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，无论是否成功再通，良好的侧支血流的存在都与临床和放射学结果测量的改善有关。尽管如此，目前评估侧支循环充足性的唯一方法是侵入性且昂贵的数字减影脑血管造影（DSA）。如果可以使用基于断层扫描、非侵入性成像的方式对侧支循环进行可视化，那么早期的治疗决策就可以纳入这一关键信息，这将是非常有益的。目的和方法 急性中风侧支成像 (iCAS) 研究的总体目标是使用动脉自旋标记 (ASL)（一种非对比 MRI 技术）来识别和量化通过侧支途径输送的脑血流量 (CBF)，以及以确定其对缺血性病变生长和患者预后的影响。我们将对 180 名急性中风患者进行一项前瞻性、多中心研究，这些患者在 4.5-12 小时的时间窗口内进行成像，患有大血管闭塞性中风，正在考虑接受血管内溶栓治疗。我们将在快速中风方案中添加两个 ASL 序列：用于识别侧支循环的伪连续 ASL（pcASL，2.5 分钟）和用于测量独立于动脉到达延迟的定量 CBF 的速度选择性 ASL（VS-ASL，2.5 分钟）。在目标 1 中，我们将证明 DSA 和 pcASL 在抵押品评估方面的等效性，并使用 VS-ASL 确定抵押品和定量 CBF 之间的关系。然后，在目标 2 中，我们将确定 ASL 是否可用于补充或替代传统的推注对比 PWI，确定附带评估对缺血性病变生长的预测能力，并评估如何将附带测量纳入血管内治疗的患者选择算法中：检查侧支循环、血运重建和患者预后之间的关系。意义 我们相信，通过验证基于 MRI 的非侵入性方法来评估侧支循环的存在及其提供的 CBF 量，成功实现这些目标将显着改善急性中风护理。 iCAS 将是 ASL 的第一个前瞻性、多中心研究，ASL 是一种有前途的新型非对比灌注方法，用于治疗急性卒中。特别是，使用 VS-ASL 在急性卒中的连续时间点获得定量 CBF 测量将产生有关这一关键血流动力学参数的宝贵信息。它将提供一个将侧支状况纳入治疗决策的框架，特别是通过回答侧支循环非常好或非常差的患者是否从再通中受益的问题。这项研究将有助于更好地了解 ASL 测量对严重脑血管疾病患者的益处，并增强 MRI 对急性缺血性中风本已显着的诊断能力。

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