Integrated PET/MR Assessment of Brain Recovery After Recanalization of Non-Acute Atherosclerotic MCA Occlusion
RESTORE: A Prospective Observational Study of Perfusion-Metabolism Recoupling and Functional Network Recovery After Recanalization of Non-Acute Atherosclerotic Middle Cerebral Artery Occlusion Using Integrated PET/MR
Restoration of arterial patency following recanalization of non-acute atherosclerotic middle cerebral artery (MCA) occlusion may improve cerebral blood supply. However, the extent to which restored perfusion is accompanied by changes in cerebral metabolism and functional brain network organization remains incompletely understood.
This prospective observational study, RESTORE, aims to characterize cerebral perfusion-metabolism recoupling and functional network recovery in patients with non-acute atherosclerotic MCA occlusion who undergo clinically indicated recanalization.
Integrated positron emission tomography/magnetic resonance imaging (PET/MR) will be used to assess cerebral perfusion, metabolic activity, and brain functional connectivity at protocol-defined time points. Imaging measurements will be evaluated in relation to vascular characteristics, recanalization status, and neurological and cognitive outcomes, as applicable.
The study seeks to clarify the temporal and spatial relationships among reperfusion, metabolic changes, and functional network reorganization, and to explore imaging markers associated with clinical recovery after recanalization.
The decision to perform recanalization and the selection of treatment strategies will be based on routine clinical care and will not be assigned by the observational study protocol.
Descripción general del estudio
Estado
Descripción detallada
Background and Rationale: Non-acute atherosclerotic MCA occlusion can result in persistent cerebral hypoperfusion, altered metabolic activity, and disruption of functional brain networks. Although recanalization can restore arterial patency in selected patients, anatomical reopening of an occluded artery does not necessarily indicate complete restoration of tissue-level perfusion, cerebral metabolism, or neuronal network function.
Cerebral perfusion and metabolism are closely related under physiological conditions. Chronic hypoperfusion may disrupt this relationship, while successful revascularization may facilitate subsequent physiological adaptation. The timing, magnitude, and distribution of perfusion-metabolism recoupling after recanalization remain uncertain.
Integrated PET/MR allows complementary evaluation of cerebral hemodynamics, tissue metabolic activity, structural abnormalities, and functional connectivity. Its multimodal capabilities may provide a more comprehensive assessment of cerebral recovery than vascular imaging alone.
Tipo de estudio
Inscripción (Estimado)
Contactos y Ubicaciones
Estudio Contacto
- Nombre: Ju Han, MD
- Número de teléfono: 86+13791120710
- Correo electrónico: hanjujack@163.com
Ubicaciones de estudio
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Shandong
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Jinan, Shandong, Porcelana, 261053
- Reclutamiento
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital
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Contacto:
- Ju Han, MD
- Número de teléfono: 86+13791120710
- Correo electrónico: hanjujack@163.com
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Investigador principal:
- Ju Han, MD
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Método de muestreo
Población de estudio
The study population will consist of patients with non-acute atherosclerotic MCA occlusion who are evaluated for recanalization at participating clinical centers.
Eligible patients undergoing clinically indicated recanalization will be invited to participate in prospective PET/MR imaging assessments and clinical follow-up.
Descripción
Inclusion Criteria:
- Aged 18-80 years, regardless of sex.
- Symptomatic non-acute middle cerebral artery (MCA) occlusion, with an interval of ≥4 weeks between the most recent ischemic event or imaging confirmation of occlusion and the recanalization procedure.
- Occlusion involving the M1 segment of the MCA, confirmed by computed tomography angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography (DSA).
- Occlusion presumed to be of atherosclerotic origin.
- Persistence of at least one of the following despite guideline-directed medical therapy: recurrent transient ischemic attacks (TIAs), minor ischemic stroke, symptoms attributable to cerebral hypoperfusion, watershed infarction, or imaging evidence of cerebral hypoperfusion or metabolic abnormalities.
- Preoperative PET/MR images of sufficient quality for quantitative analysis.
- Clinically scheduled to undergo endovascular recanalization.
- Provision of written informed consent by the patient or their legally authorized representative.
Exclusion Criteria:
- Acute large-territory cerebral infarction involving more than one-third of the MCA territory.
- Extensive encephalomalacia within the affected vascular territory that precludes reliable assessment of cortical regions of interest (ROIs).
- Non-atherosclerotic causes of MCA occlusion, including moyamoya disease, arterial dissection, central nervous system vasculitis, or cardioembolism.
- Severe bilateral intracranial arterial occlusive disease that precludes reliable calculation of hemispheric asymmetry indices.
- Structural lesions involving the cerebellum or brainstem that may interfere with metabolic analysis using the cerebellum as a reference region.
- Contraindications to MRI (e.g., incompatible cardiac pacemakers, metallic foreign bodies, or severe claustrophobia) or PET imaging.
