Serial Physiologic MRI in Minor Stroke with Large Vessel Occlusion

伴有大血管闭塞的小中风的系列生理 MRI

• 批准号: 10432419
• 负责人: JOHN A DETRE
• 金额: $ 24.38万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10432419
• 关键词: 3-Dimensional; Arteries; Blood Vessels; Blood flow; Brain; Caring; Catheters; Cerebrovascular Circulation; Characteristics; Clinical; Clinical Management; Clinical Trials; Coagulation Process; Conflict (Psychology); Data; Deterioration; Development; Diffusion; Diffusion Magnetic Resonance Imaging; Evolution; Excision; Exposure to; Functional Imaging; Future; Hour; Image; Infarction; Ischemic Penumbra; Ischemic Stroke; Knowledge; MRI Scans; Magnetic Resonance Imaging; Mechanics; Medicine; Metabolic; Metabolism; Methodology; Minor; Nature; Neurologic; Observational Study; Outcome; Oxygen; Patient Selection; Patient Triage; Patients; Perfusion; Phase; Physiological; Physiology; Play; Predictive Value; Protocols documentation; Research; Role; Scanning; Selection Bias; Serial Magnetic Resonance Imaging; Stroke; Symptoms; Testing; Thrombectomy; Time; Tissues; United States National Institutes of Health; X-Ray Computed Tomography; acute stroke; arterial spin labeling; base; clinical care; design; disability; early detection biomarkers; early experience; functional outcomes; hypoperfusion; improved; innovation; insight; novel; novel strategies; outcome prediction; patient population; patient stratification; perfusion imaging; predict clinical outcome; predictive marker; rate of change; stroke patient; stroke symptom; stroke therapy; tissue oxygenation

PROJECT SUMMARY Mechanical thrombectomy (MT) has revolutionized the treatment of stroke due to large vessel occlusion (LVO) in patients with moderate or severe stroke symptoms. However, clinical management remains controversial in LVO patients with relatively minor deficits because these patients were not well represented in the MT clinical trials. Up to one third of patients with LVO and minor deficits will experience early neurologic deterioration (END) which portends significant long-term disability. Observational studies, though conflicting and limited by selection bias, suggest that some of these patients may benefit from early MT, but it remains challenging to predict END and waiting for END to pursue MT has been associated with poor functional outcome. The development of predictive biomarkers for END represents a critical need for the optimization of MT therapy in patients with LVO and relatively mild clinical deficits. In moderate or severe stroke with LVO, contrast based perfusion imaging indicates the presence of an ischemic penumbra based on prolonged transit time, and has been crucial in optimizing patient selection and extending the time window for MT. However, the role of contrast based perfusion imaging is less clear in LVO patients with minor clinical deficits because prolonged transit time in this patient population does not reliably predict eventual infarction. Further, current imaging strategies are limited to a snapshot in time and thus fail to account for the dynamic nature of tissue physiology and function. END is a consequence of progressive loss of collateral blood flow supplying the ischemic penumbra, but the paucity of data on the early temporal evolution of the ischemic penumbra remains a key knowledge gap for predicting clinical outcomes such as END. This project will leverage the availability of research MRI within a new stroke and neurointensive care unit to characterize the temporal evolution of penumbral blood flow and oxygen metabolism in LVO patients with NIH stroke scale (NIHSS) < 6, within the first 24 hours of symptom onset. A unique aspect of this study will be the use of serial MRI scanning to quantify short-term changes in penumbral physiology. The scanning protocol will also leverage innovative MRI methodologies for noninvasively mapping cerebral blood flow and tissue oxygen extraction. We hypothesize that serial MRI will identify flow and metabolic deterioration in advance of clinical deterioration and with greater sensitivity than standard clinical single time point imaging. This exploratory R21 project will validate a novel imaging strategy, provide new insights into the evolution of the ischemic penumbra during the hyperacute phase of ischemic stroke, and provide critical data needed to design future studies using this approach to personalize clinical care of stroke patients with LVO and minor deficits.

项目摘要 机械血栓切除术（MT）彻底改变了由于大血管闭塞（LVO）引起的中风的处理 中度或重度中风症状的患者。但是，临床管理仍然存在争议 LVO患者相对较小，因为这些患者在MT临床中没有很好地代表 试验。多达三分之一的LVO和少量缺陷患者会出现早期神经系统恶化（END） 这预示着重大的长期残疾。观察性研究虽然相互矛盾，并且受到选择的限制 偏见，表明其中一些患者可能会从早期MT中受益，但预测结局仍然具有挑战性 等待最终追求MT与功能不良有关。发展的发展 末端的预测生物标志物代表了在LVO患者中优化MT治疗的关键需求 和相对温和的临床缺陷。 在使用LVO的中度或重度中，基于对比的灌注成像表明存在缺血性 基于长时间的过境时间的半月，对于优化患者选择和延长至关重要 MT的时间窗口。但是，在LVO患者中，基于对比的灌注成像的作用尚不清楚 较小的临床缺陷，因为该患者人群的长时间过境时间无法可靠地预测最终 梗塞。此外，当前的成像策略仅限于及时的快照，因此无法解决 组织生理和功能的动态性质。结束是副产品造成附带血液的结果 提供缺血性半体的流量，但缺血早期暂时进化的数据很少 Penumbra仍然是预测临床结果（例如结束）的关键知识差距。 该项目将利用新的中风和神经性护理部门内的研究MRI的可用性 表征NIH的LVO患者的半血流和氧代谢的时间演变 症状发作的前24小时内，中风量表（NIHSS）<6。这项研究的一个独特方面将是 使用串行MRI扫描来量化半月生理学的短期变化。扫描协议将 还利用创新的MRI方法论，用于非侵入性映射脑血流和组织氧气 萃取。我们假设串行MRI将在临床之前识别流动和代谢恶化 与标准临床单个时间点成像相比，恶化且灵敏度更高。此探索性R21 项目将验证一种新型的成像策略，为缺血性半阴茎的演变提供新的见解 在缺血性中风的超急性阶段，并提供了使用未来研究的关键数据 这种方法可以个性化患有LVO和小缺陷的中风患者的临床护理。