US-China Collaborative Research on Stroke Imaging

中美脑卒中影像学合作研究

• 批准号: 8545468
• 负责人: JINYUAN ZHOU
• 金额: $ 19.98万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8545468
• 关键词: Acidosis; Acute; Adult; Alteplase; Amides; Animal Model; Animals; Area; Benign; Biological Markers; Blood Vessels; Blood flow; Brain Ischemia; Cause of Death; Cell Respiration; Cerebral Ischemia; Characteristics; China; Clinic; Clinical; Clinical Data; Clinical Trials; Development; Diagnosis; Diffusion; Diffusion Magnetic Resonance Imaging; Diffusion weighted imaging; Evolution; FDA approved; Geriatrics; Goals; Hemorrhage; Hospitals; Hour; Human; Image; Imaging Techniques; Imaging technology; Individual; Infarction; Intervention; Intravenous; Ischemia; Ischemic Penumbra; Ischemic Stroke; Lesion; Magnetic Resonance Imaging; Methodology; Methods; Middle Cerebral Artery Occlusion; Modeling; Morbidity - disease rate; Outcome; Patients; Perfusion; Protocols documentation; Protons; Rattus; Reperfusion Therapy; Research; Research Personnel; Research Project Grants; Research Proposals; Risk; Scanning; Selection Criteria; Sensitivity and Specificity; Staging; Stroke; Surrogate Markers; Symptoms; Techniques; Testing; Therapeutic; Time; Tissues; Universities; Weight; acute stroke; base; brain tissue; clinical application; clinically relevant; design; disability; imaging modality; improved; mortality; novel; outcome forecast; public health relevance; restoration; spatial relationship; stroke recovery

DESCRIPTION (provided by applicant): The overall goal of this collaborative research project between researchers at Johns Hopkins University and Beijing Hospital is to validate a novel comprehensive MRI exam protocol, including pH, diffusion, and perfusion imaging, for the assessment of ischemic stroke and recovery from stroke. Stroke is a leading cause of death and disability among adults worldwide, second in China and fourth in the US. Currently, the only FDA- approved treatment for ischemic stroke is intravenous tissue plasminogen activator (IV tPA) that is given within three hours of symptom onset. Patients who present beyond three hours after stroke onset are now treated in several clinical trials only. However, the selection criteria for this type of therapy are still not well defined. This is further complicated by the unfortunate fact that patients who receive tPA are at increased risk for hemorrhage. Thus, the benefit versus risk with tPA should be assessed on an individual basis, based on the presence and extent of an ischemic penumbra, defined as tissue that is still viable but at risk of infarctio. APT imaging is an entirely new MRI methodology that can non-invasively detect tissue pH. This totally noninvasive pH imaging method can identify regions of tissue acidosis following impaired aerobic metabolism. We hypothesize that the pH-weighted imaging (pHWI) deficit in stroke, due to tissue acidosis, predicts the maximum final infarction size if no reperfusion is initiated, and he addition of APT-pH imaging to the perfusion/diffusion MRI protocol could better visualize an ischemic penumbra, thus improving predictions about final infarct size and outcome. We will test our hypothesis on animals, using a clinically relevant middle cerebral artery occlusion model, and perform pilot human scanning on hyperacute and acute ischemic stroke patients to assess the possible utility of this new technique in the clinic. Our specific aims are: (i) to assess the characteristics and spatio-temporal evolution of perfusion/pH/diffusion deficits in rat brain ischemia/reperfusion models; and (ii) to determine the radiologic characteristics and clinical values of pH imaging of hyperacute and acute ischemic stroke patients. If the hypotheses are proven correct, we expect to have an additional marker that can be used for diagnosis and prognosis of stroke patients in the clinic.

描述（由申请人提供）：约翰·霍普金斯大学研究人员与北京医院研究人员之间的合作研究项目的总体目标是验证一种新颖的全面MRI考试协议，包括PH，扩散和灌注成像，以评估缺血性中风和从中风中恢复。中风是全球成年人的死亡和残疾的主要原因，在中国第二，在美国第四。目前，唯一的缺血性中风的FDA批准治疗方法是静脉内组织纤溶酶原激活剂（IV TPA），在症状发作后三个小时内给予。现在仅在几项临床试验中治疗中风后三个小时以上的患者。但是，这种类型的治疗的选择标准仍然没有很好地定义。不幸的是，接受TPA的患者出血风险增加，这使情况更加复杂。因此，应根据缺血性半阴茎的存在和程度来评估TPA的利益与风险，该组织定义为仍然可行但有梗塞风险的组织。 APT成像是一种全新的MRI方法，可以非侵入性检测组织pH。这种完全无创的pH成像方法可以在有氧代谢受损后鉴定组织酸中毒的区域。我们假设由于组织酸中毒而导致的pH加权成像（PHWI）缺陷，如果未启动再灌注，则可以预测最大的最终梗塞大小，并且他将APT-PH成像添加到灌注/扩散MRI方案中可以更好地可视化缺血性的Penumbra，从而提高了对最终的尺寸和结果的预测。我们将使用临床上相关的脑动脉闭塞模型来检验动物的假设，并在超急性和急性缺血性中风患者上进行人体扫描，以评估该新技术在诊所中的可能实用性。我们的具体目的是：（i）评估大鼠脑缺血/再灌注模型中灌注/pH/扩散缺陷的特征和时空演化； （ii）确定超急性和急性缺血性中风患者的pH成像的放射学特征和临床值。如果证明这些假设是正确的，我们预计将有一个额外的标记物，可用于诊所中卒中患者的诊断和预后。