Model for laser Doppler measurements of blood flow in tissue

[Techniques for imaging optic disc vasculature in glaucomatous optic neuropathy: A review of the literature]

The anatomy and vasculature of the optic nerve head are complex and subject to numerous variations. The main risk factor for glaucomatous optic neuropathy is elevated intraocular pressure, but many other factors have been identified. A vascular component seems to play an important role in the pathogenesis and/or progression of glaucomatous optic neuropathy, either under the influence of ocular hypertension or as an independent risk factor, particularly as in normal tension glaucoma (NTG). Reduced ocular blood flow has been identified as a risk factor for glaucoma. Numerous instruments have therefore been developed to explore the vasculature of the optic nerve head and to try to better understand the changes in blood flow in the optic nerve in glaucomatous optic neuropathy. In this review, we provide an update on the various means of imaging the vasculature of the optic nerve head, from angiography to the most modern techniques with angiographic OCT and laser Doppler holography. Using the results found in glaucomatous optic neuropathies, we will explore the close link between reduced ocular blood flow and the development or progression of glaucoma. A better understanding of this pathophysiology opens the door to improved management of our glaucoma patients.

All-optical dual module platform for motility-based functional scrutiny of microencapsulated probiotic bacteria

Probiotic bacteria are widely used in pharmaceutics to offer health benefits. Microencapsulation is used to deliver probiotics into the human body. Capsules in the stomach have to keep bacteria constrained until release occurs in the intestine. Once outside, bacteria must maintain enough motility to reach the intestine walls. Here, we develop a platform based on two label-free optical modules for rapidly screening and ranking probiotic candidates in the laboratory. Bio-speckle dynamics assay tests the microencapsulation effectiveness by simulating the gastrointestinal transit. Then, a digital holographic microscope 3D-tracks their motility profiles at a single element level to rank the strains.

Interferometric near-infrared spectroscopy (iNIRS) reveals that blood flow index depends on wavelength

Blood flow index (BFI) is an optically accessible parameter, with unit distance-squared-over-time, that is widely used as a proxy for tissue perfusion. BFI is defined as the dynamic scattering probability (i.e. the ratio of dynamic to overall reduced scattering coefficients) times an effective Brownian diffusion coefficient that describes red blood cell (RBC) motion. Here, using a wavelength division multiplexed, time-of-flight- (TOF) - resolved iNIRS system, we obtain TOF-resolved field autocorrelations at 773 nm and 855 nm via the same source and collector. We measure the human forearm, comprising biological tissues with mixed static and dynamic scattering, as well as a purely dynamic scattering phantom. Our primary finding is that forearm BFI increases from 773 nm to 855 nm, though the magnitude of this increase varies across subjects (23% ± 19% for N = 3). However, BFI is wavelength-independent in the purely dynamic scattering phantom. From these data, we infer that the wavelength-dependence of BFI arises from the wavelength-dependence of the dynamic scattering probability. This inference is further supported by RBC scattering literature. Our secondary finding is that the higher-order cumulant terms of the mean squared displacement (MSD) of RBCs are significant, but decrease with wavelength. Thus, laser speckle and related modalities should exercise caution when interpreting field autocorrelations.

Blood flow ratio in the gastric conduit measured by laser Doppler flowmetry: A predictor of anastomotic leakage after esophagectomy

Background

Anastomotic leakage after esophagectomy is a common complication. Laser Doppler flowmetry (LDF) can quantitatively evaluate the blood flow in the gastric conduit.

Methods

A total of 326 patients who underwent thoracoscopic/robot-assisted esophagectomy followed by gastric conduit reconstruction and end-to-side anastomosis were enrolled. We divided the gastric conduit into zones I (dominated by the right gastroepiploic vessels), II (dominated by the left gastroepiploic vessels), and III (perfused with short gastric vessels). Before pulling up the gastric conduit to the neck, LDF values were measured at the pylorus, the border between zones I and II (zone I/II), the border between zones II and III (zone II/III), and the gastric conduit tip (tip). The blood flow ratio was calculated as the LDF value divided by the LDF value at the pylorus.

Results

Anastomotic leakage developed in 32 of 326 patients. Leakage was significantly associated with the blood flow ratio at the tip (p < 0.001), but not at zone I/II, zone II/III, and the anastomotic site. The receiver-operating characteristic curve analysis identified an anastomotic leakage cutoff ratio of 0.41 (at the tip). A multivariate Cox analysis showed that a blood flow ratio <0.41 at the tip was an independent risk factor for anastomotic leakage (p < 0.001).

Conclusion

Anastomotic leakage after esophagectomy was significantly associated with the blood flow ratio at the tip of the gastric conduit. Preservation of the blood supply to the tip via the gastric wall might contribute to a decreased incidence of anastomotic leakage.

Optical Flow-Based Full-Field Quantitative Blood-Flow Velocimetry Using Temporal Direction Filtering and Peak Interpolation

The quantitative measurement of the microvascular blood-flow velocity is critical to the early diagnosis of microvascular dysfunction, yet there are several challenges with the current quantitative flow velocity imaging techniques for the microvasculature. Optical flow analysis allows for the quantitative imaging of the blood-flow velocity with a high spatial resolution, using the variation in pixel brightness between consecutive frames to trace the motion of red blood cells. However, the traditional optical flow algorithm usually suffers from strong noise from the background tissue, and a significant underestimation of the blood-flow speed in blood vessels, due to the errors in detecting the feature points in optical images. Here, we propose a temporal direction filtering and peak interpolation optical flow method (TPIOF) to suppress the background noise, and improve the accuracy of the blood-flow velocity estimation. In vitro phantom experiments and in vivo animal experiments were performed to validate the improvements in our new method.

Using pressure-driven flow systems to evaluate laser speckle contrast imaging

SIGNIFICANCE

Microfluidic flow phantom studies are commonly used for characterizing the performance of laser speckle contrast imaging (LSCI) instruments. The selection of the flow control system is critical for the reliable generation of flow during testing. The majority of recent LSCI studies using microfluidics used syringe pumps for flow control.

AIM

We quantified the uncertainty in flow generation for a syringe pump and a pressure-regulated flow system. We then assessed the performance of both LSCI and multi-exposure speckle imaging (MESI) using the pressure-regulated flow system across a range of flow speeds.

APPROACH

The syringe pump and pressure-regulated flow systems were evaluated during stepped flow profile experiments in a microfluidic device using an inline flow sensor. The uncertainty associated with each flow system was calculated and used to determine the reliability for instrument testing. The pressure-regulated flow system was then used to characterize the relative performance of LSCI and MESI during stepped flow profile experiments while using the inline flow sensor as reference.

