depend on excitation and emission wavelengths. We also show that for the diffusely scattering solvents (milk and intralipid), the lifetime may depend on the dye concentration (especially for large concentrations of ICG). This effect should be taken into account when analyzing changes in the mean time of arrival of fluorescence photons excited in ICG dissolved in such optically turbid media.
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Affiliation(s)
- Anna Gerega
- Polish Academy of Sciences, Institute of Biocybernetics and Biomedical Engineering, Trojdena 4, 02-109 Warsaw, Poland.
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19
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Liebert A, Sawosz P, Milej D, Kacprzak M, Weigl W, Botwicz M, Maczewska J, Fronczewska K, Mayzner-Zawadzka E, Królicki L, Maniewski R. Assessment of inflow and washout of indocyanine green in the adult human brain by monitoring of diffuse reflectance at large source-detector separation. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:046011. [PMID: 21529080 DOI: 10.1117/1.3574018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Recently, it was shown in measurements carried out on humans that time-resolved near-infrared reflectometry and fluorescence spectroscopy may allow for discrimination of information originating directly from the brain avoiding influence of contaminating signals related to the perfusion of extracerebral tissues. We report on continuation of these studies, showing that the near-infrared light can be detected noninvasively on the surface of the tissue at large interoptode distance. A multichannel time-resolved optical monitoring system was constructed for measurements of diffuse reflectance in optically turbid medium at very large source-detector separation up to 9 cm. The instrument was applied during intravenous injection of indocyanine green and the distributions of times of flight of photons were successfully acquired showing inflow and washout of the dye in the tissue. Time courses of the statistical moments of distributions of times of flight of photons are presented and compared to the results obtained simultaneously at shorter source-detector separations (3, 4, and 5 cm). We show in a series of experiments carried out on physical phantom and healthy volunteers that the time-resolved data acquisition in combination with very large source-detector separation may allow one to improve depth selectivity of perfusion assessment in the brain.
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Affiliation(s)
- Adam Liebert
- Polish Academy of Sciences, Nalecz Institute of Biocybernetics and Biomedical Engineering, Trojdena 4, 02-109 Warsaw, Poland.
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20
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Neuromonitoring in intensive care: a new brain tissue probe for combined monitoring of intracranial pressure (ICP) cerebral blood flow (CBF) and oxygenation. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 110:217-20. [PMID: 21125474 DOI: 10.1007/978-3-7091-0356-2_39] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND the benefits of monitoring cerebral blood flow (CBF) in stroke patients are apparent. New techniques combining near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution to estimate cerebral hemodynamics are available. However, with transcutaneous NIRS and optodes applied over the skin, the signal is contaminated by extracerebral tissues. The objective is to develop a new brain tissue probe for combined monitoring of intracranial pressure (ICP), CBF and cerebral blood volume (CBV). METHODS conventional intraparenchymal probes for ICP monitoring are supplied with optical fibers. The light is coupled into the brain tissue and collected after absorption and scattering with a light detector. Venous injections of 0.2 mg/kgbw ICG are performed. The mean transit time of ICG (mttICG), CBF and CBV are calculated. RESULTS with a prototype of the probe in a first patient with subarachnoid hemorrhage 6 pairs of repetitive measurements were performed. Mean values were for mttICG 5.6 ± 0.2 s, CBF 22.3 ± 2.8 ml/100 g/min and CBV 2.1 ± 0.3 ml/100 g. CONCLUSIONS NIR spectroscopy allows the synchronous determination of multiple parameters with one single device. By measurements in parallel with the NeMo Probe and NIRS optodes placed over the skin, new algorithms can be developed to subtract the extracerebral contamination from the NIRS signal.
