Paperdoi:10.3390/s25185654

In Vitro Evaluation of Confounders in Brain Optical Monitoring: A Review

Venue listed2025Added Nov 5, 2026

Authors: Karina Awad-Pérez, Maria Roldan, Panicos A. Kyriacou

Sensors

TL;DR

Optical brain monitoring techniques, including near-infrared spectroscopy (NIRS), diffuse correlation spectroscopy (DCS), and photoplethysmography (PPG) have gained attention for their non-invasive, affordable, and portable nature. These methods offer real-time insights into cerebral parameters like cerebral blood flow (CBF), intracranial pressure (ICP), and oxygenation. However, confounding factors like extracerebral layers, skin pigmentation, skull thickness, and brain-related pathologies may affect measurement accuracy.

  • Published in Sensors (2025).

Abstract

Optical brain monitoring techniques, including near-infrared spectroscopy (NIRS), diffuse correlation spectroscopy (DCS), and photoplethysmography (PPG) have gained attention for their non-invasive, affordable, and portable nature. These methods offer real-time insights into cerebral parameters like cerebral blood flow (CBF), intracranial pressure (ICP), and oxygenation. However, confounding factors like extracerebral layers, skin pigmentation, skull thickness, and brain-related pathologies may affect measurement accuracy. This review examines the potential impact of confounders, focusing on in vitro studies that use phantoms to simulate human head properties under controlled conditions. A systematic search identified six studies on extracerebral layers, two on skin pigmentation, two on skull thickness, and four on brain pathologies. While variation in phantom designs and optical devices limits comparability, findings suggest that the extracerebral layer and skull thickness influence measurement accuracy, and skin pigmentation introduces bias. Pathologies like oedema and haematomas affect the optical signal, though their influence on parameter estimation remains inconclusive. This review highlights limitations in current research and identifies areas for future investigation, including the need for improved brain phantoms capable of simulating pulsatile signals to assess the impact of confounders on PPG systems, given the growing interest in PPG-based cerebral monitoring. Addressing these challenges will improve the reliability of optical monitoring technologies.

Verbatim from the publisher's DOI record (opens in a new tab) · Publisher licence: https://creativecommons.org/licenses/by/4.0/

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Keywords

Kyriacou BibliographyBrain Monitoring Icp

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Awad-Pérez, K., Roldan, M., & Kyriacou, P. A. (2025). In Vitro Evaluation of Confounders in Brain Optical Monitoring: A Review. Sensors. https://doi.org/10.3390/s25185654
Awad-Pérez, Karina, Maria Roldan, and Panicos A. Kyriacou. 2025. "In Vitro Evaluation of Confounders in Brain Optical Monitoring: A Review." Sensors. https://doi.org/10.3390/s25185654.
Awad-Pérez, K., Roldan, M. and Kyriacou, P. A. (2025) 'In Vitro Evaluation of Confounders in Brain Optical Monitoring: A Review', Sensors. doi: 10.3390/s25185654.
Awad-Pérez, Karina, et al. "In Vitro Evaluation of Confounders in Brain Optical Monitoring: A Review." Sensors, 2025. https://doi.org/10.3390/s25185654.
K. Awad-Pérez, M. Roldan, and P. A. Kyriacou, "In Vitro Evaluation of Confounders in Brain Optical Monitoring: A Review," Sensors, 2025, doi: 10.3390/s25185654.
@article{awadperez2025vitro,
  title         = {{In Vitro Evaluation of Confounders in Brain Optical Monitoring: A Review}},
  author        = {Awad-Pérez, Karina and Roldan, Maria and Kyriacou, Panicos A.},
  year          = {2025},
  journal       = {Sensors},
  doi           = {10.3390/s25185654}
}

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