Assessment of the frequency-domain multi-distance method to evaluate the brain optical properties: Monte Carlo simulations from neonate to adult

Maximizing the Reliability and Precision of Measures of Prefrontal Cortical Oxygenation Using Frequency-Domain Near-Infrared Spectroscopy

Frequency-domain near-infrared spectroscopy (FD-NIRS) has been used for non-invasive assessment of cortical oxygenation since the late 1990s. However, there is limited research demonstrating clinical validity and general reproducibility. To address this limitation, recording duration for adequate validity and within- and between-day reproducibility of prefrontal cortical oxygenation was evaluated. To assess validity, a reverse analysis of 10-min-long measurements (n = 52) at different recording durations (1-10-min) was quantified via coefficients of variation and Bland-Altman plots. To assess within- and between-day within-subject reproducibility, participants (n = 15) completed 2-min measurements twice a day (morning/afternoon) for five consecutive days. While 1-min recordings demonstrated sufficient validity for the assessment of oxygen saturation (StO2) and total hemoglobin concentration (THb), recordings ≥4 min revealed greater clinical utility for oxy- (HbO) and deoxyhemoglobin (HHb) concentration. Females had lower StO2, THb, HbO, and HHb values than males, but variability was approximately equal between sexes. Intraclass correlation coefficients ranged from 0.50-0.96. The minimal detectable change for StO2 was 1.15% (95% CI: 0.336-1.96%) and 3.12 µM for THb (95% CI: 0.915-5.33 µM) for females and 2.75% (95%CI: 0.807-4.70%) for StO2 and 5.51 µM (95%CI: 1.62-9.42 µM) for THb in males. Overall, FD-NIRS demonstrated good levels of between-day reliability. These findings support the application of FD-NIRS in field-based settings and indicate a recording duration of 1 min allows for valid measures; however, data recordings of ≥4 min are recommended when feasible.

Depth-selective method for time-domain diffuse reflectance measurements: validation study of the dual subtraction technique

Research on the spatial distribution of sensitivity of time-domain near infrared diffuse reflectance measurement is reported in this paper. The main objective of the investigation is to validate theoretically calculated sensitivity profiles for a measurement geometry with two detectors and two sources in which sensitivity profiles of statistical moments of distributions of time of flight of photons (DTOFs) are spatially restricted to a region underneath the detectors. For this dual subtraction method, smaller sensitivities to changes appearing in the superficial layer of the medium were observed compared to the single distance and single subtraction methods. Experimental validation of this approach is based on evaluation of changes in the statistical moments of DTOFs measured on a liquid phantom with local absorption perturbations. The spatial distributions of sensitivities, depth-related sensitivity and depth selectivities were obtained from the dual subtraction method and compared with those from single distance and single subtraction approaches. Also, the contrast to noise ratio (CNR) was calculated for the dual subtraction technique and combined with depth selectivity in order to assess the overall performance (product of CNR and depth selectivity) of the method. Spatial sensitivity profiles from phantom experiments are in a good agreement with the results of theoretical studies and feature more locally restricted sensitivity volume with the point of maximal sensitivity located deeper. The highest value of overall performance was obtained experimentally for the second statistical moment in the dual subtraction method (∼10.8) surpassing that of the single distance method (∼8.7). This confirms the advantage of dual subtraction measurement geometries in the suppression of optical signals originated in the superficial layer of the medium.

The Comparison of Early Hemodynamic Response to Single-Pulse Transcranial Magnetic Stimulation following Inhibitory or Excitatory Theta Burst Stimulation on Motor Cortex

We present a new study design aiming to enhance the understanding of the mechanism by which continuous theta burst stimulation (cTBS) or intermittent theta burst stimulation (iTBS) paradigms elicit cortical modulation. Using near-infrared spectroscopy (NIRS), we compared the cortical hemodynamics of the previously inhibited (after cTBS) or excited (after iTBS) left primary motor cortex (M1) as elicited by single-pulse TMS (spTMS) in a cross-over design. Mean relative changes in hemodynamics within 6 s of the stimulus were compared using a two-sample t-test (p < 0.05) and linear mixed model between real and sham stimuli and between stimuli after cTBS and iTBS. Only spTMS after cTBS resulted in a significant increase (p = 0.04) in blood volume (BV) compared to baseline. There were no significant changes in other hemodynamic parameters (oxygenated/deoxygenated hemoglobin). spTMS after cTBS induced a larger increase in BV than spTMS after iTBS (p = 0.021) and sham stimulus after cTBS (p = 0.009). BV showed no significant difference between real and sham stimuli after iTBS (p = 0.37). The greater hemodynamic changes suggest increased vasomotor reactivity after cTBS compared to iTBS. In addition, cTBS could decrease lateral inhibition, allowing activation of surrounding areas after cTBS.

Estimation of optical properties of turbid media using spatially resolved diffuse reflectance combined with LSTM-attention network

The accurate estimation of the optical properties of turbid media by using a spatially resolved (SR) technique remains a challenging task due to measurement errors in the acquired spatially resolved diffuse reflectance (SRDR) and challenges in inversion model implementation. In this study, what we believe to be a novel data-driven model based on a long short-term memory network and attention mechanism (LSTM-attention network) combined with SRDR is proposed for the accurate estimation of the optical properties of turbid media. The proposed LSTM-attention network divides the SRDR profile into multiple consecutive and partially overlaps sub-intervals by using the sliding window technique, and uses the divided sub-intervals as the input of the LSTM modules. It then introduces an attention mechanism to evaluate the output of each module automatically and form a score coefficient, finally obtaining an accurate estimation of the optical properties. The proposed LSTM-attention network is trained with Monte Carlo (MC) simulation data to overcome the difficulty in preparing training (reference) samples with known optical properties. Experimental results of the MC simulation data showed that the mean relative error (MRE) with 5.59% for the absorption coefficient [with the mean absolute error (MAE) of 0.04 cm^-1, coefficient of determination (R²) of 0.9982, and root mean square error (RMSE) of 0.058 cm^-1] and 1.18% for the reduced scattering coefficient (with an MAE of 0.208 cm^-1, R² of 0.9996, and RMSE of 0.237 cm^-1), which were significantly better than those of the three comparative models. The SRDR profiles of 36 liquid phantoms, collected using a hyperspectral imaging system that covered a wavelength range of 530-900 nm, were used to test the performance of the proposed model further. The results showed that the LSTM-attention model achieved the best performance (with the MRE of 14.89%, MAE of 0.022 cm^-1, R² of 0.9603, and RMSE of 0.026 cm^-1 for the absorption coefficient; and the MRE of 9.76%, MAE of 0.732 cm^-1, R² of 0.9701, and RMSE of 1.470 cm^-1for the reduced scattering coefficient). Therefore, SRDR combined with the LSTM-attention model provides an effective method for improving the estimation accuracy of the optical properties of turbid media.

