Noninvasive investigation of blood oxygenation dynamics of tumors by near-infrared spectroscopy

Frontal lobe hemodynamics detected by functional near-infrared spectroscopy during head-up tilt table tests in patients with electrical burns

Significance

Electrical burns can cause severe damage to the nervous system, resulting in autonomic dysfunction with reduced cerebral perfusion. However, few studies have investigated these consequences.

Aim

To elucidate changes in prefrontal cerebral hemodynamics using functional near-infrared spectroscopy (fNIRS) during the head-up tilt table test (HUT) for patients with electrical burns.

Approach

We recruited 17 patients with acute electrical burns within 1 week after their accidents and 10 healthy volunteers. The NIRS parameters acquired using an fNIRS device attached to the forehead were analyzed in five distinct HUT phases.

Results

Based on their HUT response patterns, patients with electrical burns were classified into the group with abnormal HUT results (APG, n = 4) or normal HUT results (NPG, n = 13) and compared with the healthy control (HC, n = 10) participants. We found trends in hemodynamic changes during the HUT that distinguished HC, NPG, and APG. Reduced cerebral perfusion and decreased blood oxygenation during the HUT were found in both the NPG and APG groups. Patients with electrical burns had autonomic dysfunction compared to the HC participants.

Conclusions

Using fNIRS, we observed that acute-stage electrical burn injuries could affect cerebral perfusion.

Enhancement of Frequency-Specific Hemodynamic Power and Functional Connectivity by Transcranial Photobiomodulation in Healthy Humans

Transcranial photobiomodulation (tPBM) has been considered a safe and effective brain stimulation modality being able to enhance cerebral oxygenation and neurocognitive function. To better understand the underlying neurophysiological effects of tPBM in the human brain, we utilized a 111-channel functional near infrared spectroscopy (fNIRS) system to map cerebral hemodynamic responses over the whole head to 8-min tPBM with 1,064-nm laser given on the forehead of 19 healthy participants. Instead of analyzing broad-frequency hemodynamic signals (0–0.2 Hz), we investigated frequency-specific effects of tPBM on three infra-slow oscillation (ISO) components consisting of endogenic, neurogenic, and myogenic vasomotions. Significant changes induced by tPBM in spectral power of oxygenated hemoglobin concentration (Δ[HbO]), functional connectivity (FC), and global network metrics at each of the three ISO frequency bands were identified and mapped topographically for frequency-specific comparisons. Our novel findings revealed that tPBM significantly increased endogenic Δ[HbO] powers over the right frontopolar area near the stimulation site. Also, we demonstrated that tPBM enabled significant enhancements of endogenic and myogenic FC across cortical regions as well as of several global network metrics. These findings were consistent with recent reports and met the expectation that myogenic oscillation is highly associated with endothelial activity, which is stimulated by tPBM-evoked nitric oxide (NO) release.

Prognostic Value of Fluorine-19 MRI Oximetry Monitoring in cancer

Hypoxia is a key prognostic indicator in most solid tumors, as it is correlated to tumor angiogenesis, metastasis, recurrence, and response to therapy. Accurate measurement and mapping of tumor oxygenation profile and changes upon intervention could facilitate disease progression assessment and assist in treatment planning. Currently, no gold standard exists for non-invasive spatiotemporal measurement of hypoxia. Magnetic resonance imaging (MRI) represents an attractive option as it is a clinically available and non-ionizing imaging modality. Specifically, perfluorocarbon (PFC) beacons can be externally introduced into the tumor tissue and the linear dependence of their spin-lattice relaxation rate (R1) on the local partial pressure of oxygen (pO₂) exploited for real-time tissue oxygenation monitoring in vivo. In this review, we will focus on early studies and recent developments of fluorine-19 MRI and spectroscopy (MRS) for evaluation of tumor oximetry and response to therapy.

Retrieval of Absorption or Scattering Coefficient Spectrum (RASCS) Program: A Tool to Monitor Optical Properties in Real Time

BACKGROUND AND OBJECTIVES

Optical properties characterize light propagation in turbid media, such as tissue. Recovery of optical properties is of great importance in a wide variety of biomedical applications, including both therapeutic treatments and diagnosis. Most of the available methodologies are well established, however, these are not optimized for real-time measurements.

STUDY DESIGN/MATERIALS AND METHODS

Optical properties are recovered using the Inverse Adding Doubling program from reflectance measurements measured with an integrating sphere and light in the visible range. A user-friendly interface was programmed in Visual Studio and the libraries of a particular spectrophotometer were used. To achieve real-time measurements, a parallel computing routine was implemented, splitting the whole spectra in threads to be computed independently. Several tests using living tissue and inorganic materials were carried out to validate the proposed algorithm.

RESULTS

Recovery of absorption/scattering coefficient spectrum in the visible range with high precision in a couple of seconds was achieved, demonstrating its capabilities for real-time monitoring in biomedical applications. The absorption coefficient spectrum shows the expected characteristics according to the different melanin and blood concentration of various volunteers, also showing the expected changes during a thermoregulation process.

