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Dr Andrew Bivard

Early Career Researcher

School of Medicine and Public Health

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.”

Brain imaging adds impact to stroke research

Dr Andrew Bivard is an award-winning imaging expert.

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Career Summary

Biography

Dr Andrew Bivard works in acute ischemic stroke imaging using perfusion-based imaging techniques. An early-career researcher with a focus on identifying new treatment targets and therapies for stroke, Andrew is looking to develop therapies which are effective and improve an individual’s quality of life.

Stroke patients have a broad range of clinical symptoms that can make both diagnosis and treatment very difficult. By using perfusion imaging, a technique which measures the blood flow in the brain, researchers are looking to be able to positively identify a stroke – excluding mimics. Because stroke treatment requires a potent drug which can have severe side-effects, accurate identification of stroke is essential. Brain imaging allows clinicians to specifically target patients who will benefit from treatment, and exclude those likely to be harmed.

Awarded his PhD in 2013, the work from Andrew’s PhD has been used in a successful Phase II clinical trial which has now been translated into an International Phase III trial funded by an NHMRC grant. His work has helped establish CT perfusion as a clinically-reliable tool. This work has been translated directly into clinical care in 19 stroke centres around the world.


Qualifications

  • PhD, University of Newcastle

Keywords

  • acute stroke therapies
  • brain imaging
  • clinical imaging
  • stroke
  • stroke genetics
  • stroke recovery
  • stroke rehabilitation

Professional Experience

UON Appointment

Title Organisation / Department
Early Career Researcher University of Newcastle
School of Medicine and Public Health
Australia
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Chapter (2 outputs)

Year Citation Altmetrics Link
2016 Bivard AP, 'Normal and Abnormal Physiology of Cerebral Blood Flow', MR & CT Perfusion Imaging: Clinical Applications and Theoretical Principles, Lippincott Williams & Wilkins, USA (2016)
2014 Bivard A, Stanwell P, Parsons M, 'Stroke and Cerebral Ischaemia', Magnetic Resonance Spectroscopy: Tools for Neuroscience Research and Emerging Clinical Applications, Academic Press, London, UK 183-195 (2014) [B2]
Co-authors Peter Stanwell, Mark Parsons

Journal article (59 outputs)

Year Citation Altmetrics Link
2017 Bivard A, Lillicrap T, Krishnamurthy V, Holliday E, Attia J, Pagram H, et al., 'MIDAS (Modafinil in Debilitating Fatigue after Stroke): A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Trial', Stroke, 48 1293-1298 (2017) [C1]

© 2017 American Heart Association, Inc. Background and Purpose - This study aimed to assess the efficacy of modafinil, a wakefulness-promoting agent in alleviating post-stroke fa... [more]

© 2017 American Heart Association, Inc. Background and Purpose - This study aimed to assess the efficacy of modafinil, a wakefulness-promoting agent in alleviating post-stroke fatigue =3 months after stroke. We hypothesized that 200 mg of modafinil daily for 6 weeks would result in reduced symptoms of fatigue compared with placebo. Methods - This single-center phase 2 trial used a randomized, double-blind, placebo-controlled, crossover design. The key inclusion criterion was a multidimensional fatigue inventory score of =60. Patients were randomized to either modafinil or placebo for 6 weeks of therapy, then after a 1 week washout period swapped treatment arms for a second 6 weeks of therapy. The primary outcome was the multidimensional fatigue inventory; secondary outcomes included the Montreal cognitive assessment, the Depression, Anxiety, and Stress Scale (DASS), and the Stroke-Specific Quality of Life (SSQoL) scale. The multidimensional fatigue inventory is a self-administered questionnaire with a range of 0 to 100. Treatment efficacy was assessed using linear regression by estimating within-person, baseline-adjusted differences in mean outcomes after therapy. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000350527). Results - A total of 232 stroke survivors were screened and 36 were randomized. Participants receiving modafinil reported a significant decrease in fatigue (multidimensional fatigue inventory, -7.38; 95% CI, -21.76 to -2.99; P < 0.001) and improved quality of life (SSQoL, 11.81; 95% CI, 2.31 to 21.31; P=0.0148) compared with placebo. Montreal cognitive assessment and DASS were not significantly improved with modafinil therapy during the study period (P > 0.05). Conclusions - Stroke survivors with nonresolving fatigue reported reduced fatigue and improved quality of life after taking 200 mg daily treatment with modafinil.

DOI 10.1161/STROKEAHA.116.016293
Citations Scopus - 1Web of Science - 1
Co-authors Liz Holliday, Mark Parsons, John Attia, Christopher Levi, Michael Nilsson
2017 Demeestere J, Sewell C, Rudd J, Ang T, Jordan L, Wills J, et al., 'The establishment of a telestroke service using multimodal CT imaging decision assistance: ¿Turning on the fog lights¿', Journal of Clinical Neuroscience, 37 1-5 (2017) [C1]

© 2016 Telestroke services have been shown to increase stroke therapy access in rural areas. The implementation of advanced CT imaging for patient assessment may improve patient ... [more]

© 2016 Telestroke services have been shown to increase stroke therapy access in rural areas. The implementation of advanced CT imaging for patient assessment may improve patient selection and detection of stroke mimics in conjunction with telestroke. We implemented a telestroke service supported by multimodal CT imaging in a rural hospital in Australia. Over 21¿months we conducted an evaluation of service activation, thrombolysis rates and use of multimodal imaging to assess the feasibility of the service. Rates of symptomatic intracranial haemorrhage and 90-day modified Rankin Score were used as safety outcomes. Fifty-eight patients were assessed using telestroke, of which 41 were regarded to be acute ischemic strokes and 17 to be stroke mimics on clinical grounds. Of the 41 acute stroke patients, 22 patients were deemed eligible for thrombolysis. Using multimodal CT imaging, 8 more patients were excluded from treatment because of lack of treatment target. Multimodal imaging failed to be obtained in one patient. For the 14 treated patients, median door-imaging time was 38¿min. Median door-treatment time was 91¿min. A 90-day mRS ¿2 was achieved in 40% of treated patients. We conclude that a telestroke service using advanced CT imaging for therapy decision assistance can be successfully implemented in regional Australia and can be used to guide acute stroke treatment decision-making and improve access to thrombolytic therapy. Efficiency and safety is comparable to established telestroke services.

DOI 10.1016/j.jocn.2016.10.018
Citations Scopus - 1Web of Science - 1
Co-authors Neil Spratt, Christopher Levi, Mark Parsons
2017 Pagram H, Bivard A, Lincz LF, Levi C, 'Immunity and stroke, the hurdles of stroke research translation', International Journal of Stroke, 12 123-131 (2017) [C1]

© 2016, © 2016 World Stroke Organization. Immunomodulatory therapies after stroke have the potential to provide clinical benefit to a subset of patients, but risk subverting the... [more]

© 2016, © 2016 World Stroke Organization. Immunomodulatory therapies after stroke have the potential to provide clinical benefit to a subset of patients, but risk subverting the protective, healing aspects of the innate immune response. Neutrophils clear necrotic cerebral tissue and are important in immunomodulation, but can also contribute to tissue injury. Human trials for immunomodulatory stroke treatments in the sub-acute time frame have attempted to prevent peripheral neutrophil infiltration, but none have been successful and one trial demonstrated harm. These unselected trials had broad inclusion criteria and appear to not have had a specific treatment target. Unfortunately, due to the heterogeneous nature of brain ischemia in humans resulting in variation in clinical severity, the negative effect of thrombolytic drugs on the blood¿brain barrier, and the heterogeneity of immune response, it may only be a subset of stroke patients who can realistically benefit from immunomodulation therapies. Translational research strategies require both an understanding of lab practices which create highly controlled environments in contrast to clinical practice where the diagnosis of stroke does not require the identification of a vessel occlusion. These differences between lab and clinical practices can be resolved through the integration of appropriate patient selection criteria and use of advanced imaging and ridged patient selection practices in clinical trials which will be an important part to the success of any future trials of translational research such as immunomodulation.

