Oscillometric techniques are the established standard for non-invasively determining blood pressure. Several algorithms exist for translating oscillometric cardiac waveforms to blood pressure values. These algorithms utilize features of the oscillometric blood pressure waveform to extract systolic and diastolic pressures. Though validated empirically, these features remain contested and are somewhat detached from physiology. The accuracy of current algorithms therefore varies on a patient-to-patient basis and especially declines in non-normotensive patients. We propose an alternative technique based on the assertion that, during cuff deflation following arm occlusion, reperfusion begins when cuff pressure equals systolic pressure. This reperfusion process manifests in relative oxyhemoglobin changes (∆HbO). We measure these changes via near-infrared spectroscopy (NIRS) and show that they produce a more accurate estimate of systolic pressure than existing oscillometric methods.
SignificanceDiffuse correlation spectroscopy (DCS) is an optical method to measure relative changes in cerebral blood flow (rCBF) in the microvasculature. Each heartbeat generates a pulsatile signal with distinct morphological features that we hypothesized to be related to intracranial compliance (ICC).AimWe aim to study how three features of the pulsatile rCBF waveforms: the augmentation index (AIx), the pulsatility index, and the area under the curve, change with respect to ICC. We describe ICC as a combination of vascular compliance and extravascular compliance.ApproachSince patients with Chiari malformations (CM) (n=30) have been shown to have altered extravascular compliance, we compare the morphology of rCBF waveforms in CM patients with age-matched healthy control (n=30).ResultsAIx measured in the supine position was significantly less in patients with CM compared to healthy controls (p<0.05). Since physiologic aging also leads to changes in vessel stiffness and intravascular compliance, we evaluate how the rCBF waveform changes with respect to age and find that the AIx feature was strongly correlated with age (Rhealthy subjects=−0.63, Rpreoperative CM patient=−0.70, and Rpostoperative CM patients=−0.62, p<0.01).ConclusionsThese results suggest that the AIx measured in the cerebral microvasculature using DCS may be correlated to changes in ICC.
Cerebral autoregulation (CA) is a mechanism to maintain cerebral blood flow (CBF) in response to changes in cerebral perfusion pressure (CPP), through active vasoconstriction and vasodilation of arterioles in the brain. Dynamic CA is believed to act as a high-pass filter such that only low frequency changes in pressure are counteracted by an active vasculature response. With high frequency oscillations in pressure, such as those that occur at the heart rate (HR), the effects of dynamic CA are absent and changes in CPP are passively transmitted to CBF based on the cerebrovascular resistance (CVR) and compliance (CVC). These changes in CVR/CVC occur with steady-state changes in CA which can be described by Lassen’s curve. However, it is unclear what drives phase differences between pressure and flow at the respiration rate of around 0.2 Hz (12 breaths per minute). Quantifying phase differences at the physiologic respiration rate could be useful to gain a better understanding of the effects of CA and as a potential clinical monitoring tool. In this work, we looked at phase differences between arterial blood pressure (ABP) and intracranial pressure (ICP) measured with invasive pressure sensors, which serve as surrogates for CPP and CBF, to investigate how Arg(ABP)-Arg(ICP) change at the respiration rate as a function of the CPP. We quantify how Arg(ABP)-Arg(ICP) changes with respect to CPP after low-frequency oscillations, respiratory induced oscillations, and with oscillations driven by the heart rate. In each frequency regime, the trends in phase differences between Arg(ABP)-Arg(ICP) are unique with respect to CPP. At the respiration rate, the trends in Arg(ABP)-Arg(ICP) did not completely follow those predicted by a dynamic CA response or by CVC/CVR, thus we believe that there is a combination of effects influencing the phase difference between Arg(ABP)-Arg(ICP) at the respiration frequency. We also explore whether this response could be monitored completely non-invasively using near infrared spectroscopy (NIRS). We use Arg(ΔHbT)-Arg(ΔHbO) as surrogates for CPP and CBF and see a similar response of phase differences with respect to CPP at the respiration rate.