CONCLUSIONS

A real-time monitoring of optical properties algorithm was developed, including parallel computing and a user-friendly interface. The proposed algorithm would be of help in biomedical applications, where real-time monitoring optical properties is required. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Oxygen-sensitive MRI assessment of tumor response to hypoxic gas breathing challenge

Oxygen-sensitive MRI has been extensively used to investigate tumor oxygenation based on the response (R₂ * and/or R₁ ) to a gas breathing challenge. Most studies have reported response to hyperoxic gas indicating potential biomarkers of hypoxia. Few studies have examined hypoxic gas breathing and we have now evaluated acute dynamic changes in rat breast tumors. Rats bearing syngeneic subcutaneous (n = 15) or orthotopic (n = 7) 13762NF breast tumors were exposed to a 16% O₂ gas breathing challenge and monitored using blood oxygen level dependent (BOLD) R₂ * and tissue oxygen level dependent (TOLD) T₁ -weighted measurements at 4.7 T. As a control, we used a traditional hyperoxic gas breathing challenge with 100% O₂ on a subset of the subcutaneous tumor bearing rats (n = 6). Tumor subregions identified as responsive on the basis of R₂ * dynamics coincided with the viable tumor area as judged by subsequent H&E staining. As expected, R₂ * decreased and T₁ -weighted signal increased in response to 100% O₂ breathing challenge. Meanwhile, 16% O₂ breathing elicited an increase in R₂ *, but divergent response (increase or decrease) in T₁ -weighted signal. The T₁ -weighted signal increase may signify a dominating BOLD effect triggered by 16% O₂ in the relatively more hypoxic tumors, whereby the influence of increased paramagnetic deoxyhemoglobin outweighs decreased pO₂ . The results emphasize the importance of combined BOLD and TOLD measurements for the correct interpretation of tumor oxygenation properties.

The hemodynamic changes during cupping therapy monitored by using an optical sensor embedded cup

Cupping therapy is one form of alternative medicine that is used widely across the world. Although the applications of cupping therapy including pain relief have a 1000-year history, the therapeutic effect of cupping is still questionable due to a lack of scientific evidence. Therefore, in the present study, we embedded a near-infrared spectroscopic sensor into a suction cup to monitor the hemodynamic changes on the treated site while the hemodynamics at the surrounding tissue of the cup was also simultaneously monitored by another near-infrared spectroscopic sensor. The results from 10 healthy male subjects show a dramatic increase of the oxy-hemoglobin (OHb) and deoxy-hemoglobin (RHb) concentrations at the treatment site while the OHb and RHb levels were decreased at the surrounding tissue. Moreover, after the treatment, we observed that the OHb concentrations were maintained at a higher level than before treatment at both sites, which may demonstrate how cupping therapy works for treatment. In summary, the results showed that cupping therapy increases blood volume and tissue oxygenation at the treatment site while those were slightly decreased at the surrounding tissue. This study showed that the embedding of near-infrared spectroscopy in a cupping system could offer a better understanding of the mechanism of cupping therapy.

Prefrontal hemodynamic changes measured using near-infrared spectroscopy during the Valsalva maneuver in patients with orthostatic intolerance

The Valsalva maneuver (VM) with beat-to-beat blood pressure and heart rate monitoring are used to evaluate orthostatic intolerance (OI). However, they lack the ability to detect cerebral hemodynamic changes, which may be a cause of OI symptoms. Therefore, we utilized near-infrared spectroscopy during VM. Patients with OI symptoms and normal healthy subjects were recruited. Patients were subgrouped according to VM results: patients with normal VM (NVM) and abnormal VM (AbVM). Oxyhemoglobin (HbO), deoxyhemoglobin, and total hemoglobin changes were measured at four different source-detector distances (SD) (15, 30, 36, and 45 mm), and latency, amplitude, duration, and integrated total signal were calculated. Those parameters were compared between a normal healthy control (HC) group and the two OI patient subgroups. We found that HbO increment latency at 30-mm SD in the HC, NVM, and AbVM groups was as follows: [Formula: see text], [Formula: see text], and [Formula: see text], respectively ([Formula: see text]). Among the four parameters we evaluated, latency of HbO increment was the best marker for differentiating OI.

Change of tumor vascular reactivity during tumor growth and postchemotherapy observed by near-infrared spectroscopy

Breast cancer is one of the most common cancers in females. To monitor chemotherapeutic efficacy for breast cancer, medical imaging systems such as x-ray mammography, computed tomography, magnetic resonance imaging, and ultrasound imaging have been used. Currently, it can take up to 3 to 6 weeks to see the tumor response from chemotherapy by monitoring tumor volume changes. We used near-infrared spectroscopy (NIRS) to predict breast cancer treatment efficacy earlier than tumor volume changes by monitoring tumor vascular reactivity during inhalational gas interventions. The results show that the amplitude of oxy-hemoglobin changes (vascular reactivity) during hyperoxic gas inhalation is well correlated with tumor growth and responded one day earlier than tumor volume changes after chemotherapy. These results may imply that NIRS with respiratory challenges can be useful in early detection of tumor and in the prediction of tumor response to chemotherapy.

Monitoring cerebral oxygenation and local field potential with a variation of isoflurane concentration in a rat model

We aimed to investigate experimentally how anesthetic levels affect cerebral metabolism measured by near-infrared spectroscopy (NIRS) and to identify a robust marker among NIRS parameters to discriminate various stages of anesthetic depth in rats under isoflurane anesthesia. In order to record the hemodynamic changes and local field potential (LFP) in the brain, fiber-optic cannulae and custom-made microelectrodes were implanted in the frontal cortex of the skull. The NIRS and LFP signals were continuously monitored before, during and after isoflurane anesthesia. As isoflurane concentration is reduced, the level of oxyhemoglobin and total hemoglobin concentrations of the frontal cortex decreased gradually, while deoxyhemoglobin increased. The reflectance ratio between 730nm and 850nm and burst suppression ratio (BSR) correspond similarly with the change of oxyhemoglobin during the variation of isoflurane concentration. These results suggest that NIRS signals in addition to EEG may provide a possibility of developing a new anesthetic depth index.

