Well shit, once again they don't even consider being able to reduce the tPA bolus by directing it via magnetic nanoparticles.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=141200&CultureCode=en
A new computer program could help doctors predict which patients
might suffer potentially fatal side-effects from a key stroke treatment.
The program, which assesses brain scans using pattern recognition
software similar to that used in airport security and passport control,
has been developed by researchers at Imperial College London. Results of
a pilot study funded by the Wellcome Trust, which used the software are
published in the journal Neuroimage Clinical.
Stroke affects over 15 million people each year worldwide. Ischemic
strokes are the most common and these occur when small clots interrupt
the blood supply to the brain. The most effective treatment is called
intravenous thrombolysis, which injects a chemical into the blood
vessels to break up or ‘bust’ the clots, allowing blood to flow again.
However, because intravenous thombolysis effectively thins the blood,
it can cause harmful side effects in about six per cent of patients,
who suffer bleeding within the skull. This often worsens the disability
and can cause death.
Clinicians attempt to identify patients
most at risk of bleeding on the basis of several signs assessed from
brain scans. However, these signs can often be very subtle and human
judgements about their presence and severity tend to lack accuracy and
reliability.
In the new study, researchers trained a computer
program to recognise patterns in the brain scans that represent signs
such as brain-thinning or diffuse small-vessel narrowing, in order to
predict the likelihood of bleeding. They then pitted the automated
pattern recognition software against radiologists’ ratings of the scans.
The computer program predicted the occurrence of bleeding with 74 per
cent accuracy compared to 63 per cent for the standard prognostic
approach.
Dr Paul Bentley from the Department of Medicine,
lead author of the study, said: “For each patient that doctors see, they
have to weigh up whether the benefits of a treatment will outweigh the
risks of side effects. Intravenous thrombolysis carries the risk of very
severe side effects for a small proportion of patients, so having the
best possible information on which to base our decisions is vital. Our
new study is a pilot but it suggests that ultimately doctors might be
able to use our pattern recognition software, alongside existing
methods, in order to make more accurate assessments about who is most at
risk and treat them accordingly. We are now planning to carry out a
much larger study to more fully assess its potential.”
The
research team conducted a retrospective analysis of computerized
tomography (CT) scans from 116 patients. These are scans that use x-rays
to produce ‘virtual slices’ of the brain. All the patients had suffered
ischemic strokes and undergone intravenous thrombolysis in Charing
Cross Hospital. In the sample the researchers included scans from 16
patients who had subsequently developed serious bleeding within the
brain.
Without knowing the outcomes of the treatment, three independent
experts examined the scans and used standard prognostic tools to predict
whether patients would develop bleeding after treatment.
In parallel the computer program directly assessed and classified the
patterns of the brain scans to produce its own predictions.
Researchers evaluated the performance of both approaches by comparing
their predictions of bleeding with the actual experiences of the
patients.
Using a statistical test the research showed the computer program
predicted the occurrence of bleeding with 74 per cent accuracy compared
to 63 per cent for the standard prognostic approach.
The researchers also gave the computer a series of ‘identity parades’
by asking the software to choose which patient out of ten scans went on
to suffer bleeding. The computer correctly identified the patient 56
per cent of the time while the standard approach was correct 31 per cent
of the time.
The researchers are keen to explore whether their software could also
be used to identify stroke patients who might be helped by intravenous
thrombolysis who are not currently offered this treatment. At present
only about 20 per cent of patients with strokes are treated using
intravenous thrombolysis, as doctors usually exclude those with
particularly severe strokes or patients who have suffered the stroke
more than four and half hours before arriving at hospital. The
researchers believe that their software has the potential to help
doctors to identify which of those patients are at low risk of suffering
side effects and hence might benefit from treatment.
The study was supported through the Wellcome Trust Institutional
Strategic Support Fund and the researchers have secured further funding
from the Trust to conduct a larger study that will be looking at data
from about 2000 more subjects across London.
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