Mehrkanal-Nahinfrarotspektroskopie zur Charakterisierung der kortikalen Perfusion

Zusammenfassung

Die Nahinfrarotspektroskopie (NIRS) erlaubt unter anderem die nichtinvasive Bestimmung der kortikalen Konzentration von oxy- und deoxygeniertem Hämoglobin. Insbesondere moderne Mehrkanalsysteme werden daher alternativ zur funktionellen Kernspintomografie für die Darstellung aufgabenspezifischer Aktivierungsmuster des zerebralen Kortex genutzt. Durch eine Bolusapplikation fluoreszierender Farbstoffe als exogenes Kontrastmittel lassen sich allerdings auch hier perfusionsverwandte Parameter reproduzierbar bestimmen. Begünstigt wird dies durch das hohe zeitliche Auflösungsvermögen der Nahinfrarotspektroskopie im Vergleich zu klassischen Schnittbildverfahren. In dieser NIRS-Studie erfolgte nach Bolusapplikation von Indocyaningrün die Bestimmung der Time-to-peak (TTP) bei jeweils 10 gesunden Probanden und Patienten mit einer einseitigen hochgradigen Stenose bzw. segmentalem Verschluss der A. cerebri media. In der Patientengruppe zeigte sich auf der erkrankten Seite in 9 der 10 Fälle eine TTP-Verlängerung, die für die gesamte Gruppe im Mittel 0,44 s betrug. In der Kontrollgruppe fand sich ein mittlerer Seitenunterschied von 0,12 s bei statistisch signifikanter Reproduzierbarkeit der Ergebnisse in 2 aufeinander Zusammen folgenden Messungen. Die lineare Korrelation zu TTP-Werten, die für einen Patienten zusätzlich durch MRT-Perfusionsbildgebung bestimmt wurden, betrug 0,61 (p<0,001). Darüber hinaus fand sich ein statistisch signifikanter Zusammenhang zwischen der distal des Strömungshindernisses duplexsonografisch gemessenen reziproken Strömungsgeschwindigkeit und der durch ­Nahinfrarotspektroskopie bestimmten mittleren TTP im zentralen Stromgebiet der A. cerebrimedia (r=0,81, p=0,042). Die Ergebnisse der vorliegenden Studie lassen annehmen, dass die Mehrkanal-Nahinfrarotspektroskopie sensitiv ist für Veränderungen der kortikalen Perfusion, wie sie z. B. infolge einer Stenose oder Okklusion einer hirnzuführenden Arterie auftreten können. Das Verfahren stellt unter Umständen eine weitere Möglichkeit zur klinischen Evaluation betroffener Patienten dar.

Abstract

Near-infrared spectroscopy (NIRS) allows the cortical concentrations of oxy- and deoxygenated haemoglobin to be determined in a non-invasive fashion. Therefore modern multi-channel systems provide an alternative to functional magnetic resonance imaging for assessing task-related cortical patterns of activation. Moreover, here too bolus administration of exogenous contrast media facilitates the measurement of perfusion-related parameters. Sampling rates of up to 10 Hz provide a temporal accuracy that is difficult to achieve by the use of tomographic imaging modalities. In the present study time-to-peak (TTP) maps were acquired by multi-channel near-infrared spectroscopy after bolus administration of indocyanine green in 10 healthy controls and 10 patients suffering from unilateral sev­ere stenosis or occlusion of the middle cerebral artery. In 9 of these patients TTP was increased on the affected hemisphere. Mean difference in TTP between affected and unaffected hemisphere was 0.44 s (p<0.05) as compared to a mean lateral difference of 0.12 s found in the controls. A linear correlation of 0.61 between TTP values determined by NIRS and dynamic susceptibility MRI in one patient was found to be statistically significant (p<0.001). Furthermore, a statistically significant correlation between reciprocal post-stenotic flow velocity, as determined by transcranial duplex sonography, and NIRS-TTP in the core distribution of the middle cerebral artery could be established (r=0.81, p=0.042). The results of our study suggest that multi-channel near-infrared spectroscopy is sensitive to changes in cortical perfusion as found, e. g., in stenosis or occlusion of cerebral arteries. This technique might therefore provide clinical benefit in monitoring patients suffering from cerebrovascular disease.

Schlüsselwörter

kortikale Perfusion - Hämodynamik - Nahinfrarotspektroskopie - zerebrovaskuläre Erkrankung - A. cerebri media

Key words

cortical perfusion - haemodynamics - near-infrared spectroscopy - steno-occlusive disease - middle cerebral artery

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