Imaging Collaterals in Acute Stroke (iCAS)

急性中风的侧枝循环成像 (iCAS)

• 批准号: 9314645
• 负责人: Gregory George Zaharchuk
• 金额: $ 59.21万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-05 至 2019-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9314645
• 关键词: Acute; Address; Affect; Algorithms; Blood flow; Bolus Infusion; Brain; Bypass; Caring; Cerebral Angiography; Cerebrovascular Circulation; Cerebrovascular Disorders; Clinical; Clinical/Radiologic; Coagulation Process; Decision Making; Diagnostic; Diffusion; Digital Subtraction Angiography; Early treatment; Failure; Funding; Goals; Grant; Growth; Hemorrhage; Hospitals; Image; Infarction; International; Intravenous; Ischemic Stroke; Kidney Failure; Label; Lesion; Link; Magnetic Resonance Imaging; Measurement; Measures; Medical center; Methods; Modality; Moyamoya Disease; Multicenter Studies; Outcome; Outcome Measure; Patient Schedules; Patient Selection; Patient Triage; Patient-Focused Outcomes; Patients; Peer Review; Perfusion; Physiological; Physiology; Play; Population; Prospective Studies; Prospective cohort; Protocols documentation; Publishing; Recruitment Activity; Reference Standards; Reperfusion Therapy; Reproducibility; Risk; Role; Route; Selection Criteria; Sensitivity and Specificity; Severities; Site; Spin Labels; Stroke; Techniques; Testing; Thrombolytic Therapy; Time; Tissue Viability; Tissues; United States National Institutes of Health; Universities; Variant; Vascular Diseases; Vascular blood supply; Xenon; acute stroke; base; cohort; cost; digital; follow-up; forest; hemodynamics; imaging study; improved; ischemic lesion; meetings; non-invasive imaging; novel; prospective; public health relevance; quantitative imaging; stroke therapy; success

DESCRIPTION (provided by applicant): Collateral blood flow plays a central role during acute ischemic stroke, and the presence of good collaterals has been linked to improved clinical and radiologi- cal outcome measures both with and without successful recanalization. Despite this, the only method to assess adequacy of collaterals currently is in- vasive and expensive, digital subtraction cerebral angiography (DSA). It would be tremendously beneficial if collaterals could be visualized using a tomo- graphic, non-invasive imaging based modality, so that early treatment deci- sions could incorporate this critical information. AIMS AND METHODS The overall goal of the imaging the Collaterals in Acute Stroke (iCAS) study, is to identify and quantify cerebral blood flow (CBF) delivered via collateral routes using arterial spin labeling (ASL), a non-contrast MRI technique, and to determine its impact on ischemic lesion growth and patient outcome. We will perform a prospective, multi-center study of 180 acute stroke patients imaged in the 4.5-12 hr time window with large vessel occlusive stroke who are under consideration for endovascular thrombolytic therapy. We will add two ASL sequences to our rapid stroke protocol: pseudocontinuous ASL (pcASL, 2.5 min) for identifying collaterals and velocity-selective ASL (VS-ASL, 2.5 min) for measuring quantitative CBF independent of arterial arrival delay. In Aim 1, we will demonstrate equivalence between DSA and pcASL for collateral assessment, and determine the relationship between collateral and quantitative CBF using VS-ASL. Then, in Aim 2, we will determine whether ASL might be used to supplement or replace conventional bolus contrast PWI, determine the predictive ability of collateral assessment upon ischemic lesion growth, and evaluate how to incorporate collateral measurements into patient selection algorithms for endovascular therapy by examining the relationship between collaterals, revascularization, and patient outcome. SIGNIFICANCE We believe successful attainment of these aims will markedly improve acute stroke care by validating a non-invasive MRI-based method to assess both the presence of collaterals and the amount of CBF they deliver. iCAS will be the first prospective, multi-center study of ASL, a promising new non-contrast perfusion method, in acute stroke. In particular, the use of VS-ASL to obtain quantitative CBF measurements at serial timepoints in acute stroke will yield invaluable information on this critica hemodynamic parameter. It will provide a framework for incorporating collateral status into treatment decision-making, specifically by answering the question of whether patients with either very good or very poor collaterals benefit from recanalization. This study will lead to bettr understanding of the benefit of ASL measurements in patients with severe cerebrovascular disease and enhance the already significant diagnostic power of MRI in acute ischemic stroke.

