Acute Stroke Imaging Research Roadmap II

The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), industry representatives, and members of the US Food and Drug Administration (FDA) to discuss the role of advanced neuroimaging in acute stroke treatment. The goals of the meeting were to assess state-of-the-art practice in terms of acute stroke imaging research and to propose specific recommendations regarding: (1) the standardization of perfusion and penumbral imaging techniques, (2) the validation of the accuracy and clinical utility of imaging markers of the ischemic penumbra, (3) the validation of imaging biomarkers relevant to clinical outcomes, and (4) the creation of a central repository to achieve these goals. The present article summarizes these recommendations and examines practical steps to achieve them.

[1]  King Bm.  WESTERN GENERAL HOSPITAL, EDINBURGH. , 1965 .

[2]  B. Siesjö,et al.  Thresholds in cerebral ischemia - the ischemic penumbra. , 1981, Stroke.

[3]  Society of magnetic resonance in medicine , 1990 .

[4]  N. Lassen.  Pathophysiology of Brain Ischemia as It Relates to the Therapy of Acute Ischemic Stroke , 1990, Clinical neuropharmacology.

[5]  D. S. Williams,et al.  Magnetic resonance imaging of perfusion using spin inversion of arterial water. , 1992, Proceedings of the National Academy of Sciences of the United States of America.

[6]  D. Leys,et al.  Prevalence and Significance of Hyperdense Middle Cerebral Artery in Acute Stroke , 1992, Stroke.

[7]  M. Pessin,et al.  Neuroradiologic evaluation of patients with acute stroke treated with recombinant tissue plasminogen activator. The rt-PA Acute Stroke Study Group. , 1993, AJNR. American journal of neuroradiology.

[8]  P. Sandercock,et al.  Does Early Reperfusion of a Cerebral Infarct Influence Cerebral Infarct Swelling in the Acute Stage or the Final Clinical Outcome , 1993 .

[9]  J. Wardlaw,et al.  A simple practical classification of cerebral infarcts on CT and its interobserver reliability. , 1994, AJNR. American journal of neuroradiology.

[10]  B. Rosen,et al.  High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part I: Mathematical approach and statistical analysis , 1996, Magnetic resonance in medicine.

[11]  B R Rosen,et al.  NMR imaging of changes in vascular morphology due to tumor angiogenesis , 1998, Magnetic resonance in medicine.

[12]  Jean-Claude Baron,et al.  Mapping the Ischaemic Penumbra with PET: Implications for Acute Stroke Treatment , 1999, Cerebrovascular Diseases.

[13]  H. Urbach,et al.  Middle Cerebral Artery (MCA) Susceptibility Sign at Susceptibility-based Perfusion MR Imaging: Clinical Importance and Comparison with Hyperdense MCA Sign at CT 1 , 2000 .

[14]  H. Urbach,et al.  Middle cerebral artery (MCA) susceptibility sign at susceptibility-based perfusion MR imaging: clinical importance and comparison with hyperdense MCA sign at CT. , 2000, Radiology.

[15]  Stephen Rose,et al.  Diffusion‐ and perfusion‐weighted MRI response to thrombolysis in stroke , 2002, Annals of neurology.

[16]  Javier M Romero,et al.  Total occlusion versus hairline residual lumen of the internal carotid arteries: accuracy of single section helical CT angiography. , 2003, AJNR. American journal of neuroradiology.

[17]  Jinyuan Zhou,et al.  Using the amide proton signals of intracellular proteins and peptides to detect pH effects in MRI , 2003, Nature Medicine.

[18]  A. Alexandrov,et al.  CLOTBUST: Design of a Randomized Trial of Ultrasound‐Enhanced Thrombolysis for Acute Ischemic Stroke , 2004, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[19]  Steven Warach,et al.  Early blood–brain barrier disruption in human focal brain ischemia , 2004, Annals of neurology.

[20]  G. Duckwiler,et al.  Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. , 2005, AJNR. American journal of neuroradiology.

[21]  E. Ringelstein,et al.  Dual Antiplatelet Therapy With Clopidogrel and Aspirin in Symptomatic Carotid Stenosis Evaluated Using Doppler Embolic Signal Detection: The Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) Trial , 2005, Circulation.

[22]  A. Demchuk,et al.  Triaging transient ischemic attack and minor stroke patients using acute magnetic resonance imaging , 2005, Annals of neurology.

[23]  S. Warach,et al.  Diagnostic and prognostic value of early MR Imaging vessel signs in hyperacute stroke patients imaged <3 hours and treated with recombinant tissue plasminogen activator. , 2005, AJNR. American journal of neuroradiology.

[24]  Sang Joon Kim,et al.  Progression of middle cerebral artery susceptibility sign on T2*-weighted images: its effect on recanalization and clinical outcome after thrombolysis. , 2006, AJR. American journal of roentgenology.

[25]  S M Davis,et al.  Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage , 2006, Neurology.

[26]  Jeffrey L Saver,et al.  The Impact of Recanalization on Ischemic Stroke Outcome: A Meta-Analysis , 2007, Stroke.

