Bedside functional imaging of the premature infant brain during passive motor activation

Cerebral hemodynamic responses in preterm-born neonates to visual stimulation: classification according to subgroups and analysis of frontotemporal-occipital functional connectivity

How neurovascular coupling develops in preterm-born neonates has been largely neglected in scientific research. We measured visually evoked (flicker light) hemodynamic responses (HRs) in preterm-born neonates ( n = 25 , gestational age: 31.71 ± 3.37 weeks, postnatal age: 25.48 ± 23.94 days) at the visual cortex (VC) and left frontotemporal lobe (FTL) using functional near-infrared spectroscopy (fNIRS) neuroimaging. We found that the HR characteristics show a large intersubject variability but could be classified into three groups according to the changes of oxyhemoglobin concentration at the VC [(A) increase, (B) decrease, or (C) inconclusive]. In groups A and B, the HRs at the left FTL were correlated with those at the VC, indicating the presence of a frontotemporal-occipital functional connectivity. Neonates in group A had a higher weight at measurement compared to those in group B, and had the lowest baseline total hemoglobin concentration and hematocrit compared to group C. To the best of our knowledge, this is the first fNIRS study showing (1) that the HRs of preterm-born neonates need to be classified into subgroups, (2) that the subgroups differed in terms of weight at measurement, and (3) that HRs can be observed also at the FTL during visual stimulation. These findings add insights into how neurovascular coupling develops in preterm-born neonates.

Approach to optimize 3-dimensional brain functional activation image with high resolution: a study on functional near-infrared spectroscopy

In this study, 3-dimensional (3-D) enhanced brain-function-map generation and estimation methodology is presented. Optical signals were modelled in the form of numerical optimization problem to infer the best existing waveform of canonical hemodynamic response function. Inter-channel activity patterns were also estimated. The estimation of activation of inter-channel gap depends on the minimization of generalized cross-validation. 3-D brain activation maps were produced through inverse discrete cosine transform. The proposed algorithm acquired significant results for 3-D functional maps with high resolution, in comparison with that of 2-D functional t-maps. A comprehensive analysis by exhibiting images corresponding to several layers has also been appended.

Changes of functional response in sensorimotor cortex of preterm and full-term infants during the first year: An fNIRS study

BACKGROUND

Motor impairments are frequently associated with preterm birth and interfere in acquisition of essential skills to global development. Using Near Infrared Spectroscopy (NIRS), the study of neural correlates of motor development in early stages of life are feasible in an ecological assessment.

AIMS

To evaluate changes in cortical activity in response to a sensorimotor stimulation in preterm and full-term infants at 6 and 12 months of age.

STUDY DESIGN

A longitudinal study was conducted with 22 infants (12 preterm and 10 full-term). Hemodynamic activity during sensorimotor task (8 blocks of 8 s of vibration applied to infant's right hand) was measured by Functional Near Infrared Spectroscopy (fNIRS). The optical probe consisted of 84 channels positioned according to the international 10-20 system coordinates, covering the frontal (38 channels), parietal (16 channels), temporal (22 channels) and occipital (8 channels) lobes of both hemispheres.

RESULTS

Preterm and full-term infants exhibited differences of location of the activation as well on the hemodynamic response in both the evaluated age groups.

CONCLUSIONS

Group differences in activation of sensorimotor cortex observed in this study demonstrate the potential of fNIRS application for preterm evaluation of motor development in children. Overall, the present work contributes to our understanding of cortical activation of cerebral motor skills spanning early ages in preterm-born children.

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.

Clinical Brain Monitoring with Time Domain NIRS: A Review and Future Perspectives

Near-infrared spectroscopy (NIRS) is an optical technique that can measure brain tissue oxygenation and haemodynamics in real-time and at the patient bedside allowing medical doctors to access important physiological information. However, despite this, the use of NIRS in a clinical environment is hindered due to limitations, such as poor reproducibility, lack of depth sensitivity and poor brain-specificity. Time domain NIRS (or TD-NIRS) can resolve these issues and offer detailed information of the optical properties of the tissue, allowing better physiological information to be retrieved. This is achieved at the cost of increased instrument complexity, operation complexity and price. In this review, we focus on brain monitoring clinical applications of TD-NIRS. A total of 52 publications were identified, spanning the fields of neonatal imaging, stroke assessment, traumatic brain injury (TBI) assessment, brain death assessment, psychiatry, peroperative care, neuronal disorders assessment and communication with patient with locked-in syndrome. In all the publications, the advantages of the TD-NIRS measurement to (1) extract absolute values of haemoglobin concentration and tissue oxygen saturation, (2) assess the reduced scattering coefficient, and (3) separate between extra-cerebral and cerebral tissues, are highlighted; and emphasize the utility of TD-NIRS in a clinical context. In the last sections of this review, we explore the recent developments of TD-NIRS, in terms of instrumentation and methodologies that might impact and broaden its use in the hospital.

