Brain imaging adds impact to stroke research

Dr Andrew Bivard is an award-winning imaging expert who is working on an HMRI clinical trial of the clot-busting drug Tenecteplase involving 20 stroke centres across Australia, and 50 world-wide.

Dr Andrew Bivard

It was a circuitous and fortuitous path that led Dr Andrew Bivard to his current field of research. Commencing an undergraduate degree in IT, Andrew soon discovered that the field was too dry to maintain his interest. A shift in focus to psychology unveiled the wonderful world of neuroscience. First Class Honours and a Bachelor of Biomedical Science at UON led to an invitation to undertake a PhD under the supervision of Professor Mark Parsons and Chris Levi. As part of his PhD with the Priority Research Centre for Brain and Mental Health, Andrew developed a software platform which has formed the basis of his current research and is being tested in clinical trials and routine care.

“During my PhD I worked on validating perfusion imaging for routine clinical practice which was then used in a Phase II clinical trial comparing two different drugs for the treatment of acute ischemic stroke patients. The data from the phase II trial was then used to secure a large NHMRC grant for an international Phase III trial, for which I’m now the imaging coordinator of” Andrew explains.

Stroke imaging is more than just patient diagnosis. The 2013 European Stroke Conference Young Investigator of the Year was awarded to Andrew for using non-invasive chemical imaging in stroke survivors to identify a unique metabolic pattern that predicts excellent patient recovery. This key finding may mean that these individuals require less extensive post stroke rehabilitation and can get back into the community sooner. Andrew was also awarded the Young Investigator of the Year award by the Stroke Society of Australasia for validating contrast-free perfusion imaging in acute stroke. This imaging technique does not require the injection of a contrast dye into patients – something that can cause a severe allergic reaction.

The most common complaint after stroke is not motor weakness, it’s fatigue.

Finding fault with fatigue

Andrew is currently the coordinator of the MIDAS Fatigue Trial at HMRI. “The most common complaint after stroke is not motor weakness, it’s fatigue. The tricky thing about fatigue is that it will actually resolve itself within the first three months in about half the people who experience fatigue. So we’re doing a trial with people after that three-month-period where fatigue is persistent by giving participants a wakefulness agent to see if that resolves the fatigue to improve their quality of life.”

“With this trial we’re trying to start from the ground-up. We want to see if we can resolve one of the most profound barriers to rehabilitation, fatigue. If we are successful, we can look at using our fatigue therapy as an adjunct to enhance physical performance in the post stroke rehabilitation setting.”

An international biobank of ideas

“Imaging is a very powerful tool - because you can’t see through the skull, so without imaging you’re in the dark as to what is really happening which is partially relevant in stroke. The history of stroke trials really highlights just how important to the use of advanced imaging is. Previous trial which didn’t use advanced imaging, failed to show better patient outcomes with therapy. However recent trials, including our own, highlight that when imaging is used as a tool to identify patients we think will respond the most to treatment, that there is a clear treatment effect from therapy.”

What next? Andrew is the Imaging coordinator of INSPIRE (International Stroke Perfusion Imaging Registry) – as part of an international study to find a biomarker of stroke. “While imaging is the most powerful, and the best diagnostic tool, it’s not available everywhere. We need to keep validating to predictive power of advanced imaging in the clinical setting so that one day it becomes the standard of care.”

“The key to dependable, implementable imaging is to make it quick, reliable and accessible to the clinical population. This is part of our biggest success with acute stroke, where we implemented a software platform to enable automated processing where the clinician gets an email with the processed brain images and relevant imaging information which will let them know whether the patient that they just scanned is an ideal candidate for therapy or not. This also means that the clinician can take the patient away from the scanner and take the imaging information with them.”

As one of the leaders in his field, in just five years of research (including his PhD) it’s reasonable to ask about the fortuitous path that led Andrew to stroke research. “I wouldn’t say that I chose stroke as an area of interest, it was an opportunity and I just took it. I was just lucky to work with some of the leading researchers in the field as my Honours and PhD supervisors and I’ve been able to ride that opportunity through my career.”

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