Assessing Population-based Radiological brain health in Stroke Epidemiology (APRISE) Study

评估中风流行病学中基于人群的放射学脑健康 (APRISE) 研究

• 批准号: 10456166
• 负责人: BRETT M KISSELA
• 金额: $ 57.44万
• 依托单位: UNIVERSITY OF CINCINNATI
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456166
• 关键词: Acute; Address; Ancillary Study; Area; Automobile Driving; Biometry; Black Populations; Blood Vessels; Brain hemorrhage; Carotid Stenosis; Cause of Death; Cerebrovascular Disorders; Cerebrum; Clinical; Collection; Data; Disease; Educational Intervention; Epidemiology; Event; Family; Fibrinolytic Agents; Funding; Future; Genetic; Goals; Guidelines; Image; Incidence; Individual; Infrastructure; Investigation; Ischemia; Ischemic Stroke; Kentucky; Lacunar Infarctions; Magnetic Resonance Imaging; Measures; Microvascular Dysfunction; Minor; Modeling; Modernization; Morbidity - disease rate; National Institute of Neurological Disorders and Stroke; Outcome; Pathway interactions; Patients; Population; Population Heterogeneity; Positioning Attribute; Predisposition; Prevalence; Public Health; Radiologic Finding; Radiology Specialty; Recording of previous events; Recurrence; Research Priority; Risk; Risk Factors; Role; Severities; Source; Stroke; Surveys; Time; Tissues; United States National Institutes of Health; Vascular Dementia; White Matter Hyperintensity; Work; base; biracial; brain health; career; cerebral atrophy; cerebrovascular; clinical care; clinical decision-making; clinical investigation; cohort; disability; epidemiology study; high risk; imaging biomarker; improved; innovation; mortality; multidisciplinary; novel; parent grant; population based; predictive modeling; racial disparity; racial diversity; spectrograph; stroke event; stroke patient; stroke risk; tool

DESCRIPTION/ABSTRACT: Stroke recurrence is a major public health problem. It has been understudied epidemiologically despite comprising ~25% of all stroke in the US, and leading to higher morbidity and mortality compared to initial events. Furthermore, compared to our understanding of the role of traditional risk factors for first stroke, we have limited understanding of the risk factors for recurrent stroke. Radiological measures of small vessel and large-vessel disease may provide a measure of a subject’s current “Brain Health” to predict future cerebrovascular events and vascular dementia. Understanding small vessel disease in particular—manifesting as white matter hyperintensity, microbleeds, lacunar infarcts, dilated perivascular spaces, and brain atrophy–is a top NINDS priority. Although the Framingham risk score is widely used for clinical decision-making, and the ABCD scores predict 90-day stroke risk among minor stroke/TIA patients, no clinical prediction tool in a broader ischemic or a hemorrhagic stroke population-based cohort has been established. A Framingham-like “Risk Function Tool for Secondary Stroke,” especially one incorporating the full gamut of modern imaging parameters developed in a racially diverse population, would likely identify high-risk patients for targeted education interventions, novel antithrombotics, and aggressive clinical care. Moreover, it may reveal novel causal pathways and risk factors for future investigation. We propose an ancillary study to the ongoing Greater Cincinnati/Northern Kentucky Stroke Study (GCKNSS) entitled APRISE (Assessing Population-based Radiological brain health in Stroke Epidemiology). Our objective is to build on the GCNKSS infrastructure to radiologically characterize the full stroke/TIA population of Greater Cincinnati/Northern Kentucky from 2015 and create the first modern, largely MRI-based characterization of brain health in a contemporary stroke/TIA population. Our specific aim is to create a prediction model of cerebrovascular disease recurrence (ischemic or hemorrhagic stroke) incorporating imaging parameters in a biracial, large-scale ischemic stroke/TIA population using state-of-the-art modeling approaches. We will achieve these goals by radiologically characterizing the stroke/TIA population (~2700 ischemic and ~525 hemorrhagic stroke, and ~1025 TIA patients) in the NIH-funded GCNKSS of a 1.4 million, biracial population. We will leverage the extensive GCNKSS infrastructure, which is already in place to detect recurrent stroke, placing us in a unique position to develop a recurrent stroke risk model using newly acquired radiologic data with remarkable efficiency. The proposed study will allow the first and only population-based characterization of the entire imaging spectrum of brain health in stroke/TIA patients. Our multi-disciplinary team with imaging, epidemiology, outcomes, and biostatistics expertise will address NINDS priority research areas with precision and innovation currently unavailable.