Neonatal brain injury and aberrant connectivity

Brain injury sustained during the neonatal period may disrupt development of critical structural and functional connectivity networks leading to subsequent neurodevelopmental impairment in affected children. These networks can be characterized using structural (via diffusion MRI) and functional (via resting state-functional MRI) neuroimaging techniques. Advances in neuroimaging have led to expanded application of these approaches to study term- and prematurely-born infants, providing improved understanding of cerebral development and the deleterious effects of early brain injury. Across both modalities, neuroimaging data are conducive to analyses ranging from characterization of individual white matter tracts and/or resting state networks through advanced 'connectome-style' approaches capable of identifying highly connected network hubs and investigating metrics of network topology such as modularity and small-worldness. We begin this review by summarizing the literature detailing structural and functional connectivity findings in healthy term and preterm infants without brain injury during the postnatal period, including discussion of early connectome development. We then detail common forms of brain injury in term- and prematurely-born infants. In this context, we next review the emerging body of literature detailing studies employing diffusion MRI, resting state-functional MRI and other complementary neuroimaging modalities to characterize structural and functional connectivity development in infants with brain injury. We conclude by reviewing technical challenges associated with neonatal neuroimaging, highlighting those most relevant to studying infants with brain injury and emphasizing the need for further targeted study in this high-risk population.

Aberrant structural and functional connectivity and neurodevelopmental impairment in preterm children

Background

Despite advances in antenatal and neonatal care, preterm birth remains a leading cause of neurological disabilities in children. Infants born prematurely, particularly those delivered at the earliest gestational ages, commonly demonstrate increased rates of impairment across multiple neurodevelopmental domains. Indeed, the current literature establishes that preterm birth is a leading risk factor for cerebral palsy, is associated with executive function deficits, increases risk for impaired receptive and expressive language skills, and is linked with higher rates of co-occurring attention deficit hyperactivity disorder, anxiety, and autism spectrum disorders. These same infants also demonstrate elevated rates of aberrant cerebral structural and functional connectivity, with persistent changes evident across advanced magnetic resonance imaging modalities as early as the neonatal period. Emerging findings from cross-sectional and longitudinal investigations increasingly suggest that aberrant connectivity within key functional networks and white matter tracts may underlie the neurodevelopmental impairments common in this population.

Main body

This review begins by highlighting the elevated rates of neurodevelopmental disorders across domains in this clinical population, describes the patterns of aberrant structural and functional connectivity common in prematurely-born infants and children, and then reviews the increasingly established body of literature delineating the relationship between these brain abnormalities and adverse neurodevelopmental outcomes. We also detail important, typically understudied, clinical, and social variables that may influence these relationships among preterm children, including heritability and psychosocial risks.

Conclusion

Future work in this domain should continue to leverage longitudinal evaluations of preterm infants which include both neuroimaging and detailed serial neurodevelopmental assessments to further characterize relationships between imaging measures and impairment, information necessary for advancing our understanding of modifiable risk factors underlying these disorders and best practices for improving neurodevelopmental trajectories in this high-risk clinical population.

Diffuse optical tomography to investigate the newborn brain

Over the past 15 years, functional near-infrared spectroscopy (fNIRS) has emerged as a powerful technology for studying the developing brain. Diffuse optical tomography (DOT) is an extension of fNIRS that combines hemodynamic information from dense optical sensor arrays over a wide field of view. Using image reconstruction techniques, DOT can provide images of the hemodynamic correlates to neural function that are comparable to those produced by functional magnetic resonance imaging. This review article explains the principles of DOT, and highlights the growing literature on the use of DOT in the study of healthy development of the infant brain, and the study of novel pathophysiology in infants with brain injury. Current challenges, particularly around instrumentation and image reconstruction, will be discussed, as will the future of this growing field, with particular focus on whole-brain, time-resolved DOT.

Somatic stimulation causes frontoparietal cortical changes in neonates: a functional near-infrared spectroscopy study

Palmar and plantar grasp are the foremost primitive neonatal reflexes and functions. Persistence of these reflexes in infancy is a sign of evolving cerebral palsy. Our aims were to establish measurement feasibility in a clinical setting and to characterize changes in oxyhemoglobin (HbO) and deoxyhemoglobin (HbD) concentration in the bilateral frontoparietal cortex in unsedated neonates at the crib-side using functional near-infrared spectroscopy (fNIRS). We hypothesized that bilateral concentration changes will occur upon somatic central and peripheral somatic stimulation. Thirteen preterm neonates (five males) underwent time 1, and six (two males) returned for time 2 (mean [Formula: see text] and 47.0 weeks, respectively). Signals from a total of 162 somatic stimuli responses were measured. Response amplitude, duration, and latency were log-transformed and compared between palmar, plantar, and oromotor stimuli using linear mixed models, adjusted for cap, electroencephalogram abnormality, time (1 versus 2), and Sarnat score, if necessary. The oromotor stimulus resulted in a 50% greater response than the palmar or plantar stimuli for HbO left and right hemisphere duration ([Formula: see text]). There were no other statistically significant differences between stimuli for any other outcome ([Formula: see text]). Utilizing fNIRS in conjunction with occupational and physical therapy maneuvers is efficacious to study modifiable and restorative neurophysiological mechanisms.

Cerebral haemodynamic response to somatosensory stimulation in near-term fetal sheep

KEY POINTS

Cerebral haemodynamic response to neural stimulation has been extensively investigated in animal and clinical studies, in both adult and paediatric populations, but little is known about cerebral haemodynamic functional response in the fetal brain. The present study describes the cerebral haemodynamic response measured by near-infrared spectroscopy to somatosensory stimulation in fetal sheep. The cerebral haemodynamic response in the fetal sheep brain changes from a positive (increase in oxyhaemoglobin (oxyHb)) response pattern to a negative or biphasic response pattern when the duration of somatosensory stimulation is increased, probably due to cerebral vasoconstriction with prolonged stimulations. In contrast to adult studies, we have found that changes in fetal cerebral blood flow and oxyHb are positively increased in response to somatosensory stimulation during hypercapnia. We propose this is related to reduced vascular resistance and recruitment of cerebral vasculature in the fetal brain during hypercapnia.

