Abstract

Recently, conventional near infrared spectroscopy (NIRS) for oxymetry has been extended with an indocyanine green (ICG) dye dilution method which allows the estimation of cerebral blood flow (CBF) and cerebral blood volume (CBV). The signal obtained through the skull is substantially influenced by extracerebral tissue. In order to quantify and eliminate extracerebral contamination of the optical density signal we have applied two approaches. Firstly, we used spatially resolved spectroscopy (SRS) with a two receiver arrangement, with separations between emitter and two receivers in distances of d1=4.0cm and d2=6.5cm. The magnitude of the determined extracerebral contamination was verified with NIRS measurements in patients after brain herniation. Intracerebral circulatory arrest was confirmed by transcerebral Doppler examination. Secondly, Monte Carlo simulation was used to simulate the light propagation through the head to quantify the extracerebral contamination of the optical density signal of NIRS. The anatomical structure is determined from 3D-magnetic resonance imaging (MRI) using a voxel resolution of 0.8 x 0.8 x 0 .8 mm3 for three different pairs of T1/T2 values. We segment the MRI data to obtain a material matrix describing the composition of skin, skull, cerebral spinal fluid (CSF), grey and white matter. Each voxel in this material matrix characterizes the light absorption and dispersion coefficient of the identified material. This material matrix is applied in the Monte Carlo simulation. With SRS an extracerebral contamination of 65% of the optical density signal is extracted, while the Monte Carlo simulation results show that the extracerebral contamination decreases from 70% to 30% with increasing emitter-receiver distance. Differences between the NIRS ICG dye dilution technique and conventional NIRS oxymetry concerning the extracerebral contamination are discussed.

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