Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov;10(11):2085-2097.
doi: 10.21037/qims-20-742.

Dynamic contrast-enhanced near-infrared spectroscopy using indocyanine green on moderate and severe traumatic brain injury: a prospective observational study

Mario Forcione  1   2 , Kamal Makram Yakoub  1 , Antonio Maria Chiarelli  3 , David Perpetuini  3 , Arcangelo Merla  3 , Rosa Sun  1 , Piotr Sawosz  4 , Antonio Belli  1   2 , David James Davies  1   2
Affiliations

Dynamic contrast-enhanced near-infrared spectroscopy using indocyanine green on moderate and severe traumatic brain injury: a prospective observational study

Mario Forcione et al. Quant Imaging Med Surg. 2020 Nov.

Abstract

Background: The care given to moderate and severe traumatic brain injury (TBI) patients may be hampered by the inability to tailor their treatments according to their neurological status. Contrast-enhanced near-infrared spectroscopy (NIRS) with indocyanine green (ICG) could be a suitable neuromonitoring tool.

Methods: Monitoring the effective attenuation coefficients (EAC), we compared the ICG kinetics between five TBI and five extracranial trauma patients, following a venous-injection of 5 mL of 1 mg/mL ICG, using two commercially available NIRS devices.

Results: A significantly slower passage of the dye through the brain of the TBI group was observed in two parameters related to the first ICG inflow into the brain (P=0.04; P=0.01). This is likely related to the reduction of cerebral perfusion following TBI. Significant changes in ICG optical properties minutes after injection (P=0.04) were registered. The acquisition of valid optical data in a clinical environment was challenging.

Conclusions: Future research should analyze abnormalities in the ICG kinetic following brain trauma, test how these values can enhance care in TBI, and adapt the current optical devices to clinical settings. Also, studies on the pattern in changes of ICG optical properties after venous injection can improve the accuracy of the values detected.

Keywords: Near-infrared spectroscopy (NIRS); blood-brain barrier (BBB); cerebral perfusion; indocyanine green (ICG); traumatic brain injury (TBI).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-742). The authors report grants from European Union Horizon 2020 Research and Innovation Program, and from Polish National Science Centre, during the conduct of the study. Ethical Statement: The study conforms to the Declaration of Helsinki (as revised in 2013) and was approved by East of England-Cambridge Central Research Ethics Board (Ref REC: 14/EE/0165; IRAS ID: 144979) and informed consent was taken from all the patients. Written informed consent was obtained from the patient for publication of this study and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Figures