ABSTRACT

Functional hyperaemia induced by a localised increase in neuronal activity has been suggested to occur in the fetal brain owing to a positive blood oxygen level-dependent (BOLD) signal recorded by functional magnetic resonance imaging following acoustic stimulation. To study the effect of somatosensory input on local cerebral perfusion we used near-infrared spectroscopy (NIRS) in anaesthetised, partially exteriorised fetal sheep where the median nerve was stimulated with trains of pulses (2 ms, 3.3 Hz) for durations of 1.8, 4.8 and 7.8 s. Signal averaging of cerebral NIRS responses to 20 stimulus trains repeated every 60 s revealed that a short duration of stimulation (1.8 s) increased oxyhaemoglobin in the contralateral cortex consistent with a positive functional response, whereas longer durations of stimulation (4.8, 7.8 s) produced more variable oxyhaemoglobin responses including positive, negative and biphasic patterns of change. Mean arterial blood pressure and cerebral perfusion as monitored by laser Doppler flowmetry always showed small, but coincident increases following median nerve stimulation regardless of the type of response detected by the NIRS in the contralateral cortex. Hypercapnia significantly increased the baseline total haemoglobin and deoxyhaemoglobin, and in 7 of 8 fetal sheep positively increased the changes in contralateral total haemoglobin and oxyhaemoglobin in response to the 7.8 s stimulus train, compared to the response recorded during normocapnia. These results show that activity-driven changes in cerebral perfusion and oxygen delivery are present in the fetal brain, and persist even during periods of hypercapnia-induced cerebral vasodilatation.

Long-term continuous monitoring of the preterm brain with diffuse optical tomography and electroencephalography: a technical note on cap manufacturing

Diffuse optical tomography (DOT) has recently proved useful for detecting whole-brain oxygenation changes in preterm and term newborns' brains. The data recording phase in prior explorations was limited up to a maximum of a couple of hours, a time dictated by the need to minimize skin damage caused by the protracted contact with optode holders and interference with concomitant clinical/nursing procedures. In an attempt to extend the data recording phase, we developed a new custom-made cap for multimodal DOT and electroencephalography acquisitions for the neonatal population. The cap was tested on a preterm neonate (28 weeks gestation) for a 7-day continuous monitoring period. The cap was well tolerated by the neonate, who did not suffer any evident discomfort and/or skin damage. Montage and data acquisition using our cap was operated by an attending nurse with no difficulty. DOT data quality was remarkable, with an average of 92% of reliable channels, characterized by the clear presence of the heartbeat in most of them.

Correction of motion artifacts and serial correlations for real-time functional near-infrared spectroscopy

Functional near-infrared spectroscopy (fNIRS) is a relatively low-cost, portable, noninvasive neuroimaging technique for measuring task-evoked hemodynamic changes in the brain. Because fNIRS can be applied to a wide range of populations, such as children or infants, and under a variety of study conditions, including those involving physical movement, gait, or balance, fNIRS data are often confounded by motion artifacts. Furthermore, the high sampling rate of fNIRS leads to high temporal autocorrelation due to systemic physiology. These two factors can reduce the sensitivity and specificity of detecting hemodynamic changes. In a previous work, we showed that these factors could be mitigated by autoregressive-based prewhitening followed by the application of an iterative reweighted least squares algorithm offline. This current work extends these same ideas to real-time analysis of brain signals by modifying the linear Kalman filter, resulting in an algorithm for online estimation that is robust to systemic physiology and motion artifacts. We evaluated the performance of the proposed method via simulations of evoked hemodynamics that were added to experimental resting-state data, which provided realistic fNIRS noise. Last, we applied the method post hoc to data from a standing balance task. Overall, the new method showed good agreement with the analogous offline algorithm, in which both methods outperformed ordinary least squares methods.

Nonlinear approach to difference imaging in diffuse optical tomography

Difference imaging aims at recovery of the change in the optical properties of a body based on measurements before and after the change. Conventionally, the image reconstruction is based on using difference of the measurements and a linear approximation of the observation model. One of the main benefits of the linearized difference reconstruction is that the approach has a good tolerance to modeling errors, which cancel out partially in the subtraction of the measurements. However, a drawback of the approach is that the difference images are usually only qualitative in nature and their spatial resolution can be weak because they rely on the global linearization of the nonlinear observation model. To overcome the limitations of the linear approach, we investigate a nonlinear approach for difference imaging where the images of the optical parameters before and after the change are reconstructed simultaneously based on the two datasets. We tested the feasibility of the method with simulations and experimental data from a phantom and studied how the approach tolerates modeling errors like domain truncation, optode coupling errors, and domain shape errors.