- Severe head motion or imaging artifacts that render PET/MR, arterial spin labeling (ASL), or blood oxygen level-dependent (BOLD) imaging data unsuitable for analysis.
- Poor glycemic control (fasting blood glucose >11.1 mmol/L) that may compromise the quality of 18F-fluorodeoxyglucose (18F-FDG) PET imaging.
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Modelos observacionales: COHORT
- Perspectivas temporales: PROSPECTIVE
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
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Change in Perfusion-Metabolism Abnormality Burden in the Affected Hemisphere From Baseline to 1 Month After Recanalization (ΔPMB)
Periodo de tiempo: Baseline and 1 Month After Recanalization;
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The cerebral perfusion-metabolism coupling index will be derived from spatially corresponding cerebral perfusion and PET-based metabolic measurements within prespecified regions of interest in the affected MCA territory. The exact coupling metric, its calculation, normalization, and interpretation will be defined in the prespecified imaging analysis protocol. The primary measure will be the within-participant change in this index between baseline and the specified follow-up visit. |
Baseline and 1 Month After Recanalization;
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Change in Regional Cerebral Blood Flow From Baseline to 1 Month After Recanalization;
Periodo de tiempo: Preoperative baseline and 1 month after recanalization.
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Cerebral blood flow (CBF) in the affected hemisphere will be quantified using arterial spin labeling (ASL) MRI, expressed in mL/100 g/min. The change in CBF will be calculated as the value at 1 month after recanalization minus the preoperative baseline value. |
Preoperative baseline and 1 month after recanalization.
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Change in Arterial Cerebral Blood Volume in the Affected Hemisphere
Periodo de tiempo: Baseline and 1 Month After Recanalization;
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Arterial cerebral blood volume (aCBV) in the affected hemisphere will be quantified using the prespecified ASL-derived imaging method. The change in aCBV will be calculated as the value at 1 month after recanalization minus the preoperative baseline value. |
Baseline and 1 Month After Recanalization;
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Change in Arterial Transit Time in the Affected Hemisphere
Periodo de tiempo: Baseline and 1 Month After Recanalization;
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Arterial transit time (ATT) will be quantified using the prespecified ASL MRI technique and expressed in milliseconds. The change in ATT will be calculated as the value at 1 month after recanalization minus the preoperative baseline value. |
Baseline and 1 Month After Recanalization;
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Change in 18F-FDG Standardized Uptake Value Ratio in the Affected Hemisphere
Periodo de tiempo: Baseline and 1 Month After Recanalization;
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Cerebral glucose metabolism will be assessed using 18F-fluorodeoxyglucose (18F-FDG) PET. The standardized uptake value ratio (SUVR) will be calculated using the prespecified reference region and expressed as a dimensionless ratio. The change in SUVR will be calculated as the value at 1 month after recanalization minus the preoperative baseline value. |
Baseline and 1 Month After Recanalization;
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Change in Hemispheric Asymmetry Index of Cerebral Blood Flow
Periodo de tiempo: Baseline and 1 Month After Recanalization;
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The hemispheric asymmetry index of cerebral blood flow (CBF-AI) will be calculated from corresponding CBF measurements in the affected and contralateral hemispheres using the prespecified asymmetry formula. The change will be calculated as the index at 1 month after recanalization minus the baseline index. |
Baseline and 1 Month After Recanalization;
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Change in Hemispheric Asymmetry Index of Arterial Cerebral Blood Volume
Periodo de tiempo: Baseline and 1 Month After Recanalization;
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The hemispheric asymmetry index of arterial cerebral blood volume (aCBV-AI) will be derived from aCBV measurements in the affected and contralateral hemispheres using the prespecified asymmetry formula. The change will be calculated as the index at 1 month after recanalization minus the baseline index. |
Baseline and 1 Month After Recanalization;
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Change in Hemispheric Asymmetry Index of Arterial Transit Time
Periodo de tiempo: Baseline and 1 Month After Recanalization;
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The hemispheric asymmetry index of arterial transit time (ATT-AI) will be calculated from ATT measurements in the affected and contralateral hemispheres using the prespecified asymmetry formula. The change will be calculated as the index at 1 month after recanalization minus the baseline index. |
Baseline and 1 Month After Recanalization;
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Change in Hemispheric Asymmetry Index of 18F-FDG Standardized Uptake Value Ratio
Periodo de tiempo: Baseline and 1 Month After Recanalization;
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Change in Hemispheric Asymmetry Index of 18F-FDG Standardized Uptake Value Ratio |
Baseline and 1 Month After Recanalization;
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Proportion of Brain Regions Showing Spatially Concordant Perfusion and Metabolic Improvement After Recanalization
Periodo de tiempo: Baseline and 1 Month After Recanalization;
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Integrated PET/MR will be used to identify regions of interest (ROIs) exhibiting both perfusion improvement and metabolic improvement at 1 month after recanalization compared with preoperative baseline. Spatial coupling will be quantified as the percentage of evaluable ROIs demonstrating concordant improvement in both parameters, according to prespecified quantitative thresholds and spatial matching criteria. |
Baseline and 1 Month After Recanalization;
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Change in Global Efficiency of Resting-State Functional Brain Networks
Periodo de tiempo: Baseline and 1 Month After Recanalization;
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Resting-state functional MRI will be used to construct whole-brain functional connectivity networks. Global efficiency will be calculated using graph-theoretical analysis as a quantitative measure of network-wide information integration. The change in global efficiency will be calculated as the value at 1 month after recanalization minus the preoperative baseline value. |
Baseline and 1 Month After Recanalization;
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Change in Interhemispheric Functional Connectivity Strength
Periodo de tiempo: Baseline and 1 Month After Recanalization;
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Interhemispheric functional connectivity will be assessed using resting-state blood oxygen level-dependent (BOLD) MRI. Connectivity strength between prespecified corresponding regions in the two hemispheres will be quantified using Fisher z-transformed correlation coefficients. The change will be calculated as the value at 1 month after recanalization minus the preoperative baseline value. |
Baseline and 1 Month After Recanalization;
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Change in Nodal Efficiency of Prespecified Brain Network Hubs
Periodo de tiempo: Preoperative baseline and 1 month after recanalization.