Intracranial pressure (ICP) measurements help monitor patient status following cerebral injury, and currently require implantation of an invasive pressure probe. The potential complications associated with this implantation have restricted the application of ICP measurements in less severe conditions. We propose a non-invasive alternative that derives features from the cardiac waveforms present in near-infrared spectroscopy (NIRS) measurements and inputs these features into a decision tree regressor to estimate ICP. We evaluated this method in nine subjects already fitted with invasive ICP sensors. The non-invasive nature of NIRS instrumentation eases the clinical adoption of this ICP estimation approach.
SignificanceCerebrovascular impedance (CVI) is related to cerebral autoregulation (CA), which is the mechanism of the brain to maintain near-constant cerebral blood flow (CBF) despite changes in cerebral perfusion pressure (CPP). Changes in blood vessel impedance enable the stabilization of blood flow. Due to the interplay between CVI and CA, assessment of CVI may enable quantification of CA and may serve as a biomarker for cerebral health.AimWe developed a method to quantify CVI based on a combination of diffuse correlation spectroscopy (DCS) and continuous wave (CW) near-infrared spectroscopy (NIRS). Data on healthy human volunteers were used to validate the method.ApproachA combined high-speed DCS-NIRS system was developed, allowing for simultaneous, noninvasive blood flow, and volume measurements in the same tissue compartment. Blood volume was used as a surrogate measurement for blood pressure and CVI was calculated as the spectral ratio of blood volume and blood flow changes. This technique was validated on six healthy human volunteers undergoing postural changes to elicit CVI changes.ResultsAveraged across the six subjects, a decrease in CVI was found for a head of bed (HOB) tilting of −40 deg. These impedance changes were reversed when returning to the horizontal (0 deg) HOB baseline.ConclusionsWe developed a combined DCS-NIRS system, which measures CBF and volume changes, which we demonstrate can be used to measure CVI. Using CVI as a metric of CA may be beneficial for assessing cerebral health, especially in patients where CPP is altered.
SignificanceIntracranial pressure (ICP) measurements are important for patient treatment but are invasive and prone to complications. Noninvasive ICP monitoring methods exist, but they suffer from poor accuracy, lack of generalizability, or high cost.AimWe previously showed that cerebral blood flow (CBF) cardiac waveforms measured with diffuse correlation spectroscopy can be used for noninvasive ICP monitoring. Here we extend the approach to cardiac waveforms measured with near-infrared spectroscopy (NIRS).ApproachChanges in hemoglobin concentrations were measured in eight nonhuman primates, in addition to invasive ICP, arterial blood pressure, and CBF changes. Features of average cardiac waveforms in hemoglobin and CBF signals were used to train a random forest (RF) regressor.ResultsThe RF regressor achieves a cross-validated ICP estimation of 0.937r2, 2.703-mmHg2 mean squared error (MSE), and 95% confidence interval (CI) of [ − 3.064 3.160 ] mmHg on oxyhemoglobin concentration changes; 0.946r2, 2.301-mmHg2 MSE, and 95% CI of [ − 2.841 2.866 ] mmHg on total hemoglobin concentration changes; and 0.963r2, 1.688 mmHg2 MSE, and 95% CI of [ − 2.450 2.397 ] mmHg on CBF changes.ConclusionsThis study provides a proof of concept for the use of NIRS in noninvasive ICP estimation.
Current standard-of-care methods for measuring intracranial pressure (ICP) are highly invasive. To overcome this limitation, we recently demonstrated non-invasive quantification of ICP in an animal model using morphological analysis of the pulsatile cerebral blood flow (CBF) measured with Diffuse Correlation Spectroscopy. Here, we present results from a pilot study in pediatric patients admitted to an intensive care unit. We show that the CBF pulsatile waveform changes with ICP. Using a regression forest-based machine learning algorithm on a cohort of patients (n>15) we demonstrate that ICP extraction in humans can be possible, suggesting the potential for successful clinical translation in future.
