Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking.

Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.

Fast 19 F spectroscopic imaging with pseudo-spiral k-space sampling.

Fluorine MRI is finding wider acceptance in theranostics applications where imaging of 19 F hotspots of fluorinated contrast material is central. The essence of such applications is to capture ghosting-artifact-free images of the inherently low MR response under clinically viable conditions. To serve this purpose, this work introduces the balanced spiral spectroscopic imaging (BaSSI) sequence, which is implemented on a 3.0 T clinical scanner and is capable of generating 19 F hotspot images in an efficient manner. The sequence utilizes an all-phase-encoded pseudo-spiral k-space trajectory, enabling the acquisition of broadband (80 ppm) fluorine spectra free from chemical shift ghosting. BaSSI can acquire a 64 × 64 image with 1 mm × 1 mm voxels in just 14 s, significantly outperforming typical MRSI sequences used in 1 H or 31 P imaging. The study employed in silico characterization to verify essential design choices such as the excitation pulse, as well as to identify the boundaries of the parameter space explored for optimization. BaSSI's performance was further benchmarked against the 3D ultrashort-echo-time balanced steady-state free precession (3D UTE BSSFP) sequence, a well established method used in 19 F MRI, in vitro. Both sequences underwent extensive optimization through exploration of a wide parameter space on a small phantom containing 10 µL of non-diluted bulk perfluorooctylbromide (PFOB) prior to comparative experiments. Subsequent to optimization, BaSSI and 3D UTE BSSFP were employed to capture images of small non-diluted bulk PFOB samples (0.10 and 0.05 µL), with variations in the number of signal averages, and thus the total scan time, in order to assess the detection sensitivities of the sequences. In these experiments, the detection sensitivity was evaluated using the Rose criterion (Rc ), which provides a quantitative metric for assessing object visibility. The study further demonstrated BaSSI's utility as a (pre)clinical tool through postmortem imaging of polymer microspheres filled with PFOB in a BALB/c mouse. Anatomic localization of 19 F hotspots was achieved by denoising raw data obtained with BaSSI using a filter based on the Rose criterion. These data were then successfully registered to 1 H anatomical images. BaSSI demonstrated superior detection sensitivity in the benchmarking analysis, achieving Rc values approximately twice as high as those obtained with the 3D UTE BSSFP method. The technique successfully facilitated imaging and precise localization of 19 F hotspots in postmortem experiments. However, it is important to highlight that imaging 10 mM PFOB in small mice postmortem, utilizing a 48 × 48 × 48 3D scan, demanded a substantial scan time of 1 h and 45 min. Further studies will explore accelerated imaging techniques, such as compressed sensing, to enhance BaSSI's clinical utility.