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21
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Abstracts of the 8th International Conference on Xenon CT and Related Cerebral Blood Flow Techniques: cerebral blood flow and brain metabolic imaging in clinical practice. Br J Neurosurg 2009; 20:333-58. [PMID: 17129888 DOI: 10.1080/02688690601002432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Lee JH, Lee Y, In J, Chung SH, Shin HI, Lee K, Kim KO, Cho H. Response of cerebral oximetry to increase in alveolar concentration of desflurane: effect of remifentanil and cerebrovascular CO 2reactivity. Korean J Anesthesiol 2009; 56:543-551. [DOI: 10.4097/kjae.2009.56.5.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jeoung Hyuk Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Younsuk Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Junyong In
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Seung-Hyun Chung
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Hong-il Shin
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Kyoungjin Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Kyoung Ok Kim
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Hun Cho
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
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23
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Abstract
Transcranial perfusion monitoring provides early warning of impending brain ischemia and may be used to guide management of cerebral perfusion and oxygenation. The monitoring options include measurement of intracranial and cerebral perfusion pressures, assessment of cerebral blood flow, and assessment of the adequacy of perfusion by measurement of cerebral oxygenation and brain tissue biochemistry. Some monitoring techniques are well established, whereas others are relatively new to the clinical arena and their indications are still being evaluated. Currently available monitoring techniques are reviewed and their appropriateness and application to the perioperative period is discussed.
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Affiliation(s)
- Martin Smith
- Department of Neuroanaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust and Centre for Anaesthesia, London, UK.
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24
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Dunn JF, Zhang Q, Wu Y, Srinivasan S, Smith MR, Shaw RA. Monitoring angiogenesis noninvasively with near-infrared spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2008; 13:064043. [PMID: 19123689 PMCID: PMC6859065 DOI: 10.1117/1.3000431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Near-infrared (NIR) spectroscopy is used to quantify cerebral blood volume (CBV) as a marker of angiogenesis (formation of new blood vessels). Rats are exposed to chronic hypoxia for 3 weeks at half atmospheric pressure to stimulate angiogenesis, and second-differential NIR spectroscopy is used to quantify total cerebral hemoglobin before and after angiogenesis. The cerebral hemoglobin (from broadband NIR spectroscopy), and the large vessel hemoglobin and hematocrit (from blood samples), are used to derive values for the calculation of CBV. The total hemoglobin in brain is 46.6+/-1.9 micromoll (mean+/-SD, n=5) preacclimation and increases by 72% postacclimation. CBV is initially 3.26+/-0.41% v/v and increases by 31% with acclimation. Each individual animal shows a measureable increase in CBV. This study indicates that NIR broadband spectroscopy can be used for repeated measurements of CBV and can be applied as a noninvasive method to study angiogenesis.
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Affiliation(s)
- Jeffrey F Dunn
- University of Calgary, Experimental Imaging Centre and Hotchkiss Brain Institute and Department of Radiology, Faculty of Medicine, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1 Canada
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25
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A liquid chromatography tandem mass spectrometry method for the quantification of indocyanine green in dog plasma and bile. J Pharm Biomed Anal 2008; 47:351-9. [DOI: 10.1016/j.jpba.2008.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 01/04/2008] [Accepted: 01/07/2008] [Indexed: 11/19/2022]
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26
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Wolf M, Ferrari M, Quaresima V. Progress of near-infrared spectroscopy and topography for brain and muscle clinical applications. JOURNAL OF BIOMEDICAL OPTICS 2007; 12:062104. [PMID: 18163807 DOI: 10.1117/1.2804899] [Citation(s) in RCA: 301] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This review celebrates the 30th anniversary of the first in vivo near-infrared (NIR) spectroscopy (NIRS) publication, which was authored by Professor Frans Jobsis. At first, NIRS was utilized to experimentally and clinically investigate cerebral oxygenation. Later it was applied to study muscle oxidative metabolism. Since 1993, the discovery that the functional activation of the human cerebral cortex can be explored by NIRS has added a new dimension to the research. To obtain simultaneous multiple and localized information, a further major step forward was achieved by introducing NIR imaging (NIRI) and tomography. This review reports on the progress of the NIRS and NIRI instrumentation for brain and muscle clinical applications 30 years after the discovery of in vivo NIRS. The review summarizes the measurable parameters in relation to the different techniques, the main characteristics of the prototypes under development, and the present commercially available NIRS and NIRI instrumentation. Moreover, it discusses strengths and limitations and gives an outlook into the "bright" future.
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Affiliation(s)
- Martin Wolf
- University Hospital Zurich, Clinic of Neonatology, Biomedical Optics Research Laboratory, 8091 Zurich, Switzerland.
