CTP to predict Response to recanalization in Ischemic Stroke Project (CRISP)

项目摘要 在美国，中风是导致残疾的头号原因。为了减轻残疾人的负担 由中风引起的中风需要更好的中风治疗方法，以供更多的中风患者使用。 血管内治疗正越来越多地被使用，并可能满足这一需求，因为它们具有很高的 再通畅。然而，目前还不知道哪些患者在临床上受益。 以往的研究表明，中风患者具有小体积的不可逆缺血性损伤(梗死 核心)和大量可逆性缺血损伤(半影区)最有可能受益于 血液流动。MRI显示了识别缺血核心和半暗带的希望，但它的作用非常有限 可在美国急诊室使用。计算机断层成像(CTP)成像是一种潜在的解决方案，因为 它广泛可用，可以很容易地添加到已经常规获得的非对比剂头部CT中进行评估 急诊室里的中风病人。然而，CTP图像的处理方法和标准 对这些图像的解读仍然不成熟。因此，基于CTP图像的患者选择还没有准备好 在临床试验或临床实践中实施。 CTP的总体目标是预测缺血性卒中项目(CRISP)再通的反应 开发一种实用的工具来识别可能从血管内治疗中受益的急性中风患者。 该项目包括两个主要部分。在第一部分(第一年)，我们建议开发一个全自动的 用于处理CT灌注(CTP)图像的系统(快速)，该系统将生成脑缺血的脑图 核心和半影。我们还将根据这些CTP图定义标准，以预测患者是否有可能 从血液流动的恢复中受益。这些标准将基于95名回溯性队列的数据 在圣卢克医院接受治疗的患者。 在第二部分(第2-5年)中，我们的目标是演示急诊环境中的医生 借助全自动CTP分析程序(RAPID)，可以准确地预测再通的反应 接受血管重建术的中风患者。为了达到这个目的，我们将进行一项前瞻性队列研究。 在血管内治疗前将接受CTP扫描的100名连续中风患者中。这项研究将 在两个地点(斯坦福大学和圣卢克医院)进行。患者将得到早期的随访 在6小时内进行扫描以评估再通情况，并在第5天进行后续扫描以确定最终的梗死灶。 这项研究的成功实施将为医生提供一种简单、自动化的方法来选择 可能从血流恢复中受益的患者。这样的方法，由于很容易访问 CT技术在多中心急性卒中临床试验中的患者选择方面将具有重要价值， 最终，在常规的临床实践中。

Project Summary Stroke is the number one cause of disability in the United States. In order to reduce the burden of disability caused by stroke there is a need for better stroke treatments that are available to more stroke victims. Endovascular therapies are increasingly being used and may fill this need as they have high rates of recanalization. It is, however, not known which patients benefit clinically. Previous studies suggest that stroke patients with a small volume of irreversible ischemic injury (infarct core) and a large volume of reversible ischemic injury (penumbra) are most likely to benefit from restoration of blood flow. MRI shows promise for identification of the ischemic core and penumbra but it has very limited availability in US emergency rooms. Computed Tomography Perfusion (CTP) imaging is a potential solution as it is widely available and can easily be added to a non-contrast head CT, already routinely obtained to evaluate stroke patients in the emergency room. However, methods for processing of CTP images and criteria for interpretation of the images are still immature. Therefore, patient selection based on CTP images is not ready for implementation in clinical trials or clinical practice. The overall goal of the CTP to predict Response to recanalization in Ischemic Stroke Project (CRISP) is to develop a practical tool to identify acute stroke patients who are likely to benefit from endovascular therapy. The project has two main parts. During the first part (year 1), we propose to develop a fully automated system (RAPID) for processing of CT Perfusion (CTP) images that will generate brain maps of the ischemic core and penumbra. We will also define criteria, based on these CTP maps, which predict if a patient is likely to benefit from restoration of blood flow. These criteria will be based on data from a retrospective cohort of 95 patients treated at St Luke's hospital. During the second part (years 2-5), we aim to demonstrate that physicians in the emergency setting, with the aid of a fully automated CTP analysis program (RAPID), can accurately predict response to recanalization in stroke patients undergoing revascularization. To achieve this aim we will conduct a prospective cohort study of 100 consecutive stroke patients who will undergo a CTP scan prior to endovascular therapy. The study will be conducted at two sites (Stanford University and St Luke's Hospital). Patients will have an early follow-up scan within 6 hours to assess reperfusion and a late follow-up scan at day 5 to determine the final infarct. The successful execution of this research will provide physicians with an easy, automated method to select patients who are likely to benefit from restoration of blood flow. Such a method, thanks to easy accessibility to CT technology, would be of great value for patient selection in multi-center clinical acute stroke trials and, eventually, in routine clinical practice.