Acute Stroke Imaging Research Roadmap II

A full list of authors and affiliations appears at the end of the article.The STroke Imaging Research (STIR) group, the American Society of Neuroradiology and the Foundation of the American Society of Neuroradiology sponsored a series of working group meetings over 12 months, with the final meeting occurring during the Stroke Treatment Academy Industry Roundtable (STAIR) on March 9-10, 2013 in Washington, D.C.This process brought together vascular neurologists, neuroradiologists, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), industry representatives, and members of the U.S. Food and Drug Administration (FDA) to discuss stroke imaging research priorities, especially in the light of the recent negative results of acute stroke clinical trials that tested the concept of penumbral imaging selection.The goal of this process was to propose a research roadmap for the next 5 years.STIR recommendations include: 1) the use of standard terminology, aligned with the NINDS Common Data Elements (CDE); 2) a standardized imaging assessment of revascularization in acute ischemic stroke trials, including a modified Treatment In Cerebral Ischemia (mTICI) score; 3) a standardized process to assess whether ischemic core and penumbral imaging methods meet the requirements to be considered as an acceptable selection tool in acute ischemic stroke trials; 4) the characteristics of a clinical and imaging data repository to facilitate the development and testing process described in recommendation #3; 5) the optimal study design for a clinical trial to evaluate whether advanced imaging adds value in selecting acute ischemic stroke patients for revascularization therapy; and 6) the structure of a stroke neuroimaging network to implement and coordinate the recommendations listed above.All of these recommendations pertain to research, not to clinical care. Stroke Imaging TerminologySTIR recommends the use of a standard terminology in compliance with the Common Data Elements (CDE) developed by NINDS (http://www.commondataelements.ninds.nih.gov/ stroke.aspx#tab=Data_Standards). 1 In addition, the following refinements are proposed.Perfusion imaging with CT (CTP) or MRI (MRP) needs to be accompanied by an explicit definition of the perfusion parameters that are going to be derived and used, e.g.cerebral