NIRS in the temporal region--strong influence of external carotid artery

Characterizing near-infrared spectroscopy signal under hypercapnia

Vasoactive stress tests (i.e. hypercapnia, elevated partial pressure of arterial CO₂ [PaCO₂ ]) are commonly used in functional MRI (fMRI), to induce cerebral blood flow changes and expose hidden perfusion deficits in the brain. Compared with fMRI, near-infrared spectroscopy (NIRS) is an alternative low-cost, real-time, and non-invasive tool, which can be applied in out-of-hospital settings. To develop and optimize vasoactive stress tests for NIRS, several hypercapnia-induced tasks were tested using concurrent-NIRS/fMRI on healthy subjects. The results indicated that the cerebral and extracerebral reactivity to elevated PaCO₂ depended on the rate of the CO₂ increase. A steep increase resulted in different cerebral and extracerebral reactivities, leading to unpredictable NIRS measurements compared with fMRI. However, a ramped increase, induced by ramped-CO₂ inhalation or breath-holding tasks, induced synchronized cerebral, and extracerebral reactivities, resulting in consistent NIRS and fMRI measurements. These results demonstrate that only tasks that increase PaCO₂ gradually can produce reliable NIRS results.

Bedside assessment of regional cerebral perfusion using near-infrared spectroscopy and indocyanine green in patients with atherosclerotic occlusive disease

This pilot study aimed to investigate the utility of near-infrared spectroscopy/indocyanine green (NIRS/ICG) for examining patients with occlusive cerebrovascular disease. Twenty-nine patients with chronic-stage atherosclerotic occlusive cerebrovascular disease were included. The patients were monitored using NIRS at the bedside. Using ICG time-intensity curves, the affected-to-unaffected side ratios were calculated for several parameters, including the maximum ICG concentration (ΔICGmax), time to peak (TTP), rise time (RT), and blood flow index (BFI = ΔICGmax/RT), and were compared to the affected-to-unaffected side ratios of the regional cerebral blood flow (rCBF) and regional oxygen extraction fraction (rOEF) obtained using positron emission tomography with ¹⁵O-labeled gas. The BFI ratio showed the best correlation with the rCBF ratio among these parameters (r = 0.618; P = 0.0004), and the RT ratio showed the best correlation with the rOEF ratio (r = 0.593; P = 0.0007). The patients were further divided into reduced rCBF or elevated rOEF groups, and the analysis revealed significant related differences. The present results advance the measurement of ICG kinetics using NIRS as a useful tool for the detection of severely impaired perfusion with reduced rCBF or elevated rOEF. This method may be applicable as a monitoring tool for patients with acute ischemic stroke.

False positives and false negatives in functional near-infrared spectroscopy: issues, challenges, and the way forward

We highlight a significant problem that needs to be considered and addressed when performing functional near-infrared spectroscopy (fNIRS) studies, namely the possibility of inadvertently measuring fNIRS hemodynamic responses that are not due to neurovascular coupling. These can be misinterpreted as brain activity, i.e., "false positives" (errors caused by wrongly assigning a detected hemodynamic response to functional brain activity), or mask brain activity, i.e., "false negatives" (errors caused by wrongly assigning a not observed hemodynamic response in the presence of functional brain activity). Here, we summarize the possible physiological origins of these issues and suggest ways to avoid and remove them.

False positives and false negatives in functional near-infrared spectroscopy: issues, challenges, and the way forward

We highlight a significant problem that needs to be considered and addressed when performing functional near-infrared spectroscopy (fNIRS) studies, namely the possibility of inadvertently measuring fNIRS hemodynamic responses that are not due to neurovascular coupling. These can be misinterpreted as brain activity, i.e., "false positives" (errors caused by wrongly assigning a detected hemodynamic response to functional brain activity), or mask brain activity, i.e., "false negatives" (errors caused by wrongly assigning a not observed hemodynamic response in the presence of functional brain activity). Here, we summarize the possible physiological origins of these issues and suggest ways to avoid and remove them.

