Screening Technology and Outcomes Project in Stroke

中风筛查技术和结果项目

• 批准号: 6669163
• 负责人: Walter J. Koroshetz
• 金额: $ 45.64万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2006-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6669163
• 关键词: angiography; brain disorder diagnosis; brain imaging /visualization /scanning; clinical research; computed axial tomography; decision making; diagnosis design /evaluation; human subject; longitudinal human study; neuroimaging; outcomes research; patient oriented research; perfusion; prognosis; stroke

DESCRIPTION (after the Application): The proposed research is a four-year study of 600 ischemic stroke patients which is designed to evaluate the utility of new neuroimaging technology in the acute setting to improve prediction of stroke outcome. Currently, data from the standard imaging study, a non-contrast computed tomography (CT) scan of the brain, add little to clinical measures of stroke severity. In the majority of ischemic stroke cases, the study is normal. In contrast, functional stroke outcome varies dramatically among patients and is affected by the size, location and subtype of stroke. Prognosis is usually determined after diagnostic tests, including brain imaging, are performed over the course of the patient?s hospital stay. However, decisions regarding the risk/benefit profile of acute treatment options and resource allocation occur in the first hours after stroke. The costs of stroke, to the patient as well as to the healthcare system, are potentially modifiable if early diagnostic studies are able to predict outcome and directly impact on acute management. In a study that takes only minutes, new, ultra-fast multidector CT (MDCT) scanners enable the emergency evaluation of stroke patients, combining non-contrast brain computerized tomography (CT), computed tomographic angiography of the head and neck (CTA), and computed tomographic brain tissue perfusion (CTP). Coupled with careful clinical assessment, this "next generation" imaging technology has the potential to identify both the vascular cause of the stroke and the precise brain regions at risk, establishing the prognosis within an hour of the patient?s arrival in the emergency ward. The proposed research seeks to better define the characteristics affecting the clinical and financial costs of specific subtypes of strokes and to test this new imaging technology in the emergency setting for its ability to predict long term patient outcome. To this end, the applicant has developed three specific aims. First, investigators will determine the test performance characteristics (sensitivity, specificity) of acute ischemic stroke neuroimaging with MDCT in predicting those patients most likely to have poor outcome using the final clinical diagnosis based on the well known TOAST (Trial of Organon 10172 in Acute Stroke Treatment) criteria as the gold standard. Second, investigators will determine whether MDCT is superior to conventional non-contrast brain computerized tomography alone in predicting functional outcome from stroke. Third, a predictive model will be developed of stroke cost based on the contributions of subtype of strokes, treatments, co-morbidities, stroke size and location. The economic model will establish a means to measure the cost effectiveness of innovative stroke management, diagnostic testing, and therapies. This research will allow develop of economic models based on the costs and outcomes of different subtype of strokes. It will enable early prognostication of functional outcome, improving the clinician?s ability to make difficult treatment decisions in the hours after stroke onset, and serve as a guide for the allocation of health care resources.

描述（申请后）：拟议的研究是对600名缺血性中风患者的四年研究，旨在评估急性环境中新的神经成像技术的实用性，以改善中风结果的预测。目前，来自标准成像研究的数据，一项大脑的非对比度计算机断层扫描（CT）扫描，很少添加 到中风严重程度的临床措施。在大多数缺血性中风病例中，该研究是正常的。相比之下，患者的功能性中风结果差异很大，并且受到中风的大小，位置和亚型的影响。通常在患者住院期间进行诊断测试（包括脑成像）后确定预后。 但是，关于急性治疗方案和资源分配的风险/收益概况的决定发生在中风后的头几个小时。如果早期诊断研究能够预测结果并直接影响急性管理，则中风的成本，对患者以及医疗保健系统的成本可能会改变。 在一项仅需几分钟的研究中，新的，超快速的多部门CT（MDCT）扫描仪可以对中风患者进行紧急评估，结合了非对比度的大脑计算机计算机层析成像（CT），头颈部和颈部计算机断层造影（CTA）和计算机断层扫描Brain Trainsue Tissue（CTP）。再加上仔细的临床评估，这是“接下来 一代“成像技术有可能识别中风的血管原因和处于危险的确切大脑区域，在患者到达紧急病房的一个小时内建立预后。拟议的研究旨在更好地定义影响中风的临床和财务成本的特征 在紧急环境中的新成像技术可以预测长期患者结果的能力。为此，申请人开发了三个具体目标。首先，研究人员将确定急性缺血性中风的测试性能特征（灵敏度，特异性） 使用MDCT进行神经影像，以预测这些患者最有可能使用最终的临床诊断，基于众所周知的吐司（Organon 10172在急性中风治疗中的试验）作为金标准。其次，研究人员将确定MDCT是否仅在预测中仅比常规的非对比度大脑计算机断层扫描 中风的功能结果。第三，将根据中风，治疗，合并症，中风和位置的亚型的贡献来开发中风成本的预测模型。经济模型将建立一种衡量创新中风管理，诊断测试和疗法的成本效益的手段。 这项研究将允许根据不同中风子类型的成本和结果发展经济模型。它将能够早期对功能结果的预测，从而提高临床医生在中风发作后的几个小时内做出艰难治疗决策的能力，并作为卫生保健资源分配的指南。