Noninvasive assessment of hemodynamic and brain metabolism parameters following closed head injury in a mouse model by comparative diffuse optical reflectance approaches

Optical techniques have gained substantial interest over the past four decades for biomedical imaging due to their unique advantages, which may suggest their use as alternatives to conventional methodologies. Several optical techniques have been successfully adapted to clinical practice and biomedical research to monitor tissue structure and function in both humans and animal models. This paper reviews the analysis of the optical properties of brain tissue in the wavelength range between 500 and 1000 nm by three different diffuse optical reflectance methods: spatially modulated illumination, orthogonal diffuse light spectroscopy, and dual-wavelength laser speckle imaging, to monitor changes in brain tissue morphology, chromophore content, and metabolism following head injury. After induction of closed head injury upon anesthetized mice by weight-drop method, significant changes in hemoglobin oxygen saturation, blood flow, and metabolism were readily detectible by all three optical setups, up to 1 h post-trauma. Furthermore, the experimental results clearly demonstrate the feasibility and reliability of the three methodologies, and the differences between the system performances and capabilities are also discussed. The long-term goal of this line of study is to combine these optical systems to study brain pathophysiology in high spatiotemporal resolution using additional models of brain trauma. Such combined use of complementary algorithms should fill the gaps in each system's capabilities, toward the development of a noninvasive, quantitative tool to expand our knowledge of the principles underlying brain function following trauma, and to monitor the efficacy of therapeutic interventions in the clinic.

Simultaneous blood flow and blood oxygenation measurements using a combination of diffuse speckle contrast analysis and near-infrared spectroscopy

A combined diffuse speckle contrast analysis (DSCA)-near-infrared spectroscopy (NIRS) system is proposed to simultaneously measure qualitative blood flow and blood oxygenation changes in human tissue. The system employs an optical switch to alternate two laser sources at two different wavelengths and a CCD camera to capture the speckle image. Therefore, an optical density can be measured from two wavelengths for NIRS measurements and a speckle contrast can be calculated for DSCA measurements. In order to validate the system, a flow phantom test and an arm occlusion protocol for arterial and venous occlusion were performed. Shorter exposure times (<1 ms ) show a higher drop (between 50% and 66%) and recovery of 1/K²S values after occlusion (approximately 150%), but longer exposure time (3 ms) shows more consistent hemodynamic changes. For four subjects, the 1/K²S values dropped to an average of 82.1±4.0% during the occlusion period and the average recovery of 1/K²S values after occlusion was 109.1±0.8% . There was also an approximately equivalent amplitude change in oxyhemoglobin (OHb) and deoxyhemoglobin (RHb) during arterial occlusion (max RHb=0.0085±0.0024 mM/DPF, min OHb=-0.0057±0.0044 mM/DPF). The sensitivity of the system makes it a suitable modality to observe qualitative hemodynamic trends during induced physiological changes.

Quantifying Gleason scores with photoacoustic spectral analysis: feasibility study with human tissues

Gleason score is a highly prognostic factor for prostate cancer describing the microscopic architecture of the tumor tissue. The standard procedure for evaluating Gleason scores, namely biopsy, is to remove prostate tissue for observation under microscope. Currently, biopsies are guided by transrectal ultrasound (TRUS). Due to the low sensitivity of TRUS to prostate cancer (PCa), non-guided and saturated biopsies are frequently employed, unavoidably causing pain, damage to the normal prostate tissues and other complications. More importantly, due to the limited number of biopsy cores, current procedure could either miss early stage small tumors or undersample aggressive cancers. Photoacoustic (PA) measurement has the unique capability of evaluating tissue microscopic architecture information at ultrasonic resolution. By frequency domain analysis of the broadband PA signal, namely PA spectral analysis (PASA), the microscopic architecture within the assessed tissue can be quantified. This study investigates the feasibility of evaluating Gleason scores by PASA. Simulations with the classic Gleason patterns and experiment measurements from human PCa tissues have demonstrated strong correlation between the PASA parameters and the Gleason scores.

Assessment of tumor response to oxygen challenge using quantitative diffusion MRI in an animal model

PURPOSE

To assess tumor response to oxygen challenge using quantitative diffusion magnetic resonance imaging (MRI).

MATERIALS AND METHODS

A well-characterized Dunning R3327-AT1 rat prostate cancer line was implanted subcutaneously in the right thigh of male Copenhagen rats (n = 8). Diffusion-weighted images (DWI) with multiple b values (0, 25, 50, 100, 150, 200, 300, 500, 1000, 1500 s/mm(2) ) in three orthogonal directions were obtained using a multishot FSE-based Stejskal-Tanner DWI sequence (FSE-DWI) at 4.7T, while rats breathed medical air (21% oxygen) and with 100% oxygen challenge. Stretched-exponential and intravoxel incoherent motion (IVIM) models were used to calculate and compare quantitative diffusion parameters: diffusion heterogeneity index (α), intravoxel distribution of diffusion coefficients (DDC), tissue diffusivity (Dt), pseudo-diffusivity (Dp), and perfusion fraction (f) on a voxel-by-voxel basis.

RESULTS

A significant increase of α (73.9 ± 4.7% in air vs. 78.1 ± 4.5% in oxygen, P = 0.0198) and a significant decrease of f (13.4 ± 3.7% in air vs. 10.4 ± 2.7% in oxygen, P = 0.0201) were observed to accompany oxygen challenge. Correlations between f and α during both air and oxygen breathing were found; the correlation coefficients (r) were -0.90 and -0.96, respectively. Positive correlations between Dt and DDC with oxygen breathing (r = 0.95, P = 0.0003), f and DDC with air breathing were also observed (r = 0.95, P = 0.0004).

CONCLUSION

Quantitative diffusion MRI demonstrated changes in tumor perfusion in response to oxygen challenge.

Hybrid diffuse optical techniques for continuous hemodynamic measurement in gastrocnemius during plantar flexion exercise

Occlusion calibrations and gating techniques have been recently applied by our laboratory for continuous and absolute diffuse optical measurements of forearm muscle hemodynamics during handgrip exercises. The translation of these techniques from the forearm to the lower limb is the goal of this study as various diseases preferentially affect muscles in the lower extremity. This study adapted a hybrid near-infrared spectroscopy and diffuse correlation spectroscopy system with a gating algorithm to continuously quantify hemodynamic responses of medial gastrocnemius during plantar flexion exercises in 10 healthy subjects. The outcomes from optical measurement include oxy-, deoxy-, and total hemoglobin concentrations, blood oxygen saturation, and relative changes in blood flow (rBF) and oxygen consumption rate (rV̇O2). We calibrated rBF and rV̇O2 profiles with absolute baseline values of BF and V̇O2 obtained by venous and arterial occlusions, respectively. Results from this investigation were comparable to values from similar studies. Additionally, significant correlation was observed between resting local muscle BF measured by the optical technique and whole limb BF measured concurrently by a strain gauge venous plethysmography. The extensive hemodynamic and metabolic profiles during exercise will allow for future comparison studies to investigate the diagnostic value of hybrid technologies in muscles affected by disease.