Quantitative evaluation of atlas-based high-density diffuse optical tomography for imaging of the human visual cortex

Image recovery in diffuse optical tomography (DOT) of the human brain often relies on accurate models of light propagation within the head. In the absence of subject specific models for image reconstruction, the use of atlas based models are showing strong promise. Although there exists some understanding in the use of some limited rigid model registrations in DOT, there has been a lack of a detailed analysis between errors in geometrical accuracy, light propagation in tissue and subsequent errors in dynamic imaging of recovered focal activations in the brain. In this work 11 different rigid registration algorithms, across 24 simulated subjects, are evaluated for DOT studies in the visual cortex. Although there exists a strong correlation (R(2) = 0.97) between geometrical surface error and internal light propagation errors, the overall variation is minimal when analysing recovered focal activations in the visual cortex. While a subject specific mesh gives the best results with a 1.2 mm average location error, no single algorithm provides errors greater than 4.5 mm. This work demonstrates that the use of rigid algorithms for atlas based imaging is a promising route when subject specific models are not available.

Time efficiency and diagnostic agreement of 2-D versus 3-D ultrasound acquisition of the neonatal brain

The purpose of this study was to compare acquisition time efficiency and diagnostic agreement of neonatal brain ultrasound (US) scans obtained with a 3-D volume US acquisition protocol and the conventional 2-D acquisition protocol. Ninety-one consecutive premature neonatal brain ultrasound scans were prospectively performed on 59 neonates with the conventional 2-D acquisition protocol. Immediately after the 2-D study, a coronal 3-D ultrasound volume was acquired and later reconstructed into axial and sagittal planes. All 59 neonates were imaged in the neonatal intensive care unit to rule out intracranial hemorrhage. Total time for 2-D and 3-D acquisition protocols was recorded, and a two-tailed t-test was used to determine if study durations differed significantly. One pediatric neuroradiologist reviewed the reformatted 3-D images, tomographic ultrasound images. Results were compared with the clinical interpretation of the 2-D conventional study. The mean scanning time for the 2-D US acquisition protocol was 10.56 min (standard deviation [SD] = 7.11), and that for the 3-D volume US acquisition protocol was 1.48 min (SD = 0.59) (p ≤ 0.001). Inter-observer agreement revealed k values of 0.84 for hydrocephalus, 0.80 for germinal matrix hemorrhage/intraventricular hemorrhage, 0.74 for periventricular leukomalacia and 0.91 for subdural collection, hence near-perfect to substantial agreement between imaging protocols. There was a significant decrease in acquisition time for the 3-D volume ultrasound acquisition protocol compared with the conventional 2-D US protocol (p = <0.001), without compromising the diagnostic quality compared with a conventional 2-D US imaging protocol.

Extrauterine environment influences spontaneous low-frequency oscillations in the preterm brain

Low-frequency oscillations in cerebral blood flow that are suggestive of resting-state brain activity have recently been reported, but no study on the development of resting-state brain activity in preterm infants has been performed. The objective of this study was to measure the cerebral blood flow oscillations, which are assumed to represent brain function in the resting state, in preterm and term infants of the same postconceptional age. The subjects were 9 preterm infants who had reached full term (gestational age (GA): 23-34 weeks, postconceptional age: 37-46 weeks) and 10 term infants (GA: 37-40 weeks, postconceptional age: 37-41 weeks). Their changes in concentration of oxyhemoglobin ([oxyHb]) and deoxyhemoglobin ([deoxyHb]) were measured in the parieto-temporal region during quiet sleep using multi-channel near-infrared spectroscopy, and the power spectral densities (PSD) of the oscillations in the concentrations of these molecules were analyzed and compared. The preterm infants displayed a higher proportion of 0.06-0.10 Hz low frequency oscillations of [oxyHb] and [deoxyHb] than the term infants, and the gestational age and the proportion of low frequency oscillations were inversely correlated. These findings suggest that resting-state cerebral blood flow oscillations differ between preterm and term infants, and that the development of circulatory regulation and nerve activity in preterm infants are influenced by the extrauterine environment.

Assessment of brain oxygenation in term and preterm neonates using near infrared spectroscopy

PURPOSE

The aim of this study was to determine brain oxygenation in full-term and preterm neonates using near infrared spectroscopy.

MATERIAL AND METHODS

A total of 88 full-term and preterm newborn infants without hypoxic-ischaemic disorders admitted to the NICU were examined using NIRS on the first day of life and on day 28 of life. Additional measurements were taken at the end of the first week of life in the premature neonates group. Measurements of oxyhaemoglobin (HbO2), deoxyhaemoglobin (Hb), total haemoglobin (HbT) concentration and tissue oxygen saturation (Ox) were performed in 5 brain regions. Right and left frontal areas, the occipital area and right and left temporal areas were measured.

RESULTS

In full-term healthy neonates a marked decrease in HbO, Hb and HbT values was observed on day 28 of life in all brain regions except the occipital area. In the neonatal period the greatest changes in brain oxygenation occurred in the right and left frontal regions of the brain. In preterm neonates constant values of HbO2 and Ox were observed in the first 28 days of life. In preterm newborn infants, as well as in full term newborn infants, similar Ox and HbO2 values were obtained on day 28 of life.

CONCLUSIONS

NIRS is a safe method and can be used to evaluate brain oxygenation in newborn infants. The results of these measurements are in accordance with changes in brain oxygenation in the first month of life, which are predicated on the basis of the neonate's physiology.