RESULTS

The pressure-regulated flow system produced much more stable and reproducible flow outputs compared to the syringe pump. The expanded uncertainty for the syringe pump was 8 to 20 × higher than that of the pressure-regulated flow system across the tested flow speeds. Using the pressure-regulated flow system, MESI outperformed single-exposure LSCI at all flow speeds and closely mirrored the flow sensor measurements, with average errors of 4.6 % ± 2.6 % and 15.7 % ± 4.6 % , respectively.

CONCLUSIONS

Pressure-regulated flow systems should be used instead of syringe pumps when assessing the performance of flow measurement techniques with microfluidic studies. MESI offers more accurate relative flow measurements than traditional LSCI across a wide range of flow speeds.

Diagnosis of Skin Vascular Complications Revealed by Time-Frequency Analysis and Laser Doppler Spectrum Decomposition

Nowadays, photonics-based techniques are used extensively in various applications, including functional clinical diagnosis, progress monitoring in treatment, and provision of metrological control. In fact, in the frame of practical implementation of optical methods, such as laser Doppler flowmetry (LDF), the qualitative interpretation and quantitative assessment of the detected signal remains vital and urgently required. In the conventional LDF approach, the key measured parameters, index of microcirculation and perfusion rate, are proportional to an averaged concentration of red blood cells (RBC) and their average velocity within a diagnostic volume. These quantities compose mixed signals from different vascular beds with a range of blood flow velocities and are typically expressed in relative units. In the current paper we introduce a new signal processing approach for the decomposition of LDF power spectra in terms of ranging blood flow distribution by frequency series. The developed approach was validated in standard occlusion tests conducted on healthy volunteers, and applied to investigate the influence of local pressure rendered by a probe on the surface of the skin. Finally, in limited clinical trials, we demonstrate that the approach can significantly improve the diagnostic accuracy of detection of microvascular changes in the skin of the feet in patients with Diabetes Mellitus type 2, as well as age-specific changes. The results obtained show that the developed approach of LDF signal decomposition provides essential new information about blood flow and blood microcirculation and has great potential in the diagnosis of vascular complications associated with various diseases.

Non-Invasive Blood Flow Speed Measurement Using Optics

Non-invasive measurement of the arterial blood speed gives important health information such as cardio output and blood supplies to vital organs. The magnitude and change in arterial blood speed are key indicators of the health conditions and development and progression of diseases. We demonstrated a simple technique to directly measure the blood flow speed in main arteries based on the diffused light model. The concept is demonstrated with a phantom that uses intralipid hydrogel to model the biological tissue and an embedded glass tube with flowing human blood to model the blood vessel. The correlation function of the measured photocurrent was used to find the electrical field correlation function via the Siegert relation. We have shown that the characteristic decorrelation rate (i.e., the inverse of the decoherent time) is linearly proportional to the blood speed and independent of the tube diameter. This striking property can be explained by an approximate analytic solution for the diffused light equation in the regime where the convective flow is the dominating factor for decorrelation. As a result, we have demonstrated a non-invasive method of measuring arterial blood speed without any prior knowledge or assumption about the geometric or mechanic properties of the blood vessels.

Microcirculation during surgery

Throughout the long history of surgery, there has been great advancement in the hemodynamic management of surgical patients. Traditionally, hemodynamic management has focused on macrocirculatory monitoring and intervention to maintain appropriate oxygen delivery. However, even after optimization of macro-hemodynamic parameters, microcirculatory dysfunction, which is related to higher postoperative complications, occurs in some patients. Although the clinical significance of microcirculatory dysfunction has been well reported, little is known about interventions to recover microcirculation and prevent microcirculatory dysfunction. This may be at least partly caused by the fact that the feasibility of monitoring tools to evaluate microcirculation is still insufficient for use in routine clinical practice. However, considering recent advancements in these research fields, with more popular use of microcirculation monitoring and more clinical trials, clinicians may better understand and manage microcirculation in surgical patients in the future. In this review, we describe currently available methods for microcirculatory evaluation. The current knowledge on the clinical relevance of microcirculatory alterations has been summarized based on previous studies in various clinical settings. In the latter part, pharmacological and clinical interventions to improve or restore microcirculation are also presented.

Dynamics of isoflurane-induced vasodilation and blood flow of cerebral vasculature revealed by multi-exposure speckle imaging

BACKGROUND

Anesthetized animal models are used extensively during neurophysiological and behavioral studies despite systemic effects from anesthesia that undermine both accurate interpretation and translation to awake human physiology. The majority of work examining the impact of anesthesia on cerebral blood flow (CBF) has been restricted to before and after measurements with limited spatial resolution.

NEW METHOD

We used multi-exposure speckle imaging (MESI), an advanced form of laser speckle contrast imaging (LSCI), to characterize the dynamics of isoflurane anesthesia induction on cerebral vasculature and blood flow in the mouse brain.

RESULTS

The large anatomical changes caused by isoflurane are depicted with wide-field imagery and video highlighting the induction of general anesthesia. Within minutes of exposure, both vessel diameter and blood flow increased drastically compared to the awake state and remained elevated for the duration of imaging. An examination of the dynamics of anesthesia induction reveals that blood flow increased faster in arteries than in veins or parenchyma regions.

COMPARISON WITH EXISTING METHODS

MESI offers robust hemodynamic measurements across large fields-of-view and high temporal resolutions sufficient for continuous visualization of cerebrovascular events featuring major changes in blood flow.

CONCLUSION

The large alterations caused by isoflurane anesthesia to the cortical vasculature and CBF are readily characterized using MESI. These changes are unrepresentative of normal physiology and provide further evidence that neuroscience experiments would benefit from transitioning to un-anesthetized awake animal models.

Retinal blood flow reversal quantitatively monitored in out-of-plane vessels with laser Doppler holography

Laser Doppler holography is a planar blood flow imaging technique recently introduced in ophthalmology to image human retinal and choroidal blood flow non-invasively. Here we present a digital method based on the Doppler spectrum asymmetry that reveals the local direction of blood flow with respect to the optical axis in out-of-plane vessels. This directional information is overlaid on standard grayscale blood flow images to depict flow moving towards the camera in red and flow moving away from the camera in blue, as in ultrasound color Doppler imaging. We show that thanks to the strong contribution of backscattering to the Doppler spectrum in out-of-plane vessels, the local axial direction of blood flow can be revealed with a high temporal resolution, which enables us to evidence pathological blood flow reversals. We also demonstrate the use of optical Doppler spectrograms to quantitatively monitor retinal blood flow reversals.