DOI 10.1177/1747493016676622
Co-authors Lisa Lincz, Christopher Levi
2017 Chen C, Parsons MW, Clapham M, Oldmeadow C, Levi CR, Lin L, et al., 'Influence of Penumbral Reperfusion on Clinical Outcome Depends on Baseline Ischemic Core Volume', Stroke, 48 2739-2745 (2017) [C1]

© 2017 American Heart Association, Inc. BACKGROUND AND PURPOSE: In alteplase-treated patients with acute ischemic stroke, we investigated the relationship between penumbral reper... [more]

© 2017 American Heart Association, Inc. BACKGROUND AND PURPOSE: In alteplase-treated patients with acute ischemic stroke, we investigated the relationship between penumbral reperfusion at 24 hours and clinical outcomes, with and without adjustment for baseline ischemic core volume. RESULTS: This study included 1507 patients. Reperfused penumbral volume had moderate ability to predict 90-day mRS 0 to 1 (area under the curve, 0.77; R2, 0.28; P < 0.0001). However, after adjusting for baseline ischemic core volume, the reperfused penumbral volume was a strong predictor of good functional outcome (area under the curve, 0.946; R2, 0.55; P < 0.0001). For every 1% increase in penumbral reperfusion, the odds of achieving mRS 0 to 1 at day 90 increased by 7.4%. Improvement in acute 24-hour National Institutes of Health Stroke Scale was also significantly related to the degree of reperfused penumbra (R2, 0.31; P < 0.0001). This association was again stronger after adjustment for baseline ischemic core volume (R2, 0.41; P < 0.0001). For each 1% of penumbra that was reperfused, the 24-hour National Institutes of Health Stroke Scale decreased by 0.069 compared with baseline. METHODS: Data were collected from consecutive acute ischemic stroke patients with baseline and follow-up perfusion imaging presenting to hospital within 4.5 hours of symptom onset at 7 hospitals. Logistic regression models were used for predicting the effect of the reperfused penumbral volume on the dichotomized modified Rankin Scale (mRS) at 90 days and improvement of National Institutes of Health Stroke Scale at 24 hours, both adjusted for baseline ischemic core volume. CONCLUSIONS: In patients treated with alteplase, the extent of the penumbra that is reperfused is a powerful predictor of early and late clinical outcomes, particularly when baseline ischemic core is taken into account.

DOI 10.1161/STROKEAHA.117.018587
Co-authors Christopher Oldmeadow, Mark Parsons, Christopher Levi
2017 Demeestere J, Garcia-Esperon C, Garcia-Bermejo P, Ombelet F, Mcelduff P, Bivard A, et al., 'Evaluation of hyperacute infarct volume using ASPECTS and brain CT perfusion core volume', Neurology, 88 2248-2253 (2017) [C1]

© 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. Objective: To compare the accuracy of Alberta Stroke Program Early ... [more]

© 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. Objective: To compare the accuracy of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and CT perfusion to detect established infarction in acute anterior circulation stroke. Methods: We performed an observational study in 59 acute anterior circulation ischemic stroke patients who underwent brain noncontrast CT, CT perfusion, and MRI within 100 minutes from CT imaging. ASPECTS scores were calculated by 4 blinded vascular neurologists. The accuracy of ASPECTS and CT perfusion core volume to detect an acute MRI diffusion lesion of =70 mL was evaluated using receiver operating characteristics analysis and optimum cutoff values were calculated using Youden J. Results: Median ASPECTS score was 8 (interquartile range [IQR] 5-9). Median CT perfusion core volume was 22 mL (IQR 10.4-71.9). Median MRI diffusion lesion volume was 24.5 mL (IQR 10-63.9). No significant difference was found between the accuracy of CT perfusion and ASPECTS (c statistic 0.95 vs 0.87, p value for difference = 0.17). The optimum ASPECTS cutoff score to detect a diffusion-weighted imaging lesion =70 mL was < 7 (sensitivity 0.74, specificity 0.86, Youden J = 0.60) and the optimum CT perfusion core volume cutoff was =50 mL (sensitivity 0.86, specificity 0.97, Youden J = 0.84). The CT perfusion core lesion covered a median of 100% (IQR 86%-100%) of the acute MRI lesion volume (Pearson R = 0.88; R 2 = 0.77). Conclusions: We found no significant difference between the accuracy of CT perfusion and ASPECTS to predict hyperacute MRI lesion volume in ischemic stroke.

DOI 10.1212/WNL.0000000000004028
Citations Scopus - 2Web of Science - 2
Co-authors Christopher Levi, Mark Parsons, Patrick Mcelduff
2017 Bivard A, Huang X, Levi CR, Spratt N, Campbell BCV, Cheripelli BK, et al., 'Tenecteplase in ischemic stroke offers improved recanalization', Neurology, 89 62-67 (2017) [C1]

© 2017 American Academy of Neurology. Objective: To test whether patients with complete vessel occlusion show greater recanalization at 24 hours and have improved clinical outcom... [more]

© 2017 American Academy of Neurology. Objective: To test whether patients with complete vessel occlusion show greater recanalization at 24 hours and have improved clinical outcomes at 24 hours and 90 days when treated with tenecteplase compared to alteplase. Methods: Pooled clinical and imaging data from 2 phase 2 randomized trials comparing tenecteplase with alteplase allowed CT angiography (CTA) scans to be assessed centrally for occlusion status at baseline and at 24 hours post thrombolysis using the modified thrombolysis in cerebral infarction (TICI) scale. Twenty-four-hour poststroke NIH Stroke Scale (NIHSS) and 90-day modified Rankin Scale (mRS) scores were also compared between treatment groups using linear regression to generate odds ratios (ORs). Results: From 146 pooled patients, 69 had a TICI 0/1 occlusion overall at baseline. Tenecteplase-treated patients with a complete vessel occlusion had greater complete recanalization rates at 24 hours (71% for tenecteplase vs 43% for alteplase, p < 0.001). Patients with a TICI 0/1 occlusion who were treated with tenecteplase also showed greater early clinical improvement (median NIHSS change with tenecteplase was 9, interquartile range [IQR] 6, alteplase 1, IQR 1, p = 0.001) and higher rates of favorable 90-day outcomes (mRS 0-1 of tenecteplase compared with alteplase, OR 4.82, 95% confidence interval 1.02-7.84, p = 0.05). Conclusions: Tenecteplase may offer greater recanalization efficacy compared to alteplase, possibly exaggerated in patients with complete vessel occlusions on baseline CTA.

DOI 10.1212/WNL.0000000000004062
Co-authors Mark Parsons, Neil Spratt, Christopher Levi
2017 Lillicrap T, Tahtali M, Neely A, Wang X, Bivard A, Lueck C, 'A model based on the Pennes bioheat transfer equation is valid in normal brain tissue but not brain tissue suffering focal ischaemia.', Australas Phys Eng Sci Med, (2017)
DOI 10.1007/s13246-017-0595-6
2017 Gao J, Parsons MW, Kawano H, Levi CR, Evans TJ, Lin L, Bivard A, 'Visibility of CT early ischemic change is significantly associated with time from stroke onset to baseline scan beyond the first 3 hours of stroke onset', Journal of Stroke, 19 340-346 (2017) [C1]
DOI 10.5853/jos.2016.01424
Co-authors Christopher Levi, Mark Parsons
2017 Lin L, Cheng X, Bivard A, Levi CR, Dong Q, Parsons MW, 'Quantifying reperfusion of the ischemic region on whole-brain computed tomography perfusion', Journal of Cerebral Blood Flow and Metabolism, 37 2125-2136 (2017) [C1]

© The Author(s) 2016. To derive the reperfusion index best predicting clinical outcome of ischemic stroke patients, we retrospectively analysed the acute and 24-h computed tomogr... [more]

© The Author(s) 2016. To derive the reperfusion index best predicting clinical outcome of ischemic stroke patients, we retrospectively analysed the acute and 24-h computed tomography perfusion data of 116 patients, collected from two centres equipped with whole-brain computed tomography perfusion. Reperfusion index was defined by the percentage of the ischemic region reperfused from acute to 24-h computed tomography perfusion. Recanalization was graded by arterial occlusive lesion system. Receiver operator characteristic analysis was performed to assess the prognostic value of reperfusion and recanalization in predicting good clinical outcome, defined as modified Rankin Score of 0¿2 at 90 days. Among previous reported reperfusion measurements, reperfusion of the Tmax > 6 s region resulted in higher prognostic value than recanalization at predicting good clinical outcome (area under the curve = 0.88 and 0.74, respectively, p = 0.002). Successful reperfusion of the Tmax > 6 s region (=60%) had 89% sensitivity and 78% specificity in predicting good clinical outcome. A reperfusion index defined by Tmax > 2 s or by mean transit time > 145% had much lower area under the curve in comparison to Tmax > 6 s measurement (p < 0.001 and p = 0.003, respectively), and had no significant difference to recanalization at predicting clinical outcome (p = 0.58 and 0.63, respectively). In conclusion, reperfusion index calculated by Tmax > 6 s is a stronger predictor of clinical outcome than recanalization or other reperfusion measures.

