One Stop Shop Imaging for Acute Ischemic StrokeTreatment

急性缺血性中风治疗的一站式成像

• 批准号: 8998333
• 负责人: Guang-Hong Chen
• 金额: $ 74.44万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8998333
• 关键词: Acute; Algorithms; Angiography; Animal Model; Animals; Background Radiation; Brain; Canis familiaris; Caring; Cause of Death; Clinical; Data; Diagnosis; Dose; Environment; Healthcare; Hemorrhage; Image; Imaging technology; Injury; Intervention; Ischemic Stroke; Left; Literature; Low Dose Radiation; Maps; Measures; Methods; Microvascular Dysfunction; Modality; Modeling; Morphologic artifacts; Nervous System Trauma; Outcome; Patient Selection; Patients; Perfusion; Phase; Physicians; Predisposing Factor; Prevalence; Radiation; Rehabilitation therapy; Research; Risk; Rotation; Scheme; Science; Selection for Treatments; Series; Site; Stroke; Subgroup; System; Techniques; Technology; Testing; Textbooks; Time; Treatment Efficacy; Triage; United States; United States National Institutes of Health; Work; Writing; X-Ray Computed Tomography; acute stroke; arm; artery occlusion; base; clinical practice; cone-beam computed tomography; cost; data acquisition; disability; human subject; image guided; image processing; image reconstruction; imaging platform; improved; injured; innovation; killings; novel; prevent; public health relevance; quantum; reconstruction; social; technological innovation; temporal measurement; treatment planning

 DESCRIPTION (provided by applicant): Stroke is one of the leading causes of death and disability in the United States. Each year more than 795,000 people in the U.S. have a stroke; over 100,000 will die and a majority of the others will suffer varying degrees of neurological injury. An NIH estimate indicated that the cost of caring for people with strokes exceeded $73 billion in U.S. healthcare dollars each year. While many advances have been made in the care of people with strokes (e.g. preventative measures and rehabilitation), once a stroke has occurred, the ability to effectively prevent or limit neurological injury remains elusive. Only a small fraction of people having an acute stroke are suitable candidates for endovascular therapy; estimates place this number between 58,000 and 120,000 per year. Critical factors which impact both the likelihood of successful revascularization and, more importantly, the chances of a good clinical outcome are: 1) the time from onset of a stroke to revascularization and 2) the ability to distinguish patients who have a small volume of irreversibly injured brain (ischemic core) and a large volume of ischemic but salvageable brain (penumbra) from ones where there is a large ischemic core and very little or no penumbra. It is on these two factors that we believe the application of the proposed techniques will have a quantum impact. Our overarching objective is to develop a new imaging workflow using available C-arm cone-beam CT data acquisition systems that are currently widely available in angiography suites worldwide. We believe that this new clinical paradigm will enable selected patients with an acute ischemic stroke (AIS) to be diagnosed, triaged, and treated using a single modality, thus greatly reducing delay in the time from stroke onset to treatment. The proposed imaging scheme provides imaging data that will enhance the ability to select those patients most likely to benefit from revascularization and eliminate ones for whom revascularization may be futile or potentially harmful. This new workflow is enabled by a revolutionary image reconstruction technique, namely the Synchronized Multi-Artifact Reduction with Tomographic RECONstruction (SMART-RECON) technique, invented by the PI of the project. This new reconstruction method fundamentally challenges the traditional conditions for image reconstruction written in textbooks and other recent literature: Its application enables the reconstruction of time-resolved CT images using data acquired from a series of angular segments taken over an angular span of about 60 degrees rather than the conventional standard of 180 degrees plus the fan angle. This new technique enables a quantum leap in C-arm based cone beam CT imaging, allowing one to acquire and reconstruct high temporal resolution images at ultra low radiation dose levels. These SMART- RECON processed images may then be used to generate non-contrast CT images to exclude the presence of hemorrhage, time-resolved cone beam CT angiography to evaluate the site of occlusion and collaterals, and CT perfusion parametric images to assess the extent of ischemic core and penumbra, thereby fulfilling the imaging requirements for one-stop-shop imaging in an angiography suite. Adding further value is the ability to obtain these images with such low levels of radiation exposure that multiple assessments during an intervention become feasible. Therefore, in this proposal, the theme is to use this innovation in technology to take a quantum leap forward in clinical practice. To fully optimize and validate the proposed imaging workflow for acute ischemic stroke diagnosis and treatment, three aims are planned using both an animal model and human subject studies. The purpose of Aim #1 is to develop and optimize the SMART-RECON technique to enable One-Stop-Shop imaging; Aim #2 is to validate One-Stop-Shop workflow in animal studies; and Aim #3 is to validate One-Stop-Shop imaging in a two-phase human subject studies. Upon the completion of the proposed aims and the associated quantifiable milestones, a new neurovascular imaging platform should have been developed and tested in clinical environment. It will provide image guidance for diagnosis, patient selection, treatment planning, treatment delivery, and treatment efficacy assessment in patients presenting with an AIS. It is impossible to overstate the degree to which "Time is Brain" in patients with an AIS. Thus, a workflow which can save time compared to current techniques enabled by the proposed revolutionary imaging technology should allow for a quantum leap in diagnosis and treatment for patients suffering from an acute ischemic stroke.