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27
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Abstract
Transcranial perfusion monitoring provides early warning of impending brain ischemia and may be used to guide management of cerebral perfusion and oxygenation. The monitoring options include measurement of intracranial and cerebral perfusion pressures, assessment of cerebral blood flow, and assessment of the adequacy of perfusion by measurement of cerebral oxygenation and brain tissue biochemistry. Some monitoring techniques are well established, whereas others are relatively new to the clinical arena and their indications are still being evaluated. Currently available monitoring techniques are reviewed and their appropriateness and application to the perioperative period is discussed.
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Affiliation(s)
- Martin Smith
- Department of Neuroanaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, University College London, London, WC1N 3BG, UK.
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28
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Tisdall MM, Smith M. Multimodal monitoring in traumatic brain injury: current status and future directions. Br J Anaesth 2007; 99:61-7. [PMID: 17548431 DOI: 10.1093/bja/aem143] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Traumatic brain injury (TBI) remains a major cause of morbidity and mortality, particularly in young people. Despite encouraging animal studies, human trials assessing the use of pharmacological agents after TBI have all failed to show efficacy. Current management strategies are therefore directed towards providing an optimal physiological environment in order to minimize secondary insults and maximize the body's own regenerative processes. Modern neurocritical care management utilizes a host of monitoring techniques to identify or predict the occurrence of secondary insults and guide subsequent therapeutic interventions in an attempt to minimize the resulting secondary injury. Recent data suggest that the use of protocolized management strategies, informed by multimodality monitoring, can improve patient outcome after TBI. Developments in multimodality monitoring have allowed a movement away from rigid physiological target setting towards an individually tailored, patient-specific, approach. The wealth of monitoring information available provides a challenge in terms of data integration and accessibility and modern software applications may aid this process.
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Affiliation(s)
- M M Tisdall
- Department of Neuroanaesthesia and Neurocritical Care, Box 30, The National Hospital for Neurology and Neurosurgery, Centre for Anaesthesia, University College London, Queen Square, London WC1N 3BG, UK
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29
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Mudra R, Nadler A, Keller E, Niederer P. Analysis of near-infrared spectroscopy and indocyanine green dye dilution with Monte Carlo simulation of light propagation in the adult brain. JOURNAL OF BIOMEDICAL OPTICS 2006; 11:044009. [PMID: 16965166 DOI: 10.1117/1.2341652] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Near-infrared spectroscopy (NIRS) combined with indocyanine green (ICG) dilution is applied externally on the head to determine the cerebral hemodynamics of neurointensive care patients. We applied Monte Carlo simulation for the analysis of a number of problems associated with this method. First, the contamination of the optical density (OD) signal due to the extracerebral tissue was assessed. Second, the measured OD signal depends essentially on the relative blood content (with respect to its absorption) in the various transilluminated tissues. To take this into account, we weighted the calculated densities of the photon distribution under baseline conditions within the different tissues with the changes and aberration of the relative blood volumes that are typically observed under healthy and pathologic conditions. Third, in case of NIRS ICG dye dilution, an ICG bolus replaces part of the blood such that a transient change of absorption in the brain tissues occurs that can be recorded in the OD signal. Our results indicate that for an exchange fraction of Delta=30% of the relative blood volume within the intracerebral tissue, the OD signal is determined from 64 to 74% by the gray matter and between 8 to 16% by the white matter maximally for a distance of d=4.5 cm.
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Affiliation(s)
- R Mudra
- Institute of Biomedical Engineering, University and ETH Zürich, Gloriastrasse 35, 8092 Zürich, Switzerland.