Vascular impedance is a frequency dependent quantity relating a vascular compartment's flow dynamics to pressure changes. Although vascular impedance has been investigated in larger arteries using Doppler ultrasound, probing the smaller microvasculature using similar techniques is difficult due to their small cross-sectional area. However, recent developments using diffuse optics have enabled the possibility of measuring blood flow and volume in arterioles and other microvasculature. This research presents a method to estimate the arteriole impedance non-invasively using diffuse correlation spectroscopy (DCS) as well as near-infrared spectroscopy (NIRS).
Significance: Longitudinal tracking of hemodynamic changes in the breast has shown potential for neoadjuvant chemotherapy (NAC) outcome prediction. Spatial frequency domain imaging (SFDI) could be suitable for frequent monitoring of shallow breast tumors, but strong sensitivity to superficial absorbers presents a challenge.
Aim: We investigated the efficacy of a two-layer SFDI inverse model that accounts for varying melanin concentration in the skin to improve discrimination of optical properties of deep tissue of the breast.
Approach: Hemodynamic changes in response to localized breast compression were measured in 13 healthy volunteers using a handheld SFDI device. Epidermis optical thickness was determined based on spectral fitting of the model output and used to calculate subcutaneous optical properties.
Results: Optical properties from a homogeneous model yielded physiologically unreasonable absorption and scattering coefficients for highly pigmented volunteers. The two-layer model compensated for the effect of melanin and yielded properties in the expected range for healthy breast. Extracted epidermal optical thickness was higher for higher Fitzpatrick types. Compression induced a decrease in total hemoglobin consistent with tissue blanching.
Conclusions: The handheld SFDI device and two-layer model show potential for imaging hemodynamic responses that potentially could help predict efficacy of NAC in patients of varying skin tones.
Vascular impedance is a frequency dependent quantity relating a vascular compartment's flow dynamics to pressure changes. Although vascular impedance has been investigated in larger arteries, probing smaller arterioles using similar techniques has been difficult due to their small cross-sectional area. Here we show how vascular impedance can be quantified based on pulsatile data from cerebral measurements using diffuse correlation spectroscopy (DCS) as well as near-infrared spectroscopy (NIRS). Results from head of bed tilting in healthy volunteers will be presented, showing that quantification of vascular impedance is possible. Applications and the relationship to cerebral autoregulation will be discussed.
Cerebrovascular Autoregulation failure is known to allow drastic changes in cerebral blood flow in cases of extreme Cerebral Perfusion Pressure (CPP) or Intracranial Pressure (ICP). Brain pathologies (such as traumatic brain injury, hydrocephalus, stroke, etc.) which alter CPP and ICP are also known to show impaired neurovascular coupling. We analyzed these characteristic changes in neurovascular coupling in a model to develop a non-invasive diagnostic marker of autoregulation failure using EEG, Near-Infrared Spectroscopy and Diffuse Correlation Spectroscopy.
Intracranial pressure (ICP) is an important metric in the management of severe head injury. We show alternatives to today’s standard of highly invasive measurement devices using near-infrared spectroscopy and diffuse correlation spectroscopy to create a real-time ICP monitor. The algorithms were developed and tested in an animal model. First results of a clinical validation will be presented.
Measuring intracranial pressure (ICP) is typically a highly invasive procedure, in which a ventricular catheter or pressure sensor is placed into the brain. To improve the availability of ICP measurements in non-intensive care patients and research and to reduce the invasiveness and underlying risks of ICP sensing, we developed a non-invasive method to measure ICP with Diffuse Correlation Spectroscopy (DCS) and machine learning. ICP baseline changes were induced in non-human primates (Macaca mulatta) through adjusting the height of a saline reservoir connected to the lateral ventricle via a catheter. ICP was precisely measured with an invasive parenchymal pressure sensor. Cerebral blood flow (CBF) was measured with DCS. The DCS system was operated by a software correlator able to resolve cardiac pulse waves at a sampling rate of 100Hz. To increase signal-to-noise ratio, multiple cardiac pulse waves in CBF were averaged based on systolic peak maximum in invasively measured arterial blood pressure. We hypothesized that the cerebral blood flow pulse waves will change their shape with increasing ICP. The shape of the curve was expressed in numerical features and passed into a regression forest training algorithm. Preliminary results show successful prediction of underlying ICP baselines by the decision forest in one animal. The prediction of non-invasive ICP was achieved with a sampling rate of 1 Hz, an equivalent of about 120 averaged pulses. A larger data set for increased generalizability is the next step to push this approach further.
