Report

Teaser, summary, work performed and final results

Periodic Reporting for period 3 - HEARTOFSTROKE (The heart of stroke: Pipes, Perfusion, Parenchyma)

Teaser

Stroke is the second cause of death and the third cause of disability worldwide. Treatment options for stroke are limited and the underlying causes remain unknown in 40% of patients. In HEARTOFSTROKE I perform in depth investigations of the vasculature (Pipes), blood supply...

Summary

Stroke is the second cause of death and the third cause of disability worldwide. Treatment options for stroke are limited and the underlying causes remain unknown in 40% of patients. In HEARTOFSTROKE I perform in depth investigations of the vasculature (Pipes), blood supply (Perfusion) and brain tissue damage (Parenchyma) to better understand the cause of a stroke in an individual patient. Together, these Pipes, Perfusion and Parenchyma are described in HEARTOFSTROKE as the ‘3Ps’. In HEARTOFSTROKE, I will develop innovative MRI methods to quantify the burden of cerebrovascular disease of the Pipes, Perfusion and Parenchyma (Objective 1-7). The new MRI methods will be applied in patients to explain the presence of smaller and larger infarcts (Objective 8-10). The developed patient specific biomarkers may pave the way for designing preventive and therapeutic strategies aimed at reducing the burden of neurodegenerative diseases.

Work performed

The results of the HEARTOFSTROKE project has moved beyond the state of the art for both the vasculature (Pipes), Perfusion and Parenchyma. The HEARTOFSTROKE results have contributed to a more complete assessment of the burden of cerebrovascular disease. For the vasculature (Pipes) the characterization of the burden of disease on the level of the brain vasculature is now possible with intracranial vessel wall MRI scans developed and criteria for the assessment of vessel wall lesions on these scan with correlations performed with histopathology. For the Perfusion new analysis methods have been developed to extract more hemodynamic information from arterial spin labeling perfusion MRI scans. For the Parenchyma the complete burden of brain tissue infarcts is better extracted from the high resolution 7Tesla, 3Tesla and 1.5Tesla MRI scans based on the characterization, including imaging criteria, for small infarcts of the cerebellum and the deep gray matter.

Final results

Until the end of the project the MRI imaging results from the clinical translational studies (Objectives 8-10) will be fully analysed which will be ready in the next year for the methods already developed and in the next 2 years for the new or optimized methods developed in the next year. From the input of the first clinical studies a further improvements of the methods developed under the Objectives 1-7 will be performed. As an example for the Pipes (Vasculature; Objective 1-3) MRI vessel wall imaging methods will be developed and evaluated in patients for the detection of intracranial vascular calcifications. Furthermore, the regional perfusion heterogeneity of arterial spin labeling perfusion signal will be analysed with methods that take into account the normal arterial spin label signal that is expected from a reference group (Objective 4-6); these methods are ready to be applied and the results of the analysis in patients groups will follow in the upcoming 2 years. For the brain tissue the characterization (Objective 7) of small (micro) infarcts in all deep gray matter structures of the brain will be performed in the next 2 years. The ‘next generation’ of biomarkers developed in the first years of the HEARTOFSTROKE project (Objective 1-7) will be evaluated in the patients studies in the next 2 years (Objective 8-10). By doing so the complete burden of brain tissue damage of the cortex (macro and microinfarcts), deep gray matter and cerebellum (smaller and larger infarcts) and white matter lesions will be established and correlated with vascular changes in the next 2 years (Objective 8-10). The data analysis and publications of articles for these analysis will be performed in the next 2 years of the HEARTOFSTROKE project.