One Stop Shop Imaging for Acute Ischemic StrokeTreatment

急性缺血性中风治疗的一站式成像

• 批准号: 8998333
• 负责人: Guang-Hong Chen
• 金额: $ 74.44万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8998333
• 关键词: Acute; Algorithms; Angiography; Animal Model; Animals; Background Radiation; Brain; Canis familiaris; Caring; Cause of Death; Clinical; Data; Diagnosis; Dose; Environment; Healthcare; Hemorrhage; Image; Imaging technology; Injury; Intervention; Ischemic Stroke; Left; Literature; Low Dose Radiation; Maps; Measures; Methods; Microvascular Dysfunction; Modality; Modeling; Morphologic artifacts; Nervous System Trauma; Outcome; Patient Selection; Patients; Perfusion; Phase; Physicians; Predisposing Factor; Prevalence; Radiation; Rehabilitation therapy; Research; Risk; Rotation; Scheme; Science; Selection for Treatments; Series; Site; Stroke; Subgroup; System; Techniques; Technology; Testing; Textbooks; Time; Treatment Efficacy; Triage; United States; United States National Institutes of Health; Work; Writing; X-Ray Computed Tomography; acute stroke; arm; artery occlusion; base; clinical practice; cone-beam computed tomography; cost; data acquisition; disability; human subject; image guided; image processing; image reconstruction; imaging platform; improved; injured; innovation; killings; novel; prevent; public health relevance; quantum; reconstruction; social; technological innovation; temporal measurement; treatment planning

 DESCRIPTION (provided by applicant): Stroke is one of the leading causes of death and disability in the United States. Each year more than 795,000 people in the U.S. have a stroke; over 100,000 will die and a majority of the others will suffer varying degrees of neurological injury. An NIH estimate indicated that the cost of caring for people with strokes exceeded $73 billion in U.S. healthcare dollars each year. While many advances have been made in the care of people with strokes (e.g. preventative measures and rehabilitation), once a stroke has occurred, the ability to effectively prevent or limit neurological injury remains elusive. Only a small fraction of people having an acute stroke are suitable candidates for endovascular therapy; estimates place this number between 58,000 and 120,000 per year. Critical factors which impact both the likelihood of successful revascularization and, more importantly, the chances of a good clinical outcome are: 1) the time from onset of a stroke to revascularization and 2) the ability to distinguish patients who have a small volume of irreversibly injured brain (ischemic core) and a large volume of ischemic but salvageable brain (penumbra) from ones where there is a large ischemic core and very little or no penumbra. It is on these two factors that we believe the application of the proposed techniques will have a quantum impact. Our overarching objective is to develop a new imaging workflow using available C-arm cone-beam CT data acquisition systems that are currently widely available in angiography suites worldwide. We believe that this new clinical paradigm will enable selected patients with an acute ischemic stroke (AIS) to be diagnosed, triaged, and treated using a single modality, thus greatly reducing delay in the time from stroke onset to treatment. The proposed imaging scheme provides imaging data that will enhance the ability to select those patients most likely to benefit from revascularization and eliminate ones for whom revascularization may be futile or potentially harmful. This new workflow is enabled by a revolutionary image reconstruction technique, namely the Synchronized Multi-Artifact Reduction with Tomographic RECONstruction (SMART-RECON) technique, invented by the PI of the project. This new reconstruction method fundamentally challenges the traditional conditions for image reconstruction written in textbooks and other recent literature: Its application enables the reconstruction of time-resolved CT images using data acquired from a series of angular segments taken over an angular span of about 60 degrees rather than the conventional standard of 180 degrees plus the fan angle. This new technique enables a quantum leap in C-arm based cone beam CT imaging, allowing one to acquire and reconstruct high temporal resolution images at ultra low radiation dose levels. These SMART- RECON processed images may then be used to generate non-contrast CT images to exclude the presence of hemorrhage, time-resolved cone beam CT angiography to evaluate the site of occlusion and collaterals, and CT perfusion parametric images to assess the extent of ischemic core and penumbra, thereby fulfilling the imaging requirements for one-stop-shop imaging in an angiography suite. Adding further value is the ability to obtain these images with such low levels of radiation exposure that multiple assessments during an intervention become feasible. Therefore, in this proposal, the theme is to use this innovation in technology to take a quantum leap forward in clinical practice. To fully optimize and validate the proposed imaging workflow for acute ischemic stroke diagnosis and treatment, three aims are planned using both an animal model and human subject studies. The purpose of Aim #1 is to develop and optimize the SMART-RECON technique to enable One-Stop-Shop imaging; Aim #2 is to validate One-Stop-Shop workflow in animal studies; and Aim #3 is to validate One-Stop-Shop imaging in a two-phase human subject studies. Upon the completion of the proposed aims and the associated quantifiable milestones, a new neurovascular imaging platform should have been developed and tested in clinical environment. It will provide image guidance for diagnosis, patient selection, treatment planning, treatment delivery, and treatment efficacy assessment in patients presenting with an AIS. It is impossible to overstate the degree to which "Time is Brain" in patients with an AIS. Thus, a workflow which can save time compared to current techniques enabled by the proposed revolutionary imaging technology should allow for a quantum leap in diagnosis and treatment for patients suffering from an acute ischemic stroke.