Development of a Preclinical Laser Speckle Contrast Imaging Instrument for Assessing Systemic and Retinal Vascular Function in Small Rodents

Purpose

To develop and test a non-contact, contrast-free, retinal laser speckle contrast imaging (LSCI) instrument for use in small rodents to assess vascular anatomy, quantify hemodynamics, and measure physiological changes in response to retinal vascular dysfunction over a wide field of view (FOV).

Methods

A custom LSCI instrument capable of wide-field and non-contact imaging in small rodents was constructed. The effect of camera gain, laser power, and exposure duration on speckle contrast variance was standardized before the repeatability of LSCI measurements was determined in vivo. Finally, the ability of LSCI to detect alterations in local and systemic vascular function was evaluated using a laser-induced branch retinal vein occlusion and isoflurane anesthesia model, respectively.

Results

The LSCI system generates contrast-free maps of retinal blood flow with a 50° FOV at >376 frames per second (fps) and under a short exposure duration (>50 µs) with high reliability (intraclass correlation R = 0.946). LSCI was utilized to characterize retinal vascular anatomy affected by laser injury and longitudinally measure alterations in perfusion and blood flow profile. Under varied doses of isoflurane, LSCI could assess cardiac and systemic vascular function, including heart rate, peripheral resistance, contractility, and pulse propagation.

Conclusions

We present a LSCI system for detecting anatomical and physiological changes in retinal and systemic vascular health and function in small rodents.

Translational Relevance

Detecting and quantifying early anatomical and physiological changes in vascular function in animal models of retinal, systemic, and neurodegenerative diseases could strengthen our understanding of disease progression and enable the identification of new prognostic and diagnostic biomarkers for disease management and for assessing treatment efficacies.

Recent Advances in Atherosclerotic Disease Screening Using Pervasive Healthcare

Atherosclerosis screening helps the medical model transform from therapeutic medicine to preventive medicine by assessing degree of atherosclerosis prior to the occurrence of fatal vascular events. Pervasive screening emphasizes atherosclerotic monitoring with easy access, quick process, and advanced computing. In this work, we introduced five cutting-edge pervasive technologies including imaging photoplethysmography (iPPG), laser Doppler, radio frequency (RF), thermal imaging (TI), optical fiber sensing and piezoelectric sensor. IPPG measures physiological parameters by using video images that record the subtle skin color changes consistent with cardiac-synchronous blood volume changes in subcutaneous arteries and capillaries. Laser Doppler obtained the information on blood flow by analyzing the spectral components of backscattered light from the illuminated tissues surface. RF is based on Doppler shift caused by the periodic movement of the chest wall induced by respiration and heartbeat. TI measures vital signs by detecting electromagnetic radiation emitted by blood flow. The working principle of optical fiber sensor is to detect the change of light properties caused by the interaction between the measured physiological parameter and the entering light. Piezoelectric sensors are based on the piezoelectric effect of dielectrics. All these pervasive technologies are noninvasive, mobile, and can detect physiological parameters related to atherosclerosis screening.

Evaluation of the optimal cooling temperature for the face measured by the tissue perfusion during hilotherapy using laser Doppler spectrophotometry

After craniofacial trauma, symptoms like swelling and pain occur. Cooling reduces these symptoms but the optimal cooling temperature for a maximum benefit without adverse effects is unclear. 30 participants were cooled at 10 °C, 15 °C, 20 °C, 25 °C and 30 °C for 30 min. Before cooling and at 15, 30, 45 and 60 min after cooling, the skin blood flow, oxygen saturation (SO) and haemoglobin concentration (Hb) were measured by laser Doppler spectrophotometry at 2 mm and 8 mm depth. The skin temperature was measured, and the participant’s satisfaction was marked on a visual analogue scale. There were significant differences between males and females in the blood flow, SO and Hb (p < 0.0001). After cooling, the blood flow, SO and Hb was reduced. The measured values rose slightly above the initial values 60 min after cooling. Depending on the cooling temperature the decrease in blood flow, SO and Hb was significantly different. Both sexes were most comfortable with a 25 °C cooling temperature and satisfaction decreased with lower temperatures. Significant differences for the satisfaction between both sexes were measured (10 °C: p < 0.0001, 15 °C: p < 0.0001, 20 °C: p = 0.0168, 25 °C: p = 0.0293). After 60 min, the males and females exhibited mild skin hyperthermia. The optimal cooling temperatures their physiological effects and their perception for females and males were different. For females, around 20 °C is an optimal cooling temperature. For males, it is around 15–20 °C.

Optical incoherent technique for noninvasive assessment of blood flow in tissues: Theoretical model and experimental study

Laser noninvasive methods for assessment of a tissue blood flow (BF), for example, the Laser Doppler Flowmetry (LDF), are well-known today. However, in such methods, low-frequency fluctuations (LFFs) in the registered optical signal caused by blood volume changes inside a tissue have not been studied in details until now. The aim of this study is to investigate the LFFs formation and to justify the LFFs-based diagnostic technique for cutaneous BF assessment. LFFs are theoretically described and experimentally shown in the input LDF signal inside the frequency range 0 to 10 Hz. They are substantiated as the basis of the new diagnostic method, in which BF is defined as the magnitude of blood volume changes in a tissue per unit time. The hand-made prototype of the promising diagnostic tool with light emitted diodes is used to validate the technique in experiments in vivo on 16 healthy volunteers in comparison with the LDF method. Experimental results show a good similarity of the recorded BF for both coherent and incoherent method. The proposed technique makes it possible the creation of inexpensive diagnostic equipment for assessment of cutaneous BF without using lasers and coherent light, completely and functionally comparable to LDF devices.

Functional interferometric diffusing wave spectroscopy of the human brain

Cerebral blood flow (CBF) is essential for brain function, and CBF-related signals can inform us about brain activity. Yet currently, high-end medical instrumentation is needed to perform a CBF measurement in adult humans. Here, we describe functional interferometric diffusing wave spectroscopy (fiDWS), which introduces and collects near-infrared light via the scalp, using inexpensive detector arrays to rapidly monitor coherent light fluctuations that encode brain blood flow index (BFI), a surrogate for CBF. Compared to other functional optical approaches, fiDWS measures BFI faster and deeper while also providing continuous wave absorption signals. Achieving clear pulsatile BFI waveforms at source-collector separations of 3.5 cm, we confirm that optical BFI, not absorption, shows a graded hypercapnic response consistent with human cerebrovascular physiology, and that BFI has a better contrast-to-noise ratio than absorption during brain activation. By providing high-throughput measurements of optical BFI at low cost, fiDWS will expand access to CBF.