Inconsistent detection of changes in cerebral blood volume by near infrared spectroscopy in standard clinical tests

The attractive possibility of near infrared spectroscopy (NIRS) to noninvasively assess cerebral blood volume and oxygenation is challenged by the possible interference from extracranial tissues. However, to what extent this may affect cerebral NIRS monitoring during standard clinical tests is ignored. To address this issue, 29 healthy subjects underwent a randomized sequence of three maneuvers that differently affect intra- and extracranial circulation: Valsalva maneuver (VM), hyperventilation (HV), and head-up tilt (HUT). Putative intracranial ("i") and extracranial ("e") NIRS signals were collected from the forehead and from the cheek, respectively, and acquired together with cutaneous plethysmography at the forehead (PPG), cerebral blood velocity from the middle cerebral artery, and arterial blood pressure. Extracranial contribution to cerebral NIRS monitoring was investigated by comparing Beer-Lambert (BL) and spatially resolved spectroscopy (SRS) blood volume indicators [the total hemoglobin concentration (tHb) and the total hemoglobin index, (THI)] and by correlating their changes with changes in extracranial circulation. While THIe and tHbe generally provided concordant indications, tHbi and THIi exhibited opposite-sign changes in a high percentage of cases (VM: 46%; HV: 31%; HUT: 40%). Moreover, tHbi was correlated with THIi only during HV (P < 0.05), not during VM and HUT, while it correlated with PPG in all three maneuvers (P < 0.01). These results evidence that extracranial circulation may markedly affect BL parameters in a high percentage of cases, even during standard clinical tests. Surface plethysmography at the forehead is suggested as complementary monitoring helpful in the interpretation of cerebral NIRS parameters.

Near infrared spectroscopy in brain injury: today’s perspective

The technique of near infrared spectroscopy (NIRS) is based on the principle of light attenuation by the chromophores oxyhaemoglobin (HbO2), deoxyhaemoglobin (Hb) and cytochrome oxidase. Changes in the detected light levels can therefore represent changes in concentrations of these chromophores. Clinical use of NIRS in the brain has been well established in neonates where transillumination is possible. While it has become a useful research tool for monitoring the adult brain, clinical application has been hampered by the fact that it must be applied in reflectance mode. This has resulted in a number of concerns, most significantly the issue of signal contamination by the extracranial tissue layers. Algorithms have been applied to try to overcome this problem, and techniques such as time resolved, phase resolved and spatially resolved spectroscopy have been developed. There has been renewed interest in NIRS as an easy to use, non-invasive technique for measuring tissue oxygenation in the adult brain. Recent technical advances have led to the development of compact, portable instruments that detect changes in optical attenuation of several wavelengths of light. Near infrared spectroscopy is an evolving technology that holds significant potential for technical advancement. In particular, NIRS shows future promise as a clinical tool for bedside cerebral blood flow measurements and as a cerebral imaging modality for mapping structure and function.

Transcranial Doppler and Near-Infrared Spectroscopy Can Evaluate the Hemodynamic Effect of Carotid Artery Occlusion

Background and Purpose— Cerebral hemodynamic and metabolic changes can compensate for the decrease in cerebral blood flow occurring in patients with carotid occlusive disease. At present, a complete assessment of the cerebral adaptive status is only possible with positron-emission tomography. Near-infrared spectroscopy (NIRS) is a noninvasive technique that, providing a real time assessment of fluctuations in cerebral hemoglobin, has been used to estimate the cerebral blood volume and to measure cerebral vasomotor reactivity (VMR). Moreover, NIRS technology, by allowing the absolute measurement of absorption and scattering coefficients of brain, can determine the oxyhemoglobin and deoxyhemoglobin concentrations in situ in the blood stream.

Methods— In order to evaluate different aspects of the cerebral hemodynamic status, 27 subjects with symptomatic and asymptomatic carotid artery occlusion and 30 healthy subjects underwent a simultaneous examination by means of transcranial Doppler (TCD), able to reliably detect collateral circulation and VMR, and NIRS at rest condition and during CO 2 reactivity test.

Results— The main finding of this study was the demonstration of a difference between asymptomatic and symptomatic patients in terms of mean flow velocity increase (52.4% versus 21.0%; P <0.001) estimated by TCD and of hemoglobin saturation increase measured by NIRS (6.8% versus 3.8%; P =0.015).

Conclusions— The opportunity to perform NIRS and TCD simultaneously provides useful information about both hemodynamic and metabolic cerebral adaptive status in patients with occlusive disease in a simple, noninvasive, and reliable way.

Dynamic cerebral autoregulatory response to blood pressure rise measured by near-infrared spectroscopy and intracranial pressure

OBJECTIVES

Noninvasive near-infrared spectroscopy (NIRS) continuously monitors changes in cerebral hemoglobin saturation (Hb(Diff) ) and content (Hb(Total)). It may allow visualization of the dynamic cerebral autoregulatory response to rapid blood pressure increases without relevant contamination of the NIRS signal from extracerebral hemoglobin.