Fetal cardiac and neonatal cerebral hemodynamics and oxygen metabolism in transposition of the great arteries

OBJECTIVES

Hemodynamic abnormalities and brain development disorders have been reported previously in fetuses and infants with transposition of the great arteries and intact ventricular septum (TGA-IVS). A ventricular septal defect (VSD) is thought to be an additional risk factor for adverse neurodevelopment, but literature describing this population is sparse. The objectives of this study were to assess fetal cardiac hemodynamics throughout pregnancy, to monitor cerebral hemodynamics and oxygen metabolism in neonates, and to compare these data between patients with TGA-IVS, those with TGA-VSD and age-matched controls.

METHODS

Cardiac hemodynamics were assessed in TGA-IVS and TGA-VSD fetuses and compared with healthy controls matched for gestational age (GA) during three periods: ≤ 22 + 5 weeks (GA1), 27 + 0 to 32 + 5 weeks (GA2) and ≥ 34 + 5 weeks (GA3). Left (LVO), right (RVO) and combined (CVO) ventricular outputs, ductus arteriosus flow (DAF, sum of ante- and retrograde flow in systole and diastole), diastolic DAF, transpulmonary flow (TPF) and foramen ovale diameter were measured. Aortic (AoF) and main pulmonary artery (MPAF) flows were derived as a percentage of CVO. Fetal middle cerebral artery and umbilical artery (UA) pulsatility indices (PI) were measured and the cerebroplacental ratio (CPR) was derived. Bedside optical brain monitoring was used to measure cerebral hemoglobin oxygen saturation (SO2 ) and an index of microvascular cerebral blood flow (CBFi ), along with peripheral arterial oxygen saturation (SpO2 ), in TGA-IVS and TGA-VSD neonates. Using hemoglobin (Hb) concentration measurements, these parameters were used to derive cerebral oxygen delivery and extraction fraction (OEF), as well as an index of cerebral oxygen metabolism (CMRO2i ). These data were acquired in the early preoperative period (within 3 days after birth and following balloon atrial septostomy) and compared with those of age-matched healthy controls, and repeat measurements were collected before discharge when vital signs were stable.

RESULTS

LVO was increased in both TGA groups compared with controls throughout pregnancy. Compared with controls, TPF was increased and diastolic DAF was decreased in TGA-IVS fetuses throughout pregnancy, but only during GA1 and GA2 in TGA-VSD fetuses. Compared with controls, DAF was decreased in TGA-IVS fetuses throughout pregnancy and in TGA-VSD fetuses at GA2 and GA3. At GA2, AoF was higher in TGA-IVS and TGA-VSD fetuses than in controls, while MPAF was lower. At GA3, RVO and CVO were higher in the TGA-IVS group than in the TGA-VSD group. In addition, UA-PI was lower at GA2 and CPR higher at GA3 in TGA-VSD fetuses compared with TGA-IVS fetuses. Within 3 days after birth, SpO2 and SO2 were lower in both TGA groups than in controls, while Hb, cerebral OEF and CMRO2i were higher. Preoperative SpO2 was also lower in TGA-VSD neonates than in those with TGA-IVS. From preoperative to predischarge periods, SpO2 and OEF increased in both TGA groups, but CBFi and CMRO2i increased only in the TGA-VSD group. During the predischarge period, SO2 was higher in TGA-IVS than in TGA-VSD neonates, while CBFi was lower.

CONCLUSIONS

Fetal cardiac and neonatal cerebral hemodynamic/metabolic differences were observed in both TGA groups compared with controls. Compared to those with TGA-IVS, fetuses with TGA-VSD had lower RVO and CVO in late gestation. A higher level of preoperative hypoxemia was observed in the TGA-VSD group. Postsurgical cerebral adaptive mechanisms probably differ between TGA groups. Patients with TGA-VSD have a specific physiology that warrants further study to improve neonatal care and neurodevelopmental outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Associations between neurological examination at term-equivalent age and cerebral hemodynamics and oxygen metabolism in infants born preterm

Background

Infants born at 29-36 weeks gestational age (GA) are at risk of experiencing neurodevelopmental challenges. We hypothesize that cerebral hemodynamics and oxygen metabolism measured by bedside optical brain monitoring are potential biomarkers of brain development and are associated with neurological examination at term-equivalent age (TEA).

Methods

Preterm infants (N = 133) born 29-36 weeks GA and admitted in the neonatal intensive care unit were enrolled in this prospective cohort study. Combined frequency-domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) were used from birth to TEA to measure cerebral hemoglobin oxygen saturation and an index of microvascular cerebral blood flow (CBF _i ) along with peripheral arterial oxygen saturation (SpO₂). In combination with hemoglobin concentration in the blood, these parameters were used to derive cerebral oxygen extraction fraction (OEF) and an index of cerebral oxygen metabolism (CMRO_2i ). The Amiel-Tison and Gosselin Neurological Assessment was performed at TEA. Linear regression models were used to assess the associations between changes in FDNIRS-DCS parameters from birth to TEA and GA at birth. Logistic regression models were used to assess the associations between changes in FDNIRS-DCS parameters from birth to TEA and neurological examination at TEA.

Results

Steeper increases in CBF _i (p < 0.0001) and CMRO_2i (p = 0.0003) were associated with higher GA at birth. Changes in OEF, CBF _i , and CMRO_2i from birth to TEA were not associated with neurological examination at TEA.

Conclusion

In this population, cerebral FDNIRS-DCS parameters were not associated with neurological examination at TEA. Larger increases in CBF _i and CMRO_2i from birth to TEA were associated with higher GA. Non-invasive bedside FDNIRS-DCS monitoring provides cerebral hemodynamic and metabolic parameters that may complement neurological examination to assess brain development in preterm infants.

Diffuse correlation spectroscopy blood flow monitoring for intraventricular hemorrhage vulnerability in extremely low gestational age newborns

In premature infants with an extremely low gestational age (ELGA, < 29 weeks GA), dysregulated changes in cerebral blood flow (CBF) are among the major pathogenic factors leading to germinal matrix/intraventricular hemorrhage (GM/IVH). Continuous monitoring of CBF can guide interventions to minimize the risk of brain injury, but there are no clinically standard techniques or tools for its measurement. We report the feasibility of the continuous monitoring of CBF, including measures of autoregulation, via diffuse correlation spectroscopy (DCS) in ELGA infants using CBF variability and correlation with scalp blood flow (SBF, served as a surrogate measure of systemic perturbations). In nineteen ELGA infants (with 9 cases of GM/IVH) monitored for 6–24 h between days 2–5 of life, we found a strong correlation between CBF and SBF in severe IVH (Grade III or IV) and IVH diagnosed within 72 h of life, while CBF variability alone was not associated with IVH. The proposed method is potentially useful at the bedside for the prompt assessment of cerebral autoregulation and early identification of infants vulnerable to GM/IVH.

