Explore our research
On this page, we list main projects that are currently run by members auf the CSI lab.
Wake-up trial
Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke
WAKE-UP was a European multicentre investigator-initiated randomized placebo-controlled clinical trial of MRI based thrombolysis in acute stroke patients with unknown time of symptom onset, e.g. due to recognition of stroke symptoms on awakening.
WAKE-UP was a European collaborative research project launched by a consortium of academic and SME partners. The trial involved 70 study centers from 8 European countries. Of 1,362 patients screened by MRI, 503 were randomized to treatment with intravenous alteplase or placebo. The primary end point was favorable outcome, as defined by a score of 0 or 1 on the modified Rankin scale (mRS) of neurologic disability.
WAKE-UP demonstrated efficacy and safety of treatment with intravenous alteplase in patients with acute stroke with an unknown time of onset, who had a mismatch between diffusion-weighted imaging and FLAIR in the region of ischemia (DWI-FLAIR mismatch) (Thomalla et al., 2018). The results of the trial have led to changes in guideline recommendations and clinical practice. WAKE-UP received funding by the European Union Seventh Framework Program
ClinicalTrials.gov Identifier, NCT01525290
Wake-up MRI visual rating training tool
TENSION Trial
Efficacy and Safety of Thrombectomy in Stroke With Extended Lesion and Extended Time Window
TENSION is an investigator-initiated, randomized controlled, open label, blinded endpoint, European, two-arm, postmarket study to compare the safety and effectiveness of thrombectomy as compared to best medical care alone in stroke patients with extended stroke lesions. Patients are eligible, of they present with an Alberta Stroke Program Early Computed Tomography Scan score of 3–5. In an adaptive design study, up to 665 patients will be randomized. The primary endpoint is functional outcome at 90 days post-stroke measured by the Modified Rankin Scale.
The vision of TENSION is to reduce the burden of death and disability from stroke by providing innovative effective treatment to severe stroke patients for whom currently no effective treatment is available.
TENSION receives funding by the European Union’s Horizon 2020 research and innovation programme.
ClinicalTrials.gov Identifier, NCT03094715
SFB 936 Multi-site communication in the brain
Project C2
Our group investigates disturbances of structural and functional brain networks within the collaborative research group 936 (SFB 936, Multi-Site Communication in the Brain, project C2). In collaboration with project C1 from the SFB, we collected and curated the UKE stroke database, a longitudinal study of patients with first symptomatic stoke and upper extremity motor deficit, including a comprehensive clinical characterization and tailored state-of-the-art MRI examinations.
We examined the structural impact of a focal ischemic lesion within a network of interconnected sensorimotor brain areas using reconstruction of white matter tracts (DTI) and analysis of cortical thickness. Dynamics of structural alterations of grey and white matter within the sensorimotor network were related to clinical outcome. Findings of our study are integrated into a complex model of recovery from stroke with results from functional imaging and EEG analysis together with other projects in SFB 936.
In the current funding period, we investigate fundamental questions concerning the organization and structural determinants of a neuronal network involved in decision making. We study stroke patients and patients with cerebral small vessel disease, providing models for focal and distributed brain lesions, by algorithmic modeling of behavior, structural MRI, EEG, and catecholaminergic pharmacologic intervention. By this, we aim at a better understanding of the structural underpinnings and organization of the cortical decision network in the healthy brain, and of cognitive impairments in patients with vascular brain lesions.
Multivariate lesion symptom mapping
We explore novel, innovative multivariate approaches, and lesion-network-mapping for lesion-deficit inference in patients with ischemic stroke. Our group investigates prediction of post-stroke deficits considering changes of structural brain network connectivity beyond traditional imaging markers. The extend of structural “dys-connection” is measured, either directly in DTI and fMRI data from affected patients or indirectly in reference connectomes from healthy subjects.
In collaboration with our research partners at the Institute of Computational Neuroscience at the UKE (head: Prof. C. Hilgetag), we apply an innovative inference approach based on game theory, the Multi-perturbation Shapley value Analysis (MSA), to better account for the dimensionalities inherent in brain anatomy and lesion patterns. MSA considers brain regions as ‘players’ in a game who interact to achieve a behavioral outcome and can also be used to quantify the interactions of the network elements (Zavaglia et al., 2015).