Utilisation of Chick Embryo Chorioallantoic Membrane as a Model Platform for Imaging-Navigated Biomedical Research

The fertilised chick egg and particularly its chorioallantoic membrane (CAM) have drawn continuing interest in biomedicine and bioengineering fields, especially for research on vascular study, cancer, drug screening and development, cell factors, stem cells, etc. This literature review systemically introduces the CAM's structural evolution, functions, vascular features and the circulation system, and cell regulatory factors. It also presents the major and updated applications of the CAM in assays for pharmacokinetics and biodistribution, drug efficacy and toxicology testing/screening in preclinical pharmacological research. The time course of CAM applications for different assays and their advantages and limitations are summarised. Among these applications, two aspects are emphasised: (1) potential utility of the CAM for preclinical studies on vascular-disrupting agents (VDAs), promising for anti-cancer vascular-targeted therapy, and (2) modern imaging technologies, including modalities and their applications for real-time visualisation, monitoring and evaluation of the changes in CAM vasculature as well as the interactions occurring after introducing the tested medical, pharmaceutical and biological agents into the system. The aim of this article is to help those working in the biomedical field to familiarise themselves with the chick embryo CAM as an alternative platform and to utilise it to design and optimise experimental settings for their specific research topics.

Laser Doppler Spectrum Analysis Based on Calculation of Cumulative Sums Detects Changes in Skin Capillary Blood Flow in Type 2 Diabetes Melitus

In this article, we introduce a new method of signal processing and data analysis for the digital laser Doppler flowmetry. Our approach is based on the calculation of cumulative sums over the registered Doppler power spectra. The introduced new parameter represents an integral estimation for the redistribution of moving red blood cells over the range of speed. The prototype of the device implementing the technique is developed and tested in preliminary clinical trials. The methodology was verified with the involvement of two age groups of healthy volunteers and in a group of patients with type 2 diabetes mellitus. The main practical result of the study is the development of a set of binary linear classifiers that allow the method to identify typical patterns of the microcirculation for the healthy volunteers and diabetic patients based on the presented diagnostic algorithm.

Low-Level Laser Therapy for Diabetic Dermopathy in Patients With Type 2 Diabetes: A Placebo-Controlled Pilot Study

Introduction: Diabetic dermopathy (DD) is the most common cutaneous diabetes marker. Few studies have targeted DD using low-level laser therapy (LLLT). This pilot study aimed to evaluate the effect of LLLT on DD in patients with type 2 diabetes (T2D). Methods: 12 patients with T2D (9 men, 3 women) and bilateral DD were enrolled in this placebo controlled pilot study, and their ages ranged 50-65 years. One side was subjected to LLLT, three sessions weekly for one month (LLLT side), while the other side received the same treatment protocol with a laser device switched off as a placebo (placebo side). All patients were instructed to receive skincare for both sides, such as debridement, antibiotic creams, and dressings with betadine solution. The diameter of DD lesion and the cutaneous blood flow of the knees and ankles sites were assessed before and after one month at the end of the intervention. Results: At the baseline, no significant differences existed between LLLT and placebo sides in the DD and skin blood flow at the knee and ankle sites (P >0.05). Post-intervention, a significant improvement occurred in DD diameter and the skin blood flow of the knee and ankle sites in the LLLT side (P <0.05), while the placebo side showed a significant improvement only in DD diameter (P <0.05) and non-significant changes in skin blood flow (P >0.05). Comparing both sides, all measures significantly favored LLLT. Conclusion: The findings of this study indicate that LLLT has beneficial effects on decreasing DD in T2D patients. Also, it was approved that the short term of LLLT is a safe modality to control DD in T2D patients.

Target delivery of drug carriers in mice kidney glomeruli via renal artery. Balance between efficiency and safety

Targeting drug delivery systems is crucial to reducing the side effects of therapy. However, many of them are lacking effectiveness for kidney targeting, due to systemic dispersion and accumulation in the lungs and liver after intravenous administration. Renal artery administration of carriers provides their effective local accumulation but may cause irreversible vessel blockage. Therefore, the combination of the correct administration procedure, suitable drug delivery system, selection of effective and safe dosage is the key to sparing local therapy. Here, we propose the 3-μm sized fluorescent capsules based on poly-L-arginine and dextran sulfate for targeting the kidney via a mice renal artery. Hemodynamic study of the target kidney in combination with the histological analysis reveals a safe dose of microcapsules (20 × 10⁶), which has not lead to irreversible pathological changes in blood flow and kidney tissue, and provides retention of 20.5 ± 3% of the introduced capsules in the renal cortex glomeruli. Efficacy of fluorescent dye localization in the target kidney after intra-arterial administration is 9 times higher than in the opposite kidney and after intravenous injection. After 24 h microcapsules are not observed in the target kidney when the safe dose of carriers is being used but a high level of fluorescent signal persists for 48 h indicating that fluorescent cargo accumulation in tissues. Injection of non-safe microcapsule dose leads to carriers staying in glomeruli for at least 48 h which has consequences of blood flow not being restored and tissue damage being observed in histology.

Autoencoder based blind source separation for photoacoustic resolution enhancement

Photoacoustics is a promising technique for in-depth imaging of biological tissues. However, the lateral resolution of photoacoustic imaging is limited by size of the optical excitation spot, and therefore by light diffraction and scattering. Several super-resolution approaches, among which methods based on localization of labels and particles, have been suggested, presenting promising but limited solutions. This work demonstrates a novel concept for extended-resolution imaging based on separation and localization of multiple sub-pixel absorbers, each characterized by a distinct acoustic response. Sparse autoencoder algorithm is used to blindly decompose the acoustic signal into its various sources and resolve sub-pixel features. This method can be used independently or as a combination with other super-resolution techniques to gain further resolution enhancement and may also be extended to other imaging schemes. In this paper, the general idea is presented in details and experimentally demonstrated.

Real-time video-rate perfusion imaging using multi-exposure laser speckle contrast imaging and machine learning

SIGNIFICANCE

Multi-exposure laser speckle contrast imaging (MELSCI) estimates microcirculatory blood perfusion more accurately than single-exposure LSCI. However, the technique has been hampered by technical limitations due to massive data throughput requirements and nonlinear inverse search algorithms, limiting it to an offline technique where data must be postprocessed.

