Screening Technology and Outcomes Project in Stroke

中风筛查技术和结果项目

• 批准号: 6546064
• 负责人: Walter J. Koroshetz
• 金额: $ 55.95万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2006-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6546064
• 关键词: angiography; brain disorder diagnosis; brain imaging /visualization /scanning; clinical research; computed axial tomography; decision making; diagnosis design /evaluation; human subject; longitudinal human study; neuroimaging; outcomes research; patient oriented research; perfusion; prognosis; stroke

DESCRIPTION (after the Application): The proposed research is a four-year study of 600 ischemic stroke patients which is designed to evaluate the utility of new neuroimaging technology in the acute setting to improve prediction of stroke outcome. Currently, data from the standard imaging study, a non-contrast computed tomography (CT) scan of the brain, add little to clinical measures of stroke severity. In the majority of ischemic stroke cases, the study is normal. In contrast, functional stroke outcome varies dramatically among patients and is affected by the size, location and subtype of stroke. Prognosis is usually determined after diagnostic tests, including brain imaging, are performed over the course of the patient?s hospital stay. However, decisions regarding the risk/benefit profile of acute treatment options and resource allocation occur in the first hours after stroke. The costs of stroke, to the patient as well as to the healthcare system, are potentially modifiable if early diagnostic studies are able to predict outcome and directly impact on acute management. In a study that takes only minutes, new, ultra-fast multidector CT (MDCT) scanners enable the emergency evaluation of stroke patients, combining non-contrast brain computerized tomography (CT), computed tomographic angiography of the head and neck (CTA), and computed tomographic brain tissue perfusion (CTP). Coupled with careful clinical assessment, this "next generation" imaging technology has the potential to identify both the vascular cause of the stroke and the precise brain regions at risk, establishing the prognosis within an hour of the patient?s arrival in the emergency ward. The proposed research seeks to better define the characteristics affecting the clinical and financial costs of specific subtypes of strokes and to test this new imaging technology in the emergency setting for its ability to predict long term patient outcome. To this end, the applicant has developed three specific aims. First, investigators will determine the test performance characteristics (sensitivity, specificity) of acute ischemic stroke neuroimaging with MDCT in predicting those patients most likely to have poor outcome using the final clinical diagnosis based on the well known TOAST (Trial of Organon 10172 in Acute Stroke Treatment) criteria as the gold standard. Second, investigators will determine whether MDCT is superior to conventional non-contrast brain computerized tomography alone in predicting functional outcome from stroke. Third, a predictive model will be developed of stroke cost based on the contributions of subtype of strokes, treatments, co-morbidities, stroke size and location. The economic model will establish a means to measure the cost effectiveness of innovative stroke management, diagnostic testing, and therapies. This research will allow develop of economic models based on the costs and outcomes of different subtype of strokes. It will enable early prognostication of functional outcome, improving the clinician?s ability to make difficult treatment decisions in the hours after stroke onset, and serve as a guide for the allocation of health care resources.

描述(在申请之后)：这项拟议的研究是一项为期四年的研究，涉及600名缺血性中风患者，旨在评估新的神经成像技术在急性环境中的实用性，以改善对中风结果的预测。目前，来自标准成像研究的数据，即大脑的非对比CT扫描，增加的数据很少 到中风严重程度的临床测量。在大多数缺血性中风病例中，这项研究是正常的。相比之下，功能性中风的结局在不同患者之间差异很大，并受到中风的大小、位置和亚型的影响。预后通常是在患者S住院期间进行包括脑成像在内的诊断测试后确定的。 然而，关于急性治疗方案的风险/收益概况和资源分配的决定发生在中风后的头几个小时。如果早期诊断研究能够预测结果并直接影响急性治疗，那么中风对患者和医疗系统的成本可能是可以改变的。 在一项仅需几分钟的研究中，新型超高速多层螺旋CT(MDCT)扫描仪结合了非对比脑部CT(CT)、头颈部CT血管成像(CTA)和CT脑组织灌注(CTP)，能够对中风患者进行紧急评估。再加上仔细的临床评估，这是下一个 “一代”成像技术有可能识别中风的血管病因和精确的大脑危险区域，在患者到达急诊室一小时内确定预后--S。拟议的研究旨在更好地确定影响特定中风亚型的临床和经济成本的特征，并对此进行测试。 在紧急情况下的新成像技术，因为它能够预测患者的长期结果。为此，申请人制定了三个具体目标。首先，研究人员将确定急性缺血性中风的测试表现特征(敏感性、特异性) 以众所周知的TOAST(有机磷10172在急性卒中治疗中的试验)标准为金标准，用多层螺旋CT进行神经成像来预测那些最有可能有不良预后的患者。其次，研究人员将确定多层螺旋CT在预测预测方面是否优于传统的非对比脑层析成像。 卒中后的功能结局。第三，将根据卒中亚型、治疗方法、并存、卒中大小和位置的贡献，开发卒中成本预测模型。经济模型将建立一种方法来衡量创新的中风管理、诊断测试和治疗的成本效益。 这项研究将允许开发基于不同中风亚型的成本和结果的经济模型。它将使早期预测功能结果成为可能，提高临床医生S在卒中发病后数小时内做出困难治疗决策的能力，并对医疗资源的分配起到指导作用。