DESIGN

Prospective cohort study.

SETTINGS

Multidisciplinary pediatric intensive care unit.

PATIENTS

Six consecutive children in coma due to severe encephalopathy (head trauma, five patients; mumps encephalitis, one patient) requiring artificial ventilation, invasive arterial blood, and intracranial pressure monitoring.

INTERVENTIONS

Frontotemporal recording of Hb(Diff) and Hb(Total) while rapidly elevating blood pressure by bolus injection of phenylephrine.

MEASUREMENTS AND RESULTS

During an increase of blood pressure of 13 +/- 1 mm Hg with a "rise time" of 16 +/- 1 secs (mean of a total of 31 injections +/- sem), a significant linear correlation was found between Hb(Diff) and intracranial pressure signals (mean coefficient, 0.46 +/- 0.04) but not between Hb(Total) and intracranial pressure. Three response patterns were observed. First, Hb(Diff) and intracranial pressure reduction, corresponding with vasoconstriction and normal dynamic autoregulation (n = 3); second, Hb(Diff) and intracranial pressure increase, corresponding with persistent vasodilation and abolished autoregulation (n = 11); and third, transient Hb(Diff) and intracranial pressure increase followed by a decrease at peak blood pressure elevation, called impaired autoregulation (n = 15). In one patient with fatal brain swelling, phenylephrine testing showed no effect on NIRS signals (n = 2). Furthermore, there were significant correlations between 31 pooled interindividual pairs of Hb(Diff) changes with intracranial pressure changes (values at baseline averaged over 60 secs subtracted from values at peak blood pressure elevation averaged over 5 secs), with a correlation coefficient of .82 (p <.001).

CONCLUSIONS

NIRS represents a new and promising technique for bedside determination of dynamic cerebral autoregulation during acutely induced blood pressure rise. The significant correlations found between NIRS signals and intracranial pressure excluded relevant extracerebral contamination of the NIRS signals. In our patients with severe encephalopathy, dynamic autoregulation was in most instances not fully preserved.

Maps of optical differential pathlength factor of human adult forehead, somatosensory motor and occipital regions at multi-wavelengths in NIR

The optical differential pathlength factor (DPF) is an important parameter for physiological measurement using near infrared spectroscopy, but for the human adult head it has been available only for the forehead. Here we report measured DPF results for the forehead, somatosensory motor and occipital regions from measurements on 11 adult volunteers using a time-resolved optical imaging system. The optode separation was about 30 mm and the wavelengths used were 759 nm, 799 nm and 834 nm. Measured DPFs were 7.25 for the central forehead and 6.25 for the temple region at 799 nm. For the central somatosensory and occipital areas (10 mm above the inion), DPFs at 799 nm are 7.5 and 8.75, respectively. Less than 10% decreases of DPF for all these regions were observed when the wavelength increased from 759 nm to 834 nm. To compare these DPF maps with the anatomical structure of the head, a Monte Carlo simulation was carried out to calculate DPF for these regions by using a two-layered semi-infinite model and assuming the thickness of the upper layer to be the sum of the thicknesses of scalp and skull, which was measured from MRI images of a subject's head. The DPF data will be useful for quantitative monitoring of the haemodynamic changes occurring in adult heads.

The influence of positioning on spectroscopic measurements of brain oxygenation

This study was designed to evaluate the influence of body position during neurosurgical and cerebrovascular operations on regional cerebral oxygen saturation (rSO2). Awake volunteers (group I; n = 14), anesthetized patients (group II; n = 48) undergoing lumbar discectomy, and 12 patients undergoing carotid endarterectomy (group III) with internal carotid artery (ICA) stenosis were studied. Anesthesia in the patient groups was performed with sevoflurane (1.1 Vol% insp.) in N2O2/O2 mixture (FiO2 0.4) rSO2 was monitored with a INVOS 4100 cerebral oxymeter (Somanetics Corporation, Troy, MI). Measurements were done in all groups in supine position with head turned to the right and left side. Furthermore, in groups I and II, rSO2 was measured in right lateral, left lateral, prone, or sitting position. In each position the parameters were registered at three times (1, 3, and 5 min after taking up the position). In the healthy volunteers, the mean rSO2 values of both hemispheres were 71.3 +/- 5.0%. No significant changes of rSO2 were found interhemispherical and upon turning the head to both sides or positioning to the prone and both lateral positions. After assuming the sitting position, the decrease of rSO2 was not significant. In group II, rSO2 decreased significantly in the sitting position. In group III, baseline readings for rSO2 obtained from the side of ICA stenosis were significantly lower, compared to the contralateral side. After turning the head to the ipsilateral side, this difference diminished. In contrast, turning the head toward the contralateral side, the rSO2 difference remained nearly constant, both values decreasing constantly throughout the observation period. In conclusion, after different positioning maneuvers awake and under anesthesia, alterations of rSO2 can be registrated by near-infrared spectroscopy (NIRS).