[27]  G. Chang.  Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage , 2006, Neurology.

[28]  Alan Connelly,et al.  Robust determination of the fibre orientation distribution in diffusion MRI: Non-negativity constrained super-resolved spherical deconvolution , 2007, NeuroImage.

[29]  R. Seitz,et al.  Functional Neuroimaging in Stroke Recovery and Neurorehabilitation: Conceptual Issues and Perspectives , 2007, International journal of stroke : official journal of the International Stroke Society.

[30]  J. Wardlaw,et al.  Factors Influencing the Detection of Early CT Signs of Cerebral Ischemia: An Internet-Based, International Multiobserver Study , 2007, Stroke.

[31]  T. Tomsick.  TIMI, TIBI, TICI: I came, I saw, I got confused. , 2007, AJNR. American journal of neuroradiology.

[32]  H. Woo,et al.  Influence of Patient Age and Stenosis Location on Wingspan In-Stent Restenosis , 2008, American Journal of Neuroradiology.

[33]  K. Furie,et al.  Perfusion CT Imaging Follows Clinical Severity in Left Hemispheric Strokes , 2008, European Neurology.

[34]  Geoffrey A. Donnan,et al.  Acute Stroke Imaging Research Roadmap , 2008, Stroke.

[35]  A. Alexandrov,et al.  Design of a Prospective Multi-National CLOTBUST Collaboration on Reperfusion Therapies for Stroke , 2008, International journal of stroke : official journal of the International Stroke Society.

[36]  J. Wardlaw,et al.  Disappearing hyperdense middle cerebral artery sign in ischaemic stroke patients treated with intravenous thrombolysis: clinical course and prognostic significance , 2008, Journal of Neurology, Neurosurgery, and Psychiatry.

[37]  D. Wagner,et al.  Clinical and Imaging Data at 5 Days as a Surrogate for 90-Day Outcome in Ischemic Stroke , 2009, Stroke.

[38]  Kim Mouridsen,et al.  Comparison of 10 Perfusion MRI Parameters in 97 Sub-6-Hour Stroke Patients Using Voxel-Based Receiver Operating Characteristics Analysis , 2009, Stroke.

[39]  J. Broderick,et al.  Good clinical outcome after ischemic stroke with successful revascularization is time-dependent , 2009, Neurology.

[40]  D. Wagner,et al.  Change in Diffusion-Weighted Imaging Infarct Volume Predicts Neurologic Outcome at 90 Days: Results of the Acute Stroke Accurate Prediction (ASAP) Trial Serial Imaging Substudy , 2009, Stroke.

[41]  Yasheng Chen,et al.  Evaluation of MR-Derived Cerebral Oxygen Metabolic Index in Experimental Hyperoxic Hypercapnia, Hypoxia, and Ischemia , 2009, Stroke.

[42]  Ting-Yim Lee,et al.  Hemorrhagic Transformation of Ischemic Stroke: Prediction with CT , 2009 .

[43]  K. Furie,et al.  Hyperdense Basilar Artery Sign on Unenhanced CT Predicts Thrombus and Outcome in Acute Posterior Circulation Stroke , 2009, Stroke.

[44]  B. Biswal,et al.  The resting brain: unconstrained yet reliable. , 2009, Cerebral cortex.

[45]  Tibo Gerriets,et al.  Consensus Recommendations for Transcranial Color-Coded Duplex Sonography for the Assessment of Intracranial Arteries in Clinical Trials on Acute Stroke , 2009, Stroke.

[46]  Jeroen Hendrikse,et al.  Vascular space occupancy (VASO) cerebral blood volume‐weighted MRI identifies hemodynamic impairment in patients with carotid artery disease , 2009, Journal of magnetic resonance imaging : JMRI.

[47]  V. Puntmann.  How-to guide on biomarkers: biomarker definitions, validation and applications with examples from cardiovascular disease , 2009, Postgraduate Medical Journal.

[48]  M. Corbetta,et al.  Resting interhemispheric functional magnetic resonance imaging connectivity predicts performance after stroke , 2009, Annals of neurology.

[49]  S. Ulmer,et al.  Assessment of Thrombus in Acute Middle Cerebral Artery Occlusion Using Thin-Slice Nonenhanced Computed Tomography Reconstructions , 2010, Stroke.

[50]  S. Warach,et al.  Increased Plasma and Tissue MMP Levels are Associated with BCSFB and BBB Disruption Evident on Post-Contrast FLAIR after Experimental Stroke , 2010, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[51]  T. J. Schaewe,et al.  Blood–Brain Barrier Disruption in Humans Is Independently Associated With Increased Matrix Metalloproteinase-9 , 2010, Stroke.

[52]  Christianne Leidecker,et al.  Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. , 2010, Radiology.

[53]  D J Mikulis,et al.  Quantitative Measurement of Cerebrovascular Reactivity by Blood Oxygen Level-Dependent MR Imaging in Patients with Intracranial Stenosis: Preoperative Cerebrovascular Reactivity Predicts the Effect of Extracranial-Intracranial Bypass Surgery , 2011, American Journal of Neuroradiology.