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30
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Leung TS, Tachtsidis I, Smith M, Delpy DT, Elwell CE. Measurement of the absolute optical properties and cerebral blood volume of the adult human head with hybrid differential and spatially resolved spectroscopy. Phys Med Biol 2006; 51:703-17. [PMID: 16424590 DOI: 10.1088/0031-9155/51/3/015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A hybrid differential and spatially resolved spectroscopy (SRS) technique has been developed to measure absolute absorption coefficient (mu(a)), reduced scattering coefficient (mu'(s)) and cerebral blood volume (CBV) in the adult human head. A spectrometer with both differential and SRS capabilities has been used to carry out measurements in 12 subjects. Two versions of the calculation have been considered using the hybrid technique, with one considering water as a chromophore as well as oxy- and deoxy-haemoglobin, and one ignoring water. The CBV has also been measured using a previously described technique based on changing the arterial saturation (SaO(2)) measured separately by a pulse oximeter, resulting in mean +/- SD CBV(a) (intra-individual coefficient of variation) = 2.22 +/- 1.06 ml/100 g (29.9%). (The superscript on CBV indicates the different calculation basis.) Using the hybrid technique with water ignored, CBV(0) = 3.18 +/- 0.73 ml/100 g (10.0%), mu(0)(a)(813 nm) = 0.010 +/- 0.003 mm(-1) and mu'(0)(s)(813 nm) = 1.19 +/- 0.55 mm(-1) (data quoted at 813 nm). With water considered, CBV(w) = 3.05 +/- 0.77 ml/100 g (10.5%), mu(w)(a)(813 nm) = 0.010 +/- 0.003 mm(-1) and mu'(w)(s)(813 nm) = 1.28 +/- 0.56 mm(-1). The mean biases between CBV(0)/CBV(w), CBV(0)/CBV(a) and CBV(w)/CBV(a) are 0.14 +/- 0.09, 0.79 +/- 1.22 and 0.65 +/- 1.24 ml/100 g. The mean biases between mu(0)(a)(813 nm)/mu(w)(a)(813 nm) and mu'(0)(s)(813 nm)/mu'(w)(s)(813 nm) are (5.9 +/- 10.0) x 10(-4) mm(-1) and -0.084 +/- 0.266 mm(-1), respectively. The method we describe extends the functionality of the current SRS instrumentation.
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Affiliation(s)
- Terence S Leung
- Department of Medical Physics & Bioengineering, University College London, Gower Street, London WC1E 6BT, UK
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Leung TS, Elwell CE, Delpy DT. Estimation of cerebral oxy- and deoxy-haemoglobin concentration changes in a layered adult head model using near-infrared spectroscopy and multivariate statistical analysis. Phys Med Biol 2005; 50:5783-98. [PMID: 16333155 DOI: 10.1088/0031-9155/50/24/002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The non-invasive measurement of cerebral oxy- (DeltaHbO(br)2) and deoxy-haemoglobin (DeltaHHb(br)) changes using near-infrared spectroscopy instruments is often affected by the absorption in the extracerebral layer. We have exploited the multivariate calibration (partial least squares, PLS) method to minimize the errors for a range of blood volume, oxygen saturation and extracerebral layer thicknesses. The changes in the mean time of flight of photons (Delta tau) and attenuation (DeltaA) on the surface of a 3D adult head model were simulated using a finite-element method based on the diffusion equation. The PLS was then performed to identify the optimal number of detectors, their positions and weightings, to optimize the estimation of DeltaHbO(br)2 and DeltaHHb(br). We define the 'nominal accuracy' as the accuracy of estimating DeltaHbO(br)2 and DeltaHHb(br) over a nominal range of extracerebral layer thicknesses and 'robustness' as the accuracy beyond the nominal range. The results showed that for one or two detectors, Delta tau performed better than DeltaA while using them together gave the best performance. When more detectors were used, the performances of using Delta tau, DeltaA or both together became comparable, showing that a larger number of detectors can compensate for the performance of a simple DeltaA measurement despite this measurement having a relatively lower sensitivity to intracerebral absorption changes.
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Affiliation(s)
- Terence S Leung
- Department of Medical Physics and Bioengineering, Malet Place Engineering Building, University College London, Gower Street, London WC1E 6BT, UK
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Klaessens JHGM, Hopman JCW, Liem KD, van Os SHG, Thijssen JM. Effects of skin on bias and reproducibility of near-infrared spectroscopy measurement of cerebral oxygenation changes in porcine brain. JOURNAL OF BIOMEDICAL OPTICS 2005; 10:44003. [PMID: 16178637 DOI: 10.1117/1.1989315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The influence of skin on the bias and reproducibility of regional cerebral oxygenation measurements is investigated using cw near-infrared spectroscopy (NIRS). Receiving optodes are placed over the left and right hemispheres of a piglet (C3, C4 EEG placement code) and one transmitting optode centrally (Cz position). Optical densities (OD) are measured during stable normo, mild, and deep hypoxemia. This is done for skin condition 1: all optodes on the skin; skin condition 2: transmitting optode on the skin and one receiving optode on the skull; and skin condition 3: all optodes on the skull. Absolute changes of oxy- (cO2Hb), deoxyhemoglobin (cHHb), and total hemoglobin (ctHb) concentrations [micromolL] are calculated from the ODs. These absolute changes are calculated for each skin condition with respect to normoxic condition. Additionally, for skin condition 2, the difference of concentration changes between receiver 1 (skull) and receiver 2 (skin) is calculated. The effect of skin removal is an average increase of attenuation changes by a factor of 1.66 (=0.51 OD) and of the concentration changes due to the arterial oxygen saturation steps by 23%. We conclude that skin significantly influences regional oxygenation measurements. Nevertheless, it is hypothesized that the estimated concentration changes are dominated by changes of the oxygenation in the brain.