 描述（由申请人提供）：中风是美国导致死亡和残疾的主要原因之一，每年有超过 795,000 人中风死亡，其中大多数人都会遭受不同程度的痛苦。美国国立卫生研究院 (NIH) 的一项估计表明，美国每年用于治疗中风患者的医疗费用超过 730 亿美元，而在护理方面已经取得了许多进展。对于中风患者（例如预防措施和康复），一旦发生中风，有效预防或限制神经损伤的能力仍然难以捉摸，只有一小部分患有急性中风的人适合血管内治疗；每年的数量在 58,000 至 120,000 之间，影响血运重建成功可能性以及更重要的是获得良好临床结果的机会的关键因素是： 1) 从中风发作到中风的时间。血运重建和 2) 区分具有少量不可逆损伤的大脑（缺血核心）和大量缺血但可挽救的大脑（半影）的患者与具有大量缺血核心和很少或没有半影的患者的能力。正是基于这两个因素，我们相信所提出的技术的应用将产生量子影响，我们的总体目标是使用目前可用的 C 形臂锥形束 CT 数据采集系统开发新的成像工作流程。我们相信，这种新的临床模式将使选定的急性缺血性中风（AIS）患者能够使用单一方式进行诊断、分类和治疗，从而大大缩短从中风发病到发生的时间延迟。所提出的成像方案提供的成像数据将增强选择最有可能从血运重建术中受益的患者的能力，并消除血运重建术可能无效或可能有害的患者。这种新的工作流程是通过革命性的图像重建技术实现的。同步的该项目的 PI 发明的多伪影减少与断层重建 (SMART-RECON) 技术从根本上挑战了教科书和其他近期文献中所写的图像重建的传统条件：它的应用可以实现时间重建。使用从大约 60 度角跨度（而不是 180 度加扇角的传统标准）获取的一系列角段获取的数据来解析 CT 图像，这项新技术实现了基于 C 臂的巨大飞跃。锥形束 CT 成像，允许在超低辐射剂量水平下获取和重建高时间分辨率图像，然后可以使用这些 SMART-RECON 处理的图像生成非对比 CT 图像，以排除出血、时间分辨锥形的存在。通过束CT血管造影评估闭塞部位和络脉，通过CT灌注参数化图像评估缺血核心和半暗带的范围，满足血管造影一站式成像的成像要求。进一步增加价值的是这些图像具有如此低的辐射暴露水平，使得在干预期间获得的多次评估变得可行。因此，在本提案中，主题是利用这项技术创新在临床实践中取得巨大飞跃。为了充分优化和验证所提出的急性缺血性中风诊断和治疗的成像工作流程，计划使用动物模型和人体研究来实现三个目标，目标#1 的目的是开发和优化 SMART-RECON 技术，以实现这一目标。一站式成像；目标#2目标#3 是验证动物研究中的一站式工作流程；目标#3 是验证两阶段人体研究中的一站式成像在完成拟议目标和相关的可量化里程碑后。神经血管成像平台应该在临床环境中开发和测试，它将为 AIS 患者的诊断、患者选择、治疗计划、治疗实施和治疗效果评估提供图像指导。患者的“时间就是大脑”因此，与当前由所提出的革命性成像技术实现的技术相比，可以节省时间的工作流程应该可以使患有急性缺血性中风的患者的诊断和治疗取得巨大飞跃。