SCORE-IT: The CTA Spot Sign Score in Acute Cerebral Hemorrhage

SCORE-IT：急性脑出血的 CTA 点征评分

• 批准号: 8725749
• 负责人: JONATHAN ROSAND
• 金额: $ 44.52万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8725749
• 关键词: Acute; Ancillary Study; Angiography; Antihypertensive Agents; Biological; Biological Markers; Blood; Blood Pressure; Blood Vessels; Brain; Brain imaging; Cerebral hemisphere hemorrhage; Cerebrum; Clinical; Clinical Trials; Consent; Data; Diagnostic; Emergency Situation; Enrollment; Evaluation; Future; Goals; Growth; Head; Hematoma; Hemorrhage; Hemostatic Agents; Image; Imaging Techniques; Individual; Intervention; Lead; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Methods; Outcome; Pathogenesis; Patients; Process; Research; Risk; Rupture; Spottings; Stroke; Structure; Survivors; Techniques; Translating; Vascular Diseases; Weight; blood pressure regulation; effective therapy; expectation; functional disability; high risk; improved; mortality; neuroimaging; research clinical testing; therapeutic target

DESCRIPTION (provided by applicant): Intracerebral hemorrhage (ICH), bleeding into the brain from a ruptured blood vessel, remains the most devastating stroke subtype, with 30-day mortality approaching 40% and severe functional impairments in the majority of survivors. The amount of blood that exits the ruptured vessel is the most powerful determinant of outcome in ICH, and while there are currently no proven treatments for acute ICH, the observation that continued bleeding and hematoma growth commonly occur points to an inviting therapeutic target. Two interventions (hemostatic and antihypertensive therapy) appear to slow hematoma growth, but this reduced expansion has thus far failed to translate into clinical benefit in clinical trials. These observations underscore the importance of clarifying the relationship between hematoma expansion and clinical outcome. Motivating the current proposal is the idea that improved predictive markers and biological characterization of hematoma growth will lead to efficient, personalized selection of optimal therapy. The goal of this approach is to target treatment to patients at highest risk for expansion and likeliest to respond to a specific therapy. We focus on two neuroimaging markers characterized by our group and others: 1) pooling of contrast or "spot sign" on contrast CT angiography (CTA), a widely used extension of the standard emergency head CT; and 2) demonstration of cerebral microbleeds (CMB) on sensitive T2*-weighted MRI sequences, also part of the routine diagnostic evaluation of acute ICH. Accumulating evidence strongly supports CTA spot sign findings as powerful predictors of likelihood of expansion. Data from MRI imaging, though less definitive, also implicate CMB as markers of microvascular structure and associated risk of hematoma growth. As these two methods detect distinct aspects of ICH pathogenesis, our expectation is that they will provide complementary biological and predictive information regarding risk of expansion. Our overall goal is to apply CTA and MRI to identify patients at highest risk for hematoma expansion. Partnering with the Antihypertensive Treatment in Acute Cerebral Hemorrhage-2 (ATACH-2) trial, we will determine whether CTA and MRI can identify patients at high risk for hematoma growth and whether these imaging techniques can select patients more likely to benefit from early, intensive antihypertensive treatment. Our proposal takes advantage of three specific factors: 1) the tremendous leverage obtained from building on the wealth of data to be collected in ATACH-2, 2) the widespread use of CTA and T2*-weighted MRI by tertiary stroke centers in the clinical evaluation of ICH (thus necessitating no separate consent process for enrollment in our substudy), and 3) our research group's widely recognized expertise in the interpretation of both of these techniques. Successful completion of the proposed studies will be a major step towards optimizing the application of current and future approaches to hematoma growth and establishing tangible improvements in ICH outcome.

描述（由申请人提供）：脑内出血（ICH），从破裂的血管中流向大脑，仍然是最具毁灭性的中风亚型，大多数幸存者的死亡率接近40％，严重的功能障碍。退出破裂血管的血液量是ICH结果中最有力的决定因素，尽管目前尚无对急性ICH的可靠治疗方法，但这种观察结果表明，持续出血和血肿生长通常会引起诱人的治疗靶标。两种干预措施（止血和降压治疗）似乎会减慢血肿的生长速度，但是迄今为止，这种减少的膨胀未能转化为临床试验中的临床益处。这些观察结果强调了阐明血肿扩张与临床结果之间关系的重要性。 激励当前的建议是这样的想法，即改进的预测标记和血肿生长的生物学特征将导致有效的个性化最佳治疗选择。这种方法的目的是针对具有最高风险扩张风险的患者，并且对特定疗法有反应。我们专注于以我们的小组等为特征的两个神经影像学标记：1）对比度CT血管造影（CTA）的对比度或“点标志”，这是标准紧急头部CT的广泛使用的扩展； 2）在敏感的T2*加权MRI序列上的脑微粒（CMB）的演示，也是急性ICH常规诊断评估的一部分。积累的证据强烈支持CTA点标志发现是扩张可能性的有力预测指标。来自MRI成像的数据虽然不确定，但也暗示CMB是微血管结构的标志物以及血肿生长的相关风险。由于这两种方法检测到ICH发病机理的不同方面，我们的期望是它们将提供有关扩张风险的互补生物学和预测信息。 我们的总体目标是应用CTA和MRI来识别血肿膨胀风险最高的患者。与急性脑出血-2（ATACH-2）试验中的降压治疗合作，我们将确定CTA和MRI是否可以鉴定出血肿的高风险患者，以及这些成像技术是否可以选择更有可能从早期强化的，强化的抗型治疗中受益。 我们的提议利用了三个特定因素：1）通过在ATACH-2中收集的数据丰富而获得的巨大杠杆作用，2）第三次中心在临床评估中通过第三级中心的CTA和T2*加权MRI的广泛使用（因此不需要对我们的Entudy Interroltion Interroltion Insernity Interife of Underudy conternity Insportion Iss Interife of Unsudy），以及3），以及3），以及3），这是我们的3），以及3）。技术。成功完成拟议的研究将是优化当前和将来的血肿生长方法的应用并确定ICH结果中有形改进的主要步骤。