Diffuse optical imaging of intracranial pressure changes

颅内压变化的漫射光学成像

• 批准号: 6727377
• 负责人: GARY E STRANGMAN
• 金额: $ 21.63万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-15 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6727377
• 关键词: bioimaging /biomedical imaging; biomedical equipment development; brain imaging /visualization /scanning; brain injury; clinical research; diagnosis design /evaluation; hemodynamics; human subject; intracranial pressure; noninvasive diagnosis; optics; patient monitoring device

DESCRIPTION (provided by applicant): Elevated intracranial pressure (ICP) poses a significant risk in patients with traumatic brain injury, intracranial hemorrhage, massive stroke, and brain edema from multiple causes. Rises in ICP (i) can develop at any time following such conditions, (ii) often occur without clinical correlation (Matz and Pitts, 1997), and (iii) are associated with significant morbidity and mortality All three attributes make continuous monitoring an important goal in at-risk populations, resulting in tens of thousands of neurosurgical procedures performed per year for such monitoring (AANS, 1999). The standard means of monitoring such patients is ICP measurement involving an invasive, intracranial sensor. This approach provides a continuous, global pressure measurement. However permanent brain injury does not occur due to the pressure itself but due to the metabolic and structural consequences: impaired brain perfusion and tissue shifts. MRI and PET have identified regional ICP-related pathophysiology but only at single points in time. Intracerebral dialysis, oxygen and pH sensors have identified and monitored markers of insufficient perfusion but only at a point source. Critically, both pressure sensors and these imaging methods are costly--involving major surgery (including associated medical risks), or requiring expensive instrumentation. Diffuse optical imaging (DOI) is a potential major advance for patients with altered ICP. It is non-invasive and can be made an order of magnitude less expensive than current techniques. It is sensitive to the perfusion and oxygenation state of the brain--core concerns associated with ICP alterations--and it is an imaging technique that can be used in continuous, real-time, bedside settings. The goal of this exploratory/developmental (R21) research proposal, therefore, is to evaluate the feasibility of using DOI to perform brain imaging in altered ICP patients as a potential replacement for the existing, more expensive approaches. We will achieve this goal via two primary aims: (1) Evaluate the sensitivity and specificity of DOI-derived hemodynamic changes to ICP changes via recordings in neurointensive care patients before, during and after ICP interventions, and (2) Image the spatial components of hemodynamic modulations relative to CT-defined tissue status.

描述（由申请人提供）： 颅内压（ICP）升高对脑外伤、颅内出血、大面积中风和多种原因引起的脑水肿患者构成重大风险。 ICP 的升高 (i) 可能在此类情况发生后随时出现，(ii) 通常在没有临床相关性的情况下发生（Matz 和 Pitts，1997），以及 (iii) 与显着的发病率和死亡率相关 所有这三个属性使持续监测变得重要的目标，导致每年执行数以万计的神经外科手术进行此类监测（AANS，1999）。监测此类患者的标准方法是使用侵入性颅内传感器进行 ICP 测量。这种方法提供了连续的、全局的压力测量。然而，永久性脑损伤的发生并不是由于压力本身，而是由于代谢和结构后果：脑灌注受损和组织移位。 MRI 和 PET 已经确定了与 ICP 相关的局部病理生理学，但仅限于单个时间点。脑内透析、氧气和 pH 传感器已识别和监测灌注不足的标记，但仅限于点源。至关重要的是，压力传感器和这些成像方法都很昂贵——涉及大型手术（包括相关的医疗风险），或者需要昂贵的仪器。对于 ICP 改变的患者来说，漫反射光学成像 (DOI) 是一项潜在的重大进步。它是非侵入性的，并且可以比当前技术便宜一个数量级。它对大脑的灌注和氧合状态（与 ICP 改变相关的核心问题）敏感，并且它是一种可在连续、实时、床边设置中使用的成像技术。因此，这项探索性/开发性 (R21) 研究提案的目标是评估使用 DOI 对改变的 ICP 患者进行脑成像作为现有更昂贵方法的潜在替代方案的可行性。我们将通过两个主要目标来实现这一目标：(1) 通过神经重症监护患者在 ICP 干预之前、期间和之后的记录，评估 DOI 衍生的血流动力学变化对 ICP 变化的敏感性和特异性，以及 (2) 对与 CT 定义的组织状态相关的血流动力学调节。