Acute Stroke: Imaging the Ischaemic Penumbra with Perfusion CT

急性中风：用灌注 CT 对缺血半暗带进行成像

• 批准号: nhmrc : 351155
• 负责人: A/Pr Romesh Markus
• 金额: $ 16.2万
• 依托单位: The University of Newcastle
• 依托单位国家: 澳大利亚
• 项目类别: NHMRC Project Grants
• 财政年份: 2005
• 资助国家: 澳大利亚
• 起止时间: 2005-01-01 至 2007-12-31
• 项目状态: 已结题
• 来源: https://researchdata.edu.au/acute-stroke-imaging-perfusion-ct/82075
• 关键词: Acute; Stroke; Imaging; Ischaemic; Penumbra

The burden of stroke is large. Clot-dissolving medication (thrombolysis) may dramatically improve the outcome of many patients with severe stroke by unblocking the affected brain artery. However, very few patients receive this medication, as the current approval is restricted to treatment within 3 hours of stroke onset. The major aim of thrombolysis is to rescue brain tissue with reduced blood flow (the ischaemic penumbra) from becoming irreversibly damaged (infarcted). The penumbra progressively becomes infarcted over the next 48 hours if blood flow is not restored by the blood clot in the brain artery being dissolved. Penumbral brain tissue cannot be identified with clinical assessment or standard CT scanning. New generation CT scanners are capable of assessing brain blood flow. Perfusion CT imaging (CTP) is well tolerated and time-efficient, and can be integrated into the brain CT scanning process performed on all stroke patients. Preliminary evidence suggests that CTP can distinguish between tissue that represents the ischaemic penumbra, and tissue that is already permanently injured. This project aims to validate the use of CTP in imaging the ischaemic penumbra. This will be based on testing the accuracy of CTP tissue signatures of the penumbra in predicting clinical outcome and final stroke size. This is the only national collaborative study planned worldwide for this relatively new but increasingly accessible imaging technique. The ability to rapidly identify under-perfused but still viable brain with CTP would add new and exciting management options to the routine emergency assessment of stroke patients. The results of this unique study could have a significant impact on the management of acute stroke worldwide. If validated, it is anticipated that CTP would be widely used to improve patient selection for stroke thrombolysis, especially in safely extending the time window so that a greater number of patients can be treated with better outcomes.

中风的负担很大。血栓溶解药物（溶栓）可以通过疏通受影响的脑动脉来显著改善许多严重卒中患者的预后。然而，很少有患者接受这种药物，因为目前的批准仅限于中风发作后3小时内的治疗。溶栓的主要目的是挽救血流减少的脑组织（缺血半暗带），使其免受不可逆的损伤（梗死）。在接下来的48小时内，如果脑动脉中的血凝块没有被溶解而恢复血流，则半暗带逐渐变成梗塞。半影脑组织不能通过临床评估或标准CT扫描识别。新一代CT扫描仪能够评估脑血流。灌注CT成像（CTP）具有良好的耐受性和时效性，可以整合到所有卒中患者的脑部CT扫描过程中。初步证据表明，CTP可以区分代表缺血半暗带的组织和已经永久性损伤的组织。本项目旨在验证CTP在缺血半暗带成像中的使用。这将基于测试半暗带CTP组织特征在预测临床结局和最终卒中大小方面的准确性。这是全球范围内针对这种相对较新但日益普及的成像技术计划进行的唯一国家合作研究。CTP快速识别灌注不足但仍有活力的大脑的能力将为中风患者的常规紧急评估增加新的和令人兴奋的管理选择。这项独特研究的结果可能对全球急性卒中的管理产生重大影响。如果得到验证，预计CTP将被广泛用于改善卒中溶栓患者的选择，特别是在安全地延长时间窗方面，以便更多的患者可以获得更好的结局。