AIM

To present an MELSCI system capable of continuous acquisition and processing of MELSCI data, enabling real-time video-rate perfusion imaging with high accuracy.

APPROACH

The MELSCI algorithm was implemented in programmable hardware (field programmable gate array) closely interfaced to a high-speed CMOS sensor for real-time calculation. Perfusion images were estimated in real-time from the MELSCI data using an artificial neural network trained on simulated data. The MELSCI perfusion was compared to two existing single-exposure metrics both quantitatively in a controlled phantom experiment and qualitatively in vivo.

RESULTS

The MELSCI perfusion shows higher signal dynamics compared to both single-exposure metrics, both spatially and temporally where heartbeat-related variations are resolved in much greater detail. The MELSCI perfusion is less susceptible to measurement noise and is more linear with respect to laser Doppler perfusion in the phantom experiment (R2  =  0.992).

CONCLUSIONS

The presented MELSCI system allows for real-time acquisition and calculation of high-quality perfusion at 15.6 frames per second.

Dynamic light scattering imaging

We introduce dynamic light scattering imaging (DLSI) to enable the wide-field measurement of the speckle temporal intensity autocorrelation function. DLSI uses the full temporal sampling of speckle fluctuations and a comprehensive model to identify the dynamic scattering regime and obtain a quantitative image of the scatterer dynamics. It reveals errors in the traditional theory of laser Doppler flowmetry and laser speckle contrast imaging and provides guidance on the best model to use in cerebral blood flow imaging.

Optical flow optical coherence tomography for determining accurate velocity fields

Determining micron-scale fluid flow velocities using optical coherence tomography (OCT) is important in both biomedical research and clinical diagnosis. Numerous methods have been explored to quantify the flow information, which can be divided into either phase-based or amplitude-based methods. However, phase-based methods, such as Doppler methods, are less sensitive to transverse velocity components and suffer from wrapped phase and phase instability problems for axial velocity components. On the other hand, amplitude-based methods, such as speckle variance OCT, correlation mapping OCT and split-spectrum amplitude-decorrelation angiography, focus more on segmenting flow areas than quantifying flow velocities. In this paper, we propose optical flow OCT (OFOCT) to quantify accurate velocity fields. The equivalence between optical flow and real velocity fields is validated in OCT imaging. The sensitivity fall-off of a Fourier-domain OCT (FDOCT) system is considered in the modified optical flow continuity constraint. Spatial-temporal smoothness constraints are used to make the optical flow problem well-posed and reduce noises in the velocity fields. An iteration solution to the optical flow problem is implemented in a graphics processing unit (GPU) for real-time processing. The accuracy of the velocity fields is verified through phantom flow experiments by using a diluted milk powder solution as a scattering medium. Velocity fields are then used to detect flow turbulence and reconstruct flow trajectory. The results show that OFOCT is accurate in determining velocity fields and applicable to research concerning fluid dynamics.

Characterization of continuous wave ultrasound for acousto-optic modulated diffuse correlation spectroscopy (AOM-DCS)

Intra and post-operative blood flow monitoring of tissue has been shown to be effective in the improvement of patient outcomes. Diffuse correlation spectroscopy (DCS) has been shown to be effective in measuring blood flow at the bedside, and is a useful technique in measuring cerebral blood flow (CBF) in many clinical settings. However, DCS suffers from reduced sensitivity to blood flow changes at larger tissue depths, making measurements of CBF in adults difficult. This issue can be addressed with acousto-optic modulated diffuse correlation spectroscopy (AOM-DCS), which is a hybrid technique that combines the sensitivity of DCS to blood flow with ultrasound resolution to allow for improved spatial resolution of the optical signal based on knowledge of the area which is insonified by ultrasound. We present a quantitative model for perfusion estimation based on AOM-DCS in the presence of continuous wave ultrasound, supported by theoretical derivations, Monte Carlo simulations, and phantom and human subject experiments. Quantification of the influence of individual mechanisms that contribute to the temporal fluctuations of the optical intensity due to ultrasound is shown to agree with previously derived results. By using this model, the recovery of blood-flow induced scatterer dynamics based on ultrasound-modulated light is shown to deviate by less than one percent from the standard DCS measurement of scatterer dynamics over a range of optical scattering values and scatterer motion conditions. This work provides an important step towards future implementation of AOM-DCS setups with more complex spatio-temporal distributions of ultrasound pressure, which are needed to enhance the DCS spatial resolution.

Environmental enrichment enhances post-ischemic cerebral blood flow and functional hyperemia in the ipsilesional somatosensory cortex

Environmental enrichment has been reported to promote functional recovery in an ischemic stroke. However, the underlying mechanism remains unclear. This study aimed to investigate the effect of environmental enrichment treatment on post-ischemic cerebral blood flow and functional hyperemia in the ipsilesional primary somatosensory cortex of rats. With laser speckle imaging, we were able to monitor the resting cerebral blood flow alteration in the middle cerebral artery occlusion model. Both 3- and 28-day post-ischemic infarct volumes were then examined with triphenyltetrazolium chloride and cresyl violet staining, respectively. We found that an exposure to environmental enrichment was associated with higher post-ischemic cerebral blood flow and less brain tissue loss in the ipsilesional primary somatosensory cortex compared with the standard cage environment. Furthermore, environmental enrichment also enhanced the cerebral blood flow response to whisker stimulation in the ipsilesional barrel cortex when measured 28 days after the middle cerebral artery occlusion. Together, the data suggested that an exposure to environmental enrichment promoted the restoration of cerebral blood flow in the ipsilesional cortex and contributed to a better coupling between functional activation and cerebral blood flow change, which might be the possible mechanisms underlying the neuroprotective effects of EE after ischemia.

Validating a low-cost laser speckle contrast imaging system as a quantitative tool for assessing retinal vascular function

The ability to monitor progression of retinal vascular diseases like diabetic retinopathy in small animal models is often complicated by their failure to develop the end-stage complications which characterize the human phenotypes in disease. Interestingly, as micro-vascular dysfunction typically precedes the onset of retinal vascular and even some neurodegenerative diseases, the ability to visualize and quantify hemodynamic changes (e.g. decreased flow or occlusion) in retinal vessels may serve as a useful diagnostic indicator of disease progression and as a therapeutic outcome measure in response to treatment. Nevertheless, the ability to precisely and accurately quantify retinal hemodynamics remains an unmet challenge in ophthalmic research. Herein we demonstrate the ability to modify a commercial fundus camera into a low-cost laser speckle contrast imaging (LSCI) system for contrast-free and non-invasive quantification of relative changes to retinal hemodynamics over a wide field-of-view in a rodent model.