Quantifying the Cerebral Hemometabolic Response to Blood Transfusion in Pediatric Sickle Cell Disease With Diffuse Optical Spectroscopies

Red blood cell transfusions are common in patients with sickle cell disease who are at increased risk of stroke. Unfortunately, transfusion thresholds needed to sufficiently dilute sickle red blood cells and adequately restore oxygen delivery to the brain are not well defined. Previous work has shown that transfusion is associated with a reduction in oxygen extraction fraction and cerebral blood flow, both of which are abnormally increased in sickle patients. These reductions are thought to alleviate hemometabolic stress by improving the brain's ability to respond to increased metabolic demand, thereby reducing susceptibility to ischemic injury. Monitoring the cerebral hemometabolic response to transfusion may enable individualized management of transfusion thresholds. Diffuse optical spectroscopies may present a low-cost, non-invasive means to monitor this response. In this study, children with SCD undergoing chronic transfusion therapy were recruited. Diffuse optical spectroscopies (namely, diffuse correlation spectroscopy combined with frequency domain near-infrared spectroscopy) were used to quantify oxygen extraction fraction (OEF), cerebral blood volume (CBV), an index of cerebral blood flow (CBF_i), and an index of cerebral oxygen metabolism (CMRO_2i) in the frontal cortex immediately before and after transfusion. A subset of patients receiving regular monthly transfusions were measured during a subsequent transfusion. Data was captured from 35 transfusions in 23 patients. Transfusion increased median blood hemoglobin levels (Hb) from 9.1 to 11.7 g/dL (p < 0.001) and decreased median sickle hemoglobin (HbS) from 30.9 to 21.7% (p < 0.001). Transfusion decreased OEF by median 5.9% (p < 0.001), CBFi by median 21.2% (p = 0.020), and CBV by median 18.2% (p < 0.001). CMRO_2i did not statistically change from pre-transfusion levels (p > 0.05). Multivariable analysis revealed varying degrees of associations between outcomes (i.e., OEF, CBF_i, CBV, and CMRO_2i), Hb, and demographics. OEF, CBF_i, and CBV were all negatively associated with Hb, while CMRO_2i was only associated with age. These results demonstrate that diffuse optical spectroscopies are sensitive to the expected decreases of oxygen extraction, blood flow, and blood volume after transfusion. Diffuse optical spectroscopies may be a promising bedside tool for real-time monitoring and goal-directed therapy to reduce stroke risk for sickle cell disease.

Dedicated near-infrared oximeter to monitor oxygenation in the superior sagittal sinus in newborn infants: a research agenda

SIGNIFICANCE

Cerebral tissue oximetry is imprecise and confounded by an uncertain and variable arteriovenous volume ratio. Venous saturation is better grounded in physiology. The superior sagittal sinus (SSS) is relatively large and placed under the open fontanel on the top of the head in newborn infants.

AIM

To enable the development of a dedicated near-infrared-spectroscopy-based cerebral oximeter with sufficient claims on accuracy to be tested for benefit of clinical use.

APPROACH

To set up a research agenda based on the combination of dedicated, high-fidelity digital and physical phantoms.

RESULTS

A seven-step path is outlined to identify an optode geometry with high sensitivity to variation in hemoglobin-oxygen saturation in the SSS, with little confounding by changes in the optical properties of the skin and scalp or brain tissue, or in the width of the subarachnoidal space, and that is robust to variations in the placement of the optode.

CONCLUSION

If an oximeter that is designed after exploration of digital phantoms can produce measurements in physical phantoms with good agreement with predictions, it will contribute credibility that cannot be achieved by direct gold-standard validation in newborn human infants.

Imaging affective and non-affective touch processing in two-year-old children

Touch is an important component of early parent-child interaction and plays a critical role in the socio-emotional development of children. However, there are limited studies on touch processing amongst children in the age range from one to three years. The present study used frequency-domain diffuse optical tomography (DOT) to investigate the processing of affective and non-affective touch over left frontotemporal brain areas contralateral to the stimulated forearm in two-year-old children. Affective touch was administered by a single stroke with a soft brush over the child's right dorsal forearm at 3 cm/s, while non-affective touch was provided by multiple brush strokes at 30 cm/s. We found that in the insula, the total haemoglobin (HbT) response to slow brushing was significantly greater than the response to fast brushing (slow > fast). Additionally, a region in the postcentral gyrus, Rolandic operculum and superior temporal gyrus exhibited greater response to fast brushing than slow brushing (fast > slow). These findings confirm that an adult-like pattern of haemodynamic responses to affective and non-affective touch can be recorded in two-year-old subjects using DOT. To improve the accuracy of modelling light transport in the two-year-old subjects, we used a published age-appropriate atlas and deformed it to match the exterior shape of each subject's head. We estimated the combined scalp and skull, and grey matter (GM) optical properties by fitting simulated data to calibrated and coupling error corrected phase and amplitude measurements. By utilizing a two-compartment cerebrospinal fluid (CSF) model, the accuracy of estimation of GM optical properties and the localization of activation in the insula was improved. The techniques presented in this paper can be used to study neural development of children at different ages and illustrate that the technology is well-tolerated by most two-year-old children and not excessively sensitive to subject movement. The study points the way towards exciting possibilities in functional imaging of deeper functional areas near sulci in small children.

Brain Light-Tissue Interaction Modelling: Towards a non-invasive sensor for Traumatic Brain Injury

Traumatic brain injury (TBI) is one of the leading causes of death worldwide, yet there is no systematic approach to monitor TBI non-invasively. The main motivation of this work is to create new knowledge relating to light brain interaction using a Monte Carlo Model, which could aid in the development of non-invasive optical sensors for the continuous assessment of TBI. To this aim, a multilayer model tissue-model of adult human head was developed and explored at the near-infrared optical wavelength. Investigation reveals that maximum light (40-50%) is absorbed in the skull and the minimum light is absorbed in the subarachnoid space (0-1%). It was found that the absorbance of light decreases with increasing source-detector separation up to 3cm where light travels through the subarachnoid space, after which the absorbance increases with the increasing separation. Such information will be helpful towards the modelling of neurocritical brain tissue followed by the sensor development.

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

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

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

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

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

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

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

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

Cerebral perfusion and blood-brain barrier assessment in brain trauma using contrast-enhanced near-infrared spectroscopy with indocyanine green: A review

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.

Comparison of INVOS 5100C and Nonin SenSmart X-100 oximeter performance in preterm infants with spontaneous apnea

BACKGROUND

Tissue oximeters are not interchangeable. Two instruments with sensors dedicated to preterm infants-INVOS 5100C and Nonin SenSmart X-100-have not yet been compared.