Diffuse correlation spectroscopy (DCS) is an optical method for non-invasive measurements of blood flow in deep tissue microvasculature, such as the brain, without the need for tracers or ionizing radiation. The technique relies on determining temporal autocorrelations of light intensity fluctuations which arise due to time changing speckle patterns of moving scatterers when illuminated by a long coherence length laser. Measurements of blood flow using DCS have extensively been validated and have found some clinical translation already. High temporal resolution by fast sampling of the autocorrelation curves has recently been achieved by software based correlators. Here we demonstrate a new software correlator approach which uses components that are an order of magnitude cheaper than current approaches. We will present on the instrument design, as well as measurements of pulsatile blood flow on healthy volunteers. We will show blood flow measurements with a signal bandwidth of 50Hz and present on signal to noise ratios (SNR) of extracted pulse waveforms as a function of sampling rate. We will show how using an EKG based timing of the signal for averaging increases the fidelity of extracting the blood flow waveform even in low SNR environments. We will further present results of the pulsatile waveforms and the latency of the dicrotic notch as affected by posture changes in healthy volunteers.
During neoadjuvant chemotherapy for breast cancer, little information is available on the response or non-response of the tumor to the treatment. Pathologic complete response is correlated with survival, but patients and clinicians both must wait until after the patient undergoes surgery and the resected tissue is analyzed in order to assign pathologic response. Because structural imaging modalities and clinical palpation are poor predictors of pathologic response, there is need for an inexpensive imaging method which is sensitive to the changing physiology of the tumor. Such a method should be noninvasive, to permit frequent monitoring during therapy. Near-infrared optical imaging has already shown promise for monitoring neoadjuvant chemotherapy, with measurement of hemodynamics providing additional information over baseline chromophore concentrations. These contrasts rely on the highly vascularized nature of most breast tumors, as well as the abnormal vasculature, which can produce a different response to perturbations than healthy tissue. Here we describe the development of a new held-held spatial-frequency domain imaging (SFDI) device, to be used for measuring the response of breast tissue to local compression. Device design is described, as well as validation on optical phantoms, and in vivo. Compression studies were performed in soft optical phantoms containing stiff, tumor-mimicking inclusions, which indicate the potential for compression to be used to bring stiff lesions within a depth which can be measured with SFDI. Additionally, the hemodynamic response of pressure cuff venous occlusion is described, measured on the forearm, and this response is contrasted with the hemodynamic response to local tissue compression.
Guiding treatment in traumatic brain injury based on managing and optimizing cerebral perfusion pressure, which is the difference between mean arterial blood pressure and intracranial pressure (ICP), has been demonstrated to improve patient outcome. However, this requires ICP to be measured, which currently is only possible by placing pressure probes inside the brain. The feasibility of optical systems to measure ICP non-invasively has shown preliminary promising evidence of feasibility. To pursue the goal of non-invasive ICP acquisition further, an understanding of the influence of different pressure changes on the brain and their hemodynamic response is necessary. To investigate the frequency content of hemodynamic reactions to pressure changes in both ICP as well as arterial blood pressure (ABP), we induced changes of both pressures in non-human primates. We then demonstrate that ABP and ICP changes both influence cerebral blood flow and hemoglobin concentrations, measured with diffuse correlation spectroscopy (DCS) and near-infrared spectroscopy (NIRS), respectively. We found that the magnitude of induced oscillations is dependent on the frequency of the oscillation. Our data suggests, changes in ABP and ICP influence the hemodynamics differently, which we can use as a basis for non-invasive ICP measurements.
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