Collaboration: Institute of Computational Neuroscience, UKE
Deep Learning and lesion segmentation
White Matter Hyperintensities (WMH), lacunar stroke lesions and incident infarcts are MRI biomarkers which indicate cerebral microangiopathy, a risk factor for stroke and vascular dementia. In collaboration with our partners at the Frauenhofer Institute for Digital Medicine MEVIS and mediri Medical Imaging Research Institute, we develop automated imaging segmentation and quantification tools to apply in large-scale imaging datasets from a population at risk for cerebrovascular disease. We have received funding by German Federal Ministry for Economic Affairs and Energy for our current project DELIGHT (Deep Learning for quantification of hyperintense brain lesions). In DELIGHT, we train Deep Neural Networks (DNN) to segment WMH, based on data pooling from various, heterogeneous data sets of stroke patients and patients with presence or increased risk for cerebral small vessel disease.
StroCare
Optimised Cross-sectoral, Coordinated Treatment of Stroke Patients With Patient-orientated Outcome Measurement
StroCare is an interventional study of Optimised Cross-sectoral, Coordinated Treatment of Stroke Patients With Patient-orientated Outcome Measurement. After stroke, patients often experience incisive changes in their health, daily routine and quality of life. The developed model of care (StroCare treatment) forms a cross-sectoral, structured and coordinated treatment pathway that integrates a patient-centred outcome evaluation. It aims to optimize the transition from acute inpatient treatment after an acute stroke to the ambulant neurological rehabilitation treatment.
StroCare is a multi-centred controlled interventional study with a pre-post design. The intervention comprises the development of an electronic portal solution for a safe and coordinated transmission of clinical data between the three participating hospitals and five stroke-specialized ambulant rehabilitation clinics, as well as a case-manager provided by the participating health insurance agency for patient support and aftercare coordination. Stroke patients in both groups are assessed after the index ischemic event and 12 months thereafter.
StroCare is a collaborative project between the University Medical Center Hamburg-Eppendorf (UKE), two hospitals with stroke units (Albertinenkrankenhaus Hamburg, Elbe-Kliniken Stade), five Neurological Rehabilitation Centers (RehaCentrum Hamburg, MEDICLIN Klinikum Soltau, Klinikum Bad Bramstedt, VAMED Klinik Geesthacht and VAMED Rehaklinik Damp), and the insurance company BARMER.
StroCare receives funding from the German Innovation Fund.
ClinicalTrials.gov Identifier, NCT04159324
IMPROVE
Interdisciplinary Platform for Rehabilitation Research and Innovative Care of Stroke Patients
IMPROVE is an Interdisciplinary Platform for Rehabilitation Research and Innovative Care of Stroke Patients. The aim of this collaborative platform is to foster neurorehabilitation research and to transfer evidence-based innovative neurorehabilitation into clinical practice. As a first step, an observational, longitudinal, multicenter study of functional stroke recovery after patients’ discharge from inpatient rehabilitation is performed to better understand the dynamics and underlying mechanisms of recovery from stroke.
IMRPOVE is a cooperation between the University Medical Center Hamburg-Eppendorf (UKE), five Neurological Rehabilitation Centers in Northern Germany (RehaCentrum Hamburg, MEDICLIN Klinikum Soltau, Klinikum Bad Bramstedt, VAMED Klinik Geesthacht and VAMED Rehaklinik Damp), and the Deutsche Rentenversicherung Nord (DRV Nord).
ClinicalTrials.gov Identifier, NCT04119479
Cerebrovascular disease in population-based studies
We investigate determinants and impact of cerebrovascular disease in the HCHS study, a large-scale prospective study integrating genetic studies, blood biomarkers, modern imaging techniques and behavioral parameters (Jagodzinski et al., 2020). Integrating findings from epidemiology and genetic, blood and modern imaging markers, we aim at identifying targets for effective early detection and ultimately prevention of cerebrovascular diseases.