Cold pressor stimulation effect on hemodynamic changes following sustained isometric contraction in human jaw-closure muscles

It is postulated that an altered adrenergic response pattern may be associated with chronic muscle pain states. To evaluate this hypothesis, one must fully understand the effect of an adrenergic activation on masticatory muscle blood flow under various conditions. This study evaluated the effect of a 12 degrees C cold pressor stimulation (a mild adrenergic activator), applied to the hand-forearm area, on intramuscular hemodynamics in the human masseter and temporalis muscles following a sustained isometric contraction. We assessed hemodynamics by measuring intramuscular hemoglobin concentration repeatedly, using a non-invasive near-infrared spectroscopy device. Measurements were taken before, during, and after a 30-second sustained 50% maximum voluntary contraction task. Fourteen healthy subjects, seven males and seven females, with no history of muscle pain in the masticatory system participated in this study. This protocol was repeated three times, but in the second trial, the cold pressor stimulation was applied to the subject during and for 5 min after the sustained contraction task. Repeated-measure analysis of variance performed on these data revealed that the peak hemoglobin concentration levels in the post-contraction recovery period were significantly reduced (between 13 and 14%) with cold pressor stimulation, both in the masseter (p < 0.001) and in the temporalis (p < 0.001) muscles. The results suggest that cold pressor stimulation produced a reduced intramuscular vasodilative response in these muscles during the immediate post-contraction period. One explanation for these results is that altering the local chemical environment of the muscle affects the adrenergic response pattern typically induced by a cold pressor stimulation.

Near-infrared oximetry of the brain

Near-infrared (IR) light easily penetrates biological tissue, and the information offered by in vivo spectroscopy of cerebral oxygenation is detailed and comes with a high temporal resolution. Near-IR light spectroscopy (NIRS) reflects cerebral oxygenation during arterial hypotension, hypoxic hypoxaemia and hypo- and hypercapnia. As determined by dual-wavelength NIRS, the cerebral O2 saturation integrates the arterial O2 content and the cerebral perfusion, and as established for skeletal muscle, NIRS obtains information on tissue oxygenation and metabolism beyond that obtained by venous blood sampling. Caveats of cerebral NIRS include insufficient light shielding, optode displacement and a sample volume including muscle or the frontal sinus mucous membrane. The relative influence from the extracranial tissue is minimized by optode separation and correction for an extracranial sample volume, or both. The natural pigment melatonin and also water are of little influence to spectroscopic analysis of cerebral oxygenation, whereas bilirubin systematically lowers ScO2 and attenuates the detection of changes in cerebral oxygenation. By NIRS, reduction of cytochrome oxidase is demonstrated during hypoxic hypoxaemia and head-up tilt-induced arterial hypotension, but the changes are small. In the clinical setting, NIRS offers useful information in patients with both systemic and local cerebral circulatory impairment, for example, during cranial trauma, surgery on the cerebral arteries, orthostasis and acute heart failure. Whereas mapping of the brain circulation is needed for jugular venous sampling to reflect either global or local oxygenation, the determination of cerebral oxygenation by NIRS has the advantage of localized monitoring of the cerebral cortex.

Assessment of spatially resolved spectroscopy during cardiopulmonary bypass

Controversy remains about which tissue is primarily responsible for light attenuation of near infrared spectroscopy (NIRS) in the adult, the spatial resolution provided and the preferred algorithm for quantification. Until recently, changes in NIRS have not been fully quantified and have been difficult to interpret without sophisticated computation. A new development by Hamamatsu Photonics, the spatially resolved spectrometer (SRS), may be able to give a quantitative measure of oxygen saturation. We have incorporated the SRS into a multimodality monitoring system for the purpose of direct validation against jugular bulb oxygen saturation (SjO2) in patients undergoing routine cardiopulmonary bypass (CPB). The importance of this investigation is in the development of the SRS machine which shows potential as a useful clinical tool. The results demonstrated good correlation between SRS and SjO2 in 12 out of the 24 patients studied. Although these results are encouraging, this study suggests that the SRS, in its present form, is not a reliable clinical monitor of cerebral oxygen saturation during CPB. © 1999 Society of Photo-Optical Instrumentation Engineers.