 描述（由申请人提供）：中风是美国死亡和残疾的主要原因之一。美国每年有超过795，000人中风;超过100，000人死亡，其他大多数人将遭受不同程度的神经损伤。美国国立卫生研究院的一项估计表明，每年照顾中风患者的费用超过730亿美元。虽然在中风患者的护理方面已经取得了许多进展（例如预防措施和康复），但一旦发生中风，有效预防或限制神经损伤的能力仍然难以实现。只有一小部分急性卒中患者适合血管内治疗;估计每年有58，000至120，000人。影响成功血运重建的可能性以及更重要的是影响良好临床结局的可能性的关键因素包括：1）从中风发作到血运重建的时间和2）区分具有小体积不可逆损伤脑的患者的能力在一些实施例中，可以从存在大的缺血核心和很少或没有半暗带的脑（缺血核心）和大体积的缺血但可挽救的脑（半暗带）的脑中分离出缺血核心和半暗带。正是在这两个因素上，我们相信所提出的技术的应用将产生量子影响。我们的总体目标是使用目前在全球血管造影套件中广泛使用的可用C形臂锥束CT数据采集系统开发新的成像工作流程。我们相信，这种新的临床模式将使选定的急性缺血性卒中（AIS）患者能够使用单一模式进行诊断、分诊和治疗，从而大大减少从卒中发作到治疗的时间延迟。所提出的成像方案提供的成像数据将增强选择最有可能从血运重建中受益的患者的能力，并排除血运重建可能无效或潜在有害的患者。这一新的工作流程是由一种革命性的图像重建技术实现的，即由该项目的PI发明的同步多分辨率减少与断层重建（SMART-RECON）技术。这种新的重建方法从根本上挑战了教科书和其他最新文献中所写的传统图像重建条件：它的应用使得能够使用从约60度的角跨度而不是180度加上扇形角的常规标准上获取的一系列角段中获取的数据来重建时间分辨的CT图像。这项新技术使基于C形臂的锥形束CT成像实现了飞跃，允许在超低辐射剂量水平下采集和重建高时间分辨率图像。然后，这些经SMART-RECON处理的图像可用于生成非造影CT图像以排除出血的存在，时间分辨锥形束CT血管造影以评估闭塞和侧支的部位，以及CT灌注参数图像以评估缺血核心和半暗带的程度，从而满足血管造影套件中一站式成像的成像要求。增加进一步的价值是能够获得这些图像，具有如此低的辐射暴露水平，使得在干预期间进行多次评估变得可行。因此，在本提案中，主题是利用这种技术创新在临床实践中实现飞跃。为了充分优化和验证急性缺血性卒中诊断和治疗的拟议成像工作流程，计划使用动物模型和人类受试者研究实现三个目标。目标#1的目的是开发和优化SMART-RECON技术，以实现一站式成像;目标#2是在动物研究中确认一站式工作流程;目标#3是在两阶段人类受试者研究中确认一站式成像。在完成拟议目标和相关的可量化里程碑后，应开发新的神经血管成像平台并在临床环境中进行测试。它将为AIS患者的诊断、患者选择、治疗计划、治疗实施和治疗疗效评估提供图像指导。在AIS患者中，“时间就是大脑”的程度是不可能夸大的。因此，与由所提出的革命性成像技术实现的当前技术相比可以节省时间的工作流程应该允许对患有急性缺血性中风的患者的诊断和治疗的飞跃。