The contribution of functional near-infrared spectroscopy (fNIRS) to the presurgical assessment of language function in children

Before performing neurosurgery, an exhaustive presurgical assessment is required, usually including an investigation of language cerebral lateralization. Among the available procedures, the intracarotid amobarbital test (IAT) was formerly the most widely used. However, this procedure has many limitations: it is invasive and potentially traumatic, especially for children. To overcome these limitations, neuroimaging techniques such as functional magnetic resonance imaging (fMRI) have been used. Again, these methods are difficult to use with children, who must remain motionless during data acquisition. Functional near-infrared spectroscopy (fNIRS) is a noninvasive functional imaging technique that is easily applied to pediatric and cognitively limited patients. It has been used recently in epileptic children for presurgical assessment of expressive and receptive language brain lateralization. The aim of this review is to present the contribution of fNIRS to the presurgical assessment of language function in children with neurological diseases.

Activation and deactivation in response to visual stimulation in the occipital cortex of 6-month-old human infants

In an infant's developing cortex, the explanation for the mechanisms underlying the activations and deactivations in response to visual stimuli remains controversial. While previous near-infrared spectroscopy (NIRS) studies in awake infants have demonstrated cortical activations in response to meaningful/attractive visual stimuli, functional magnetic resonance imaging (fMRI) studies performed on sleeping infants showed negative blood oxygenation level-dependent (BOLD) responses to high-luminance unpatterned stimulations, such as a photic stimulation. To examine the effect of the characteristics of visual stimuli on cortical processing in awake infants, we measured cortical hemodynamic responses in 6-month-old infants during the presentation of a high-luminance unpatterned stimulus by using a NIRS system with 94 measurement channels. Results from 35 infants showed dissociated cortical responses between the occipital region and the other parts of the cortex, including the temporal and prefrontal regions. Although the visual stimulus produced sustained increases in oxygenated hemoglobin (oxy-Hb) signals in the temporal and prefrontal regions, it produced a transient increase in oxy-Hb signals followed by a salient decrease in oxy-Hb signals during a trial in a focal region of the occipital visual region. This suggests that the deactivation of the occipital visual region in response to visual stimulation is not a phenomenon that occurs only in the sleeping state, but that a high-luminance unpatterned stimulus can induce deactivation even in the awake infants.

Functional lateralization of sensorimotor cortex in infants measured using multichannel near-infrared spectroscopy

Multichannel near-infrared spectroscopy (MNIRS) was used for the functional imaging of the sensorimotor cortex of newborn infants during passive knee and elbow movement under sedated sleep. Contralateral knee and elbow movement caused a marked increase in the concentration of oxyhemoglobin ([oxyHb]) from the baseline values at site within the sensorimotor area in all infants. During ipsilateral knee and elbow movement, [oxyHb] showed smaller changes, equivalent to 64 ± 23 and 66 ± 28% of the changes that occurred with contralateral stimulation, respectively. The mean times corresponding to maximal changes in [oxyHb] were 16.1 ± 3.3 s for contralateral knee movement and 17.9 ± 5.7 s for contralateral elbow movement. No significant difference was noted between the mean latencies showing the maximal changes in [oxyHb] between contralateral and ipsilateral movement. There was a significant difference in the area and degree of response between the contralateral and ipsilateral movement. MNIRS could be a useful tool to understand the pathophysiology of the developing brain and monitor cortical responses in various clinical situations.

Identification of the optimal wavelengths for optical topography: a photon measurement density function analysis

A method is presented to select the optimal wavelengths for multispectral optical topography, which not only gives good separation between chromophores, absorption, and scattering, but also minimizes the differences between interrogated volumes. This method uses the sum of squared differences to compare photon measurement density functions, which were generated for wavelengths in the near-infrared (NIR) range for a suitable model of tissue optical properties. It is found that including this condition significantly influences the range of optimal wavelengths. However, for the adult human head, the differences between interrogated volumes at NIR wavelengths are very small and image reconstruction is only slightly improved when measurements with overlapping sensitivities are used.

Hemodynamic responses to speech and music in newborn infants

We used near-infrared spectroscopy (NIRS) to study responses to speech and music on the auditory cortices of 13 healthy full-term newborn infants during natural sleep. The purpose of the study was to investigate the lateralization of speech and music responses at this stage of development. NIRS data was recorded from eight positions on both hemispheres simultaneously with electroencephalography, electrooculography, electrocardiography, pulse oximetry, and inclinometry. In 11 subjects, statistically significant (P < 0.02) oxygenated (HbO2) and total hemoglobin (HbT) responses were recorded. Both stimulus types elicited significant HbO2 and HbT responses on both hemispheres in five subjects. Six of the 11 subjects had positive HbO2 and HbT responses to both stimulus types, whereas one subject had negative responses. Mixed positive and negative responses were observed in four neonates. On both hemispheres, speech and music responses were significantly correlated (r = 0.64; P = 0.018 on the left hemisphere (LH) and r = 0.60; P = 0.029 on the right hemisphere (RH)). On the group level, the average response to the speech stimuli was statistically significantly greater than zero in the LH, whereas responses on the RH or to the music stimuli did not differ significantly from zero. This suggests a more coherent response to speech on the LH. However, significant differences in lateralization of the responses or mean response amplitudes of the two stimulus types were not observed on the group level.

Optical measurement of cerebral hemodynamics and oxygen metabolism in neonates with congenital heart defects

We employ a hybrid diffuse correlation spectroscopy (DCS) and near-infrared spectroscopy (NIRS) monitor for neonates with congenital heart disease (n=33). The NIRS-DCS device measured changes during hypercapnia of oxyhemoglobin, deoxyhemoglobin, and total hemoglobin concentrations; cerebral blood flow (rCBF(DCS)); and oxygen metabolism (rCMRO(2)). Concurrent measurements with arterial spin-labeled magnetic resonance imaging (rCBF(ASL-MRI), n=12) cross-validate rCBF(DCS) against rCBF(ASL-MRI), showing good agreement (R=0.7, p=0.01). The study demonstrates use of NIRS-DCS on a critically ill neonatal population, and the results indicate that the optical technology is a promising clinical method for monitoring this population.