Beyond diffuse correlations: deciphering random flow in time-of-flight resolved light dynamics

Diffusing wave spectroscopy (DWS) and diffuse correlation spectroscopy (DCS) can assess blood flow index (BFI) of biological tissue with multiply scattered light. Though the main biological function of red blood cells (RBCs) is advection, in DWS/DCS, RBCs are assumed to undergo Brownian motion. To explain this discrepancy, we critically examine the cumulant approximation, a major assumption in DWS/DCS. We present a precise criterion for validity of the cumulant approximation, and in realistic tissue models, identify conditions that invalidate it. We show that, in physiologically relevant scenarios, the first cumulant term for random flow and second cumulant term for Brownian motion alone can cancel each other. In such circumstances, assuming pure Brownian motion of RBCs and the first cumulant approximation, a routine practice in DWS/DCS of BFI, can yield good agreement with data, but only because errors due to two incorrect assumptions cancel out. We conclude that correctly assessing random flow from scattered light dynamics requires going beyond the cumulant approximation and propose a more accurate model to do so.

Measuring cell displacements in opaque tissues: dynamic light scattering in the multiple scattering regime

Coherent light scattered by tissues brings structural and dynamic information, at depth, that standard imaging techniques cannot reach. Dynamics of cells or sub-cellular elements can be measured thanks to dynamic light scattering in thin samples (single scattering regime) or thanks to diffusive wave spectroscopy in thick samples (diffusion regime). Here, we address the intermediate regime and provide an analytical relationship between scattered light fluctuations and the distribution of cell displacements as a function of time. We illustrate our method by characterizing cell motility inside half millimeter thick multicellular aggregates.

Compact and self-aligned fluid refractometer based on the Doppler-induced self-mixing effect

The refractive index is one of the key parameters in non-invasive and label-free sensing applications. The past decade has witnessed various miniature optofluidic devices that offer several analytical functions with minuscule samples (picoliter or nanoliter) through the fusion of optics and microfluidic sciences. However, the realization of a compact, wide-range, and less-expensive refractometer is still a great challenge. In this paper, the authors have proposed a novel, to the best of our knowledge, self-mixing optical feedback interferometry (SM-OFI)-based refractometer that correlates the refractive index of a flowing liquid to the induced Doppler frequency shift. The proposed method was experimentally tested on the saline water and benzyl chloride and found close agreement with the literature results. The refractive indices of the saline water and benzyl chloride were measured to be 1.3346 and 1.54079, respectively, with a standard deviation of the order of 10^-5. The induced Doppler shift was linearly increased with the concentration of the liquid during the concentration profiling. Hence, the proposed method was also capable to profile the liquid concentration. The well-known compatibility and cost-effectiveness of the SM-OFI setup also support the proposed method for miniature applications. The compactness and the portability of the experimental setup also make it compatible in areas of application where the size of the analytical section is a decisive parameter, such as biosensors, particle manipulators, chemically active devices, lab-on-chip instruments, etc.

Measurement and visualization of stimulus-evoked tissue dynamics in mouse barrel cortex using phase-sensitive optical coherence tomography

We describe a method to measure tissue dynamics in mouse barrel cortex during functional activation via phase-sensitive optical coherence tomography (PhS-OCT). The method measures the phase changes in OCT signals, which are induced by the tissue volume change, upon which to localize the activated tissue region. Phase unwrapping, compensation and normalization are applied to increase the dynamic range of the OCT phase detection. To guide the OCT scanning, intrinsic optical signal imaging (IOSI) system equipped with a green light laser source (532 nm) is integrated with the PhS-OCT system to provide a full field time-lapsed images of the reflectance that is used to identify the transversal 2D localized tissue response in the mouse brain. The OCT results show a localized decrease in the OCT phase signal in the activated region of the mouse brain tissue. The decrease in the phase signal may be originated from the brain tissue compression caused by the vasodilatation in the activated region. The activated region revealed in the cross-sectional OCT image is consistent with that identified by the IOSI imaging, indicating the phase change in the OCT signals may associate with the changes in the corresponding hemodynamics. In vivo localized tissue dynamics in the barrel cortex at depth during whisker stimulation is observed and monitored in this study.

Time-of-flight resolved light field fluctuations reveal deep human tissue physiology

Red blood cells (RBCs) transport oxygen to tissues and remove carbon dioxide. Diffuse optical flowmetry (DOF) assesses deep tissue RBC dynamics by measuring coherent fluctuations of multiply scattered near-infrared light intensity. While classical DOF measurements empirically correlate with blood flow, they remain far-removed from light scattering physics and difficult to interpret in layered media. To advance DOF measurements closer to the physics, here we introduce an interferometric technique, surmounting challenges of bulk motion to apply it in awake humans. We reveal two measurement dimensions: optical phase, and time-of-flight (TOF), the latter with 22 picosecond resolution. With this multidimensional data, we directly confirm the unordered, or Brownian, nature of optically probed RBC dynamics typically assumed in classical DOF. We illustrate how incorrect absorption assumptions, anisotropic RBC scattering, and layered tissues may confound classical DOF. By comparison, our direct method enables accurate and comprehensive assessment of blood flow dynamics in humans.

Potential of Laser Doppler Flowmetry in the Medical Needle Insertion Procedures

Medical needle insertion procedures possess the risk of life-threatening blood vessel rapture. Here we report a compact laser Doppler Flowmetry (LDF) based system that has a potential of blood vessel detection in the vicinity of the moving needle. The developed LDF system comprises two optical fibers inserted into the needle (the probe), a laser unit and a photodetector. The latter collects the signal produced by photons, scattered from the moving red blood cells that is further converted into perfusion value. Using LDF system, we have been able to detect the flow independently from the needle penetration angle, site or depth. Moreover, we showed that the blood vessel can be identified inside the tissue phantom while the probe is moving. Our results demonstrate that the developed LDF system is flexible and compatible with different types of needles and thus has a potential in the needle insertion procedures.