METHODS

By measuring cerebral oxygenation in ten preterm infants with spontaneous apneic episodes defined by pulse oximeter readings (SpO₂) below 80%, as well as tissue oxygenation during vascular occlusion on the forearm of ten adults, simultaneously we compared performance in the hypoxic range.

RESULTS

We found the mean conversion equations to be StO_{2,SenSmart X-100} = 0.34 × StO_{2,INVOS 5100C} + 44.8% during apnea in infants and StO_{2,SenSmart X-100} = 0.59 × StO_{2,INVOS 5100C} + 34.4% during vascular occlusion. The individual regressions displayed large and statistically significant variations in both infants and adults. In three infants the INVOS sensor showed very little reaction to decreases in SpO₂.

CONCLUSIONS

These findings confirm that different NIRS devices give very different estimates when the oxygenation is low. The large variation when compared to SpO₂ suggest that the sensor placement is very important in preterm infants.

Neurovascular coupling in the developing neonatal brain at rest

The neonatal brain is an extremely dynamic organization undergoing essential development in terms of connectivity and function. Several functional imaging investigations of the developing brain have found neurovascular coupling (NVC) patterns that contrast with those observed in adults. These discrepancies are partly due to that NVC is still developing in the neonatal brain. To characterize the vascular response to spontaneous neuronal activations, a multiscale multimodal noninvasive approach combining simultaneous electrical, hemodynamic, and metabolic recordings has been developed for preterm infants. Our results demonstrate that the immature vascular network does not adopt a unique strategy to respond to spontaneous cortical activations. NVC takes on different forms in the same preterm infant during the same recording session in response to very similar types of neural activation. This includes (a) positive stereotyped hemodynamic responses (increases in HbO, decreases in HbR together with increases in rCBF and rCMRO2), (b) negative hemodynamic responses (increases in HbR, decreases in HbO together with decreases in rCBF and rCMRO2), and (c) Increases and decreases in both HbO‐HbR and rCMRO2 together with no changes in rCBF. Age‐related NVC maturation is demonstrated in preterm infants, which can contribute to a better understanding/prevention of cerebral hemodynamic risks in these infants.

Influence of extracerebral layers on estimates of optical properties with continuous wave near infrared spectroscopy: analysis based on multi-layered brain tissue architecture and Monte Carlo simulation

Continuous wave near-infrared spectroscopy (CW-NIRS) can be used to measure cerebral activity because it is noninvasive, simple and portable. However, the performance of the continuous wave near-infrared spectroscopy is distorted by the presence of extracerebral layer. Change of optical parameters in gray matter layer will then be inappropriately converted into the brain activity response. In the current study, a five-layer structure model constitute of scalp, skull, cerebrospinal fluid, gray matter and white matter, have been applied to fabricate human brain tissue. The phantom is made by the mixture of the Intralipid, India ink and agar. The optical parameters of gray matter layer can be flexibly adjusted to simulate the change of the deep brain tissue. The near infrared optical measurement system was designed to detect the changes in the absorption coefficients of the gray matter and quantitative analyze the influence of the extracerebral layers. Monte Carlo technique for the equivalent multi-layered brain tissue models is then performed to compensate partial volume effect introduced by the extracerebral layers. The results of the experiments suggested that the extracerebral layers influence the measurement and the influence of the extracerebral layers can be suppressed by correcting partial volume effect using Monte Carlo simulations.

Lawrence K. Development of a stand-alone DCS system for monitoring absolute cerebral blood flow

Diffuse correlation spectroscopy (DCS) is a noninvasive optical technique for monitoring cerebral blood flow (CBF). This work presents a stand-alone DCS system capable of monitoring absolute CBF by incorporating a quantitative dynamic contrast-enhanced (DCE) technique. Multi-distance data were acquired to measure the tissue optical properties and to perform DCE experiments. Feasibility of the technique was assessed in piglets in which the optical properties were measured independently by time-resolved near-infrared spectroscopy. A strong linear correlation was observed between CBF values derived using the two sets of optical properties, demonstrating that this hybrid DCS approach can provide real-time monitoring of absolute CBF.

Differential pathlength factor in continuous wave functional near-infrared spectroscopy: reducing hemoglobin's cross talk in high-density recordings

Functional near-infrared spectroscopy (fNIRS) estimates the functional oscillations of oxyhemoglobin and deoxyhemoglobin in the cortex through scalp-located multiwavelength recordings. Hemoglobin oscillations are inferred through temporal changes in continuous-wave (CW) light attenuation. However, because of the diffusive multilayered head tissue structures, the photon path is longer than the source-detector separation, complicating hemoglobin evaluation. This aspect is incorporated in the modified Beer-Lambert law where the source-detector distance is multiplied by the differential pathlength factor (DPF). Since DPF estimation requires photons' time-of-flight information, DPF is assumed a priori in CW-fNIRS. Importantly, errors in the DPF spectrum induce hemoglobin cross talk, which is detrimental for fNIRS. We propose to estimate subject-specific DPF spectral dependence relying on multidistance high-density measurements. The procedure estimates the effective attenuation coefficient (EAC), which is proportional to the geometric mean of absorption and reduced scattering. Since DPF depends on the scattering-to-absorption ratio, EAC limits the spectral dependence assumption to scattering. This approach was compared to a standard frequency-domain multidistance procedure. A good association between the two methods ( r 2 = 0.69 ) was obtained. This approach could estimate low-resolution maps of the DPF spectral dependence through large field of view, high-density systems, reducing hemoglobin cross talk, and increasing fNIRS sensitivity and specificity to brain activity without instrumentation modification.

Head model based on the shape of the subject's head for optical brain imaging

Optical imaging methods such as near-infrared spectroscopy and diffuse optical tomography rely on models to solve the inverse problem. Imaging an adult human head also requires a head model. Using a model, which makes describing the structure of the head better, leads to acquiring a more accurate absorption map. Here, by combining the key features of layered slab models and head atlases, we introduce a new two-layered head model that is based on the surface geometry of the subject's head with variable thickness of the superficial layer. Using the Monte Carlo approach, we assess the performance of our model for fitting the optical properties from simulated time-resolved data of the adult head in a null distance source-detector configuration. Using our model, we observed improved results at 70 percent of the locations on the head and an overall 20 percent reduction in relative error compared to layered slab model.