Advances in near-infrared spectroscopy to study the brain of the preterm and term neonate

This article reviews tissue oximetry and imaging to study the preterm and newborn infant brain by near-infrared spectroscopy. These two technologies are now advanced; nearly 100 reports on their use in newborn infants have been published, and commercial instruments are available. The precision of oximetry, however, is a limitation for its clinical use of assessing cerebral oxygenation. Imaging of brain function needs very well defined protocols for sensory stimulation as well as signal analysis to provide meaningful results.

Advances in the application of technology to epilepsy: the CIMIT/NIO Epilepsy Innovation Summit

In 2008, a group of clinicians, scientists, engineers, and industry representatives met to discuss advances in the application of engineering technologies to the diagnosis and treatment of patients with epilepsy. The presentations also provided a guide for further technological development, specifically in the evaluation of patients for epilepsy surgery, seizure onset detection and seizure prediction, intracranial treatment systems, and extracranial treatment systems. This article summarizes the discussions and demonstrates that cross-disciplinary interactions can catalyze collaborations between physicians and engineers to address and solve many of the pressing unmet needs in epilepsy.

Probabilistic atlas can improve reconstruction from optical imaging of the neonatal brain

Diffuse optical imaging is an emerging medical imaging modality based on near-infrared and visible red light. The method can be used for imaging activations in the human brain. In this study, a deformable probabilistic atlas of the distribution of tissue types within the term neonatal head was created based on MR images. The use of anatomical prior information provided by such atlas in reconstructing brain activations from optical imaging measurements was studied using Monte Carlo simulations. The results suggest that use of generic anatomical information can greatly improve the spatial accuracy and robustness of the reconstruction when noise is present in the data.

Real-time imaging of human brain function by near-infrared spectroscopy using an adaptive general linear model

Near-infrared spectroscopy is a non-invasive neuroimaging method which uses light to measure changes in cerebral blood oxygenation associated with brain activity. In this work, we demonstrate the ability to record and analyze images of brain activity in real-time using a 16-channel continuous wave optical NIRS system. We propose a novel real-time analysis framework using an adaptive Kalman filter and a state-space model based on a canonical general linear model of brain activity. We show that our adaptive model has the ability to estimate single-trial brain activity events as we apply this method to track and classify experimental data acquired during an alternating bilateral self-paced finger tapping task.

Hemodynamic changes in the infant cortex during the processing of featural and spatiotemporal information

Over the last 20 years neuroscientists have learned a great deal about the ventral and dorsal object processing pathways in the adult brain, yet little is known about the functional development of these pathways. The present research assessed the extent to which different patterns of neural activation, as measured by changes in blood volume and oxygenation, are observed in infant visual and temporal cortex in response to events that involve processing of featural differences or spatiotemporal discontinuities. Infants aged 6.5 months were tested. Increased neural activation was observed in visual cortex in response to a featural-difference and a spatiotemporal-discontinuity event. In addition, increased neural activation was observed in temporal cortex in response to the featural-difference but not the spatiotemporal-discontinuity event. The outcome of this experiment reveals early functional specialization of temporal cortex and lays the foundation for future investigation of the maturation of object processing pathways in humans.

Visualizing localized dynamic changes during epileptic seizure onset in vivo with diffuse optical tomography

Diffuse optical tomography (DOT) is a promising functional imaging modality due to its ability to provide quantitative and dynamic tomographic imaging of brain functions. This pilot study was conducted to demonstrate that DOT can be used to visualize the changes in local hemodynamics during seizures. The focal seizure was induced by microinjection of 10 microl of 1.9 mM GABAA antagonist bicuculline methiodide (BMI) into the left parietal neocortex of male Harlen Sprague-Dawley rats, which was imaged by a multispectral continuous-wave DOT system. Functional images were obtained by our finite element based image reconstruction algorithm. A series of dynamic 2D images were obtained to delineate the time course of concentration changes of oxyhaemoglobin, deoxyhaemoglobin, and total hemoglobin in the rat brain during seizure onset. The BMI induced epileptic foci were localized and observed over time from the images obtained. Our results suggest that diffuse optical tomography may be a promising modality for epilepsy imaging due to its ability to localize epileptic foci as well as its potential to map the functional activity in the area of human cerebral cortex in planning of epilepsy surgery.

