ERIS - Effective Reserve In Stroke

ERIS - 有效储备冲程

• 批准号: 10724761
• 负责人: Markus D Schirmer
• 金额: $ 45.42万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10724761
• 关键词: Accident and Emergency department; Accounting; Acute; Admission activity; Age; Aging; Area; Biological; Biological Markers; Blood Vessels; Brain; Cerebrovascular Disorders; Characteristics; Clinical; Cognitive; Compensation; Data; Dementia; Dimensions; Disease; Drops; Ensure; Event; Goals; Image; Investigation; Ischemic Stroke; Lesion; Machine Learning; Measures; Methodology; Modeling; Nature; Neurodegenerative Disorders; Outcome; Pathologic; Pathology; Patient-Focused Outcomes; Patients; Pattern; Persons; Phenotype; Population; Prevalence; Resolution; Site; Stroke; Techniques; Testing; Time; Validation; Variant; White Matter Hyperintensity; acute stroke; age related; brain health; brain volume; burden of illness; cerebrovascular pathology; clinical imaging; clinically relevant; clinically significant; cognitive reserve; cohort; deep learning; design; disability; efficacy validation; functional disability; functional independence; functional outcomes; high dimensionality; image processing; imaging biomarker; imaging study; improved outcome; insight; mixed dementia; multidisciplinary; neuroimaging; neuroimaging marker; personalized care; post stroke; prevent; prognostication; quantitative imaging; segmentation algorithm; specific biomarkers; stroke model; stroke outcome; stroke patient; stroke risk; targeted treatment; translational approach; translational potential; treatment optimization

PROJECT SUMMARY/ABSTRACT Stroke and dementia are two of the leading contributors to age-related disease burden and long-term disability. With aging populations in the US and worldwide, the prevalence of stroke increases and it becomes imperative to prevent related long-term functional disability from cerebrovascular disease and pathology. Understanding the determinants of post-stroke outcome that may lead to functional independence is of great clinical significance and essential to developing targeted treatment options. In the field of neurodegenerative diseases, the concepts of structural and functional reserve have been invoked to explain better than expected cognitive outcomes. Reserve describes the brain’s capacity to compensate for pathology. Specifically in stroke, elucidating such protective mechanisms has major practical implications for understanding outcome, however, few studies have investigated these concepts in stroke populations. Structural reserve generally aims to quantify the maximum brain reserve of a person, while pre-existing disease burden is not accounted for. The remaining, effective reserve, however, more likely reflects the brain’s ability to compensate for a sudden vascular event. The overall goal of this project is to create a translational approach to estimate the effective reserve from the low-resolution clinical imaging data of patients with acute ischemic stroke as they are acquired in the emergency department, and expand the concept by incorporating longitudinal and spatial lesion information to help improve outcome modeling. Aim 1 will investigate the concept of effective reserve and its feasibility in patients with acute ischemic stroke. We leverage two large-scale, retrospective stroke cohorts with clinical imaging available (single site: N=453, multi-site: N=912). To ensure the translational nature of effective reserve, we will enhance existing and develop new deep-learning enabled image processing pipelines to extract the required quantitative imaging biomarkers. These biomarkers will then be used to model functional outcome, measured as modified Rankin Scale score, ~90 days post-stroke. Aim 2 will develop longitudinal assessment methodologies for effective reserve and investigate how a drop in effective reserve post-stroke impacts stroke outcome. Aim 3 will further enhance this principle by harnessing spatial information of the stroke lesion and determining its impact on the brain’s ability to compensate for pathology. An important and unique feature of this project lies in its direct translational potential, as it is assessed on stroke neuroimaging data acquired in the emergency department to answer important questions about the brain’s ability to compensate for the acute vascular event and its focus on protective mechanisms in the brain relating to brain health. To achieve these goals, this project leverages unique data and multidisciplinary expertise, to create a clinically available, longitudinal, and spatially specific biomarker that enhances real-time stroke prognostication, and which can guide individualized patient care to improve outcomes.

项目摘要/摘要 中风和痴呆症是与年龄相关的疾病伯恩和长期残疾的两个主要因素。 随着美国和全球人口的老龄化，中风的流行率会增加，并且必须成为当务之急 为了防止脑血管疾病和病理学相关的长期功能障碍。了解 可能导致功能独立性的势后结果的决定因素具有极大的临床意义 对于开发目标治疗方案至关重要。在神经退行性疾病领域，概念 已调用结构和功能储备，以更好地解释比预期的认知结果更好。 储备将描述大脑补偿病理学的能力。特别是中风，阐明这种 保护机制对理解结果具有主要的实际意义，但是，很少有研究 在中风人群中研究了这些概念。结构储备通常旨在量化最大值 一个人的大脑储备，虽然没有考虑到现有疾病伯恩。剩下的，有效 但是，储备更有可能反映大脑补偿突然血管事件的能力。总体 该项目的目标是创建一种翻译方法，以估算低分辨率的有效储备 急性缺血性中风患者在急诊室获得的临床成像数据， 并通过合并纵向和空间病变信息来扩大概念，以帮助改善结果 造型。 AIM 1将研究有效储备的概念及其在急性缺血患者中的可行性 中风。我们利用两个可用的临床成像的大规模回顾性中风队列（单个站点： n = 453，多站点：n = 912）。为了确保有效储备的翻译性质，我们将增强现有和 开发新的深度学习启用图像处理管道以提取所需的定量成像 生物标志物。然后，这些生物标志物将用于建模功能结果，以修饰的Rankin测量 比例尺分数，冲程后〜90天。 AIM 2将开发有效的纵向评估方法 保留并调查有效的储备后击球后下降如何影响中风结果。 AIM 3将进一步 通过利用中风病变的空间信息来增强这一原则，并确定其对 大脑补偿病理学的能力。该项目的重要和独特的特征在于直接 转化潜力，因为它是在急诊科中获得的中风神经影像学数据评估的 回答有关大脑补偿急性血管事件的能力的重要问题 大脑中与大脑健康有关的保护机制。为了实现这些目标，该项目利用独特 数据和多学科专业知识，以创建临床上可用，纵向和特定特定的生物标志物 这可以增强实时中风的提示，并可以指导个性化的患者护理以改善 结果。