Elsevier

The Lancet

Volume 342, Issue 8884, 4 December 1993, Page 1425
The Lancet

Letters to the Editor
Estimation of cerebral blood flow with near infrared spectroscopy and indocyanine green

https://doi.org/10.1016/0140-6736(93)92786-SGet rights and content

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    But for patients with brain damage or other diseases which are vulnerable to O2 desaturation, cerebral hemodynamics may react imprecisely on changes in inspired HbO2 [11,12]. As a safety and reliable dye indicator with very few side effects for cardiac output measurements and hepatic functional reserve analysis [13], indocyanine green (ICG), which is given as a percutaneous intravenous injection with a very low retention rate in body and partially across the blood brain barrier (BBB) [14], is applied to evaluate cerebral oxygen and blood delivery with NIRS [15,16]. There are some ways to implement hemodynamics measurement micro-invasively or noninvasively by using NIRS and ICG.

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    CBF measurement using ICG, instead of oxygenated Hb has been reported [45,46]. Roberts et al. applied this method for quantitative measurement during neonatal thoracotomy: changes in ICG level in exposed blood vessels and the head were simultaneously measured to evaluate CBF [47]. They observed a marked correlation between measurements using ICG and oxygenated Hb as a tracer [48].

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    Different algorithms have been proposed to yield a sensitive and reproducible detection of intracerebral tracer kinetics and to acquire a quantitative or semiquantitative measure of CBF by NIRS. Although various studies demonstrated feasibility and reproducibility of CBF measurements by the Fick principle,9,19 the derived data could not be correlated in a study with CBF values determined by the radioactive microsphere technique,21 the criterion standard for CBF measurements. BFI, a semiquantitative parameter derived from fluorescence flowmetry, was validated against radioactive microspheres in pigs,17 and its reproducibility has been demonstrated in several patient studies.5,12

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