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Nodal efficiency of prespecified key brain regions will be calculated from resting-state functional connectivity networks using graph-theoretical analysis. Changes in nodal efficiency will be evaluated by comparing measurements obtained before recanalization and at 1 month after recanalization. The regions of interest and the summary metric will be defined in the prespecified imaging analysis protocol. |
Preoperative baseline and 1 month after recanalization.
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Correlation Between 1-Month Change in Perfusion-Metabolism Abnormality Burden and Modified Rankin Scale Score at 90 Days
Periodo de tiempo: Preoperative baseline and 1 month after recanalization.
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The association between the change in perfusion-metabolism abnormality burden (ΔPMB) from baseline to 1 month after recanalization and functional disability at 90 days will be assessed. Functional disability will be measured using the modified Rankin Scale (mRS), ranging from 0 (no symptoms) to 6 (death), with higher scores indicating greater disability. The association will be quantified using a prespecified correlation coefficient. |
Preoperative baseline and 1 month after recanalization.
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Correlation Between 1-Month Change in Perfusion-Metabolism Abnormality Burden and Barthel Index Score at 90 Days
Periodo de tiempo: Preoperative baseline, 1 month after recanalization (ΔPMB), and 90 days after recanalization (Barthel Index).
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The association between ΔPMB from baseline to 1 month after recanalization and activities of daily living at 90 days will be assessed. Functional independence will be measured using the Barthel Index (BI), ranging from 0 to 100, with higher scores indicating greater independence in activities of daily living. The association will be quantified using a prespecified correlation coefficient. |
Preoperative baseline, 1 month after recanalization (ΔPMB), and 90 days after recanalization (Barthel Index).
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Correlation Between 1-Month Change in Perfusion-Metabolism Abnormality Burden and EQ-5D Health Utility Index at 90 Days
Periodo de tiempo: Preoperative baseline, 1 month after recanalization (ΔPMB), and 90 days after recanalization (EQ-5D).
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The association between ΔPMB from baseline to 1 month after recanalization and health-related quality of life at 90 days will be assessed using the EuroQol 5-Dimension (EQ-5D) questionnaire. EQ-5D responses will be converted into a health utility index using the prespecified instrument version and population-specific value set. Higher utility scores generally indicate better health-related quality of life. The association will be quantified using a prespecified correlation coefficient. |
Preoperative baseline, 1 month after recanalization (ΔPMB), and 90 days after recanalization (EQ-5D).
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Ju Han, MD, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Actual)
Finalización primaria (Estimado)
Finalización del estudio (Estimado)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Actualizaciones de registros de estudio
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Última actualización enviada que cumplió con los criterios de control de calidad
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Más información
Términos relacionados con este estudio
Términos MeSH relevantes adicionales
- Enfermedades Cerebrales
- Enfermedades del Sistema Nervioso Central
- Enfermedades del Sistema Nervioso
- Enfermedades Vasculares
- Enfermedades cardiovasculares
- Procesos Patológicos
- Infarto cerebral
- Isquemia cerebral
- Infarto
- Necrosis
- Arteriosclerosis
- Enfermedades arteriales oclusivas
- Isquemia
- Enfermedades Arteriales Intracraneales
- Carrera
- Enfermedades Arteriales Cerebrales
- Infarto cerebral
- Condiciones Patológicas, Signos y Síntomas
- Trastornos cerebrovasculares
- Arteriosclerosis intracraneal
- Infarto De La Arteria Cerebral Media
Otros números de identificación del estudio
- RESTORE
Plan de datos de participantes individuales (IPD)
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Información sobre medicamentos y dispositivos, documentos del estudio
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