DOI 10.1177/0271678X16661338
Citations Scopus - 1Web of Science - 3
Co-authors Christopher Levi, Mark Parsons
2017 Bivard A, Levi C, Lin L, Cheng X, Aviv R, Spratt NJ, et al., 'Validating a Predictive Model of Acute Advanced Imaging Biomarkers in Ischemic Stroke', Stroke, 48 645-650 (2017) [C1]

© 2017 American Heart Association, Inc. Background and Purpose - Advanced imaging to identify tissue pathophysiology may provide more accurate prognostication than the clinical m... [more]

© 2017 American Heart Association, Inc. Background and Purpose - Advanced imaging to identify tissue pathophysiology may provide more accurate prognostication than the clinical measures used currently in stroke. This study aimed to derive and validate a predictive model for functional outcome based on acute clinical and advanced imaging measures. Methods - A database of prospectively collected sub-4.5 hour patients with ischemic stroke being assessed for thrombolysis from 5 centers who had computed tomographic perfusion and computed tomographic angiography before a treatment decision was assessed. Individual variable cut points were derived from a classification and regression tree analysis. The optimal cut points for each assessment variable were then used in a backward logic regression to predict modified Rankin scale (MRS) score of 0 to 1 and 5 to 6. The variables remaining in the models were then assessed using a receiver operating characteristic curve analysis. Results - Overall, 1519 patients were included in the study, 635 in the derivation cohort and 884 in the validation cohort. The model was highly accurate at predicting MRS score of 0 to 1 in all patients considered for thrombolysis therapy (area under the curve [AUC] 0.91), those who were treated (AUC 0.88) and those with recanalization (AUC 0.89). Next, the model was highly accurate at predicting MRS score of 5 to 6 in all patients considered for thrombolysis therapy (AUC 0.91), those who were treated (0.89) and those with recanalization (AUC 0.91). The odds ratio of thrombolysed patients who met the model criteria achieving MRS score of 0 to 1 was 17.89 (4.59-36.35, P < 0.001) and for MRS score of 5 to 6 was 8.23 (2.57-26.97, P < 0.001). Conclusions - This study has derived and validated a highly accurate model at predicting patient outcome after ischemic stroke.

DOI 10.1161/STROKEAHA.116.015143
Citations Scopus - 4Web of Science - 5
Co-authors Neil Spratt, Mark Parsons, Christopher Levi
2017 Bhaskar S, Stanwell P, Bivard A, Spratt N, Walker R, Kitsos GH, et al., 'The influence of initial stroke severity on the likelihood of unfavourable clinical outcome and death at 90 days following acute ischemic stroke: A tertiary hospital stroke register study', Neurology India, 65 1252-1259 (2017)
DOI 10.4103/0028-3886.217947
Co-authors Peter Stanwell, Neil Spratt, Mark Parsons, Christopher Levi, John Attia, Michael Nilsson
2017 Demeestere J, Garcia-Esperon C, Lin L, Bivard A, Ang T, Smoll NR, et al., 'Validation of the National Institutes of Health Stroke Scale-8 to Detect Large Vessel Occlusion in Ischemic Stroke', Journal of Stroke and Cerebrovascular Diseases, 26 1419-1426 (2017) [C1]

© 2017 National Stroke Association Background Patients with acute ischemic stroke and large vessel occlusion (LVO) may benefit from prehospital identification and transfer to a c... [more]

© 2017 National Stroke Association Background Patients with acute ischemic stroke and large vessel occlusion (LVO) may benefit from prehospital identification and transfer to a center offering endovascular therapy. Aims We aimed to assess the accuracy of an existing 8-item stroke scale (National Institutes of Health Stroke Scale-8 [NIHSS-8]) for identification of patients with acute stroke with LVO. Methods We retrospectively calculated NIHSS-8 scores in a population of consecutive patients with presumed acute stroke assessed by emergency medical services (EMS). LVO was identified on admission computed tomography angiography. Accuracy to identify LVO was calculated using receiver operating characteristics analysis. We used weighted Cohen's kappa statistics to assess inter-rater reliability for the NIHSS-8 score between the EMS and the hospital stroke team on a prospectively evaluated subgroup. Results Of the 551 included patients, 381 had a confirmed ischemic stroke and 136 patients had an LVO. NIHSS scores were significantly higher in patients with LVO (median 18; interquartile range 14-22). The NIHSS-8 score reliably predicted the presence of LVO (area under the receiver operating characteristic curve.82). The optimum NIHSS-8 cutoff of 8 or more had a sensitivity of.81, specificity of.75, and Youden index of.56 for prediction of LVO. The EMS and the stroke team reached substantial agreement (¿ =.69). Conclusions Accuracy of the NIHSS-8 to identify LVO in a population of patients with suspected acute stroke is comparable to existing prehospital stroke scales. The scale can be performed by EMS with reasonable reliability. Further validation in the field is needed to assess accuracy of the scale to identify patients with LVO eligible for endovascular treatment in a prehospital setting.

DOI 10.1016/j.jstrokecerebrovasdis.2017.03.020
Co-authors Neil Spratt, Mark Parsons, Christopher Levi
2017 Bivard A, Huang X, McElduff P, Levi CR, Campbell BCV, Cheripelli BK, et al., 'Impact of Computed Tomography Perfusion Imaging on the Response to Tenecteplase in Ischemic Stroke: Analysis of 2 Randomized Controlled Trials', Circulation, 135 440-448 (2017) [C1]

© 2016 American Heart Association, Inc. Background: We pooled 2 clinical trials of tenecteplase compared with alteplase for the treatment of acute ischemic stroke, 1 that demonst... [more]

© 2016 American Heart Association, Inc. Background: We pooled 2 clinical trials of tenecteplase compared with alteplase for the treatment of acute ischemic stroke, 1 that demonstrated superiority of tenecteplase and the other that showed no difference between the treatments in patient clinical outcomes. We tested the hypotheses that reperfusion therapy with tenecteplase would be superior to alteplase in improving functional outcomes in the group of patients with target mismatch as identified with advanced imaging. Methods: We investigated whether tenecteplase-Treated patients had a different 24-hour reduction in the National Institutes of Health Stroke Scale and a favorable odds ratio of a modified Rankin scale score of 0 to 1 versus 2 to 6 compared with alteplase-Treated patients using linear regression to generate odds ratios. Imaging outcomes included rates of vessel recanalization and infarct growth at 24 hours and occurrence of large parenchymal hematoma. Baseline computed tomography perfusion was analyzed to assess whether patients met the target mismatch criteria (absolute mismatch volume > 15 mL, mismatch ratio > 1.8, baseline ischemic core < 70 mL, and volume of severely hypoperfused tissue < 100 mL). Patients meeting target mismatch criteria were analyzed as a subgroup to identify whether they had different treatment responses from the pooled group. Results: Of 146 pooled patients, 71 received alteplase and 75 received tenecteplase. Tenecteplase-Treated patients had greater early clinical improvement (median National Institutes of Health Stroke Scale score change: Tenecteplase, 7; alteplase, 2; P=0.018) and less parenchymal hematoma (2 of 75 versus 10 of 71; P=0.02). The pooled group did not show improved patient outcomes when treated with tenecteplase (modified Rankin scale score 0-1: odds ratio, 1.77; 95% confidence interval, 0.89-3.51; P=0.102) compared with alteplase therapy. However, in patients with target mismatch (33 tenecteplase, 35 alteplase), treatment with tenecteplase was associated with greater early clinical improvement (median National Institutes of Health Stroke Scale score change: Tenecteplase, 6; alteplase, 1; P < 0.001) and better late independent recovery (modified Rankin scale score 0-1: odds ratio, 2.33; 95% confidence interval, 1.13-5.94; P=0.032) than those treated with alteplase. Conclusions: Tenecteplase may offer an improved efficacy and safety profile compared with alteplase, benefits possibly exaggerated in patients with baseline computed tomography perfusion-defined target mismatch. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01472926. URL: https://www.anzctr.org.au. Unique identifier: ACTRN12608000466347.

DOI 10.1161/CIRCULATIONAHA.116.022582
Citations Scopus - 3Web of Science - 2
Co-authors Patrick Mcelduff, Mark Parsons, Christopher Levi
2017 Alemseged F, Shah DG, Diomedi M, Sallustio F, Bivard A, Sharma G, et al., 'The Basilar Artery on Computed Tomography Angiography Prognostic Score for Basilar Artery Occlusion', Stroke, 48 631-637 (2017) [C1]
DOI 10.1161/STROKEAHA.116.015492
Citations Scopus - 1
Co-authors Mark Parsons, Christopher Levi
2017 Bivard A, Muir K, Parsons M, 'Response by Bivard et al to Letter Regarding Article, "Impact of Computed Tomography Perfusion Imaging on the Response to Tenecteplase in Ischemic Stroke: Analysis of 2 Randomized Controlled Trials"', CIRCULATION, 135 E1141-E1142 (2017)
DOI 10.1161/CIRCULATIONAHA.117.028417
Co-authors Mark Parsons
2017 Bivard A, Levi C, Parsons M, 'Response by Bivard et al to Letter Regarding Article, "Validating a Predictive Model of Acute Advanced Imaging Biomarkers in Ischemic Stroke"', STROKE, 48 E226-E226 (2017)
DOI 10.1161/STROKEAHA.117.017613
Co-authors Mark Parsons, Christopher Levi
2017 Bhaskar S, Bivard A, Stanwell P, Parsons M, Attia JR, Nilsson M, Levi C, 'Baseline collateral status and infarct topography in post-ischaemic perilesional hyperperfusion: An arterial spin labelling study', Journal of Cerebral Blood Flow and Metabolism, 37 1148-1162 (2017) [C1]

© The Author(s) 2016. Focal hyperperfusion after acute ischaemic stroke could be of prognostic value depending upon its spatial localisation and temporal dynamics. Factors associ... [more]

