Middle cerebral artery stroke: Non-contrast MR screening of high-risk plaque

大脑中动脉卒中：高危斑块的非增强磁共振筛查

• 批准号: 8189471
• 负责人: CHUN YUAN
• 金额: $ 21.5万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8189471
• 关键词: Accounting; Address; Area; Arterial Fatty Streak; Arteries; Atherosclerosis; Biological Markers; Blood; Blood Vessels; Brain; Cardiac; Carotid Arteries; Carotid Artery Plaques; Carotid Endarterectomy; Cause of Death; Clinic; Clinical; Contralateral; Dependence; Detection; Development; Disease; Embolism; Gadolinium; Health Care Costs; Hemorrhage; Histology; Histopathology; Image; Imaging Techniques; Injection of therapeutic agent; Ipsilateral; Ischemic Stroke; Lateral; Lesion; Link; Lipids; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Measurement; Methods; Middle Cerebral Artery Infarction; Monitor; Morbidity - disease rate; Myocardial Infarction; Necrosis; Neurologic; Neurology; Patient Schedules; Patients; Performance; Prevalence; Protocols documentation; Recruitment Activity; Research; Scanning; Screening procedure; Sensitivity and Specificity; Services; Side; Source; Specimen; Stenosis; Stroke; Surface; Symptoms; Techniques; Testing; Thromboembolism; Thrombosis; Thrombus; Time; Translations; Universities; Vascular blood supply; Vasculitis; Washington; aortic arch; clinical decision-making; gadolinium oxide; high risk; imaging modality; improved; in vivo; middle cerebral artery; novel strategies; plaque lesion; skull base; treatment strategy

DESCRIPTION (provided by applicant): Thromboembolic phenomena arising from atherosclerotic plaque in large arteries supplying the brain through the Middle Cerebral Artery (MCA) are known to account for a quarter to one-third of ischemic MCA stroke despite being one of the most treatable causes of stroke. Beyond luminal stenosis measurement, detection of atherosclerotic plaque at high-risk for causing thromboembolism, is not a part of routine stroke workup. Current plaque Magnetic Resonance Imaging (MRI) protocols, though effective, are limited by long scan times, small coverage and dependence on gadolinium contrast. Translation of plaque MRI to the clinic requires fast, large coverage, non-contrast detection of high-risk plaque features using clinically available coils. Our objective is to develop time-efficient MRI screening for detection of high-risk atherosclerotic lesions in the region supplied by the MCA. To accomplish this we will develop MRI sequences to specifically identify the three main biomarkers linked with the development of neurological symptoms: 1) intra-plaque hemorrhage and thrombus, 2) large lipid-rich necrotic core and 3) disrupted luminal surface. These sequences will be optimized for fast screening of the entire carotid artery from the arch of aorta to the base of the skull. Protocol performance will be validated against histology in patients scheduled for carotid endarterectomy. The validated protocol will then be used to test the hypothesis that ischemic stroke in the MCA territory that is not lacunar or cardiac-origin is associated with an MRI visible high-risk lesion. By demonstrating a significantly higher number of high-risk lesions on the symptomatic side than the contra-lateral side, we aim to establish the importance of screening for high-risk plaque. Our study will help to establish the prevalence of high-risk plaque in stroke attributable to large-artery disease and demonstrate the feasibility of non-contrast plaque screening in the clinical setting. Clinical use of high-risk plaque imaging may improve treatment options for stroke patients with large-artery atherosclerosis. PUBLIC HEALTH RELEVANCE: One of the major causes of stroke, the third leading cause of death in the US, is atherosclerosis of the major arteries supplying blood to the brain. Despite research advances in this area, atherosclerotic plaques at high-risk for causing stroke are not screened for in clinical stroke imaging centers. A clinically applicable imaging method for identifying high-risk plaque is developed in this proposal which, will guide clinical decision making and improve treatment strategies for these stroke patients.

描述(申请人提供)：通过大脑中动脉(MCA)供应大脑的大动脉中的动脉粥样硬化斑块引起的血栓栓子现象已知占缺血性MCA中风的四分之一至三分之一，尽管它是中风最可治疗的原因之一。除了测量管腔狭窄，检测动脉粥样硬化斑块是导致血栓栓塞症的高危因素，不是常规卒中检查的一部分。目前的斑块磁共振成像(MRI)方案虽然有效，但受到扫描时间长、覆盖范围小和对Gd对比度的依赖的限制。将斑块MRI转移到临床需要使用临床可用的线圈快速、大覆盖、非对比检测高危斑块特征。我们的目标是开发时间效率高的MRI筛查，以检测MCA提供的区域内的高风险动脉粥样硬化病变。为了实现这一点，我们将开发MRI序列来具体识别与神经症状的发展相关的三个主要生物标志物：1)斑块内出血和血栓，2)大量富含脂质的坏死核心和3)管腔表面破坏。这些序列将被优化，用于快速筛查从主动脉弓到颅底的整个颈动脉。计划进行颈动脉内膜切除术的患者的方案性能将与组织学对照进行验证。经过验证的方案随后将用于测试假设，即MCA区域内非腔隙或心脏起源的缺血性中风与MRI可见的高风险损害有关。通过证明症状侧的高危病变数量明显高于对侧，我们的目的是确定筛查高危斑块的重要性。我们的研究将有助于确定大动脉疾病所致卒中高危斑块的患病率，并论证在临床环境下进行非对比斑块筛查的可行性。高危斑块成像的临床应用可能会改善伴有大动脉粥样硬化的中风患者的治疗选择。 公共卫生相关性：中风的主要原因之一是为大脑提供血液的主要动脉的动脉粥样硬化，中风是美国第三大主要死亡原因。尽管这一领域的研究取得了进展，但临床卒中成像中心并未筛查出导致卒中的高危动脉粥样硬化斑块。本研究开发了一种临床适用的识别高危斑块的成像方法，将指导临床决策，并改进对这些中风患者的治疗策略。