Accuracy and precision of tissue optical properties and hemodynamic parameters estimated by the BabyLux device: a hybrid time-resolved near-infrared and diffuse correlation spectroscopy neuro-monitor

We have investigated the accuracy and precision of "the BabyLux device", a hybrid time-resolved near-infrared (TRS) and diffuse correlation spectroscopy (DCS) neuro-monitor for the pre-term infant. Numerical data with realistic noise were simulated and analyzed using the BabyLux device as a reference system and different experimental and analysis parameters. The results describe the limits for the precision and the accuracy to be expected. The dependence of these limits on different experimental conditions and choices of the analysis method is also described. Experiments demonstrate comparable values for precision with respect to the simulation results.

High-density diffuse optical tomography for imaging human brain function

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

Functional Near-Infrared Spectroscopy Recordings of Visuospatial Working Memory Processes. Part II: A Replication Study in Children on Sensitivity and Mental-Ability-Induced Differences in Functional Activation

In a previous study in young adults, we showed that hemodynamic changes as measured by functional near-infrared spectroscopy (fNIRS) were sensitive for identifying visuospatial working memory (WM)-related functional brain activation in the prefrontal cortex. This functional activation, however, could not be verified for participants with far-above-average mental ability, suggesting different cognitive processes adopted by this group. The present study was designed to confirm these findings in 11- to 13-year-old children by applying the same study design, experimental task, fNIRS setup, and statistical approach. We successfully replicated the earlier findings on sensitivity of fNIRS with regard to visuospatial WM-specific task demands in our children sample. Likewise, mental-ability-induced differences in functional activation were even more pronounced in the children compared with in the young adults. By testing a children sample, we were able to not only replicate our previous findings based on adult participants but also generalize the validity of these findings to children. This latter aspect seems to be of particular significance considering the relatively large number of fNIRS studies on WM performance in children.

Optimal positioning of optodes on the scalp for personalized functional near-infrared spectroscopy investigations

BACKGROUND

Application of functional Near InfraRed Spectroscopy (fNIRS) in neurology is still limited as a good optical coupling and optimized optode coverage of specific brain regions remains challenging, notably for prolonged monitoring.

METHODS

We propose to evaluate a new procedure allowing accurate investigation of specific brain regions. The procedure consists in: (i) A priori maximization of spatial sensitivity of fNIRS measurements targeting specific brain regions, while reducing the number of applied optodes in order to decrease installation time and improve subject comfort. (ii) Utilization of a 3D neuronavigation device and usage of collodion to glue optodes on the scalp, ensuring good optical contact for prolonged investigations. (iii) Local reconstruction of the hemodynamic activity along the cortical surface using inverse modelling.

RESULTS

Using realistic simulations, we demonstrated that maps derived from optimal montage acquisitions showed, after reconstruction, spatial resolution only slightly lower to that of ultra high density montages while significantly reducing the number of optodes. The optimal montages provided overall good quantitative accuracy especially at the peak of the spatially reconstructed map. We also evaluated real motor responses in two healthy subjects and obtained reproducible motor responses over different sessions.

COMPARISON WITH EXISTING METHODS

We are among the first to propose a mathematical optimization strategy, allowing high sensitivity measurements.

CONCLUSIONS

Our results support that using personalized optimal montages should allow to conduct accurate fNIRS studies in clinical settings and realistic lifestyle conditions.

Development and characterization of a multidistance and multiwavelength diffuse correlation spectroscopy system

This paper presents a multidistance and multiwavelength diffuse correlation spectroscopy (DCS) approach and its implementation to simultaneously measure the optical proprieties of deep tissue as well as the blood flow. The system consists of three long coherence length lasers at different wavelengths in the near-infrared, eight single-photon detectors, and a correlator board. With this approach, we collect both light intensity and DCS data at multiple distances and multiple wavelengths, which provide unique information to fit for all the parameters of interest: scattering, blood flow, and hemoglobin concentration. We present the characterization of the system and its validation with phantom measurements.

Comparison of tissue oximeters on a liquid phantom with adjustable optical properties: an extension

Cerebral near-infrared spectroscopy (NIRS) oximetry may help clinicians to improve patient treatment. However, the application of NIRS oximeters is increasingly causing confusion to the users due to the inconsistency of tissue oxygen haemoglobin saturation (StO2) readings provided by different oximeters. To establish a comparability of oximeters, in our study we performed simultaneous measurements on the liquid phantom mimicking properties of neonatal heads and compared the tested device to a reference NIRS oximeter (OxiplexTS). We evaluated the NIRS oximeters FORE-SIGHT, NIRO and SenSmart, and reproduced previous results with the INVOS and OxyPrem v1.3 oximeters. In general, linear relationships of the StO2 values with respect to the reference were obtained. Device specific hypoxic and hyperoxic thresholds (as used in the SafeBoosC study, www.safeboosc.eu) and a table allowing for conversion of StO2 values are provided.

Shedding light on the neonatal brain: probing cerebral hemodynamics by diffuse optical spectroscopic methods

Investigating the cerebral physiology of healthy term newborns' brains is important for better understanding perinatal brain injuries, of which the most common etiologies are hypoxia and ischemia. Hence, cerebral blood flow and cerebral oxygenation are important biomarkers of brain health. In this study, we employed a hybrid diffuse optical system consisting of diffuse correlation spectroscopy (DCS) and frequency-domain near infrared spectroscopy (FDNIRS) to measure hemoglobin concentration, oxygen saturation, and indices of cerebral blood flow and metabolism. We measured 30 term infants to assess the optical and physiological characteristics of the healthy neonatal brain in the frontal, temporal, and parietal lobes. We observed higher metabolism in the right hemisphere compared to the left and a positive correlation between gestational age and the level of cerebral hemoglobin concentration, blood volume, and oxygen saturation. Moreover, we observed higher cerebral blood flow and lower oxygen saturation in females compared to males. The delayed maturation in males and the sexual dimorphism in cerebral hemodynamics may explain why males are more vulnerable to perinatal brain injuries than females.

Shedding light on the neonatal brain: probing cerebral hemodynamics by diffuse optical spectroscopic methods

Investigating the cerebral physiology of healthy term newborns' brains is important for better understanding perinatal brain injuries, of which the most common etiologies are hypoxia and ischemia. Hence, cerebral blood flow and cerebral oxygenation are important biomarkers of brain health. In this study, we employed a hybrid diffuse optical system consisting of diffuse correlation spectroscopy (DCS) and frequency-domain near infrared spectroscopy (FDNIRS) to measure hemoglobin concentration, oxygen saturation, and indices of cerebral blood flow and metabolism. We measured 30 term infants to assess the optical and physiological characteristics of the healthy neonatal brain in the frontal, temporal, and parietal lobes. We observed higher metabolism in the right hemisphere compared to the left and a positive correlation between gestational age and the level of cerebral hemoglobin concentration, blood volume, and oxygen saturation. Moreover, we observed higher cerebral blood flow and lower oxygen saturation in females compared to males. The delayed maturation in males and the sexual dimorphism in cerebral hemodynamics may explain why males are more vulnerable to perinatal brain injuries than females.