© The Author(s) 2016. Focal hyperperfusion after acute ischaemic stroke could be of prognostic value depending upon its spatial localisation and temporal dynamics. Factors associated with late stage (12-24 h) perilesional hyperperfusion, identified using arterial spin labelling, are poorly defined. A prospective cohort of acute ischaemic stroke patients presenting within 4.5 h of symptom onset were assessed with multi-modal computed tomography acutely and magnetic resonance imaging at 24 ± 8 h. Multivariate logistic regression analysis and receiver operating characteristics curves were used. One hundred and nineteen hemispheric acute ischaemic stroke patients (mean age = 71 ± 12 years) with 24 h arterial spin labelling imaging were included. Forty-Two (35.3%) patients showed perilesional hyperperfusion on arterial spin labelling at 24 h. Several factors were independently associated with perilesional hyperperfusion: good collaterals (71% versus 29%, P < 0.0001; OR = 5, 95% CI = [1.6, 15.7], P = 0.005), major reperfusion (81% versus 48%, P = < 0.0001; OR = 7.5, 95% CI = [1.6, 35.1], P = 0.01), penumbral salvage (76.2% versus 47%, P = 0.002; OR = 6.6, 95% CI = [1.8, 24.5] , P = 0.004), infarction in striatocapsular (OR = 9.5, 95% CI = [2.6, 34], P = 0.001) and in cortical superior division middle cerebral artery (OR = 4.7, 95% CI = [1.4, 15.7] , P = 0.012) territory. The area under the receiver operating characteristic curve was 0.91. Our results demonstrate good arterial collaterals, major reperfusion, penumbral salvage, and infarct topographies involving cortical superior middle cerebral artery and striatocapsular are associated with perilesional hyperperfusion.

DOI 10.1177/0271678X16653133
Citations Scopus - 2Web of Science - 2
Co-authors John Attia, Michael Nilsson, Mark Parsons, Peter Stanwell, Christopher Levi
2017 Bendinelli C, Cooper S, Evans T, Bivard A, Pacey D, Parson M, Balogh ZJ, 'Perfusion Abnormalities are Frequently Detected by Early CT Perfusion and Predict Unfavourable Outcome Following Severe Traumatic Brain Injury', World Journal of Surgery, 41 2512-2520 (2017) [C1]

© 2017, Société Internationale de Chirurgie. Background: In patients with severe traumatic brain injury (TBI), early CT perfusion (CTP) provides additional information beyond t... [more]

© 2017, Société Internationale de Chirurgie. Background: In patients with severe traumatic brain injury (TBI), early CT perfusion (CTP) provides additional information beyond the non-contrast CT (NCCT) and may alter clinical management. We hypothesized that this information may prognosticate functional outcome. Methods: Five-year prospective observational study was performed in a level-1 trauma centre on consecutive severe TBI patients. CTP (obtained in conjunction with first routine NCCT) was interpreted as: abnormal, area of altered perfusion more extensive than on NCCT, and the presence of ischaemia. Six months Glasgow Outcome Scale-Extended of four or less was considered an unfavourable outcome. Logistic regression analysis of CTP findings and core variables [preintubation Glasgow Coma Scale (GCS), Rotterdam score, base deficit, age] was conducted using Bayesian model averaging to identify the best predicting model for unfavourable outcome. Results: Fifty patients were investigated with CTP (one excluded for the absence of TBI) [male: 80%, median age: 35 (23¿55), prehospital intubation: 7 (14.2%); median GCS: 5 (3¿7); median injury severity score: 29 (20¿36); median head and neck abbreviated injury scale: 4 (4¿5); median days in ICU: 10 (5¿15)] . Thirty (50.8%) patients had an unfavourable outcome. GCS was a moderate predictor of unfavourable outcome (AUC¿=¿0.74), while CTP variables showed greater predictive ability (AUC for abnormal CTP¿=¿0.92; AUC for area of altered perfusion more extensive than NCCT¿=¿0.83; AUC for the presence of ischaemia¿=¿0.81). Conclusion: Following severe TBI, CTP performed at the time of the first follow-up NCCT, is a non-invasive and extremely valuable tool for early outcome prediction. The potential impact on management and its cost effectiveness deserves to be evaluated in la rge-scale studies. Level of evidence III: Prospective study.

DOI 10.1007/s00268-017-4030-7
Co-authors Mark Parsons, Zsolt Balogh
2017 Bivard A, Lincz LF, Maquire J, Parsons M, Levi C, 'Platelet microparticles: a biomarker for recanalization in rtPA-treated ischemic stroke patients', ANNALS OF CLINICAL AND TRANSLATIONAL NEUROLOGY, 4 175-179 (2017) [C1]
DOI 10.1002/acn3.392
Co-authors Christopher Levi, Mark Parsons, Lisa Lincz
2017 Kawano H, Bivard A, Lin L, Ma H, Cheng X, Aviv R, et al., 'Perfusion computed tomography in patients with stroke thrombolysis', Brain : a journal of neurology, 140 684-691 (2017) [C1]

© The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. See Saver (doi:10.1093/awx020) for a scientific commentary on... [more]

© The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. See Saver (doi:10.1093/awx020) for a scientific commentary on this article.Stroke shortens an individual's disability-free life. We aimed to assess the relative prognostic influence of pre- and post-treatment perfusion computed tomography imaging variables (e.g. ischaemic core and penumbral volumes) compared to standard clinical predictors (such as onset-to-treatment time) on long-term stroke disability in patients undergoing thrombolysis. We used data from a prospectively collected international, multicentre, observational registry of acute ischaemic stroke patients who had perfusion computed tomography and computed tomography angiography before treatment with intravenous alteplase. Baseline perfusion computed tomography and follow-up magnetic resonance imaging were analysed to derive the baseline penumbra volume, baseline ischaemic core volume, and penumbra salvaged from infarction. The primary outcome measure was the effect of imaging and clinical variables on Disability-Adjusted Life Year. Clinical variables were age, sex, National Institutes of Health Stroke Scale score, and onset-to-treatment time. Age, sex, country, and 3-month modified Rankin Scale were extracted from the registry to calculate disability-adjusted life-year due to stroke, such that 1 year of disability-adjusted life-year equates to 1 year of healthy life lost due to stroke. There were 772 patients receiving alteplase therapy. The number of disability-adjusted life-year days lost per 1 ml of baseline ischaemic core volume was 17.5 (95% confidence interval, 13.2-21.9 days, P < 0.001). For every millilitre of penumbra salvaged, 7.2 days of disability-adjusted life-year days were saved (ß = -7.2, 95% confidence interval, -10.4 to -4.1 days, P < 0.001). Each minute of earlier onset-to-treatment time resulted in a saving of 4.4 disability-free days after stroke (1.3-7.5 days, P = 0.006). However, after adjustment for imaging variables, onset-to-treatment time was not significantly associated with savings in disability-adjusted life-year days. Pretreatment perfusion computed tomography can (independently of clinical variables) predict significant gains, or loss, of disability-free life in patients undergoing reperfusion therapy for stroke. The effect of earlier treatment on disability-free life appears explained by salvage of penumbra, particularly when the ischaemic core is not too large.

DOI 10.1093/brain/aww338
Citations Web of Science - 1
Co-authors Mark Parsons, Christopher Levi
2016 Kawano H, Levi C, Inatomi Y, Pagram H, Kerr E, Bivard A, et al., 'International benchmarking for acute thrombolytic therapy implementation in Australia and Japan', Journal of Clinical Neuroscience, 29 87-91 (2016) [C1]

© 2016 Elsevier Ltd. All rights reserved. Although a wide range of strategies have been established to improve intravenous tissue plasminogen activator (IV-tPA) treatment rates, ... [more]

© 2016 Elsevier Ltd. All rights reserved. Although a wide range of strategies have been established to improve intravenous tissue plasminogen activator (IV-tPA) treatment rates, international benchmarking has not been regularly used as a systems improvement tool. We compared acute stroke codes (ASC) between two hospitals in Australia and Japan to study the activation process and potentially improve the implementation of thrombolysis. Consecutive patients who were admitted to each hospital via ASC were prospectively collected. We compared IV-tPA rates, factors contributing to exclusion from IV-tPA, and pre- and in-hospital process of care. IV-tPA treatment rates were significantly higher in the Australian hospital than in the Japanese (41% versus 25% of acute ischaemic stroke patients, p = 0.0016). In both hospitals, reasons for exclusion from IV-tPA treatment were intracerebral haemorrhage, mild symptoms, and stroke mimic. Patients with baseline National Institutes of Health Stroke Scale score =5 were more likely to be excluded from IV-tPA in the Japanese hospital. Of patients treated with IV-tPA, the door-to-needle time (median, 63 versus 54 minutes, p = 0.0355) and imaging-to-needle time (34 versus 27 minutes, p = 0.0220) were longer in the Australian hospital. Through international benchmarking using cohorts captured under ASC, significant differences were noted in rates of IV-tPA treatment and workflow speed. This variation highlights opportunity to improve and areas to focus targeted practice improvement strategies.