Figure 1
Figure 1
Representation of the positions of the NIRO-200NX probes on a TBI patient’s forehead in ITU. A scale shows the distance in centimeters between one of the two probes and the patient’s nasion. TBI, traumatic brain injury; ITU, intensive therapy unit.
Figure 2
Figure 2
Examples of changes to the EAC evaluated with the (A) FD-NIRS ISS-OxiplexTSTM and the (B) CW-NIRS, NIRO-200NX. EAC, effective attenuation coefficient.
Figure 3
Figure 3
Example of a normalized (z-scored) EAC dynamic following ICG injection. Four parameters were extracted from each EAC curve: (A) width; (B) rate of early exponential increase; (C) rate of early exponential decay; and (D) rate of late linear decay. EAC, effective attenuation coefficient; ICG, indocyanine green.
Figure 4
Figure 4
Average of the normalized (z-scored) EAC curves in TBI and non-TBI patients. (A) Right channel, infrared light; (B) right channel, red light; (C) left channel, infrared light; and (D) left channel, red light. EAC, effective attenuation coefficient; TBI, traumatic brain injury.
Figure 5
Figure 5
Box-and-whisker plots of the different parameters for different combinations of channel locations (left and right), wavelengths (red and infrared) and groups (TBI and non-TBI patients). The EAC curve parameters evaluated were (A) width; (B) rate of exponential increase; (C) rate of early exponential decay; and (D) rate of late linear decay. EAC, effective attenuation coefficient; TBI, traumatic brain injury.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. James SL, Theadom A, Ellenbogen RG, Bannick MS, Montjoy-Venning W, Lucchesi LR, Abbasi N, Abdulkader R, Abraha HN, Adsuar JC, Afarideh M, Agrawal S, Ahmadi A, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akinyemi RO, Akseer N, Alahdab F, Alebel A, Alghnam SA, Ali BA, Alsharif U, Altirkawi K, Andrei CL, Anjomshoa M, Ansari H, Ansha MG, Antonio CAT, Appiah SCY, Ariani F, Asefa NG, Asgedom SW, Atique S, Awasthi A, Ayala Quintanilla BP, Ayuk TB, Azzopardi PS, Badali H, Badawi A, Balalla S, Banstola A, Barker-Collo SL, Bärnighausen TW, Bedi N, Behzadifar M, Behzadifar M, Bekele BB, Belachew AB, Belay YA, Bennett DA, Bensenor IM, Berhane A, Beuran M, Bhalla A, Bhaumik S, Bhutta ZA, Biadgo B, Biffino M, Bijani A, Bililign N, Birungi C, Boufous S, Brazinova A, Brown AW, Car M, Cárdenas R, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Catalá-López F, Chaiah Y, Champs AP, Chang JC, Choi JYJ, Christopher DJ, Cooper C, Crowe CS, Dandona L, Dandona R, Daryani A, Davitoiu DV, Degefa MG, Demoz GT, Deribe K, Djalalinia S, Do HP, Doku DT, Drake TM, Dubey M, Dubljanin E, El-Khatib Z, Ofori-Asenso R, Eskandarieh S, Esteghamati A, Esteghamati S, Faro A, Farzadfar F, Farzaei MH, Fereshtehnejad S-M, Fernandes E, Feyissa GT, Filip I, Fischer F, Fukumoto T, Ganji M, Gankpe FG, Gebre AK, Gebrehiwot TT, Gezae KE, Gopalkrishna G, Goulart AC, Haagsma JA, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Haro JM, Hassankhani H, Hassen HY, Havmoeller R, Hawley C, Hay SI, Hegazy MI, Hendrie D, Henok A, Hibstu DT, Hoffman HJ, Hole MK, Homaie Rad E, Hosseini SM, Hostiuc S, Hu G, Hussen MA, Ilesanmi OS, Irvani SSN, Jakovljevic M, Jayaraman S, Jha RP, Jonas JB, Jones KM, Jorjoran Shushtari Z, Jozwiak JJ, Jürisson M, Kabir A, Kahsay A, Kahssay M, Kalani R, Karch A, Kasaeian A, Kassa GM, Kassa TD, Kassa ZY, Kengne AP, Khader YS, Khafaie MA, Khalid N, Khalil I, Khan EA, Khan MS, Khang Y-H, Khazaie H, Khoja AT, Khubchandani J, Kiadaliri AA, Kim D, Kim Y-E, Kisa A, Koyanagi A, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Lalloo R, Lami FH, Lansingh VC, Laryea DO, Latifi A, Leshargie CT, Levi M, Li S, Liben ML, Lotufo PA, Lunevicius R, Mahotra NB, Majdan M, Majeed A, Malekzadeh R, Manda A-L, Mansournia MA, Massenburg BB, Mate KKV, Mehndiratta MM, Mehta V, Meles H, Melese A, Memiah PTN, Mendoza W, Mengistu G, Meretoja A, Meretoja TJ, Mestrovic T, Miazgowski T, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Moazen B, Mohammadi M, Molokhia M, Monasta L, Mondello S, Moosazadeh M, Moradi G, Moradi M, Moradi-Lakeh M, Moradinazar M, Morrison SD, Moschos MM, Mousavi SM, Murthy S, Musa KI, Mustafa G, Naghavi M, Naik G, Najafi F, Nangia V, Nascimento BR, Negoi I, Nguyen TH, Nichols E, Ningrum DNA, Nirayo YL, Nyasulu PS, Ogbo FA, Oh IH, Okoro A, Olagunju AT, Olagunju TO, Olivares PR, Otstavnov SS, Owolabi MO, P A M, Pakhale S, Pandey AR, Pesudovs K, Pinilla-Monsalve GD, Polinder S, Poustchi H, Prakash S, Qorbani M, Radfar A, Rafay A, Rafiei A, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MA, Rai RK, Rajati F, Ram U, Rawaf DL, Rawaf S, Reiner RC, Reis C, Renzaho AMN, Resnikoff S, Rezaei S, Rezaeian S, Roever L, Ronfani L, Roshandel G, Roy N, Ruhago GM, Saddik B, Safari H, Safiri S, Sahraian MA, Salamati P, Saldanha RdF, Samy AM, Sanabria J, Santos JV, Santric Milicevic MMM, Sartorius B, Satpathy M, Savuon K, Schneider IJC, Schwebel DC, Sepanlou SG, Shabaninejad H, Shaikh MAA, Shams-Beyranvand M, Sharif M, Sharif-Alhoseini M, Shariful Islam SM, She J, Sheikh A, Shen J, Sheth KN, Shibuya K, Shiferaw MS, Shigematsu M, Shiri R, Shiue I, Shoman H, Siabani S, Siddiqi TJ, Silva JP, Silveira DGA, Sinha DN, Smith M, Soares Filho AM, Sobhani S, Soofi M, Soriano JB, Soyiri IN, Stein DJ, Stokes MA, Sufiyan MaB, Sunguya BF, Sunshine JE, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Te Ao BJ, Tehrani-Banihashemi A, Tekle MG, Temsah MH, Temsah O, Topor-Madry R, Tortajada-Girbés M, Tran BX, Tran KB, Tudor Car L, Ukwaja KN, Ullah I, Usman MS, Uthman OA, Valdez PR, Vasankari TJ, Venketasubramanian N, Violante FS, Wagnew FWS, Waheed Y, Wang YP, Weldegwergs KG, Werdecker A, Wijeratne T, Winkler AS, Wyper GMA, Yano Y, Yaseri M, Yasin YJ, Ye P, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yost MG, Younis MZ, Yousefifard M, Yu C, Zaidi Z, Zaman SB, Zamani M, Zenebe ZM, Zodpey S, Feigin VL, Vos T, Murray CJL. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019;18:56-87. - PubMed
    1. Andrews PJ, Sinclair HL, Rodriguez A, Harris BA, Battison CG, Rhodes JK, Murray GD, Eurotherm Trial C. Hypothermia for Intracranial Hypertension after Traumatic Brain Injury. N Engl J Med 2015;373:2403-12. 10.1056/NEJMoa1507581 - DOI - PubMed
    1. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, Kossmann T, Ponsford J, Seppelt I, Reilly P, Wolfe R. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011;364:1493-502. 10.1056/NEJMoa1102077 - DOI - PubMed
    1. Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ, Collaborators RET. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. N Engl J Med 2016;375:1119-30. 10.1056/NEJMoa1605215 - DOI - PubMed
    1. Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J, Machamer J, Chaddock K, Celix JM, Cherner M, Hendrix T, Global Neurotrauma Research G. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012;367:2471-81. 10.1056/NEJMoa1207363 - DOI - PMC - PubMed