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Affiliation(s)
- John H G M Klaessens
- Radboud University Nijmegen Medical Centre, Department of Pediatrics, Clinical Physics, Nijmegen, The Netherlands.
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Ferrari M, Mottola L, Quaresima V. Principles, techniques, and limitations of near infrared spectroscopy. ACTA ACUST UNITED AC 2005; 29:463-87. [PMID: 15328595 DOI: 10.1139/h04-031] [Citation(s) in RCA: 601] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In the last decade the study of the human brain and muscle energetics underwent a radical change, thanks to the progressive introduction of noninvasive techniques, including near-infrared (NIR) spectroscopy (NIRS). This review summarizes the most recent literature about the principles, techniques, advantages, limitations, and applications of NIRS in exercise physiology and neuroscience. The main NIRS instrumentations and measurable parameters will be reported. NIR light (700-1000 m) penetrates superficial layers (skin, subcutaneous fat, skull, etc.) and is either absorbed by chromophores (oxy- and deoxyhemoglobin and myoglobin) or scattered within the tissue. NIRS is a noninvasive and relatively low-cost optical technique that is becoming a widely used instrument for measuring tissue O2 saturation, changes in hemoglobin volume and, indirectly, brain/muscle blood flow and muscle O2 consumption. Tissue O2 saturation represents a dynamic balance between O2 supply and O2 consumption in the small vessels such as the capillary, arteriolar, and venular bed. The possibility of measuring the cortical activation in response to different stimuli, and the changes in the cortical cytochrome oxidase redox state upon O2 delivery changes, will also be mentioned.
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Affiliation(s)
- Marco Ferrari
- Department of Biomedical Sciences and Technologies, University of L'Aquila, Italy
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Al-Rawi PG. Near infrared spectroscopy in brain injury: today’s perspective. INTRACRANIAL PRESSURE AND BRAIN MONITORING XII 2005; 95:453-7. [PMID: 16463900 DOI: 10.1007/3-211-32318-x_93] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The technique of near infrared spectroscopy (NIRS) is based on the principle of light attenuation by the chromophores oxyhaemoglobin (HbO2), deoxyhaemoglobin (Hb) and cytochrome oxidase. Changes in the detected light levels can therefore represent changes in concentrations of these chromophores. Clinical use of NIRS in the brain has been well established in neonates where transillumination is possible. While it has become a useful research tool for monitoring the adult brain, clinical application has been hampered by the fact that it must be applied in reflectance mode. This has resulted in a number of concerns, most significantly the issue of signal contamination by the extracranial tissue layers. Algorithms have been applied to try to overcome this problem, and techniques such as time resolved, phase resolved and spatially resolved spectroscopy have been developed. There has been renewed interest in NIRS as an easy to use, non-invasive technique for measuring tissue oxygenation in the adult brain. Recent technical advances have led to the development of compact, portable instruments that detect changes in optical attenuation of several wavelengths of light. Near infrared spectroscopy is an evolving technology that holds significant potential for technical advancement. In particular, NIRS shows future promise as a clinical tool for bedside cerebral blood flow measurements and as a cerebral imaging modality for mapping structure and function.
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Affiliation(s)
- P G Al-Rawi
- Academic Neurosurgery Unit, Addenbrooke's Hospital, Cambridge, UK.
