We have come a long way since Jöbsis first demonstrated that noninvasive cerebral monitoring was possible in humans within the near-infrared light window (approximately 700 to 1000 nm) in the late 1970s.¹ What started as a tool to quantify blood oxygenation in the brain has exploded into a whole field of study that aims to exploit this window to reveal a battery of information related to human brain physiology, including brain metabolism, blood flow, autoregulation, perfusion pressure, water concentration, light scattering, exogenous contrast agents, and more. In this text, we use the term “diffuse optics” to broadly describe any technique that employs a near-infrared light source and a photodetector to capture multiply scattered photons in the diffusion limit (i.e., in the limit wherein the absorption coefficient, ${\mu }_a$, is much less than the reduced scattering coefficient, ${\mu }_s^{\prime }$, and the source-detector separation is much greater than the photon mean free path). The term “diffuse” has historical connotations in the field and reflects how near-infrared photons propagate through biological tissue. However, it should be noted that this term is in no way associated with how the field/community is organized or conducts its science. On the contrary, the breadth and depth of the progress made in the field over the past decade could only be accomplished by a cohesive, focused, and tight-knit community of researchers!

Acute stroke is associated with high morbidity and mortality. In the last decades, new therapies have been investigated with the aim of improving clinical outcomes in the acute phase post stroke onset. However, despite such advances, a large number of patients do not demonstrate improvement, furthermore, some unfortunately deteriorate. Thus, there is a need for additional treatments targeted to the individual patient. A potential therapeutic target is interventions to optimize cerebral perfusion guided by cerebral hemodynamic parameters such as dynamic cerebral autoregulation (dCA). This narrative led to the development of the INFOMATAS (Identifying New targets FOr Management And Therapy in Acute Stroke) project, designed to foster interventions directed towards understanding and improving hemodynamic aspects of the cerebral circulation in acute cerebrovascular disease states. This comprehensive review aims to summarize relevant studies on assessing dCA in patients suffering acute ischemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage. The review will provide to the reader the most consistent findings, the inconsistent findings which still need to be explored further and discuss the main limitations of these studies. This will allow for the creation of a research agenda for the use of bedside dCA information for prognostication and targeted perfusion interventions.

Noncontact optical imaging of curved objects can result in strong artifacts due to the object’s shape, leading to curvature biased intensity distributions. This artifact can mask variations due to the object’s optical properties, and makes reconstruction of optical/physiological properties difficult. In this work we demonstrate a curvature correction method that removes this artifact and recovers the underlying data, without the necessity of measuring the object’s shape. This method is applicable to many optical imaging modalities that suffer from shape-based intensity biases. By separating the spatially varying data (e.g., physiological changes) from the background signal (dc component), we show that the curvature can be extracted by either averaging or fitting the rows and columns of the images. Numerical simulations show that our method is equivalent to directly removing the curvature, when the object’s shape is known, and accurately recovers the underlying data. Experiments on phantoms validate the numerical results and show that for a given image with 16.5% error due to curvature, the method reduces that error to 1.2%. Finally, diffuse multispectral images are acquired on forearms in vivo. We demonstrate the enhancement in image quality on intensity images, and consequently on reconstruction results of blood volume and oxygenation distributions.

Near-infrared spectroscopy (NIRS) is a developing technology for low-cost noninvasive functional brain imaging. With multichannel optical instruments, it becomes possible to measure not only local changes in hemoglobin concentrations but also temporal correlations of those changes in different brain regions which gives an optical analog of functional connectivity traditionally measured by fMRI. We recorded hemodynamic activity during the Go-NoGo task from 11 right-handed subjects with probes placed bilaterally over prefrontal areas. Subjects were detecting animals as targets in natural scenes pressing a mouse button. Data were low-pass filtered <1 Hz and cardiac/respiration/superficial layers artifacts were removed using Independent Component Analysis. Fisher's transformed correlations of poststimulus responses (30 s) were averaged over groups of channels unilaterally in each hemisphere (intrahemispheric connectivity) and the corresponding channels between hemispheres (interhemispheric connectivity). The hemodynamic response showed task-related activation (an increase/decrease in oxygenated/deoxygenated hemoglobin, respectively) greater in the right versus left hemisphere. Intra- and interhemispheric functional connectivity was also significantly stronger during the task compared to baseline. Functional connectivity between the inferior and the middle frontal regions was significantly stronger in the right hemisphere. Our results demonstrate that optical methods can be used to detect transient changes in functional connectivity during rapid cognitive processes.

Near-infrared spectroscopy is a novel imaging technique potentially sensitive to both brain hemodynamics (slow signal) and neuronal activity (fast optical signal, FOS). The big challenge of measuring FOS noninvasively lies in the presumably low signal-to-noise ratio. Thus, detectability of the FOS has been controversially discussed. We present reliable detection of FOS from 11 individuals concurrently with electroencephalogram (EEG) during a Go-NoGo task. Probes were placed bilaterally over prefrontal cortex. Independent component analysis (ICA) was used for artifact removal. Correlation coefficient in the best correlated FOS–EEG ICA pairs was highly significant (p < 10⁻⁸), and event-related optical signal (EROS) was found in all subjects. Several EROS components were similar to the event-related potential (ERP) components. The most robust “optical N200” at t = 225 ms coincided with the N200 ERP; both signals showed significant difference between targets and nontargets, and their timing correlated with subject's reaction time. Correlation between FOS and EEG even in single trials provides further evidence that at least some FOS components “reflect” electrical brain processes directly. The data provide evidence for the early involvement of prefrontal cortex in rapid object recognition. EROS is highly localized and can provide cost-effective imaging tools for cortical mapping of cognitive processes.

Intracranial pressure (ICP) is the pressure inside the skull.¹ Healthy ICP is maintained through a balance of cerebral blood volume, cerebrospinal fluid (CSF), and brain tissue.² Abnormal ICP occurs when an imbalance in one compartment outweighs the compensatory limits of the other two compartments, as explained by the Monro–Kellie doctrine.² An increase in ICP can stem from many issues, including brain bleeds, cerebral edema, a mass lesion such as a brain tumor, and others.¹