Cold pressor stimulus temperature and resting masseter muscle haemodynamics in normal humans

Cold pressor stimulation reportedly increases sympathetic nerve activity in human skeletal muscles. This study examined the effect of cold pressor stimulation on the resting haemodynamics of the right masseter muscle in normal individuals, using near-infrared spectroscopy. Nine healthy non-smoking males with no history of chronic muscle pain or vascular headaches participated. Their right hand was immersed in a water bath (4, 10, 15 degrees C) for exactly 1 min. Each trial lasted 7 min (1 min before, 1 min during, 5 min after stimulation) and a strictly random order was utilized for the three test temperatures and the mock trial. Masseter muscle haemoglobin concentration and oxygen saturation, as well as heart rate and blood pressure, were continuously recorded in each trial. After completing the four trials, each participant produced and sustained a 30-s maximum voluntary clench in the intercuspal position. Data across the four trials were baseline-corrected and then magnitude-normalized to the individual's highest absolute haemoglobin and oxygen signal during the 30-s maximal clenching effort. Haemoglobin and oxygen saturation increased progressively during cold pressor stimulation as the water temperature decreased (Hb, p < 0.0001; O2, p = 0.0327); very little effect was seen during the mock trial. Heart rate and blood pressure also increased progressively during the stimulation as the temperature decreased (heart rate, p = 0.0013; systolic blood pressure, p = 0.0042; diastolic blood pressure, p = 0.0156). These data suggest that cold pressor, stimulation induces a strong increase in intramuscular blood volume which appears to be due to both a local vasodilative response and increased cardiac output.

Sensitivity of near infrared spectroscopy to cerebral and extra-cerebral oxygenation changes is determined by emitter-detector separation

OBJECTIVE

To examine the effect of two emitter-detector separations (2.7 and 5.5 cm) on the detection of changes in cerebral and extra-cerebral tissue oxygenation using near infrared spectroscopy (NIRS).

METHODS

Two NIR detectors were placed on the scalp 2.7 and 5.5 cm from a single NIR emitter. Changes in deoxyhaemoglobin (HHb), oxyhaemoglobin (O2Hb),oxidised cytochrome C oxidase (Cyt) and total haemoglobin (tHb) were recorded from each detector during the induction of cerebral oligaemia (transition from hypercapnia to hypocapnia) and scalp hyperaemia (following release of a scalp tourniquet).

RESULTS

Cerebral oligaemia (mean decrease in middle cerebral artery blood flow velocity of 44%) induced by a mean reduction in end tidal CO2 of 18 mmHg was accompanied by a significant increase in the spectroscopic signal for HHb and a decrease in the O2Hb signal. The signal change per unit photon path length detected at 5.5 cm was significantly greater for HHb (p = 0.007) than that detected at 2.7 cm. In contrast, the increase in all chromophores detected at 5.5 cm during scalp hyperaemia was significantly less than that detected at 2.7 cm (p<0.001).

CONCLUSIONS

The differing sensitivity of the proximal and distal channels to changes in cerebral and extracerebral oxygenation is compatible with theoretical models of NIR light transmission in the adult head and may provide a basis for spatially resolving these changes. The optimal emitter-detector separation for adult NIRS requires further investigation and may differ between individuals.

Noninvasive measurement of regional cerebral blood flow by near-infrared spectroscopy and indocyanine green

Clinicians lack a practical method for measuring CBF rapidly, repeatedly, and noninvasively at the bedside. A new noninvasive technique for estimation of cerebral hemodynamics by use of near-infrared spectroscopy (NIRS) and an intravenously infused tracer dye is proposed. Kinetics of the infrared tracer indocyanine green were monitored on the intact skull in pigs. According to an algorithm derived from fluorescein flowmetry, a relative blood flow index (BFI) was calculated. Data obtained were compared with cerebral and galeal blood flow values assessed by radioactive microspheres under baseline conditions and during hemorrhagic shock and resuscitation. Blood flow index correlated significantly (rs = 0.814, P < 0.001) with cortical blood flow but not with galeal blood flow (rs = 0.258). However, limits of agreement between BFI and CBF are rather wide (+/- 38.2 +/- 6.4 mL 100 g-1 min-1) and require further studies. Data presented demonstrate that detection of tracer kinetics in the cerebrovasculature by NIRS may serve as valuable tool for the noninvasive estimation of regional CBF. Indocyanine green dilution curves monitored noninvasively on the intact skull by NIRS reflect dye passage through the cerebral, not extracerebral, circulation.