Novel method for early signs of clinical shock detection by monitoring blood capillary/vessel spatial pattern

The ability to monitor capillary/vessel spatial patterns and local blood volume fractions is critical in clinical shock detection and its prevention in Intensive Care Units (ICU). Although the causes of shock might be different, the basic abnormalities in pathophysiological changes are the same. To detect these changes, we have developed a novel method based on both spectrally and spatially resolved diffuse reflectance spectra. The preliminary study has shown that this method can monitor the spatial distribution of capillary/vessel spatial patterns through local blood volume fractions of reduced hemoglobin and oxyhemoglobin. This method can be used as a real-time and non-invasive tool for the monitoring of shock development and feedback on the therapeutic intervention.

Toward stable electron paramagnetic resonance oximetry probes: synthesis, characterization, and metabolic evaluation of new ester derivatives of a tris-(para-carboxyltetrathiaaryl)methyl (TAM) radical

Tris(p-carboxyltetrathiaaryl)methyl (TAM) radicals, such as 1a ("Finland" radical), are useful EPR probes for oximetry. However, they are rapidly metabolized by liver microsomes in the presence of NADPH, with the formation of diamagnetic quinone-methide metabolites resulting from an oxidative decarboxylation of one of their carboxylate substituents. In an effort to obtain TAM derivatives potentially more metabolically stable in vivo, we have synthesized four new TAM radicals in which the carboxylate substituents of 1a have been replaced with esters groups bearing various alkyl chains designed to render them water-soluble. The new compounds were completely characterized by UV-vis and EPR spectroscopies, high resolution mass spectrometry (HRMS), and electrochemistry. Two of them were water-soluble enough to undergo detailed microsomal metabolic studies in comparison with 1a. They were found to be stable in the presence of the esterases present in rat liver microsomes and cytosol, and, contrary to 1a, stable to oxidation in the presence of NADPH-supplemented microsomes. A careful study of their possible microsomal reduction under anaerobic or aerobic conditions showed that they were more easily reduced than 1a, in agreement with their higher reduction potentials. They were reduced into the corresponding anions not only under anaerobic conditions but also in the presence of dioxygen. These anions were much more stable than that of 1a and could be characterized by UV-vis spectroscopy, MS, and at the level of their protonated product. However, they were oxidized by O₂, giving back to the starting ester radicals and catalyzing a futile cycle of O₂ reduction. Such reactions should be considered in the design of future stable EPR probes for oximetry in vivo.

Noninvasive monitoring of treatment response in a rabbit cyanide toxicity model reveals differences in brain and muscle metabolism

Noninvasive near infrared spectroscopy measurements were performed to monitor cyanide (CN) poisoning and recovery in the brain region and in foreleg muscle simultaneously, and the effects of a novel CN antidote, sulfanegen sodium, on tissue hemoglobin oxygenation changes were compared using a sub-lethal rabbit model. The results demonstrated that the brain region is more susceptible to CN poisoning and slower in endogenous CN detoxification following exposure than peripheral muscles. However, sulfanegen sodium rapidly reversed CN toxicity, with brain region effects reversing more quickly than muscle. In vivo monitoring of multiple organs may provide important clinical information regarding the extent of CN toxicity and subsequent recovery, and facilitate antidote drug development.

Fast imaging of high-resolution two-dimensional effective attenuation profile from diffuse reflectance

Biological tissue is non-homogeneous in nature. It is difficult to measure its optical properties due to non-uniformity throughout the tissue being tested. To obtain the spatial distribution of optical parameters, conventional approaches use an array of light sources and detectors to reconstruct the image, thus, there is very limited spatial resolution. In contrast, solutions that provide high resolution have a high computational complexity. In this paper, we propose a fast, simple scheme to resolve the effective attenuation profile from the spatial diffuse reflectance. Rather than giving one single value for the absorption and reduced scattering coefficients, a novel algorithm is proposed for the reconstruction of an effective attenuation profile in 2-dimension from a diffuse reflectance curve. This technique is applied to the reconstruction of a 2-D effective attenuation profile. By obtaining the diffuse reflectance image from a camera and using the algorithm developed here, fast imaging of the effective attenuation profile with relatively high spatial resolution can be achieved.

ESTIMATION OF OPTICAL PROPERTIES IN BIOLOGICAL TISSUES USING MONTE CARLO SIMULATION

In this paper, the optical properties of skin lesion are determined with the help of laser reflectometry. The result is compared with the phantom and simulation values to obtain an accurate result. Surface backscattering is determined by laser reflectometry. The tissue-equivalent phantom is prepared with the help of white paraffin wax mixed with various color pigments in multiple proportions. A familiar Monte Carlo simulation is used to analyze the optical properties of the tissue. The normalized backscattered intensity (NBI) signals from the tissue surface, measured by the output probes after digitization, are used to reconstruct the reflectance images of tissues in various layers below the skin surface. From NBI profiles measured at various locations of the tissues on the forearm, the corresponding optical parameters, the scattering (μ s ) and absorption (μ a ) coefficients, and the anisotropy parameter g are determined by matching these with profiles simulated by the Monte Carlo procedure. The correlation analysis between the lesion thickness and the diffuse reflectance gives the optical wavelengths which are selected for multispectral images of skin lesions. Comparison of results shows the presence of abnormal level in the tissue.

