The fast label-free detection of the extent and degree of cerebral ischemia has been the difficulty and hotspot for precise and accurate neurosurgery. We experimentally demonstrated that the fresh cerebral tissues at different ischemic stages within 24 hours can be well distinguished from the normal tissues using terahertz (THz) attenuated total reflection (ATR) imaging system. It was indicated that the total reflectivity of THz wave for ischemic cerebral tissues was lower than that for normal tissues. Especially, compared to the images stained with 2,3,5-triphenyl tetrazolium chloride (TTC), the ischemic tissues can be detected using THz wave with high sensitivity as early as the ischemic time of 2.5 hours, where THz images showed the ischemic areas became larger and diffused as the ischemic time increasing. Furthermore, the THz spectroscopy of cerebral ischemic tissues at different ischemic times was obtained in the range of 0.5-2.0 THz. The absorption coefficient of ischemic tissue increased with the increase of ischemic time, whereas the refractive index decreased with prolonging the ischemic time. Additionally, it was found from hematoxylin and eosin (H&E) staining microscopic images that, with the ischemic time increasing, the cell size and cell density of the ischemic tissues decreased, whereas the intercellular substance of the ischemic tissues increased. The result showed that THz recognition mechanism of the ischemia is mainly based on the increase of intercellular substance, especially water content, which has a stronger impact on absorption of THz wave than that of cell density. Thus, THz imaging has great potential for recognition of cerebral ischemia and it may become a new method for intraoperative real-time guidance, recognition in situ, and precise excision.
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