DOI 10.1016/j.jocn.2015.10.043
Co-authors Neil Spratt, Christopher Levi, Mark Parsons
2016 Bivard A, Cheng X, Lin LT, Levi C, Spratt N, Kleinig T, et al., 'Global White Matter Hypoperfusion on CT Predicts Larger Infarcts and Hemorrhagic Transformation after Acute Ischemia', CNS Neuroscience and Therapeutics, 22 238-243 (2016) [C1]

© 2016 John Wiley &amp; Sons Ltd. Introduction: Presence of white matter hyperintensity (WMH) on MRI is a marker of cerebral small vessel disease and is associated with increas... [more]

© 2016 John Wiley & Sons Ltd. Introduction: Presence of white matter hyperintensity (WMH) on MRI is a marker of cerebral small vessel disease and is associated with increased small vessel stroke and increased risk of hemorrhagic transformation (HT) after thrombolysis. Aim: We sought to determine whether white matter hypoperfusion (WMHP) on perfusion CT (CTP) was related to WMH, and if WMHP predisposed to acute lacunar stroke subtype and HT after thrombolysis. Methods: Acute ischemic stroke patients within 12 h of symptom onset at 2 centers were prospectively recruited between 2011 and 2013 for the International Stroke Perfusion Imaging Registry. Participants routinely underwent baseline CT imaging, including CTP, and follow-up imaging with MRI at 24 h. Results: Of 229 ischemic stroke patients, 108 were Caucasians and 121 Chinese. In the contralateral white matter, patients with acute lacunar stroke had lower cerebral blood flow (CBF) and cerebral blood volume (CBV), compared to those with other stroke subtypes (P = 0.041). There were 46 patients with HT, and WMHP was associated with increased risk of HT (R 2 = 0.417, P = 0.002). Compared to previously reported predictors of HT, WMHP performed better than infarct core volume (R 2 = 0.341, P = 0.034), very low CBV volume (R 2 = 0.249, P = 0.026), and severely delayed perfusion (Tmax > 14 second R 2 = 0.372, P = 0.011). Patients with WMHP also had larger acute infarcts and increased infarct growth compared to those without WMHP (mean 28 mL vs. 13 mL P < 0.001). Conclusion: White matter hypoperfusion remote to the acutely ischemic region on CTP is a marker of small vessel disease and was associated with increased HT, larger acute infarct cores, and greater infarct growth.

DOI 10.1111/cns.12491
Citations Scopus - 1Web of Science - 1
Co-authors Neil Spratt, Christopher Levi, Mark Parsons
2016 Bhaskar S, Bivard A, Stanwell P, Attia JR, Parsons M, Nilsson M, Levi C, 'Association of Cortical Vein Filling with Clot Location and Clinical Outcomes in Acute Ischaemic Stroke Patients', SCIENTIFIC REPORTS, 6 (2016) [C1]
DOI 10.1038/srep38525
Co-authors Mark Parsons, John Attia, Michael Nilsson, Peter Stanwell, Christopher Levi
2016 Bhaskar S, Bivard A, Parsons M, Nilsson M, Attia JR, Stanwell P, Levi C, 'Delay of late-venous phase cortical vein filling in acute ischemic stroke patients: Associations with collateral status', Journal of Cerebral Blood Flow and Metabolism, 37 671-682 (2016) [C1]

© The Author(s) 2016. Evaluation of the venous system may be useful in stroke prognostication and patient selection for acute intervention strategies. We report a novel phenomeno... [more]

© The Author(s) 2016. Evaluation of the venous system may be useful in stroke prognostication and patient selection for acute intervention strategies. We report a novel phenomenon, delayed-late venous phase cortical vein filling, observed on dynamic computed tomography angiography obtained using multidetector computed tomography scanner, in acute ischemic stroke patients. The aim of this study was to examine the frequency of delayed-late venous phase cortical vein filling and assess its association to baseline collateral status. Dynamic computed tomography angiography images of acute ischemic stroke patients, being assessed for reperfusion therapy, were prospectively studied. Delayed-late venous phase cortical vein filling was defined by late venous phase opacification of cortical veins despite contrast clearance from contralateral cortical veins on dynamic computed tomography angiography. Time to peak of maximum arterial enhancement was recorded. A total of 117 patients (mean age = 70.6 ± 13.3 years; males = 48%) with hemispheric ischemic stroke who underwent acute dynamic computed tomography angiography were included in the study. Overall, 56 (48%) demonstrated delayed-late venous phase cortical vein filling. Poor collateralization (OR = 13.50; 95% CI = (4.2, 43); p = 0.0001) and longer time to peak of maximum arterial enhancement (OR = 3.2; 95% CI = (1.96, 5.3); p= 0.0001) were positively associated with delayed-late venous phase cortical vein filling. Delayed-late venous phase cortical vein filling was independently associated with poor baseline collateral status (75% vs. 15%, p = 0.0001; OR = 14.38; 95% CI = (4.33, 47.8); p = 0.0001). Delayed-late venous phase cortical vein filling is frequently seen in patients with acute ischemic stroke and is associated with poor baseline collateralization.

DOI 10.1177/0271678X16637611
Citations Scopus - 2Web of Science - 3
Co-authors Mark Parsons, John Attia, Michael Nilsson, Christopher Levi, Peter Stanwell
2016 Lillicrap T, Krishnamurthy V, Attia J, Nilsson M, Levi CR, Parsons MW, Bivard A, 'Modafinil In Debilitating fatigue After Stroke (MIDAS): study protocol for a randomised, double-blinded, placebo-controlled, crossover trial', TRIALS, 17 (2016)
Citations Scopus - 2Web of Science - 2
Co-authors Mark Parsons, John Attia, Michael Nilsson, Christopher Levi
2016 Huynh DC, Parsons MW, Wintermark M, Vagal A, d¿Esterre CD, Vitorino R, et al., 'Can CT perfusion accurately assess infarct core?', Neurovascular Imaging, 2 (2016) [C1]
DOI 10.1186/s40809-016-0018-1
Co-authors Mark Parsons
2016 Warach SJ, Luby M, Albers GW, Bammer R, Bivard A, Campbell BCV, et al., 'Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials: Consensus Recommendations and Further Research Priorities', Stroke, 47 1389-1398 (2016) [C1]

© 2016 American Heart Association, Inc. Background and Purpose - The Stroke Imaging Research (STIR) group, the Imaging Working Group of StrokeNet, the American Society of Neurora... [more]

© 2016 American Heart Association, Inc. Background and Purpose - The Stroke Imaging Research (STIR) group, the Imaging Working Group of StrokeNet, the American Society of Neuroradiology, and the Foundation of the American Society of Neuroradiology sponsored an imaging session and workshop during the Stroke Treatment Academy Industry Roundtable (STAIR) IX on October 5 to 6, 2015 in Washington, DC. The purpose of this roadmap was to focus on the role of imaging in future research and clinical trials. Methods - This forum brought together stroke neurologists, neuroradiologists, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), industry representatives, and members of the US Food and Drug Administration to discuss STIR priorities in the light of an unprecedented series of positive acute stroke endovascular therapy clinical trials. Results - The imaging session summarized and compared the imaging components of the recent positive endovascular trials and proposed opportunities for pooled analyses. The imaging workshop developed consensus recommendations for optimal imaging methods for the acquisition and analysis of core, mismatch, and collaterals across multiple modalities, and also a standardized approach for measuring the final infarct volume in prospective clinical trials. Conclusions - Recent positive acute stroke endovascular clinical trials have demonstrated the added value of neurovascular imaging. The optimal imaging profile for endovascular treatment includes large vessel occlusion, smaller core, good collaterals, and large penumbra. However, equivalent definitions for the imaging profile parameters across modalities are needed, and a standardization effort is warranted, potentially leveraging the pooled data resulting from the recent positive endovascular trials.

DOI 10.1161/STROKEAHA.115.012364
Citations Scopus - 10Web of Science - 10
Co-authors Mark Parsons
2016 Yassi N, Campbell BCV, Moffat BA, Steward C, Churilov L, Parsons MW, et al., 'Association between baseline peri-infarct magnetic resonance spectroscopy and regional white matter atrophy after stroke', Neuroradiology, 58 3-10 (2016) [C1]

© 2015, Springer-Verlag Berlin Heidelberg. Introduction: Cerebral atrophy after stroke is associated with poor functional outcome. The prediction and prevention of post-stroke br... [more]

© 2015, Springer-Verlag Berlin Heidelberg. Introduction: Cerebral atrophy after stroke is associated with poor functional outcome. The prediction and prevention of post-stroke brain atrophy could therefore represent a target for neurorestorative therapies. We investigated the associations between peri-infarct metabolite concentrations measured by quantitative MRS and brain volume change in the infarct hemisphere after stroke. Methods: Twenty patients with ischemic stroke were enrolled. Patients underwent 3T-MRI within 1¿week of onset, and at 1 and 3¿months. At the baseline scan, an MRS voxel was placed manually in the peri-infarct area and another in the corresponding contralateral region. Volumetric analysis of T1 images was performed using two automated processing packages. Changes in gray and white matter volume were assessed as percentage change between 1 and 3¿months. Results: Mean concentrations (institutional units) of N-acetylaspartic acid (NAA) (6.1 vs 7.0, p = 0.039), total creatine (Cr+PCr) (5.4 vs 5.8, p = 0.043), and inositol (4.5 vs 5.0, p = 0.014), were significantly lower in the peri-infarct region compared with the contralateral hemisphere. There was a significant correlation between baseline peri-infarct NAA and white matter volume change in the infarct hemisphere between 1 and 3¿months, with lower NAA being associated with subsequent white matter atrophy (Spearman¿s rho = 0.66, p = 0.010). The baseline concentration of Cr+PCr was also significantly correlated with white matter atrophy in the infarct hemisphere (Spearman¿s rho = 0.59, p = 0.027). Both of these associations were significant after adjustment for the false discovery rate and were validated using the secondary volumetric method. Conclusion: MRS may be useful in the prediction of white matter atrophy post-stroke and in the testing of novel neurorestorative therapies.