A perspective on vascular disrupting agents that interact with tubulin: preclinical tumor imaging and biological assessment

The tumor microenvironment provides a rich source of potential targets for selective therapeutic intervention with properly designed anticancer agents. Significant physiological differences exist between the microvessels that nourish tumors and those that supply healthy tissue. Selective drug-mediated damage of these tortuous and chaotic microvessels starves a tumor of necessary nutrients and oxygen and eventually leads to massive tumor necrosis. Vascular targeting strategies in oncology are divided into two separate groups: angiogenesis inhibiting agents (AIAs) and vascular disrupting agents (VDAs). The mechanisms of action between these two classes of compounds are profoundly distinct. The AIAs inhibit the actual formation of new vessels, while the VDAs damage and/or destroy existing tumor vasculature. One subset of small-molecule VDAs functions by inhibiting the assembly of tubulin into microtubules, thus causing morphology changes to the endothelial cells lining the tumor vasculature, triggered by a cascade of cell signaling events. Ultimately this results in catastrophic damage to the vessels feeding the tumor. The rapid emergence and subsequent development of the VDA field over the past decade has led to the establishment of a synergistic combination of preclinical state-of-the-art tumor imaging and biological evaluation strategies that are often indicative of future clinical efficacy for a given VDA. This review focuses on an integration of the appropriate biochemical and biological tools necessary to assess (preclinically) new small-molecule, tubulin active VDAs for their potential to be clinically effective anticancer agents.

Imaging tumour physiology and vasculature to predict and assess response to heat

The vascular supply of tumours and the tumour microenvironment both play an important role when tumours are treated with hyperthermia. Blood flow is one of the major vehicles by which heat is dissipated thus the vascular supply will influence the ability to heat the tumour. It also influences the type of microenvironment that exists within tumours, and it is now well-established that cells existing in areas of oxygen deficiency, nutrient deprivation and acidic conditions are more sensitive to the effect of hyperthermia. The vascular supply and microenvironment are also affected by hyperthermia. In general, mild heat temperatures transiently improve blood flow and oxygenation, while higher hyperthermia temperatures cause vascular collapse and so increase the adverse microenvironmental conditions. Being able to image these vascular and microenvironmental parameters both before and after heating will help in our ability to predict and assess response. Here we review the various techniques that can be applied to supply this information, especially using non-invasive imaging approaches.

Monitoring of hemodynamic changes induced in the healthy breast through inspired gas stimuli with MR-guided diffuse optical imaging

PURPOSE

The modulation of tissue hemodynamics has important clinical value in medicine for both tumor diagnosis and therapy. As an oncological tool, increasing tissue oxygenation via modulation of inspired gas has been proposed as a method to improve cancer therapy and determine radiation sensitivity. As a radiological tool, inducing changes in tissue total hemoglobin may provide a means to detect and characterize malignant tumors by providing information about tissue vascular function. The ability to change and measure tissue hemoglobin and oxygenation concentrations in the healthy breast during administration of three different types of modulated gas stimuli (oxygen/ carbogen, air/carbogen, and air/oxygen) was investigated.

METHODS

Subjects breathed combinations of gases which were modulated in time. MR-guided diffuse optical tomography measured total hemoglobin and oxygen saturation in the breast every 30 s during the 16 min breathing stimulus. Metrics of maximum correlation and phase lag were calculated by cross correlating the measured hemodynamics with the stimulus. These results were compared to an air/air control to determine the hemodynamic changes compared to the baseline physiology.

RESULTS

This study demonstrated that a gas stimulus consisting of alternating oxygen/carbogen induced the largest and most robust hemodynamic response in healthy breast parenchyma relative to the changes that occurred during the breathing of room air. This stimulus caused increases in total hemoglobin and oxygen saturation during the carbogen phase of gas inhalation, and decreases during the oxygen phase. These findings are consistent with the theory that oxygen acts as a vasoconstrictor, while carbogen acts as a vasodilator. However, difficulties in inducing a consistent change in tissue hemoglobin and oxygenation were observed because of variability in intersubject physiology, especially during the air/oxygen or air/carbogen modulated breathing protocols.

CONCLUSIONS

MR-guided diffuse optical imaging is a unique tool that can measure tissue hemodynamics in the breast during modulated breathing. This technique may have utility in determining the therapeutic potential of pretreatment tissue oxygenation or in investigating vascular function. Future gas modulation studies in the breast should use a combination of oxygen and carbogen as the functional stimulus. Additionally, control measures of subject physiology during air breathing are critical for robust measurements.

Numerical modelling and image reconstruction in diffuse optical tomography

The development of diffuse optical tomography as a functional imaging modality has relied largely on the use of model-based image reconstruction. The recovery of optical parameters from boundary measurements of light propagation within tissue is inherently a difficult one, because the problem is nonlinear, ill-posed and ill-conditioned. Additionally, although the measured near-infrared signals of light transmission through tissue provide high imaging contrast, the reconstructed images suffer from poor spatial resolution due to the diffuse propagation of light in biological tissue. The application of model-based image reconstruction is reviewed in this paper, together with a numerical modelling approach to light propagation in tissue as well as generalized image reconstruction using boundary data. A comprehensive review and details of the basis for using spatial and structural prior information are also discussed, whereby the use of spectral and dual-modality systems can improve contrast and spatial resolution.