Laser speckle auto-inverse covariance imaging for mean-invariant estimation of blood flow

Laser speckle contrast imaging maps the changes in blood flow by estimating the decorrelation time of a scattered light field. However, speckle contrast is a biased statistics estimator that results in a theoretic bias between its expected value and the true value. Moreover, the average of speckle contrast depends on the statistical sampling size, which further hinders the estimation of decorrelation time from speckle contrast. Here, we present a new, to the best of our knowledge, unbiased statistics analysis based on auto-inverse covariance to improve the estimation of decorrelation time using laser speckle. Theoretical and experimental results demonstrate that the speckle auto-inverse covariance analysis is mean-invariant, so that the average of the estimation is not dependent on the sampling size. Furthermore, it can produce less statistical fluctuation, especially for slow flow, and consume less computation time than that of speckle contrast analysis.

Topological complexity of photons' paths in biological tissues

In the present contribution, three means of measuring the geometrical and topological complexity of photons' paths in random media are proposed. This is realized by investigating the behavior of the average crossing number, the mean writhe, and the minimal crossing number of photons' paths generated by Monte Carlo (MC) simulations, for different sets of optical parameters. It is observed that the complexity of the photons' paths increases for increasing light source/detector spacing, and that highly "knotted" paths are formed. Due to the particular rules utilized to generate the MC photons' paths, the present results may have an interest not only for the biomedical optics community, but also from a pure mathematical point of view.

Respiratory modulation of peripheral vasoconstriction: a modeling perspective

Although respiratory sinus arrhythmia and blood pressure variability have been investigated extensively, there have been far fewer studies of the respiratory modulation of peripheral blood flow in humans. Existing studies have been based primarily on noninvasive measurements using digit photoplethysmography and laser-Doppler flowmetry. The cumulative knowledge derived from these studies suggests that respiration can contribute to fluctuations in peripheral blood flow and volume through a combination of mechanical, hemodynamic, and neural mechanisms. However, the most convincing evidence suggests that the sympathetic nervous system plays the predominant role under normal, resting conditions. This mini-review provides a consolidation and interpretation of the key findings reported in this topical area. Given the need to extract dynamic information from noninvasive measurements under largely “closed-loop” conditions, we propose that the application of analytical tools based on systems theory and mathematical modeling can be of great utility in future studies. In particular, we present an example of how the transfer relation linking respiration to peripheral vascular conductance can be derived using measurements recorded during spontaneous breathing, spontaneous sighs, and ventilator-induced sighs.

High-density speckle contrast optical tomography of cerebral blood flow response to functional stimuli in the rodent brain

Noninvasive, three-dimensional, and longitudinal imaging of cerebral blood flow (CBF) in small animal models and ultimately in humans has implications for fundamental research and clinical applications. It enables the study of phenomena such as brain development and learning and the effects of pathologies, with a clear vision for translation to humans. Speckle contrast optical tomography (SCOT) is an emerging optical method that aims to achieve this goal by directly measuring three-dimensional blood flow maps in deep tissue with a relatively inexpensive and simple system. High-density SCOT is developed to follow CBF changes in response to somatosensory cortex stimulation. Measurements are carried out through the intact skull on the rat brain. SCOT is able to follow individual trials in each brain hemisphere, where signal averaging resulted in comparable, cortical images to those of functional magnetic resonance images in spatial extent, location, and depth. Sham stimuli are utilized to demonstrate that the observed response is indeed due to local changes in the brain induced by forepaw stimulation. In developing and demonstrating the method, algorithms and analysis methods are developed. The results pave the way for longitudinal, nondestructive imaging in preclinical rodent models that can readily be translated to the human brain.

Clinical applications of laser speckle contrast imaging: a review

When a biological tissue is illuminated with coherent light, an interference pattern will be formed at the detector, the so-called speckle pattern. Laser speckle contrast imaging (LSCI) is a technique based on the dynamic change in this backscattered light as a result of interaction with red blood cells. It can be used to visualize perfusion in various tissues and, even though this technique has been extensively described in the literature, the actual clinical implementation lags behind. We provide an overview of LSCI as a tool to image tissue perfusion. We present a brief introduction to the theory, review clinical studies from various medical fields, and discuss current limitations impeding clinical acceptance.

Robust quantitative single-exposure laser speckle imaging with true flow speckle contrast in the temporal and spatial domains

A systematic and robust laser speckle contrast imaging (LSCI) method and procedure is presented covering the LSCI system calibration, static scattering removal, and measurement noise estimation and correction to obtain a true flow speckle contrast K f 2 and the flow speed from single-exposure LSCI measurements. We advocate the use of K 2 as the speckle contrast instead of the conventional contrast K, as the former relates simply to the flow velocity and is with additive noise alone. We demonstrate the efficacy of the proposed true flow speckle contrast by imaging phantom flow at varying speeds, showing that (1) the proposed recipe greatly enhances the linear sensitivity of the flow index (inverse decorrelation time) and the linearity covers the full span of flow speeds from 0 to 40 mm/s; and (2) the true flow speed can be recovered regardless of the overlying static scattering layers and the type of speckle statistics (temporal or spatial). The fundamental difference between the apparent temporal and spatial speckle contrasts is further revealed. The flow index recovered in the spatial domain is much more susceptible to static scattering and exhibit a shorter linearity range than that obtained in the temporal domain. The proposed LSCI analysis framework paves the way to estimate the true flow speed in the wide array of laser speckle contrast imaging applications.

Assessment of cutaneous microcirculation by laser Doppler flowmetry in type 1 diabetes

BACKGROUND

The burden of type 1 diabetes (T1D) is growing worldwide, stressing the requirement to limit the threat of its long-term complications. In this regard, the development of methods for the early diagnosis and non-invasive monitoring of vascular abnormalities is widely recognized as one of the greatest priorities of the clinical research in this field.

OBJECTIVE

To assess the deterioration of physiological properties extracted from laser Doppler flowmetry (LDF) signals of microvascular perfusion and, secondly, to investigate their association with the quality of long-term metabolic control.

METHODS

Microvascular perfusion was recorded at the hallux of 63 control subjects and 47 T1D patients, whose glycaemic control was characterized in terms of the annual average levels of glycosylated haemoglobin (HbA1c). Pulse Decomposition Analysis was applied to the LDF data, in order to derive non-invasive markers of vascular stiffness based on a multi-Gaussian representation of the peripheral pulse waveforms; furthermore, wavelet transform analysis was used to evaluate the microvascular myogenic vasomotion and, finally, a physiological model of the reactive hyperaemia to a local thermal stimulus at 43 was used to test the integrity of the neurovascular pathways.

RESULTS

Compared to the control group, T1D patients showed a lower microvascular perfusion at baseline, and a larger vasodilatory reserve upon local heating, but no significant difference in myogenic activity. Moreover, the results of the PDA carried out on the LDF pulse waves, indicate the presence of a significant strong relation between large artery stiffness and the overall loss of glycaemic control over the past year.