描述/摘要： 中风复发是一个重大的公共卫生问题。尽管它在流行病学方面尚未得到充分研究 约占美国所有中风的 25%，与最初相比，导致发病率和死亡率更高 事件。此外，与我们对首次中风的传统危险因素的作用的理解相比，我们 对复发性中风的危险因素了解有限。小型血管和血管的放射测量 大血管疾病可以提供受试者当前“大脑健康”的衡量标准以预测未来 脑血管事件和血管性痴呆。特别了解小血管疾病——表现 如白质高信号、微出血、腔隙性梗塞、血管周围空间扩张和脑萎缩 NINDS 的首要优先事项。尽管弗雷明汉风险评分广泛用于临床决策，并且 ABCD 评分可以预测轻微中风/TIA 患者 90 天的中风风险，目前尚无临床预测工具 更广泛的缺血性或出血性中风人群队列已经建立。类似弗雷明汉的 “继发性中风的风险函数工具”，尤其是一种融合了现代影像学全部功能的工具 在种族多样化人群中开发的参数可能会识别高风险患者以进行有针对性的治疗 教育干预、新型抗血栓药物和积极的临床护理。此外，它还可能揭示新颖的 未来调查的因果路径和风险因素。我们建议对正在进行的更大的研究进行一项辅助研究 辛辛那提/北肯塔基州中风研究 (GCKNSS)，题为 APRISE（基于人口的评估） 中风流行病学中的放射学脑健康）。我们的目标是建立在 GCNKSS 基础设施之上 从 2015 年起对大辛辛那提/北肯塔基州的全中风/TIA 人群进行放射学表征 并创建了第一个现代的、主要基于 MRI 的当代中风/TIA 大脑健康特征 人口。我们的具体目标是创建脑血管疾病复发的预测模型 （缺血性或出血性中风）将成像参数纳入双种族、大规模缺血性中风 使用最先进的建模方法对中风/TIA 人群进行研究。我们将通过以下方式实现这些目标 中风/TIA 人群的放射学特征（约 2700 名缺血性中风和约 525 名出血性中风，以及 约 1025 名 TIA 患者）在 NIH 资助的 GCNKSS 中对 140 万混血人口进行了研究。我们将利用 广泛的 GCNKSS 基础设施已经到位，可以检测复发性中风，使我们处于独特的地位 使用新获得的放射学数据开发复发性中风风险模型的立场 效率。拟议的研究将允许第一个也是唯一一个基于人群的整个特征 中风/TIA 患者大脑健康的成像光谱。我们的多学科团队拥有影像学、 流行病学、结果和生物统计学专业知识将精确解决 NINDS 的优先研究领域 目前还无法实现创新。

项目成果

Automated grading of enlarged perivascular spaces in clinical imaging data of an acute stroke cohort using an interpretable, 3D deep learning framework.

• DOI: 10.1038/s41598-021-04287-4
• 发表时间: 2022-01-17
• 期刊: Scientific reports
• 影响因子: 4.6
• 作者: Williamson BJ;Khandwala V;Wang D;Maloney T;Sucharew H;Horn P;Haverbusch M;Alwell K;Gangatirkar S;Mahammedi A;Wang LL;Tomsick T;Gaskill-Shipley M;Cornelius R;Khatri P;Kissela B;Vagal A
• 通讯作者: Vagal A