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Liebert A, Wabnitz H, Steinbrink J, Möller M, Macdonald R, Rinneberg H, Villringer A, Obrig H. Bed-side assessment of cerebral perfusion in stroke patients based on optical monitoring of a dye bolus by time-resolved diffuse reflectance. Neuroimage 2004; 24:426-35. [PMID: 15627584 DOI: 10.1016/j.neuroimage.2004.08.046] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Revised: 08/20/2004] [Accepted: 08/27/2004] [Indexed: 11/24/2022] Open
Abstract
We present a minimally invasive optical method, that is, multi-channel time-domain diffuse near-infrared reflectometry of the head to assess cerebral blood perfusion that is applicable at the bed-side and repetitively at short intervals. Following intravenous injection of an ICG bolus, its transit through intra- and extracerebral tissue is monitored based on changes in moments of distributions of times of flight of photons, recorded with a 4-channel instrument simultaneously on both hemispheres. In healthy volunteers, we found that variance of distributions of times of flight of photons is well suited to assess latency and initial slope of the increase in absorption of intracerebral tissue due to the bolus. We successfully applied our method in two patients demonstrating a reversible cerebral perfusion deficit in an ischemic stroke patient who was treated by thrombolysis and in another patient with a permanent impaired unilateral perfusion due to ipsilateral internal carotid artery occlusion. In either case, we observed a difference in bolus transit time between the hemispheres. In the stroke patient, this difference resolved when re-evaluated 1 day after thrombolysis. The study demonstrates the necessity of a technique with sub-nanosecond time resolution to allow for depth discrimination if clinical perfusion monitoring of cerebrovascular diseases is addressed by optical methods.
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Affiliation(s)
- A Liebert
- Physikalisch-Technische Bundesanstalt, 10587 Berlin, Germany.
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Liebert A, Wabnitz H, Steinbrink J, Obrig H, Möller M, Macdonald R, Villringer A, Rinneberg H. Time-resolved multidistance near-infrared spectroscopy of the adult head: intracerebral and extracerebral absorption changes from moments of distribution of times of flight of photons. APPLIED OPTICS 2004; 43:3037-47. [PMID: 15176190 DOI: 10.1364/ao.43.003037] [Citation(s) in RCA: 164] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
We report on multidistance time-resolved diffuse reflectance spectroscopy of the head of a healthy adult after intravenous administration of a bolus of indocyanine green. Intracerebral and extracerebral changes in absorption are deduced from moments (integral, mean time of flight, and variance) of the distributions of times of flight of photons (DTOFs), recorded simultaneously at four different source-detector separations. We calculate the sensitivity factors converting depth-dependent changes in absorption into changes of moments of DTOFs by Monte Carlo simulations by using a layered model of the head. We validate our method by analyzing moments of DTOFs simulated for the assumed changes in absorption in different layers of the head model.
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Affiliation(s)
- Adam Liebert
- Physikalisch-Technische Bundesanstalt, Abbestrasse 2-12, 10587 Berlin, Germany
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Leung TS, Aladangady N, Elwell CE, Delpy DT, Costeloe K. A new method for the measurement of cerebral blood volume and total circulating blood volume using near infrared spatially resolved spectroscopy and indocyanine green: application and validation in neonates. Pediatr Res 2004; 55:134-41. [PMID: 14561787 DOI: 10.1203/01.pdr.0000099775.87684.fb] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A new technique known as tissue dye densitometry (TDD) has been developed to simultaneously measure cerebral blood volume (CBV) and total circulating blood volume (TCV) using near infrared (NIR) spatially resolved spectroscopy (SRS) and the injection of indocyanine green (ICG). Using a medical NIR spectrometer with SRS capability (NIRO-300, Hamamatsu KK), a new parameter is calculated known as the ICG Hb index (IHI), which represents the ratio of ICG concentration to Hb concentration in tissue. Acting as a tracer, ICG is cleared by the liver over 15 min, providing a change of tracer concentration (DeltaCICG,tis), which allows the calculation of the total Hb concentration in tissue (tcHb) using the equation: tcHbtis (micro molar) = DeltaCICG,tis/DeltaIHI. The CBV can subsequently be calculated from tcHbtis given the absolute Hb concentration in blood (g/dL), from which the ICG concentration in blood (DeltaCICG,bl) is obtained. By back-extrapolating the DeltaCICG,bl curve to the peak time, the initial ICG concentration in tissue blood (C0ICG,bl) can be found and TCV can then be calculated. The TCV of 17 neonates were measured using the TDD technique and for comparison using the previously reported fetal Hb dilution technique (FHD). The mean TCV measured by the FHD and TDD techniques were 70.19 +/- 13.73 mL/kg and 70.80 +/- 32.54 mL/kg. The Bland Altman plot showed that the bias was 0.61 +/- 34.34 mL/kg and limits of agreement (2 SD) were -68.07 mL/kg and 69.30 mL/kg. The agreement is limited and the TDD technique needs further validation and development for use in a clinical environment.