DOI 10.1007/s00234-015-1593-6
Citations Scopus - 3Web of Science - 3
Co-authors Mark Parsons
2016 Pagram H, Bivard A, Lincz LF, Levi C, 'Peripheral Immune Cell Counts and Advanced Imaging as Biomarkers of Stroke Outcome.', Cerebrovasc Dis Extra, 6 120-128 (2016) [C1]
DOI 10.1159/000450620
Citations Scopus - 1
Co-authors Christopher Levi, Lisa Lincz
2016 Kawano H, Bivard A, Lin L, Spratt NJ, Miteff F, Parsons MW, Levi CR, 'Relationship between Collateral Status, Contrast Transit, and Contrast Density in Acute Ischemic Stroke', Stroke, 47 742-749 (2016) [C1]

© 2015 American Heart Association, Inc. Background and Purpose-Collateral circulation is recognized to influence the life expectancy of the ischemic penumbra in acute ischemic st... [more]

© 2015 American Heart Association, Inc. Background and Purpose-Collateral circulation is recognized to influence the life expectancy of the ischemic penumbra in acute ischemic stroke. The best method to quantify collateral status on acute imaging is uncertain. We aimed to determine the relationship between visual collateral status, quantitative collateral assessments, baseline computed tomographic perfusion measures, and tissue outcomes on follow-up imaging. Methods-Sixty-six consecutive patients with acute ischemic stroke clinically eligible for recanalization therapy and with M1 or M2 middle cerebral artery occlusion were evaluated. We compared the visual collateral scoring with measures of contrast peak time delay and contrast peak density. We also compared these measures for their ability to predict perfusion lesion and infarct core volumes, final infarct, and infarct growth. Results-Shorter contrast peak time delay (P=0.041) and higher contrast peak density (P=0.002) were associated with good collateral status. Shorter contrast peak time delay correlated with higher contrast peak density (ß=-4.413; P=0.037). In logistic regression analysis after adjustment for age, sex, onset-computed tomographic time, and occlusion site, higher contrast peak density was independently associated with good collateral status (P=0.009). Multiple regression analysis showed that higher contrast peak density was an independent predictor of smaller perfusion lesion volume (P=0.029), smaller ischemic core volume (P=0.044), smaller follow-up infarct volume (P=0.005), and smaller infarct growth volume (P=0.010). Conclusions-Visual collateral status, contrast peak density, and contrast peak time delay were inter-related, and good collateral status was strongly associated with contrast peak density. Contrast peak density in collateral vessel may be an important factor in tissue fate in acute ischemic stroke.

DOI 10.1161/STROKEAHA.115.011320
Citations Scopus - 6Web of Science - 6
Co-authors Neil Spratt, Christopher Levi, Mark Parsons
2016 Lin L, Bivard A, Krishnamurthy V, Levi CR, Parsons MW, 'Whole-Brain CT Perfusion to Quantify Acute Ischemic Penumbra and Core', RADIOLOGY, 279 876-887 (2016) [C1]
DOI 10.1148/radiol.2015150319
Citations Scopus - 7Web of Science - 6
Co-authors Christopher Levi, Mark Parsons
2016 Bivard A, Lou M, Levi CR, Krishnamurthy V, Cheng X, Aviv RI, et al., 'Too good to treat? ischemic stroke patients with small computed tomography perfusion lesions may not benefit from thrombolysis', Annals of Neurology, 80 286-293 (2016) [C1]

© 2016 American Neurological Association Objective: Although commonly used in clinical practice, there remains much uncertainty about whether perfusion computed tomography (CTP) ... [more]

© 2016 American Neurological Association Objective: Although commonly used in clinical practice, there remains much uncertainty about whether perfusion computed tomography (CTP) should be used to select stroke patients for acute reperfusion therapy. In this study, we tested the hypothesis that a small acute perfusion lesion predicts good clinical outcome regardless of thrombolysis administration. Methods: We used a prospectively collected cohort of acute ischemic stroke patients being assessed for treatment with IV-alteplase, who had CTP before a treatment decision. Volumetric CTP was retrospectively analyded to identify patients with a small perfusion lesion ( < 15ml in volume). The primary analysis was excellent 3-month outcome in patients with a small perfusion lesion who were treated with alteplase compared to those who were not treated. Results: Of 1526 patients, 366 had a perfusion lesion < 15ml and were clinically eligible for alteplase (212 being treated and 154 not treated). Median acute National Institutes of Health Stroke Scale score was 8 in each group. Of the 366 patients with a small perfusion lesion, 227 (62%) were modified Rankin Scale (mRS) 0 to 1 at day 90. Alteplase-treated patients were less likely to achieve 90-day mRS 0 to 1 (57%) than untreated patients (69%; relative risk [RR] = 0.83; 95% confidence interval [CI] , 0.71¿0.97; p = 0.022) and did not have different rates of mRS 0 to 2 (72% treated patients vs 77% untreated; RR, 0.93; 95% CI, 0.82¿1.95; p = 0.23). Interpretation: This large observational cohort suggests that a portion of ischemic stroke patients clinically eligible for alteplase therapy with a small perfusion lesion have a good natural history and may not benefit from treatment. Ann Neurol 2016;80:286¿293.

DOI 10.1002/ana.24714
Citations Scopus - 1Web of Science - 1
Co-authors Patrick Mcelduff, Mark Parsons, Christopher Levi
2016 Bivard A, Yassi N, Krishnamurthy V, Lin L, Levi C, Spratt NJ, et al., 'A comprehensive analysis of metabolic changes in the salvaged penumbra', Neuroradiology, 58 409-415 (2016) [C1]

© 2016, Springer-Verlag Berlin Heidelberg. Introduction: We aimed to assess metabolite profiles in peri-infarct tissue with magnetic resonance spectroscopy (MRS) and correlate th... [more]

© 2016, Springer-Verlag Berlin Heidelberg. Introduction: We aimed to assess metabolite profiles in peri-infarct tissue with magnetic resonance spectroscopy (MRS) and correlate these with early and late clinical recovery. Methods: One hundred ten anterior circulation ischemic stroke patients presenting to hospital within 4.5¿h of symptom onset and treated with intravenous thrombolysis were studied. Patients underwent computer tomography perfusion (CTP) scanning and subsequently 3-T magnetic resonance imaging (MRI) 24¿h after stroke onset, including single-voxel, short-echo-time (30¿ms) MRS, and diffusion- and perfusion-weighted imaging (DWI and PWI). MRS voxels were placed in the peri-infarct region in reperfused penumbral tissue. A control voxel was placed in the contralateral homologous area. Results: The concentrations of total creatine (5.39 vs 5.85¿mM, p = 0.044) and N-acetylaspartic acid (NAA, 6.34 vs 7.13¿mM ± 1.57, p < 0.001) were reduced in peri-infarct tissue compared to the matching contralateral region. Baseline National Institutes of Health Stroke Score was correlated with glutamate concentration in the reperfused penumbra at 24¿h (r 2 = 0.167, p = 0.017). Higher total creatine was associated with better neurological outcome at 24¿h (r 2 = 0.242, p = 0.004). Lower peri-infarct glutamate was a stronger predictor of worse 3-month clinical outcome (area under the curve (AUC) 0.89, p < 0.001) than DWI volume (AUC = 0.79, p < 0.001). Conclusion: Decreased glutamate, creatine, and NAA concentrations are associated with poor neurological outcome at 24¿h and greater disability at 3¿months. The significant metabolic variation in salvaged tissue may potentially explain some of the variability seen in stroke recovery despite apparently successful reperfusion.