Trans-rectal ultrasound-coupled near-infrared optical tomography of the prostate, part I: simulation

We investigate the feasibility of trans-rectal optical tomography of the prostate using an endo-rectal near-infrared (NIR) applicator that is to be integrated with a trans-rectal ultrasound (TRUS) probe. Integration with TRUS ensures accurate endo-rectal positioning of the NIR applicator and the utility of using TRUS spatial prior information to guide NIR image reconstruction. The prostate NIR image reconstruction is challenging even with the use of spatial prior owing to the anatomic complexity of the imaging domain. A hierarchical reconstruction algorithm is developed that implements cascaded initial-guesses for nested domains. This hierarchical image reconstruction method is then applied to evaluating a number of NIR applicator designs for integration with a sagittal TRUS transducer. A NIR applicator configuration feasible for instrumentation development is proposed that contains one linear array of optodes on each lateral side of the sagittal TRUS transducer. The performance of this NIR applicator is characterized for the recovery of single tumor mimicking lesion as well as dual targets in the prostate. The results suggest a strong feasibility of transrectal prostate imaging by use of the endo-rectal NIR/US probe.

A non-invasive, in vivo technique for monitoring vascular status of glioblastoma during angiogenesis

The growth of solid tumors dependent on the process of angiogenesis in which growth factors secreted by tumor and stromal cells promote endothelial cell proliferation, migration, and maturation. This process generates a tumor-specific vascular supply and enables small or dormant tumors to grow rapidly with exponential increases in tumor volume. Determination of tumor oxygenation at the microvascular level will provide important insight into tumor growth, angiogenesis, necrosis, and therapeutic response, and will facilitate to develop protocols for studying tumor behavior. A non-invasive multi-modality approach based on near infrared spectroscopy (NIRS) technique, namely: Steady State Diffuse Optical Spectroscopy (SSDOS) along with Magnetic Resonance Imaging (MRI) is applied for monitoring the concentration of oxyhemoglobin, deoxyhemoglobin and water within tumor region and for studying the vascular status of tumor and the patho-physiological changes that occur during angiogenesis. Since, the growth of solid tumors depends on the formation of new blood vessels, an association between intramural microvessel density (MVD) and tumor oxygenation is also investigated. The relative decrease in oxygenation value with tumor growth indicates that though blood vessels infiltrate and proliferate the tumor region, a hypoxic trend is clearly present.

Variation of haemoglobin extinction coefficients can cause errors in the determination of haemoglobin concentration measured by near-infrared spectroscopy

Near-infrared spectroscopy or imaging has been extensively applied to various biomedical applications since it can detect the concentrations of oxyhaemoglobin (HbO(2)), deoxyhaemoglobin (Hb) and total haemoglobin (Hb(total)) from deep tissues. To quantify concentrations of these haemoglobin derivatives, the extinction coefficient values of HbO(2) and Hb have to be employed. However, it was not well recognized among researchers that small differences in extinction coefficients could cause significant errors in quantifying the concentrations of haemoglobin derivatives. In this study, we derived equations to estimate errors of haemoglobin derivatives caused by the variation of haemoglobin extinction coefficients. To prove our error analysis, we performed experiments using liquid-tissue phantoms containing 1% Intralipid in a phosphate-buffered saline solution. The gas intervention of pure oxygen was given in the solution to examine the oxygenation changes in the phantom, and 3 mL of human blood was added twice to show the changes in [Hb(total)]. The error calculation has shown that even a small variation (0.01 cm(-1) mM(-1)) in extinction coefficients can produce appreciable relative errors in quantification of Delta[HbO(2)], Delta[Hb] and Delta[Hb(total)]. We have also observed that the error of Delta[Hb(total)] is not always larger than those of Delta[HbO(2)] and Delta[Hb]. This study concludes that we need to be aware of any variation in haemoglobin extinction coefficients, which could result from changes in temperature, and to utilize corresponding animal's haemoglobin extinction coefficients for the animal experiments, in order to obtain more accurate values of Delta[HbO(2)], Delta[Hb] and Delta[Hb(total)] from in vivo tissue measurements.

A noninvasive multimodal technique to monitor brain tumor vascularization

Determination of tumor oxygenation at the microvascular level will provide important insight into tumor growth, angiogenesis, necrosis and therapeutic response and will facilitate to develop protocols for studying tumor behavior. The non-ionizing near infrared spectroscopy (NIRS) technique has the potential to differentiate lesion and hemoglobin dynamics; however, it has a limited spatial resolution. On the other hand, magnetic resonance imaging (MRI) has achieved high spatial resolution with excellent tissue discrimination but is more susceptible to limited ability to monitor the hemoglobin dynamics. In the present work, the vascular status and the pathophysiological changes that occur during tumor vascularization are studied in an orthotopic brain tumor model. A noninvasive multimodal approach based on the NIRS technique, namely steady state diffuse optical spectroscopy (SSDOS) along with MRI, is applied for monitoring the concentrations of oxyhemoglobin, deoxyhemoglobin and water within tumor region. The concentrations of oxyhemoglobin, deoxyhemoglobin and water within tumor vasculature are extracted at 15 discrete wavelengths in a spectral window of 675-780 nm. We found a direct correlation between tumor size, intratumoral microvessel density and tumor oxygenation. The relative decrease in tumor oxygenation with growth indicates that though blood vessels infiltrate and proliferate the tumor region, a hypoxic trend is clearly present.

Tumour oxygen dynamics measured simultaneously by near-infrared spectroscopy and 19F magnetic resonance imaging in rats

Simultaneous near-infrared spectroscopy (NIRS) and magnetic resonance imaging (MRI) were used to investigate the correlation between tumour vascular oxygenation and tissue oxygen tension dynamics in rat breast 13762NF tumours with respect to hyperoxic gas breathing. NIRS directly detected global variations in the oxygenated haemoglobin concentration (Delta[HbO(2)]) within tumours and oxygen tension (pO(2)) maps were achieved using (19)F MRI of the reporter molecule hexafluorobenzene. Multiple correlations were examined between rates and magnitudes of vascular (Delta[HbO(2)]) and tissue (pO(2)) responses. Significant correlations were found between response to oxygen and carbogen breathing using either modality. Comparison of results for the two methods showed a correlation between the vascular perfusion rate ratio and the mean pO(2) values (R(2) > 0.7). The initial rates of increase of Delta[HbO(2)] and the slope of dynamic pO(2) response, d(pO(2))/dt, of well-oxygenated voxels in response to hyperoxic challenge were also correlated. These results demonstrate the feasibility of simultaneous measurements using NIRS and MRI. As expected, the rate of pO(2) response to oxygen is primarily dependent upon the well perfused rather than poorly perfused vasculature.