Hypothermia effects on neurovascular coupling and cerebral metabolic rate of oxygen

Neuronal activation is accompanied by a local increase in cerebral blood flow (CBF) and in cerebral metabolic rate of oxygen (CMRO(2)), caused by neurovascular and neurometabolic coupling. Hypothermia is used as a neuroprotective approach in surgical patients and therapeutically after cardiac arrest or stroke. The effect of hypothermia on neurovascular coupling is of interest for evaluating brain function in these patients, but has not been determined so far. It is not clear whether functional hyperaemia actually operates at subnormal temperatures. In addition, decreasing brain temperature reduces spontaneous CMRO(2) following a known quantitative relationship (Q(10)). Q(10) determination may serve to validate a recently introduced CMRO(2) measurement approach relying on optical measurements of CBF and hemoglobin concentration. We applied this method to investigate hypothermia in a functional study of the somatosensory cortex. Anesthetized Wistar rats underwent surgical implantation of a closed cranial window. Using laser Doppler flowmetry and optical spectroscopy, relative changes in CBF and hemoglobin concentration were measured continuously. At the same time, an electroencephalogram (EEG) was recorded from the measurement site. By the application of ice packs, whole-body hypothermia was induced, followed by rewarming. Spontaneous EEG, CBF and CMRO(2) were measured, interleaved by blocks of electrical forepaw stimulation. The Q(10) obtained from spontaneous CMRO(2) changes of 4.4 (95% confidence interval 3.7-5.1) was close to published values, indicating the reliability of the CMRO(2) measurement. Lowering brain temperature decreased functional changes of CBF and CMRO(2) as well as amplitudes of somatosensory evoked potentials (SEP) to the same degree. In conclusion, neurovascular and neurometabolic coupling is preserved during hypothermia.

Optical imaging of the neonatal brain

Optical systems could be valuable tools for assessing cerebral function at the cotside

Optical tomography of the neonatal brain

A new method of assessing neurological function and pathology in the newborn infant is being developed based on the transmission of near-infrared light across the brain. Absorption by blood over a range of wavelengths reveals a strong dependency on oxygenation status, and measurements of transmitted light enable the spatial variation in the concentrations of the oxygenated and de-oxygenated forms of hemoglobin to be derived. Optical tomography has so far provided static three-dimensional maps of blood volume and oxygenation as well as dynamic images revealing the brain's response to sensory stimulation and global hemodynamic changes. The imaging modality is being developed as a safe and non-invasive tool that can be utilized at the cotside in intensive care. Optical tomography of the healthy infant brain is also providing a means of studying neurophysiological processes during early development and the potential consequences of prematurity.

Selectivity and localization of cortical response to auditory and visual stimulation in awake infants aged 2 to 4 months

To better understand the development of multimodal perception, we examined selectivity and localization of cortical responses to auditory and visual stimuli in young infants. Near-infrared optical topography with 24 channels was used to measure event-related cerebral oxygenation changes of the bilateral temporal cortex in 15 infants aged 2 to 4 months, when they were exposed to speech sounds lasting 3 s and checkerboard pattern reversals lasting 3 s, which were asynchronously presented with different alternating intervals. Group analysis revealed focal increases in oxy-hemoglobin and decreases in deoxy-hemoglobin in both hemispheres in response to auditory, but not to visual, stimulation. These results indicate that localized areas of the primary auditory cortex and the auditory association cortex are involved in auditory perception in infants as young as 2 months of age. In contrast to the hypothesis that perception of distinct sensory modalities may not be separated due to cross talk over the immature cortex in young infants, the present study suggests that unrelated visual events do not influence on the auditory perception of awake infants.

The Effect of Auditory Stimulation upon Cerebral Blood Oxygenation in Infants: Measurements by Light Emitting Diode (LED) Near Infrared Spectroscopy

This study assessed the feasibility of neonatal cerebral oxygen monitoring by near-infrared light spectroscopy (NIRS) using a light emitting diode (LED) based system. We aimed to measure the changes in cerebral oxygen saturation, as regional oxygen saturation and tissue oxygenation index, in response to auditory stimuli. Documenting changes in oxygenation in response to such stimuli will help validate the usefulness of LED-NIRS as a tool in the study of cerebral oxygen saturation in neonates.

A spatial and temporal comparison of hemodynamic signals measured using optical and functional magnetic resonance imaging during activation in the human primary visual cortex

Functional near infrared spectro-imaging (fNIRSI) is potentially a very useful technique for obtaining information about the underlying physiology of the blood oxygenation level dependent (BOLD) signal used in functional magnetic resonance imaging (fMRI). In this paper the temporal and spatial statistical characteristics of fNIRSI data are compared to those of simultaneously acquired fMRI data in the human visual cortex during a variable-frequency reversing checkerboard activation paradigm. Changes in the size of activated volume caused by changes in checkerboard reversal frequency allowed a comparison of the behavior of the spatial responses measured by the two imaging methods. fNIRSI and fMRI data were each analyzed using standard correlation and fixed-effect group analyses of variance pathways. The statistical significance of fNIRSI data was found to be much lower than that of the fMRI data, due mainly to the low signal-to-noise of the measurements. Reconstructed images also showed that, while the time-course of changes in the oxy-, deoxy-, and total hemoglobin concentrations all exhibit high correlation with that of the BOLD response, the changes in the volume of tissue measured as "activated" by the BOLD response demonstrate a closer similarity to the corresponding changes in the oxy- and total hemoglobin concentrations than to that of the deoxyhemoglobin.

Assessing infants' cortical response to speech using near-infrared spectroscopy

Sensitivity to spoken language is an integral part of infants' formative development, yet relatively little is known about the neural mechanisms that underlie the emerging ability to perceive and process speech. This is in large part because there are a limited number of non-invasive techniques available to measure brain functioning in human infants. Near-infrared spectroscopy (NIRS), an optical imaging technique that estimates changes in neuronal activity by measuring changes in total hemoglobin concentration and oxygenation, may be a viable procedure for assessing the relation between speech processing and brain function in human infants. While auditory processing data have been gathered from newborn and preterm infants using NIRS, such data have not been collected from older infants. Many behavioral measures used to establish linguistic sensitivity in this population are accompanied by visual stimuli; however, it is unclear how coupling of auditory and visual stimuli influences neural processing. Here we studied cortical activity in infants aged 6-9 months, as measured by NIRS, during exposure to linguistic stimuli paired with visual stimuli and compared this to the activity observed in the same regions during exposure to visual stimuli alone. Results dissociate infants' hemodynamic responses to multimodal and unimodal stimuli, demonstrating the utility of NIRS for studying perceptual development in infants. In particular, these findings support the use of NIRS to study the neurobiology of language development in older infants, a task that is difficult to accomplish without the use of attention-getting visual stimuli.