DOI 10.1007/s00234-015-1638-x
Citations Scopus - 2Web of Science - 2
Co-authors Neil Spratt, Mark Parsons, Christopher Levi
2016 Lees KR, Khatri P, Alexandrov AV, Bivard A, Boltze J, Broderick JP, et al., 'Stroke Treatment Academic Industry Roundtable Recommendations for Individual Data Pooling Analyses in Stroke', Stroke, 47 2154-2159 (2016)

© 2016 American Heart Association, Inc. Pooled analysis of individual patient data from stroke trials can deliver more precise estimates of treatment effect, enhance power to exa... [more]

© 2016 American Heart Association, Inc. Pooled analysis of individual patient data from stroke trials can deliver more precise estimates of treatment effect, enhance power to examine prespecified subgroups, and facilitate exploration of treatment-modifying influences. Analysis plans should be declared, and preferably published, before trial results are known. For pooling trials that used diverse analytic approaches, an ordinal analysis is favored, with justification for considering deaths and severe disability jointly. Because trial pooling is an incremental process, analyses should follow a sequential approach, with statistical adjustment for iterations. Updated analyses should be published when revised conclusions have a clinical implication. However, caution is recommended in declaring pooled findings that may prejudice ongoing trials, unless clinical implications are compelling. All contributing trial teams should contribute to leadership, data verification, and authorship of pooled analyses. Development work is needed to enable reliable inferences to be drawn about individual drug or device effects that contribute to a pooled analysis, versus a class effect, if the treatment strategy combines =2 such drugs or devices. Despite the practical challenges, pooled analyses are powerful and essential tools in interpreting clinical trial findings and advancing clinical care.

DOI 10.1161/STROKEAHA.116.012966
Citations Scopus - 2
2015 Ang TE, Bivard A, Levi C, Ma H, Hsu CY, Campbell B, et al., 'Multi-modal CT in acute stroke: Wait for a serum creatinine before giving intravenous contrast? No!', International Journal of Stroke, 10 1014-1017 (2015) [C1]

© 2015 World Stroke Organization. Background: Multi-modal CT (MMCT) to guide decision making for reperfusion treatment is increasingly used, but there remains a perceived risk of... [more]

© 2015 World Stroke Organization. Background: Multi-modal CT (MMCT) to guide decision making for reperfusion treatment is increasingly used, but there remains a perceived risk of contrast-induced nephropathy (CIN). At our center, MMCT is used empirically without waiting for serum-creatinine (sCR) or renal profiling. Aims: To determine the incidence of CIN, examine the risk factors predisposing to its development, and investigate its effects on clinical outcome in the acute stroke population. Methods: An institution-wide protocol was implemented for acute stroke presentations to have MMCT (100-150ml nonionic tri-iodinated contrast, perfusion CT and CT angiography) without waiting for serum-creatinine to minimize delays. Intravenous saline is routinely infused (80-125ml/h) for at least 24-h after MMCT. Serial creatinine levels were measured at baseline, risk period, and follow-up. Renal profiles and clinical progress were reviewed up to 90 days. Results: We analyzed 735 consecutive patients who had MMCT for the evaluation of acute ischemic or hemorrhagic stroke during the last five-years. A total of 623 patients met the inclusion criteria for analysis: 16 cases (2·6%) biochemically qualified as CIN; however, the risk period serum-creatinine for 15 of these cases was confounded by dehydration, urinary tract infection, or medications. None of the group had progression to chronic kidney disease or required dialysis. Conclusions: The incidence of CIN is low when MMCT is used routinely to assess acute stroke patients. In this population, CIN was a biochemical phenomenon that did not have clinical manifestations, cause chronic kidney disease, require dialysis, or negatively impact on 90-day mRS outcomes. Renal profiling and waiting for a baseline serum-creatinine are an unnecessary delay to emergency reperfusion treatment. International Journal of Stroke

DOI 10.1111/ijs.12605
Citations Scopus - 4Web of Science - 6
Co-authors Mark Parsons, Christopher Levi
2015 Yassi N, Campbell BCV, Moffat BA, Steward C, Churilov L, Parsons MW, et al., 'Know your tools¿concordance of different methods for measuring brain volume change after ischemic stroke', Neuroradiology, 57 685-695 (2015) [C1]

© 2015, Springer-Verlag Berlin Heidelberg. Introduction: Longitudinal brain volume changes have been investigated in a number of cerebral disorders as a surrogate marker of clini... [more]

© 2015, Springer-Verlag Berlin Heidelberg. Introduction: Longitudinal brain volume changes have been investigated in a number of cerebral disorders as a surrogate marker of clinical outcome. In stroke, unique methodological challenges are posed by dynamic structural changes occurring after onset, particularly those relating to the infarct lesion. We aimed to evaluate agreement between differen t analysis methods for the measurement of post-stroke brain volume change, and to explore technical challenges inherent to these methods. Methods: Fifteen patients with anterior circulation stroke underwent magnetic resonance imaging within 1¿week of onset and at 1 and 3¿months. Whole-brain as well as grey- and white-matter volume were estimated separately using both an intensity-based and a surface watershed-based algorithm. In the case of the intensity-based algorithm, the analysis was also performed with and without exclusion of the infarct lesion. Due to the effects of peri-infarct edema at the baseline scan, longitudinal volume change was measured as percentage change between the 1 and 3-month scans. Intra-class and concordance correlation coefficients were used to assess agreement between the different analysis methods. Reduced major axis regression was used to inspect the nature of bias between measurements. Results: Overall agreement between methods was modest with strong disagreement between some techniques. Measurements were variably impacted by procedures performed to account for infarct lesions. Conclusions: Improvements in volumetric methods and consensus between methodologies employed in different studies are necessary in order to increase the validity of conclusions derived from post-stroke cerebral volumetric studies. Readers should be aware of the potential impact of different methods on study conclusions.

DOI 10.1007/s00234-015-1522-8
Citations Scopus - 1
Co-authors Mark Parsons
2015 Bivard A, Levi C, Krishnamurthy V, McElduff P, Miteff F, Spratt NJ, et al., 'Perfusion computed tomography to assist decision making for stroke thrombolysis', Brain, 138 1919-1931 (2015) [C1]

© 2015 The Author. The use of perfusion imaging to guide selection of patients for stroke thrombolysis remains controversial because of lack of supportive phase three clinical tr... [more]

© 2015 The Author. The use of perfusion imaging to guide selection of patients for stroke thrombolysis remains controversial because of lack of supportive phase three clinical trial evidence. We aimed to measure the outcomes for patients treated with intravenous recombinant tissue plasminogen activator (rtPA) at a comprehensive stroke care facility where perfusion computed tomography was routinely used for thrombolysis eligibility decision assistance. Our overall hypothesis was that patients with 'target' mismatch on perfusion computed tomography would have improved outcomes with rtPA. This was a prospective cohort study of consecutive ischaemic stroke patients who fulfilled standard clinical/non-contrast computed tomography eligibility criteria for treatment with intravenous rtPA, but for whom perfusion computed tomography was used to guide the final treatment decision. The 'real-time' perfusion computed tomography assessments were qualitative; a large perfusion computed tomography ischaemic core, or lack of significant perfusion lesion-core mismatch were considered relative exclusion criteria for thrombolysis. Specific volumetric perfusion computed tomography criteria were not used for the treatment decision. The primary analysis compared 3-month modified Rankin Scale in treated versus untreated patients after 'off-line' (post-treatment) quantitative volumetric perfusion computed tomography eligibility assessment based on presence or absence of 'target' perfusion lesion-core mismatch (mismatch ratio > 1.8 and volume > 15 ml, core < 70 ml). In a second analysis, we compared outcomes of the perfusion computed tomography-selected rtPA-treated patients to an Australian historical cohort of non-contrast computed tomography-selected rtPA-treated patients. Of 635 patients with acute ischaemic stroke eligible for rtPA by standard criteria, thrombolysis was given to 366 patients, with 269 excluded based on visual real-time perfusion computed tomography assessm ent. After off-line quantitative perfusion computed tomography classification: 253 treated patients and 83 untreated patients had 'target' mismatch, 56 treated and 31 untreated patients had a large ischaemic core, and 57 treated and 155 untreated patients had no target mismatch. In the primary analysis, only in the target mismatch subgroup did rtPA-treated patients have significantly better outcomes (odds ratio for 3-month, modified Rankin Scale 0-2 = 13.8, P < 0.001). With respect to the perfusion computed tomography selected rtPA-treated patients (n = 366) versus the clinical/non-contrast computed tomography selected rtPA-treated patients (n = 396), the perfusion computed tomography selected group had higher adjusted odds of excellent outcome (modified Rankin Scale 0-1 odds ratio 1.59, P = 0.009) and lower mortality (odds ratio 0.56, P = 0.021). Although based on observational data sets, our analyses provide support for the hypothesis that perfusion computed tomography improves the identification of patients likely to respond to thrombolysis, and also those in whom natural history may be difficult to modify with treatment.