Phosphorescent oxygen sensor with dendritic protection and two-photon absorbing antenna

Imaging oxygen in 3D with submicron spatial resolution can be made possible by combining phosphorescence quenching technique with multiphoton laser scanning microscopy. Because Pt and Pd porphyrin-based phosphorescent dyes, traditionally used as phosphors in biological oxygen measurements, exhibit extremely low two-photon absorption (2PA) cross-sections, we designed a nanosensor for oxygen, in which a 2P absorbing antenna is coupled to a metalloporphyrin core via intramolecular energy transfer (ET) with the purpose of amplifying the 2PA induced phosphorescence of the metalloporphyrin. The central component of the device is a polyfunctionalized Pt porphyrin, whose triplet state emission at ambient temperatures is strong, occurs in the near infrared and is sensitive to O2. The 2PA chromophores are chosen in such a way that their absorption is maximal in the near infrared (NIR) window of tissue (e.g., 700-900 nm), while their fluorescence is overlapped with the absorption band(s) of the core metalloporphyrin, ensuring an efficient antenna-core resonance ET. The metalloporphyrin-antenna construct is embedded inside the protecting dendritic jacket, which isolates the core from interactions with biological macromolecules, controls diffusion of oxygen and makes the entire sensor water-soluble. Several Pt porphyrin-coumarin based sensors were synthesized and their photophyics studied to evaluate the proposed design.

Investigation of bi-phasic tumor oxygen dynamics induced by hyperoxic gas intervention: A numerical study

This study intends to explore the underlying principle of the biphasic behavior of increases in oxygenated hemoglobin concentration that was observed in vivo from rat breast tumors during carbogen/oxygen inhalation. We have utilized the Finite Element Method (FEM) to simulate the effects of different blood flow rates, in several geometries, on the near infrared measurements. The results show clearly that co-existence of two blood flow velocities can result in a bi-phasic change in optical density, regardless of the orientation of vessels. This study supports our previous hypothesis that the bi-phasic tumor hemodynamic feature during carbogen inhalation results from a well-perfused and a poorly perfused region in the tumor vasculature.

Consciousness monitoring using near-infrared spectroscopy (NIRS) during high +Gz exposures

The relationship between human consciousness and oxygen saturation (rSO(2)) in cerebral tissue under high +Gz stress was non-invasively monitored by near-infrared multiple wavelength spectroscopy (NIRS). We studied the drop in rSO(2) levels in human subjects during exposure to various head-to-foot acceleration (+Gz) profiles. These profiles included sustained +Gz plateaus and repeated short duration +Gz pulses of varying duration. The end point in this study was +Gz-induced loss of consciousness (G-LOC). The rSO(2) levels under normal (asymptomatic), almost loss of consciousness (A-LOC) and G-LOC conditions were recorded. Correlations among decrease in rSO(2), +Gz pulse duration, +Gz stress level and incapacitation time (ICAP) after G-LOC were also investigated. It was found that once rSO(2) fell to a certain level, G-LOC occurred. This threshold was repeatable and independent of the +Gz level or duration. It was also observed that the total ICAP after G-LOC was dependent on the length of time that rSO(2) remained below the G-LOC threshold level, i.e. the longer the rSO(2) level remained below the G-LOC induction level, the longer the subject remained unconscious. These results may prove to be useful in designing closed loop control systems for personal protective gear for pilots of high performance aircraft.

Properties of a diffused photon-pair density wave in a multiple-scattering medium

A novel diffused photon-pair density wave (DPPDW) composed of correlated polarized photon pairs at different temporal frequencies and orthogonal linearly polarized states is proposed. A theory of DPPDWs is developed. A DPPDW selected by coherence gating and polarization gating that satisfies the diffusion equation has been verified experimentally. The sensitivity of amplitude and phase detection of the heterodyne signal has been improved by the properties of synchronized detection and common-path propagation of polarized pair photons in a multiple-scattering medium. Both reduced scattering coefficient micro2s' and absorption coefficient micro2alpha of the scattering medium in terms of the measured phase and amplitude of the heterodyne signal have been obtained. The detection sensitivity of micro2s' and micro2alpha and the properties of a DPPDW in a multiple-scattering medium are discussed and analyzed.

Carbogen breathing significantly enhances the penetration of red light in murine tumours in vivo

We report results of experiments that evaluated the influence of oxygenation on the penetration of red light in tissue, with particular emphasis on 630 and 650 nm laser wavelengths commonly used in photodynamic therapy (PDT) of solid tumours. Direct measurements in tissue-simulating phantoms comprised of intact human erythrocytes suspended in a scattering emulsion demonstrated significant enhancements in fluence rate at depths of 0.5-2 cm from the irradiated surface when the cells were fully oxygenated versus fully deoxygenated. The 630 and 650 nm fluence rates at depth in the homogeneous phantoms continued to increase when examined over a continuous range of oxygen partial pressures from 0 to 160 Torr. When considered as a function of haemoglobin oxygen saturation, the largest increases in fluence rate were observed as the saturation increased beyond 70%. Dramatic increases in optical fluence rate were measured at the base of 1-cm-thick subcutaneous EMT6 mammary carcinomas in vivo when the tumour-bearing mouse was subjected to carbogen through a nose cone. These results indicate that improved tumour oxygenation is important in PDT not only for the maintenance of the oxygen-dependent photochemistry but, through the effects reported here, may also enable more efficient treatment of thicker lesions.