In vivo measure of neonate brain optical properties and hemodynamic parameters by time-domain near-infrared spectroscopy

By exploiting a multichannel portable instrument for time-domain near-infrared spectroscopy (TD-NIRS), we characterized healthy neonates' brains in term of optical properties and hemodynamic parameters. In particular, we assessed the absolute values of the absorption and reduced scattering coefficients at two wavelengths, together with oxy-, deoxy- and total hemoglobin concentrations, and the blood oxygen saturation of the neonates' brains. In this study, 33 healthy full-term neonates were tested, obtaining the following median values: 0.28 and [Formula: see text] for [Formula: see text] at 690 and 820 nm, respectively; 5.8 and [Formula: see text] for [Formula: see text] at 690 and 820 nm, respectively; [Formula: see text] for [Formula: see text]; [Formula: see text] for [Formula: see text]; [Formula: see text] for [Formula: see text]; 72% for [Formula: see text]. In general, the agreement of these values with the sparse existing literature appears not always consistent. These findings demonstrate the first measurements of optical properties of the healthy neonate brain using TD-NIRS and show the need for clarification of optical properties across methods and populations.

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

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

Low-resolution mapping of the effective attenuation coefficient of the human head: a multidistance approach applied to high-density optical recordings

Near infrared (NIR) light has been widely used for measuring changes in hemoglobin concentration in the human brain (functional NIR spectroscopy, fNIRS). fNIRS is based on the differential measurement and estimation of absorption perturbations, which, in turn, are based on correctly estimating the absolute parameters of light propagation. To do so, it is essential to accurately characterize the baseline optical properties of tissue (absorption and reduced scattering coefficients). However, because of the diffusive properties of the medium, separate determination of absorption and scattering across the head is challenging. The effective attenuation coefficient (EAC), which is proportional to the geometric mean of absorption and reduced scattering coefficients, can be estimated in a simpler fashion by multidistance light decay measurements. EAC mapping could be of interest for the scientific community because of its absolute information content, and because light propagation is governed by the EAC for source-detector distances exceeding 1 cm, which sense depths extending beyond the scalp and skull layers. Here, we report an EAC mapping procedure that can be applied to standard fNIRS recordings, yielding topographic maps with 2- to 3-cm resolution. Application to human data indicates the importance of venous sinuses in determining regional EAC variations, a factor often overlooked.

Optical Characterization of Tissue Phantoms Using a Silicon Integrated fdNIRS System on Chip

An interface circuit with signal processing and digitizing circuits for a high frequency, large area avalanche photodiode (APD) has been integrated in a 130 nm BiCMOS chip. The system enables the absolute oximetry of tissue using frequency domain Near Infrared Spectroscopy (fdNIRS). The system measures the light absorbed and scattered by the tissue by measuring the reduction in the amplitude of signal and phase shift introduced between the light source and detector which are placed a finite distance away from each other. The received 80 MHz RF signal is downconverted to a low frequency and amplified using a heterodyning scheme. The front-end transimpedance amplifier has a 3-level programmable gain that increases the dynamic range to 60 dB. The phase difference between an identical reference channel and the optical channel is measured with a 0.5° accuracy. The detectable current range is [Formula: see text] and with a 40 A/W reponsivity using the APD, power levels as low as 500 pW can be detected. Measurements of the absorption and reduced scattering coefficients of solid tissue phantoms using this system are compared with those using a commercial instrument with differences within 30%. Measurement of a milk based liquid tissue phantom show an increase in absorption coefficient with addition of black ink. The miniaturized circuit serves as an efficiently scalable system for multi-site detection for applications in neonatal cerebral oximetry and optical mammography.

Bundled-Optode Method in Functional Near-Infrared Spectroscopy

In this paper, a theory for detection of the absolute concentrations of oxy-hemoglobin (HbO) and deoxy-hemoglobin (HbR) from hemodynamic responses using a bundled-optode configuration in functional near-infrared spectroscopy (fNIRS) is proposed. The proposed method is then applied to the identification of two fingers (i.e., little and thumb) during their flexion and extension. This experiment involves a continuous-wave-type dual-wavelength (760 and 830 nm) fNIRS and five healthy male subjects. The active brain locations of two finger movements are identified based on the analysis of the t- and p-values of the averaged HbOs, which are quite distinctive. Our experimental results, furthermore, revealed that the hemodynamic responses of two-finger movements are different: The mean, peak, and time-to-peak of little finger movements are higher than those of thumb movements. It is noteworthy that the developed method can be extended to 3-dimensional fNIRS imaging.

Design of multichannel functional near-infrared spectroscopy system with application to propofol and sevoflurane anesthesia monitoring

Monitoring the changes of cerebral hemodynamics and the state of consciousness during general anesthesia (GA) is clinically important. There is a great need for developing advanced detectors to investigate the physiological processes of the brain during GA. We developed a multichanneled, functional near-infrared spectroscopy (fNIRS) system device and applied it to GA operation monitoring. The cerebral hemodynamic data from the forehead of 11 patients undergoing propofol and sevoflurane anesthesia were analyzed. The concentration changes of oxygenated hemoglobin, deoxygenated hemoglobin, total hemoglobin, and cerebral tissue heart rate were determined from the raw optical information based on the discrete stationary wavelet transform. This custom-made device provides an easy-to-build solution for continuous wave-fNIRS system, with customized specifications. The developed device has a potential value in cerebral monitoring in clinical settings.

Reduced cerebral blood flow and oxygen metabolism in extremely preterm neonates with low-grade germinal matrix- intraventricular hemorrhage

Low-grade germinal matrix-intraventricular hemorrhage (GM-IVH) is the most common complication in extremely premature neonates. The occurrence of GM-IVH is highly associated with hemodynamic instability in the premature brain, yet the long-term impact of low-grade GM-IVH on cerebral blood flow and neuronal health have not been fully investigated. We used an innovative combination of frequency-domain near infrared spectroscopy and diffuse correlation spectroscopy (FDNIRS-DCS) to measure cerebral oxygen saturation (SO₂) and an index of cerebral blood flow (CBF_i) at the infant’s bedside and compute an index of cerebral oxygen metabolism (CMRO_2i). We enrolled twenty extremely low gestational age (ELGA) neonates (seven with low-grade GM-IVH) and monitored them weekly until they reached full-term equivalent age. During their hospital stay, we observed consistently lower CBF_i and CMRO_2i in ELGA neonates with low-grade GM-IVH compared to neonates without hemorrhages. Furthermore, lower CBF_i and CMRO_2i in the former group persists even after the resolution of the hemorrhage. In contrast, SO₂ does not differ between groups. Thus, CBF_i and CMRO_2i may have better sensitivity than SO₂ in detecting GM-IVH-related effects on infant brain development. FDNIRS-DCS methods may have clinical benefit for monitoring the evolution of GM-IVH, evaluating treatment response, and potentially predicting neurodevelopmental outcome.

Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology

Congenital heart disease (CHD) patients are at risk for neurodevelopmental delay. The etiology of these delays is unclear, but abnormal prenatal cerebral maturation and postoperative hemodynamic instability likely play a role. A better understanding of these factors is needed to improve neurodevelopmental outcome. In this study, we used bedside frequency-domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) to assess cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle (SV) CHD undergoing surgery and compared them to controls. Our goals were 1) to compare cerebral hemodynamics between unanesthetized SV and healthy neonates, and 2) to determine if FDNIRS-DCS could detect alterations in cerebral hemodynamics beyond cerebral hemoglobin oxygen saturation (SO 2). Eleven SV neonates were recruited and compared to 13 controls. Preoperatively, SV patients showed decreased cerebral blood flow (CBFi ), cerebral oxygen metabolism (CMRO 2i ) and SO 2; and increased oxygen extraction fraction (OEF) compared to controls. Compared to preoperative values, unstable postoperative SV patients had decreased CMRO 2i and CBFi , which returned to baseline when stable. However, SO 2 showed no difference between unstable and stable states. Preoperative SV neonates are flow-limited and show signs of impaired cerebral development compared to controls. FDNIRS-DCS shows potential to improve assessment of cerebral development and postoperative hemodynamics compared to SO 2 alone.

Lawrence K. Development of a combined broadband near-infrared and diffusion correlation system for monitoring cerebral blood flow and oxidative metabolism in preterm infants

Neonatal neuromonitoring is a major clinical focus of near-infrared spectroscopy (NIRS) and there is an increasing interest in measuring cerebral blood flow (CBF) and oxidative metabolism (CMRO2) in addition to the classic tissue oxygenation saturation (StO2). The purpose of this study was to assess the ability of broadband NIRS combined with diffusion correlation spectroscopy (DCS) to measured changes in StO2, CBF and CMRO2 in preterm infants undergoing pharmaceutical treatment of patent ductus arteriosus. CBF was measured by both DCS and contrast-enhanced NIRS for comparison. No significant difference in the treatment-induced CBF decrease was found between DCS (27.9 ± 2.2%) and NIRS (26.5 ± 4.3%). A reduction in StO2 (70.5 ± 2.4% to 63.7 ± 2.9%) was measured by broadband NIRS, reflecting the increase in oxygen extraction required to maintain CMRO2. This study demonstrates the applicability of broadband NIRS combined with DCS for neuromonitoring in this patient population.

Optimization of the method for assessment of brain perfusion in humans using contrast-enhanced reflectometry: multidistance time-resolved measurements

The aim of the study was to determine optimal measurement conditions for assessment of brain perfusion with the use of optical contrast agent and time-resolved diffuse reflectometry in the near-infrared wavelength range. The source-detector separation at which the distribution of time of flights (DTOF) of photons provided useful information on the inflow of the contrast agent to the intracerebral brain tissue compartments was determined. Series of Monte Carlo simulations was performed in which the inflow and washout of the dye in extra- and intracerebral tissue compartments was modeled and the DTOFs were obtained at different source-detector separations. Furthermore, tests on diffuse phantoms were carried out using a time-resolved setup allowing the measurement of DTOFs at 16 source-detector separations. Finally, the setup was applied in experiments carried out on the heads of adult volunteers during intravenous injection of indocyanine green. Analysis of statistical moments of the measured DTOFs showed that the source-detector separation of 6 cm is recommended for monitoring of inflow of optical contrast to the intracerebral brain tissue compartments with the use of continuous wave reflectometry, whereas the separation of 4 cm is enough when the higher-order moments of DTOFs are available.

Optimized multimodal functional magnetic resonance imaging/near-infrared spectroscopy probe for ultrahigh-resolution mapping

Functional near-infrared spectroscopy (fNIRS) is an increasingly important noninvasive method in neuroscience due to its high temporal resolution and ability to independently measure oxy- and deoxy-hemoglobin. However, the relatively low spatial resolution of fNIRS makes it difficult to relate this signal to underlying anatomy. Simultaneous functional magnetic resonance imaging (fMRI) can complement fNIRS with superior spatial resolution and the ability to image the entire brain, providing additional information to improve fNIRS localization. However, current simultaneous fMRI/fNIRS acquisition methods are not optimal, due to the poor physical compatibility of existing MR coils and fNIRS optodes. Here, we present a technique to manufacture a true multimodal fMRI/fNIRS probe in which both modalities can be used with maximal sensitivity. To achieve this, we designed custom MR coils with integral fNIRS optodes using three-dimensional printing. This multimodal probe can be used to optimize spatial ([Formula: see text]) and temporal resolution (2.5 Hz) of fMRI, and it provides maximal MRI sensitivity, while allowing for high flexibility in the location and density of fNIRS optodes within the area of interest. Phantom and human data are shown to confirm the improvement in sensitivity in both modalities. This probe shows promise for addressing fundamental questions of the relation of fNIRS to physiology.

NIR light propagation in a digital head model for traumatic brain injury (TBI)

Near infrared spectroscopy (NIRS) is capable of detecting and monitoring acute changes in cerebral blood volume and oxygenation associated with traumatic brain injury (TBI). Wavelength selection, source-detector separation, optode density, and detector sensitivity are key design parameters that determine the imaging depth, chromophore separability, and, ultimately, clinical usefulness of a NIRS instrument. We present simulation results of NIR light propagation in a digital head model as it relates to the ability to detect intracranial hematomas and monitor the peri-hematomal tissue viability. These results inform NIRS instrument design specific to TBI diagnosis and monitoring.

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

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

Accuracy of oxygen saturation and total hemoglobin estimates in the neonatal brain using the semi-infinite slab model for FD-NIRS data analysis

Frequency domain near-infrared spectroscopy (FD-NIRS) is a non-invasive method for measuring optical absorption in the brain. Common data analysis procedures for FD-NIRS data assume the head is a semi-infinite, homogenous medium. This assumption introduces bias in estimates of absorption (μa ), scattering ( [Formula: see text]), tissue oxygen saturation (StO2), and total hemoglobin (HbT). Previous works have investigated the accuracy of recovered μa values under this assumption. The purpose of this study was to examine the accuracy of recovered StO2 and HbT values in FD-NIRS measurements of the neonatal brain. We used Monte Carlo methods to compute light propagation through a neonate head model in order to simulate FD-NIRS measurements at 690 nm and 830 nm. We recovered μa , [Formula: see text], StO2, and HbT using common analysis procedures that assume a semi-infinite, homogenous medium and compared the recovered values to simulated values. Additionally, we characterized the effects of curvature via simulations on homogenous spheres of varying radius. Lastly, we investigated the effects of varying amounts of extra-axial fluid. Curvature induced underestimation of μa , [Formula: see text], and HbT, but had minimal effects on StO2. For the morphologically normal neonate head model, the mean absolute percent errors (MAPE) of recovered μa values were 12% and 7% for 690 nm and 830 nm, respectively, when source-detector separation was at least 20 mm. The MAPE for recovered StO2 and HbT were 6% and 9%, respectively. Larger relative errors were observed (∼20-30%), especially as StO2 and HbT deviated from normal values. Excess CSF around the brain caused very large errors in μa , [Formula: see text], and HbT, but had little effect on StO2.