Laser Doppler Flowmetry to Study the Regulation of Cerebral Blood Flow by G Protein-Coupled Receptors in Rodents

A large body of evidence suggests that G protein-coupled receptors (GPCRs) play an important role in the regulation of peripheral vascular reactivity. Meanwhile, the extent of GPCR influence on the regulation of brain vascular reactivity, or cerebral blood flow (CBF), has yet to be fully appreciated. This is of physiological importance as the modulation of CBF depends on an intricate interplay between neurons, astrocytes, pericytes, and endothelial cells, all of which partaking in the formation of a functional entity referred to as the neurovascular unit (NVU). The NVU is the anatomical substrate of neurovascular coupling (NVC) mechanisms, whereby increased neuronal activity leads to increased blood flow to accommodate energy, oxygen, and nutrients demands. In light of growing evidence showing impaired NVC in several neurological disorders, and the fact that GPCRs represent the most important targets of FDA-approved drugs, it is of utmost importance to use experimental approaches to study GPCR-induced regulation of NVC for the future development of pharmaceutical compounds that could normalize CBF function. Herein, we describe a minimally invasive approach called laser Doppler flowmetry (LDF) that, when used in combination with a whisker stimulation paradigm in rodents, allows gauging blood perfusion in activated cerebral cortex. We comprehensively explain the surgical procedure and data acquisition in mice, and discussed about important experimental considerations for the study of CBF regulation by GPCRs using pharmacological agents.

Continuous Blood Pressure Monitoring Algorithm using Laser Doppler Flowmetry

A novel machine learning algorithm is introduced to estimate continuous blood pressure monitoring using Laser Doppler Flowmetry (LDF). LDF provides instantaneous, continuous, and noninvasive measurements of blood flow in a small tissue sample. The proposed algorithm segments the continuous blood flow profile based on heartbeat cycles to subsequently extract multiple features. The beat-to-beat blood pressure was estimated from a multi-layer neural network algorithm using the extracted features. The algorithm was also validated with clinically proven cuff based continuous blood pressure sensors. Mean average error values of 4.54 \sim5.37 mmHg were observed, which conform to a Grade B/C category per the IEEE standard 1708-2014 for cuffless blood pressure measuring devices.

Assessing hyperthermia-induced vasodilation in human skin in vivo using optoacoustic mesoscopy

The aim of this study was to explore the unique imaging abilities of optoacoustic mesoscopy to visualize skin structures and microvasculature with the view of establishing a robust approach for monitoring heat-induced hyperemia in human skin in vivo. Using raster-scan optoacoustic mesoscopy (RSOM), we investigated whether optoacoustic (photoacoustic) mesoscopy can identify changes in skin response to local heating at microvasculature resolution in a cross-sectional fashion through skin in the human forearm. We visualized the heat-induced hyperemia for the first time with single-vessel resolution throughout the whole skin depth. We quantified changes in total blood volume in the skin and their correlation with local heating. In response to local heating, total blood volume increased 1.83- and 1.76-fold, respectively, in the volar and dorsal aspects of forearm skin. We demonstrate RSOM imaging of the dilation of individual vessels in the skin microvasculature, consistent with hyperemic response to heating at the skin surface. Our results demonstrate great potential of RSOM for elucidating the morphology, functional state and reactivity of dermal microvasculature, with implications for diagnostics and disease monitoring. Image: Cross-sectional view of skin microvasculature dilated in response to hyperthermia.

In vivo laser Doppler holography of the human retina

The eye offers a unique opportunity for the non-invasive exploration of cardiovascular diseases. Optical angiography in the retina requires sensitive measurements, which hinders conventional full-field laser Doppler imaging schemes. To overcome this limitation, we used digital holography to perform laser Doppler perfusion imaging of human retina with near-infrared light. Two imaging channels with a slow and a fast CMOS camera were used simultaneously for real-time narrowband measurements, and offline wideband measurements, respectively. The beat frequency spectrum of optical interferograms recorded with the fast (up to 75 kHz) CMOS camera was analyzed by short-time Fourier transformation. Power Doppler images drawn from the Doppler power spectrum density qualitatively revealed blood flow in retinal vessels over 512 × 512 pixels covering 2.4 × 2.4 mm² on the retina with a temporal resolution down to 1.6 ms. The sensitivity to lateral motion as well as the requirements in terms of sampling frequency are discussed.

False spectra formation in the differential two-channel scheme of the laser Doppler flowmeter

Noise in the differential two-channel scheme of a classic laser Doppler flowmetry (LDF) instrument was studied. Formation of false spectral components in the output signal due to beating of electrical signals in the differential amplifier was found out. The improved block-diagram of the flowmeter was developed allowing to reduce the noise.

Ultrasound-tagged near-infrared spectroscopy does not disclose absent cerebral circulation in brain-dead adults

BACKGROUND

Near-infrared spectroscopy, a non-invasive technique for monitoring cerebral oxygenation, is widely used, but its accuracy is questioned because of the possibility of extra-cranial contamination. Ultrasound-tagged near-infrared spectroscopy (UT-NIRS) has been proposed as an improvement over previous methods. We investigated UT-NIRS in healthy volunteers and in brain-dead patients.

METHODS

We studied 20 healthy volunteers and 20 brain-dead patients with two UT-NIRS devices, CerOx™ and c-FLOW™ (Ornim Medical, Kfar Saba, Israel), which measure cerebral flow index (CFI), a parameter related to changes in cerebral blood flow (CBF). Monitoring started after the patients had been declared brain dead for a median of 34 (range: 11-300) min. In 11 cases, we obtained further demonstration of absent CBF.

RESULTS

In healthy volunteers, CFI was markedly different in the two hemispheres in the same subject, with wide variability amongst subjects. In brain-dead patients (median age: 64 yr old, 45% female; 20% traumatic brain injury, 40% subarachnoid haemorrhage, and 40% intracranial haemorrhage), the median (inter-quartile range) CFI was 41 (36-47), significantly higher than in volunteers (33; 27-36).

CONCLUSIONS

In brain-dead patients, where CBF is absent, the UT-NIRS findings can indicate an apparently perfused brain. This might reflect an insufficient separation of signals from extra-cranial structures from a genuine appraisal of cerebral perfusion. For non-invasive assessment of CBF-related parameters, the near-infrared spectroscopy still needs substantial improvement.