Hemoglobin oxygen saturations in phantoms andin vivofrom measurements of steady-state diffuse reflectance at a single, short source-detector separation

We present a method for the analysis of steady state diffuse reflectance spectra obtained from vascularized tissue or from tissue simulating phantoms at a single, short source-detector separation. This method uses reasonable assumptions about the structure of the reduced scattering spectrum and basis absorption spectra for oxy- and deoxyhemoglobin, which dominate tissue absorption in the visible region of the spectrum. Using a hybrid P3-diffusion description of light propagation, described originally by Hull and Foster [J. Opt. Soc. Am. A 18, 584-599 (2001)] and suitable for short (approximately 1 mm) source-detector separations and optical properties of tissue at visible wavelengths, we create a forward model of the diffuse reflectance with four free parameters. We demonstrate that this model is able to recover accurately the hemoglobin concentrations and scattering properties from synthetic data generated by Monte Carlo simulation and from reflectance spectra acquired from tissue-simulating phantoms containing intact human erythrocytes. We show also that the method is capable of monitoring carbogen-induced changes in murine tumor oxygenation in vivo. The successful implementation of single, short detector separations enables the measurement of intratumor heterogeneities in hemoglobin oxygen saturation and responses to carbogen using a simple fiber-based probe design.

Comparison of BOLD contrast and Gd-DTPA dynamic contrast-enhanced imaging in rat prostate tumor

The microcirculation and oxygenation of a tumor play important roles in its responsiveness to cytotoxic treatment, and noninvasive assessments of its vascular properties may have prognostic value. Dynamic contrast-enhanced (DCE) (1)H MRI based on infusion of Gd-DTPA, and blood oxygen level-dependent (BOLD) contrast based on altering inhaled gas are both sensitive to vascular characteristics. This study compares the effects observed in eight Dunning prostate R3327-AT1 rat tumors imaged sequentially at 4.7 Tesla by echo-planar imaging (EPI). Both interventions generated a significant response, and each revealed significant differences between the center and periphery of the tumors. On a voxel-by-voxel basis across the whole tumor population, there was a close correlation between the maximum rate of signal response and the magnitude of response to each intervention (R(2) >or= 0.6, P < 0.0001). However, when the data were analyzed separately for each individual tumor, some showed a weak correlation (R(2) < 0.4), particularly for DCE, and the nature (slope) varied between separate tumors. Generally, there was a weak correlation (N = 7, R(2) < 0.5) between responses to the two interventions on a tumor-by-tumor basis, which emphasizes that the techniques are not equivalent. Both techniques revealed intra- and intertumor heterogeneity, but the BOLD response was more rapidly reversible than the DCE response. This suggests that the BOLD technique may be a useful tool for investigating interventions (such as drugs) that cause vascular disruption.

Breast cancer detection by mapping hemoglobin concentration and oxygen saturation

Near-infrared (NIR) spectroscopic imaging technology provides a new modality for measuring changes in total hemoglobin concentration (HbT) and blood oxygen saturation (SO2) in human tissue. The technology can be used to detect breast cancer because cancers may cause greater vascularization and greater oxygen consumption than in normal tissue. Based on the NIR technology, ViOptix, Inc., has developed an optical device that provides two-dimensional mapping of HbT and SO2 in human tissue. As an adjunctive tool to mammography, the device was preliminarily tested in a clinical trial with 50 mammogram-positive patients at the Massachusetts General Hospital. The results of the clinical trial demonstrate that the device can reach as much as 92% diagnostic sensitivity and 67% specificity in detecting ductal carcinoma. These results may indicate that the NIR technology can potentially be used as an adjunct to mammography for breast cancer detection to reduce the number of biopsies performed.

Quantitative assessment of tumor oxygen dynamics: molecular imaging for prognostic radiology

One of the fundamental molecules governing the survival of mammalian cells is oxygen. Oxygen has gained particular significance in tumor developmental biology and oncology. An increasingly diverse array of methods is now available to characterize tumor oxygenation. This Prospect will consider a new method, Fluorocarbon Relaxometry using Echo planar imaging for Dynamic Oxygen Mapping (FREDOM), which we have recently developed for oximetry, examine application to a specific therapeutic example and place this technique in the context of other approaches.

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

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

Characterization and imaging of compositional variation in tissues

The diffuse surface reflectance profiles of the goat's isolated heart, spleen, and adipose tissues by multiprobe laser reflectometer are measured. The normalized backscattered intensity values for adipose, heart, and spleen tissues at source-detector separation 0.2 cm, are 0.060, 0.021, and 0.003, respectively. The optical parameters of these tissues are determined by the best fit (chi2(0.99)) of their spatial profiles with that as obtained by Monte Carlo simulation by iterative procedure. As the optical parameters of these vary over a wide range, adipose and spleen tissues are treated as inhomogeneity of diameter 0.1, 0.2, or 0.3 cm, and placed inside the control (heart) tissue at different depths. Anisotropic simulation of light backscattering or photon depth distribution is significantly different for various tissues. The surface intensity profiles vary depending on the changes in tissue composition. From the horizontal scans of the subtracted images, the photon backscattering simulated images of control and combination of tissues are obtained. By analysis of peak intensity and full-width at half maximum, the type, location, and size of the tissue compositional variation are determined.

Simultaneous reconstruction of absorption and scattering maps with ultrasound localization: feasibility study using transmission geometry

We report the experimental results of the simultaneous reconstruction of absorption and scattering coefficient maps with ultrasound localization. Near-infrared (NIR) data were obtained from frequency domain and dc systems with source and detector fibers configured in transmission geometry. High- or low-contrast targets located close to either the boundary or the center of the turbid medium were reconstructed by using NIR data only and NIR data with ultrasound localization. Results show that the mean reconstructed absorption coefficient and the spatial distribution of the absorption map have been improved significantly with ultrasound localization. The improvements in the mean scattering coefficient and the spatial distribution of the scattering coefficient are moderate. When both the absorption and the scattering coefficients are reconstructed the performance of the frequency-domain systemis much better than that of the dc system.