描述（由申请人提供）：侧支血流在急性缺血性中风期间起着核心作用，并且有和没有成功再持有成功的临床和放射性结果指标，良好的侧支的存在与改善的临床和放射性结果指标有关。尽管如此，评估当前侧支充分性的唯一方法是易于且昂贵的数字减法脑血管造影（DSA）。如果可以使用基于非侵入性成像的模态将抵押品可视化，以便早期的治疗方法可以包含这些关键信息，那将是非常有益的。目的和方法是成像急性中风（ICAS）研究中侧支的总体目标，是通过使用动脉自旋标记（ASL），非对比度MRI技术来识别和量化通过侧支途径传递的脑血流（CBF），并确定其对缺血性病变的影响。我们将对在4.5-12 hr的时间窗口中成像的180名急性中风患者进行前瞻性，多中心研究，并使用大容器咬合中风，这些中风正在考虑进行血栓溶栓治疗。我们将在快速中风方案中添加两个ASL序列：伪连续的ASL（PCASL，2.5分钟），用于识别侧支和速度选择性ASL（VS-ASL，2.5分钟），以测量独立于动脉到达延迟的定量CBF。在AIM 1中，我们将证明DSA和PCASL之间的等价性用于抵押评估，并使用VS-ASL确定抵押和定量CBF之间的关系。然后，在AIM 2中，我们将确定是否可以使用ASL来补充或替换常规的推注对比度PWI，确定缺血性病变增长后抵押品评估的预测能力，并评估如何通过检查抵押品算法中的副标治疗，以检查内血管内治疗中的副标治疗，以检查内血管内治疗，以检查抵押品之间的关系，并进行抵押，累积，替代患者和患者，并将其纳入患者选择算法。我们认为，通过验证一种非基于MRI的方法来评估抵押品的存在和交付的CBF量，我们认为成功实现这些目标将显着改善急性中风护理。 ICA将是急性中风中首次对ASL的前瞻性，多中心研究，这是一种有希望的新的非对比度灌注方法。特别是，使用VS-ASL在急性中风中在串行时间点上获得定量的CBF测量将产生有关此批评性血流动力学参数的宝贵信息。它将提供一个框架，以将抵押品状态纳入治疗决策，特别是通过回答问题是非常好还是非常差的替补患者从重新定性中受益的问题。这项研究将导致BETTR对严重脑血管疾病患者的ASL测量益处的理解，并增强MRI在急性缺血性中风中已经显着的诊断能力。

项目成果

Acute Stroke Imaging Research Roadmap II.

• DOI: 10.1161/strokeaha.113.002015
• 发表时间: 2013-09
• 期刊: Stroke
• 影响因子: 8.3
• 作者: Wintermark M;Albers GW;Broderick JP;Demchuk AM;Fiebach JB;Fiehler J;Grotta JC;Houser G;Jovin TG;Lees KR;Lev MH;Liebeskind DS;Luby M;Muir KW;Parsons MW;von Kummer R;Wardlaw JM;Wu O;Yoo AJ;Alexandrov AV;Alger JR;Aviv RI;Bammer R;Baron JC;Calamante F;Campbell BC;Carpenter TC;Christensen S;Copen WA;Derdeyn CP;Haley EC Jr;Khatri P;Kudo K;Lansberg MG;Latour LL;Lee TY;Leigh R;Lin W;Lyden P;Mair G;Menon BK;Michel P;Mikulik R;Nogueira RG;Ostergaard L;Pedraza S;Riedel CH;Rowley HA;Sanelli PC;Sasaki M;Saver JL;Schaefer PW;Schellinger PD;Tsivgoulis G;Wechsler LR;White PM;Zaharchuk G;Zaidat OO;Davis SM;Donnan GA;Furlan AJ;Hacke W;Kang DW;Kidwell C;Thijs VN;Thomalla G;Warach SJ;Stroke Imaging Research (STIR) and Virtual International Stroke Trials Archive (VISTA)-Imaging Investigators
• 通讯作者: Stroke Imaging Research (STIR) and Virtual International Stroke Trials Archive (VISTA)-Imaging Investigators

Near-contiguous spin echo imaging using matched-phase RF and its application in velocity-selective arterial spin labeling.

• DOI: 10.1002/mrm.24866
• 发表时间: 2014-06
• 期刊: MAGNETIC RESONANCE IN MEDICINE
• 影响因子: 3.3
• 作者: Zun, Zungho;Hargreaves, Brian A.;Pauly, John;Zaharchuk, Greg
• 通讯作者: Zaharchuk, Greg

Resting-State BOLD MRI for Perfusion and Ischemia.

• DOI: 10.1097/rmr.0000000000000119
• 发表时间: 2017-04
• 期刊: Topics in magnetic resonance imaging : TMRI
• 作者: Kroll H;Zaharchuk G;Christen T;Heit JJ;Iv M
• 通讯作者: Iv M

Pseudocontinuous arterial spin labeling with prospective motion correction (PCASL-PROMO).

• DOI: 10.1002/mrm.25024
• 发表时间: 2014-10
• 期刊: MAGNETIC RESONANCE IN MEDICINE
• 影响因子: 3.3
• 作者: Zun, Zungho;Shankaranarayanan, Ajit;Zaharchuk, Greg
• 通讯作者: Zaharchuk, Greg

Long-Delay Arterial Spin Labeling Provides More Accurate Cerebral Blood Flow Measurements in Moyamoya Patients: A Simultaneous Positron Emission Tomography/MRI Study.

• DOI: 10.1161/strokeaha.117.017773
• 发表时间: 2017-09
• 期刊: Stroke
• 影响因子: 8.3
• 作者: Fan AP;Guo J;Khalighi MM;Gulaka PK;Shen B;Park JH;Gandhi H;Holley D;Rutledge O;Singh P;Haywood T;Steinberg GK;Chin FT;Zaharchuk G
• 通讯作者: Zaharchuk G