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Affiliation(s)
- Terence S Leung
- Department of Medical Physics and Bioengineering, University College London, Shropshire House, 11-20 Capper Street, London WC1E 6JA, UK.
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Keller E, Nadler A, Alkadhi H, Kollias SS, Yonekawa Y, Niederer P. Noninvasive measurement of regional cerebral blood flow and regional cerebral blood volume by near-infrared spectroscopy and indocyanine green dye dilution. Neuroimage 2003; 20:828-39. [PMID: 14568455 DOI: 10.1016/s1053-8119(03)00315-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Accepted: 05/28/2003] [Indexed: 12/16/2022] Open
Abstract
To find a suitable method for measuring regional cerebral blood flow (rCBF) rapidly at the bedside is still a matter of investigation. The purpose here was to develop a noninvasive method for bedside rCBF measurement and to validate it with a standard method such as perfusion-weighted magnetic resonance imaging (MRI). In 11 healthy volunteers 44 measurements with near-infrared spectroscopy (NIRS) and perfusion-weighted MRI without and with a mean continuous positive airway pressure (CPAP) of 10 mbar were carried out. Four (NIRS) optodes were placed bilaterally on the forehead and 25 mg indocyanine green (ICG) was injected. New algorithms were developed to calculate rCBFNIRS and rCBVNIRS. In 6 volunteers data analysis was successful. No complications associated with the method were observed. During CPAP breathing rCBFNIRS decreased from 18.5 + 6.9 16.1 + 6.2 ml/100 g/min (P = 0.034). Mean values for rCBFMRI decreased from 256 +/- 90 to 216 +/- 62 ml/100 g/min (P = 0.012). Bland and Altman plots showed that the differences did not vary in any systematic way over the range of rCBF or rCBV values assessed and 100% of differences were within the interval mean +/- 2 SD of differences. Limits of agreement (mean +/- 2 SD) were +/- 76.4 ml/100 g/min for rCBF and +/- 15.6 ml/100 g for rCBV. The NIRS ICG dye dilution technique is a promising method for serial noninvasive bedside CBF measurements. The preliminary data indicate that measurements are in agreement with values obtained by perfusion-weighted MRI.
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Affiliation(s)
- Emanuela Keller
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland.
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Keller E, Nadler A, Alkadhi H. Measurement of Regional Cerebral Blood Flow by Near Infrared Spectroscopy and Indocyanine Green Dye Dilution. Intensive Care Med 2003. [DOI: 10.1007/978-1-4757-5548-0_69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Keller E, Ishihara H, Nadler A, Niederer P, Seifert B, Yonekawa Y, Frei K. Evaluation of brain toxicity following near infrared light exposure after indocyanine green dye injection. J Neurosci Methods 2002; 117:23-31. [PMID: 12084561 DOI: 10.1016/s0165-0270(02)00044-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Indocyanine green (ICG) has excellent safety records and is widely used in medical diagnosis. Recently, a new method has been developed to estimate cerebral blood flow (CBF) using ICG in combination with near-infrared spectroscopy (NIRS). The new technique may be of wide clinical interest, as it is noninvasive and easy to perform at the bedside in stroke patients. Additionally, ICG with the use of specific wavelength lasers is documented to be effective in photodynamic therapy (PDT). Under normal conditions ICG does not cross the intact blood brain barrier (BBB). However, in patients with brain injuries where the BBB may be disturbed, ICG could accumulate in brain parenchyma and in combination with NIR-light exposure, phototoxicity could occur. The aim of the present study was to examine the possible toxicity of ICG in combination with NIRS in a specific setting for CBF measurements. In five rats with mannitol induced BBB breakdown no traces of ICG were found during spectrophotometric analysis of the brain cell suspensions. In ten rats with disrupted BBB there were no significant increases of brain temperature or histological signs of brain damage following 1 h NIR-light exposure after ICG injection. The existing literature concerning the application of ICG in combination with NIR light is reviewed.
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Affiliation(s)
- Emanuela Keller
- Department of Neurosurgery, University of Zurich, University Hospital, Nord 1, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland.
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