MRI Biomarkers in Acute Ischemic Stroke: A Conceptual Framework and Historical Analysis
MRI Biomarkers in Acute Ischemic Stroke: A Conceptual Framework and Historical Analysis
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DOI：
10.1161/strokeaha.111.626093
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发表时间：
2013-02-01
期刊：
影响因子：
8.3
通讯作者：
Kidwell, Chelsea S.
中科院分区：
文献类型：
--
作者：
Kidwell, Chelsea S.
在过去的20年里，先进的多模态成像为卒中研究者和临床医生提供了很多希望，特别是那些对利用成像优化和延长急性缺血性卒中治疗时间窗口感兴趣的人。多模态成像在急性脑卒中中有许多潜在的应用，例如：(1)确认急性脑缺血的诊断并排除治疗的禁忌症（例如，因出血性转化引起的急性血液[HT]）；(2)选择可能受益或不受益于治疗的患者（例如，通过表征核心不可逆损伤组织的程度，可挽救的半暗带或HT高风险标志物）；(3)作为检验假定治疗方法的替代或辅助结果指标。然而，先进的多模态成像作为一种选择方式来优化卒中新治疗方法的有效性和安全性，以及作为测试干预措施的替代终点，其前景尚未完全实现。这两种应用都使用神经成像作为生物标志物。对迄今为止进行的研究的成功和失误进行批判性分析，包括将动物模型转化为人类研究，可以为未来研究的设计提供宝贵的经验教训。将生物标志物的当前定义和标准应用于中风神经成像研究有助于为这一分析提供一个概念框架。
Over the past 2 decades, advanced multimodal imaging has offered much promise for stroke investigators and clinicians, particularly those interested in using imaging to optimize and extend the time window for acute ischemic stroke therapies. Multimodal imaging has many potential applications in the acute stroke setting, such as the following:(1) to confirm the diagnosis of acute cerebral ischemia and exclude contraindications to treatment (eg, acute blood because of hemorrhagic transformation [HT];(2) to select patients likely to benefit or not benefit from therapies (eg, by characterizing the extent of core irreversibly injured tissue, salvageable penumbra, or markers of high risk for HT); and (3) to serve as a surrogate or auxiliary outcome measure to test putative treatments.However, the promise of advanced multimodal imaging as a selection modality to optimize efficacy and safety of new treatments for stroke and also as a surrogate end point to test interventions has yet to be fully realized. Both of these applications use neuroimaging as a biomarker. A critical analysis of both the successes and missteps of studies performed to date, including translation of animal models to human studies, can provide valuable lessons that can be applied to the design of future studies. Applying current definitions and criteria for biomarkers to stroke neuroimaging research helps provide a conceptual framework for this analysis.