Changes in tissue oxyhaemoglobin concentration measured using multichannel near infrared spectroscopy during internal carotid angiography

OBJECTIVE

To develop an in vivo model for testing spatially resolved spectroscopy and quantified near infrared spectroscopy (NIRS) cerebral blood flow measurements.

METHOD

Multiple detector NIRS has been used to study changes in tissue oxyhaemoglobin (O2Hb) concentration during selective internal carotid angiography. A significant reduction in O2Hb occurred in tissue interrogated by detectors situated between 0.7 and 4.1 cm from the NIRS light source.

RESULTS

The time course of O2Hb concentration change was consistent with displacement of oxygenated blood by the radiocontrast medium from vascular beds of differing flow and NIR light attenuation. Increasing changes in O2Hb concentration per unit photon path length--predicted to occur at greater emitter-detector separations if those changes had occurred predominantly in cerebral tissue--were found in the first four seconds after injection of radiocontrast medium. However, later changes (6-10 s) were larger and were not proportional to emitter-detector separation.

CONCLUSION

The findings indicate that simple assumptions regarding the distribution of the internal carotid artery blood supply to cerebral and extracerebral tissues, the photon path length through those tissues, and their relative contributions to attenuation of NIR light may not be justified.

Clinical evaluation of near-infrared spectroscopy for testing cerebrovascular reactivity in patients with carotid artery disease

BACKGROUND AND PURPOSE

Near-infrared spectroscopy (NIRS) derives information about the concentrations of oxyhemoglobin (HbO2) and deoxyhemoglobin (Hb) from measurements of light attenuation caused by these chromosphores. The aim of this study was to assess NIRS as a tool for testing CO2 reactivity in patients with carotid artery disease.

METHODS

One hundred patients with symptomatic carotid occlusive disease were examined (age range, 44 to 83 years). The severity of stenosis ranged from 30% to 100% (median, 80%) on the ipsilateral side and 0% to 100% (median, 30%) on the contralateral side. Monitored parameters included transcranial Doppler flow velocity, changes in concentration of HbO2 and Hb, cutaneous laser-Doppler blood flow, endtidal CO2, arterial blood pressure, and arterial oxygen saturation. Hypercapnia was induced with the use of a 5% CO2/air mixture for inhalation. To estimate the contribution of skin flow to NIRS during reactivity testing, the superficial temporal artery was compressed, and the NIRS changes in response to the fall in laser-Doppler blood flow were recorded. Finally, reproducibility of reactivity testing was assessed in 10 patients who were subjected to repeated examinations over 3 days.

RESULTS

Flow velocity- and HbO2-derived reactivity values were related to the severity of the stenosis (P = .0001 and P = .017, respectively). The correlation between the two reactivity modalities was significant (r = .49, P < .000001). The median estimated contribution of skin flow to NIRS changes was 15.8%. Another variable affecting HbO2 signal changes during the CO2 challenge was arterial blood pressure (P = .025). Reproducibility of HbO2 reactivity was similar to flow velocity reactivity (14.3% and 18.6% variation, respectively).

CONCLUSIONS

NIRS shows potential as an alternative technique for testing CO2 reactivity in patients with carotid disease provided that conditions are carefully controlled. Marked changes in arterial blood pressure may render the NIRS reactivity indices unreliable, and the contribution from extracranial tissue must be taken into account when significant.

Near-infrared spectroscopy: theory and applications

In conclusion, NIRS appears to offer both a new monitoring modality and new information about cerebral oxygenation. Technical problems in the application of this technology persist, most notably determination of pathlength and the volume of tissue interrogated. Those familiar with the history of pulse oximetry will recall that although Millikan developed an ear oximeter in 1947, it was not until Aoyagi combined recognition of the pulse signal with spectroscopy in the 1970s that oximetry was transformed into a clinically applicable monitor. In much the same way, NIRS may find the same tremendous usefulness as a noninvasive monitor of cerebral oxygen utilization, pending resolution of the remaining technical problems.