Robust estimation of cerebral hemodynamics in neonates using multilayered diffusion model for normal and oblique incidences

The diffusion approximation is useful for many optical diagnostics modalities, such as near-infrared spectroscopy. However, the simple normal incidence, semi-infinite layer model may prove lacking in estimation of deep-tissue optical properties such as required for monitoring cerebral hemodynamics, especially in neonates. To answer this need, we present an analytical multilayered, oblique incidence diffusion model. Initially, the model equations are derived in vector-matrix form to facilitate fast and simple computation. Then, the spatiotemporal reflectance predicted by the model for a complex neonate head is compared with time-resolved Monte Carlo (TRMC) simulations under a wide range of physiologically feasible parameters. The high accuracy of the multilayer model is demonstrated in that the deviation from TRMC simulations is only a few percent even under the toughest conditions. We then turn to solve the inverse problem and estimate the oxygen saturation of deep brain tissues based on the temporal and spatial behaviors of the reflectance. Results indicate that temporal features of the reflectance are more sensitive to deep-layer optical parameters. The accuracy of estimation is shown to be more accurate and robust than the commonly used single-layer diffusion model. Finally, the limitations of such approaches are discussed thoroughly.

Higher-order modulations of fs laser pulses for GHz frequency domain photon migration system

Except the fundamental modulation frequency, by higher-order-harmonic modulations of mode-locked laser pulses and a simple frequency demodulation circuit, a novel approach to GHz frequency-domain-photon-migration (FDPM) system was reported. With this novel approach, a wide-band modulation frequency comb is available without any external modulation devices and the only electronics to extract the optical attenuation and phase properties at a selected modulation frequency in FDPM systems are good mixers and lock-in devices. This approach greatly expands the frequency range that could be achieved by conventional FDPM systems and suggests that our system could extract much more information from biological tissues than the conventional FDPM systems. Moreover, this demonstration will be beneficial for discerning the minute change of tissue properties.

Cerebral oxygen metabolism in neonatal hypoxic ischemic encephalopathy during and after therapeutic hypothermia

Pathophysiologic mechanisms involved in neonatal hypoxic ischemic encephalopathy (HIE) are associated with complex changes of blood flow and metabolism. Therapeutic hypothermia (TH) is effective in reducing the extent of brain injury, but it remains uncertain how TH affects cerebral blood flow (CBF) and metabolism. Ten neonates undergoing TH for HIE and seventeen healthy controls were recruited from the NICU and the well baby nursery, respectively. A combination of frequency domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) systems was used to non-invasively measure cerebral hemodynamic and metabolic variables at the bedside. Results showed that cerebral oxygen metabolism (CMRO2i) and CBF indices (CBFi) in neonates with HIE during TH were significantly lower than post-TH and age-matched control values. Also, cerebral blood volume (CBV) and hemoglobin oxygen saturation (SO2) were significantly higher in neonates with HIE during TH compared with age-matched control neonates. Post-TH CBV was significantly decreased compared with values during TH whereas SO2 remained unchanged after the therapy. Thus, FDNIRS-DCS can provide information complimentary to SO2 and can assess individual cerebral metabolic responses to TH. Combined FDNIRS-DCS parameters improve the understanding of the underlying physiology and have the potential to serve as bedside biomarkers of treatment response and optimization.

Comparison of a layered slab and an atlas head model for Monte Carlo fitting of time-domain near-infrared spectroscopy data of the adult head

Near-infrared spectroscopy (NIRS) estimations of the adult brain baseline optical properties based on a homogeneous model of the head are known to introduce significant contamination from extracerebral layers. More complex models have been proposed and occasionally applied to in vivo data, but their performances have never been characterized on realistic head structures. Here we implement a flexible fitting routine of time-domain NIRS data using graphics processing unit based Monte Carlo simulations. We compare the results for two different geometries: a two-layer slab with variable thickness of the first layer and a template atlas head registered to the subject's head surface. We characterize the performance of the Monte Carlo approaches for fitting the optical properties from simulated time-resolved data of the adult head. We show that both geometries provide better results than the commonly used homogeneous model, and we quantify the improvement in terms of accuracy, linearity, and cross-talk from extracerebral layers.

Optical characterization of two-layered turbid media for non-invasive, absolute oximetry in cerebral and extracerebral tissue

We introduce a multi-distance, frequency-domain, near-infrared spectroscopy (NIRS) method to measure the optical coefficients of two-layered media and the thickness of the top layer from diffuse reflectance measurements. This method features a direct solution based on diffusion theory and an inversion procedure based on the Levenberg-Marquardt algorithm. We have validated our method through Monte Carlo simulations, experiments on tissue-like phantoms, and measurements on the forehead of three human subjects. The Monte Carlo simulations and phantom measurements have shown that, in ideal two-layered samples, our method accurately recovers the top layer thickness (L), the absorption coefficient (µ a ) and the reduced scattering coefficient (µ' s ) of both layers with deviations that are typically less than 10% for all parameters. Our method is aimed at absolute measurements of hemoglobin concentration and saturation in cerebral and extracerebral tissue of adult human subjects, where the top layer (layer 1) represents extracerebral tissue (scalp, skull, dura mater, subarachnoid space, etc.) and the bottom layer (layer 2) represents cerebral tissue. Human subject measurements have shown a significantly greater total hemoglobin concentration in cerebral tissue (82±14 µM) with respect to extracerebral tissue (30±7 µM). By contrast, there was no significant difference between the hemoglobin saturation measured in cerebral tissue (56%±10%) and extracerebral tissue (62%±6%). To our knowledge, this is the first time that an inversion procedure in the frequency domain with six unknown parameters with no other prior knowledge is used for the retrieval of the optical coefficients and top layer thickness with high accuracy on two-layered media. Our absolute measurements of cerebral hemoglobin concentration and saturation are based on the discrimination of extracerebral and cerebral tissue layers, and they can enhance the impact of NIRS for cerebral hemodynamics and oxygenation assessment both in the research arena and clinical practice.