Group Analysis of FMRI and NIR Data Simultaneously Acquired During Visual Stimulation in Humans

We use our new combined functional near infrared spectro-imaging (fNIRSI) and magnetic resonance imaging (MRJ) technique to compare fMRI and fNIRSI data at different activation conditions, to obtain new information about the underlying physiology of the blood oxygen level dependent (BOLD) signal used in fMRI, and to assess statistical characteristics of spatial functional information provided by the group analysis of fNIRSI data. To achieve these goals we have acquired simultaneously fNIRSI and fMRI data during the presentation of the checkerboard reversing with different frequencies, and analyzed these data following the standard correlation and group analysis of variance pathway used in functional neuroimaging. . We have found that while the time courses of oxy-, deoxy-, and total- hemoglobin responses are equally well correlated with the time course of the BOLD response, the spatial pattern and magnitude of the BOLD response is better related to those of the oxy-, and total- hemoglobin responses rather than to the deoxyhemoglobin response. The statistical significance of the fNIRSI group maps is inferior to that of fMRI, and can be particularly compromised by the anatomical features of subjects.

Three dimensional optical imaging of blood volume and oxygenation in the neonatal brain

Optical methods provide a means of monitoring cerebral oxygenation in newborn infants at risk of brain injury. A 32-channel optical imaging system has been developed with the aim of reconstructing three-dimensional images of regional blood volume and oxygenation. Full image data sets were acquired from 14 out of 24 infants studied; successful images have been reconstructed in 8 of these infants. Regional variations in cerebral blood volume and tissue oxygen saturation are present in healthy preterm infants. In an infant with a large unilateral intraventricular haemorrhage, a corresponding region of low oxygen saturation was detected. These results suggest that optical tomography may provide an appropriate technique for investigating regional cerebral haemodynamics and oxygenation at the cotside.

Dynamic physiological modeling for functional diffuse optical tomography

Diffuse optical tomography (DOT) is a noninvasive imaging technology that is sensitive to local concentration changes in oxy- and deoxyhemoglobin. When applied to functional neuroimaging, DOT measures hemodynamics in the scalp and brain that reflect competing metabolic demands and cardiovascular dynamics. The diffuse nature of near-infrared photon migration in tissue and the multitude of physiological systems that affect hemodynamics motivate the use of anatomical and physiological models to improve estimates of the functional hemodynamic response. In this paper, we present a linear state-space model for DOT analysis that models the physiological fluctuations present in the data with either static or dynamic estimation. We demonstrate the approach by using auxiliary measurements of blood pressure variability and heart rate variability as inputs to model the background physiology in DOT data. We evaluate the improvements accorded by modeling this physiology on ten human subjects with simulated functional hemodynamic responses added to the baseline physiology. Adding physiological modeling with a static estimator significantly improved estimates of the simulated functional response, and further significant improvements were achieved with a dynamic Kalman filter estimator (paired t tests, n=10, P<0.05). These results suggest that physiological modeling can improve DOT analysis. The further improvement with the Kalman filter encourages continued research into dynamic linear modeling of the physiology present in DOT. Cardiovascular dynamics also affect the blood-oxygen-dependent (BOLD) signal in functional magnetic resonance imaging (fMRI). This state-space approach to DOT analysis could be extended to BOLD fMRI analysis, multimodal studies and real-time analysis.

Virtual 10-20 measurement on MR images for inter-modal linking of transcranial and tomographic neuroimaging methods

It is important to create a link between stereotaxic coordinates and head-surface-based positioning systems in order to share data between tomographic and transcranial brain mapping studies. In our previous studies, we established the probabilistic correspondence of the international 10-20 positions to the standard stereotaxic coordinate systems and made a reference database. However, its expansion required the physical marking of the 10-20 positions and the subsequent acquisition of MR images. To avoid such tedious procedures, we developed a virtual 10-20 measurement algorithm that can be applied to re-analyze any structural MR image that covers the whole head. As in the physical 10-20 measurements, with the reference points given, the algorithm automatically determines each 10-20 position step by step. Using the virtual 10-20 measurement method, we re-analyzed the MR images of 17 healthy subjects for whom we had determined 10-20 positions by physical marking in our previous study. The acquired 10-20 positions were normalized to the Montreal Neurological Institute (MNI) stereotactic coordinates and compared with the positions previously determined by physical measurements. 10-20 positions determined using the virtual and physical methods were roughly consistent. Average standard deviations for virtual and physical methods were 7.7 mm and 9.0 mm, respectively. There was a systematic shift in the virtual method, likely due to the absence of hair interference. We corrected the shift with affine transformation. The virtual 10-20 measurement method proved to be an effective alternative to physical marking. This method will serve as an essential tool for expanding the reference database and will further strengthen the link between tomographic and transcranial brain mapping methods.