[54]  Peter Brunecker,et al.  Vessel Size Imaging Reveals Pathological Changes of Microvessel Density and Size in Acute Ischemia , 2011, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[55]  Günther Deuschl,et al.  The Importance of Size: Successful Recanalization by Intravenous Thrombolysis in Acute Anterior Stroke Depends on Thrombus Length , 2011, Stroke.

[56]  R. Katz,et al.  Biomarkers and surrogate markers: An FDA perspective , 2004, NeuroRX.

[57]  J. Alger,et al.  Leukoaraiosis and Collaterals in Acute Ischemic Stroke , 2011, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[58]  M. Wintermark,et al.  Blood-Brain Barrier Permeability Assessed by Perfusion CT Predicts Symptomatic Hemorrhagic Transformation and Malignant Edema in Acute Ischemic Stroke , 2010, American Journal of Neuroradiology.

[59]  K. Major,et al.  The capillary index score: rethinking the acute ischemic stroke treatment algorithm. Results from the Borgess Medical Center Acute Ischemic Stroke Registry , 2012, Journal of NeuroInterventional Surgery.

[60]  S. Warach,et al.  Standardizing the Structure of Stroke Clinical and Epidemiologic Research Data: The National Institute of Neurological Disorders and Stroke (NINDS) Stroke Common Data Element (CDE) Project , 2012, Stroke.

[61]  Maurizio Corbetta,et al.  Why use a connectivity-based approach to study stroke and recovery of function? , 2012, NeuroImage.

[62]  Nancy J Fischbein,et al.  Comparison of Arterial Spin Labeling and Bolus Perfusion-Weighted Imaging for Detecting Mismatch in Acute Stroke , 2012, Stroke.

[63]  Werner Hacke,et al.  Contemporary Outcome Measures in Acute Stroke Research: Choice of Primary Outcome Measure , 2012, Stroke.

[64]  Geoff Cohen,et al.  The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial , 2012, The Lancet.

[65]  C. Sudlow,et al.  Etiology of Stroke and Choice of Models , 2012, International journal of stroke : official journal of the International Stroke Society.

[66]  Marc Fisher,et al.  Development, Expansion, and Use of a Stroke Clinical Trials Resource for Novel Exploratory Analyses , 2012, International journal of stroke : official journal of the International Stroke Society.

[67]  J. Helpern,et al.  Stroke Assessment With Diffusional Kurtosis Imaging , 2012, Stroke.

[68]  D. Leys,et al.  Assessment of Additional Endpoints for Trials in Acute Stroke – What, When, Where, in Who? , 2012, International journal of stroke : official journal of the International Stroke Society.

[69]  Michael D Hill,et al.  CT/CT Angiography and MRI Findings Predict Recurrent Stroke After Transient Ischemic Attack and Minor Stroke: Results of the Prospective CATCH Study , 2012, Stroke.

[70]  V. Howard,et al.  A Simple, Assumption-Free, and Clinically Interpretable Approach for Analysis of Modified Rankin Outcomes , 2012, Stroke.

[71]  Niels Hjort,et al.  Assessing response to stroke thrombolysis: validation of 24-hour multimodal magnetic resonance imaging. , 2012, Archives of neurology.

[72]  Olav Jansen,et al.  Thin-Slice Reconstructions of Nonenhanced CT Images Allow for Detection of Thrombus in Acute Stroke , 2012, Stroke.

[73]  Manabu Inoue,et al.  MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study , 2012, The Lancet Neurology.

[74]  Ali-Mohammad Golestani,et al.  Longitudinal Evaluation of Resting-State fMRI After Acute Stroke With Hemiparesis , 2013, Neurorehabilitation and neural repair.

[75]  Max Wintermark,et al.  A trial of imaging selection and endovascular treatment for ischemic stroke. , 2013, The New England journal of medicine.

[76]  Joanna M. Wardlaw,et al.  Recommendations on Angiographic Revascularization Grading Standards for Acute Ischemic Stroke: A Consensus Statement , 2013, Stroke.

[77]  Z. Chaudhry,et al.  Validating imaging biomarkers of cerebral edema in patients with severe ischemic stroke. , 2013, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[78]  Michael D Hill,et al.  Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. , 2013, The New England journal of medicine.

[79]  Kirsten Shuler,et al.  Clinical relevance and practical implications of trials of perfusion and angiographic imaging in patients with acute ischaemic stroke: a multicentre cohort imaging study , 2013, Journal of Neurology, Neurosurgery & Psychiatry.

[80]  Hiroki Shirato,et al.  Accuracy and reliability assessment of CT and MR perfusion analysis software using a digital phantom. , 2013, Radiology.

[81]  Nick S. Ward,et al.  How Useful is Imaging in Predicting Outcomes in Stroke Rehabilitation? , 2013, International journal of stroke : official journal of the International Stroke Society.

[82]  David F Kallmes,et al.  Clarifying Differences Among Thrombolysis in Cerebral Infarction Scale Variants: Is the Artery Half Open or Half Closed? , 2013, Stroke.