DOI 10.1093/brain/awv071
Citations Scopus - 20Web of Science - 18
Co-authors Mark Parsons, Patrick Mcelduff, Christopher Levi, Neil Spratt
2015 Aviv RI, Parsons M, Bivard A, Jahromi B, Wintermark M, 'Multiphase CT angiography: A poor man's perfusion CT', Radiology, 277 922-923 (2015) [C3]
DOI 10.1148/radiol.2015150820
Co-authors Mark Parsons
2015 Yassi N, Malpas CB, Campbell BCV, Moffat B, Steward C, Parsons MW, et al., 'Contralesional thalamic surface atrophy and functional disconnection 3 months after ischemic stroke', Cerebrovascular Diseases, 39 232-241 (2015) [C1]

© 2015 S. Karger AG, Basel. Background: Remote structural and functional changes have been previously described after stroke and may have an impact on clinical outcome. We aimed ... [more]

© 2015 S. Karger AG, Basel. Background: Remote structural and functional changes have been previously described after stroke and may have an impact on clinical outcome. We aimed to use multimodal MRI to investigate contralesional subcortical structural and functional changes 3 months after anterior circulation ischemic stroke. Methods: Fifteen patients with acute ischemic stroke had multimodal MRI imaging (including high resolution structural T1-MPRAGE and resting state fMRI) within 1 week of onset and at 1 and 3 months. Seven healthy controls of similar age group were also imaged at a single time point. Contralesional subcortical structural volume was assessed using an automated segmentation algorithm in FMRIB's Integrated Registration and Segmentation Tool (FIRST). Functional connectivity changes were assessed using the intrinsic connectivity contrast (ICC), which was calculated using the functional connectivity toolbox for correlated and anticorrelated networks (Conn). Results: Contralesional thalamic volume in the stroke patients was significantly reduced at 3 months compared to baseline (median change -2.1%, interquartile range [IQR] -3.4-0.4, p = 0.047), with the predominant areas demonstrating atrophy geometrically appearing to be the superior and inferior surface. The difference in volume between the contralesional thalamus at baseline (mean 6.41 ml, standard deviation [SD] 0.6 ml) and the mean volume of the 2 thalami in controls (mean 7.22 ml, SD 1.1 ml) was not statistically significant. The degree of longitudinal thalamic atrophy in patients was correlated with baseline stroke severity with more severe strokes being associated with a greater degree of atrophy (Spearman's rho -0.54, p = 0.037). There was no significant difference between baseline contralesional thalamic ICC in patients and control thalamic ICC. However, in patients, there was a significant linear reduction in the mean ICC of the contralesional thalamus over the imaging time points (p = 0.041), indicating reduced connectivity to the remainder of the brain. Conclusions: These findings highlight the importance of remote brain areas, such as the contralesional thalamus, in stroke recovery. Similar methods have the potential to be used in the prediction of stroke outcome or as imaging biomarkers of stroke recovery.

DOI 10.1159/000381105
Citations Scopus - 8Web of Science - 8
Co-authors Mark Parsons
2014 Bivard A, Levi C, Krishnamurthy V, Hislop-Jambrich J, Salazar P, Jackson B, et al., 'Defining acute ischemic stroke tissue pathophysiology with whole brain CT perfusion', JOURNAL OF NEURORADIOLOGY, 41 307-315 (2014) [C1]
DOI 10.1016/j.neurad.2013.11.006
Citations Scopus - 17Web of Science - 16
Co-authors Christopher Levi, Mark Parsons
2014 Bivard A, Krishnamurthy V, Stanwell P, Levi C, Spratt NJ, Davis S, Parsons M, 'Arterial Spin Labeling Versus Bolus-Tracking Perfusion in Hyperacute Stroke', Stroke, 45 127-133 (2014) [C1]
DOI 10.1161/STROKEAHA.113.003218
Citations Scopus - 14Web of Science - 14
Co-authors Christopher Levi, Mark Parsons, Neil Spratt, Peter Stanwell
2014 Lin L, Bivard A, Levi CR, Parsons MW, 'Comparison of computed tomographic and magnetic resonance perfusion measurements in acute ischemic stroke: Back-to-back quantitative analysis', Stroke, 45 1727-1732 (2014) [C1]

Background and Purpose: Magnetic resonance perfusion (MRP) and computed tomographic perfusion (CTP) are being increasingly applied in acute stroke trials and clinical practice, ye... [more]

Background and Purpose: Magnetic resonance perfusion (MRP) and computed tomographic perfusion (CTP) are being increasingly applied in acute stroke trials and clinical practice, yet the comparability of their perfusion values is not well validated. The aim of this study was to validate the comparability of CTP and MRP measures. METHODS-: A 3-step approach was used. Step 1 was a derivation step, where we analyzed 45 patients with acute ischemic stroke who had both CTP and MRP performed within 2 hours of each other and within 9 hours of stroke onset. In this step, we derived the optimal perfusion map with the least difference between MRP and CTP. In step 2, the optimal map was validated on whole-brain perfusion data of 15 patients. Step 3 was to apply the optimal perfusion map to define cross-modality reperfusion from acute CTP to 24-hour MRP in 45 patients and, in turn, to assess how accurately this predicted 3-month clinical outcome. RESULTS-: Among 8 different perfusion maps included in this study, time to peak of the residual function (T max ) was the only one with a nonsignificant difference between CTP and MRP in delineating perfusion defects. This was validated on whole-brain perfusion data, showing high concordance of T max between the 2 modalities (concordance correlation coefficient of Lin, > 0.91); the best concordance was at 6 s. At T max > 6 s threshold, MRP and CTP reached substantial agreement in mismatch classification (¿ > 0.61). Cross-modality reperfusion calculated by T max > 6 s strongly predicted good functional outcome at 3 months (area under the curve, 0.979; P < 0.05). CONCLUSIONS-: MRP and CTP can be used interchangeably if one uses T max measurement. © 2014 American Heart Association, Inc.

DOI 10.1161/STROKEAHA.114.005419
Citations Scopus - 18Web of Science - 18
Co-authors Mark Parsons, Christopher Levi
2014 Bivard A, Krishnamurthy V, Stanwell P, Yassi N, Spratt NJ, Nilsson M, et al., 'Spectroscopy of reperfused tissue after stroke reveals heightened metabolism in patients with good clinical outcomes', JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 34 1944-1950 (2014) [C1]
DOI 10.1038/jcbfm.2014.166
Citations Scopus - 10Web of Science - 10
Co-authors Mark Parsons, Peter Stanwell, Christopher Levi, Neil Spratt, Michael Nilsson
2014 Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Stroke thrombolysis: Tissue is more important than time.', CEREBROVASCULAR DISEASES, 37 154-154 (2014)
Co-authors Mark Parsons, Neil Spratt, Christopher Levi
2014 Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Does the presence of CTP mismatch predict better outcomes in thrombolysis-treated patients?', CEREBROVASCULAR DISEASES, 37 344-344 (2014)
Co-authors Mark Parsons, Neil Spratt, Christopher Levi
2014 Cheng X, Cao W, Ling Y, Tin L, Parsons MP, Dong Q, Bivard A, 'Cerebral white matter hypoperfusion predisposes to small vessel stroke subtypes and haemorrhagic transformation', CEREBROVASCULAR DISEASES, 37 493-493 (2014)
Co-authors Mark Parsons
2014 Bivard A, Levi C, Krishnamurthy V, McElduff P, Miteff F, Spratt N, et al., 'Better stroke outcomes despite worse baseline stroke severity - the value of a combined clinical and advanced CT selection approach to thrombolysis.', CEREBROVASCULAR DISEASES, 37 701-701 (2014)
Co-authors Neil Spratt, Mark Parsons, Christopher Levi
2013 Bendinelli C, Bivard A, Nebauer S, Parsons MW, Balogh ZJ, 'Brain CT perfusion provides additional useful information in severe traumatic brain injury', INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 44 1208-1212 (2013) [C1]
DOI 10.1016/j.injury.2013.03.039
Citations Scopus - 5Web of Science - 4
Co-authors Zsolt Balogh, Mark Parsons
2013 Bivard A, Levi C, Spratt N, Parsons M, 'Perfusion CT in Acute Stroke: A Comprehensive Analysis of Infarct and Penumbra', RADIOLOGY, 267 543-550 (2013) [C1]
DOI 10.1148/radiol.12120971
Citations Scopus - 74Web of Science - 75
Co-authors Mark Parsons, Christopher Levi, Neil Spratt
2013 Yassi N, Parsons MW, Christensen S, Sharma G, Bivard A, Donnan GA, et al., 'Prediction of Poststroke Hemorrhagic Transformation Using Computed Tomography Perfusion', Stroke, 44 3039-3043 (2013) [C1]
DOI 10.1161/STROKEAHA.113.002396
Citations Scopus - 16Web of Science - 13
Co-authors Mark Parsons, Christopher Levi
2013 Bivard A, Lin L, Parsons MW, 'Review of Stroke Thrombolytics', JOURNAL OF STROKE, 15 90-98 (2013)
DOI 10.5853/jos.2013.15.2.90
Citations Web of Science - 9
Co-authors Mark Parsons
2013 Menon BK, O'Brien B, Bivard A, Spratt NJ, Demchuk AM, Miteff F, et al., 'Assessment of leptomeningeal collaterals using dynamic CT angiography in patients with acute ischemic stroke', Journal of Cerebral Blood Flow and Metabolism, 33 365-371 (2013) [C1]
Citations Scopus - 70Web of Science - 62
Co-authors Mark Parsons, Christopher Levi, Neil Spratt
2013 Bivard A, Stanwell PT, Levi CR, Parsons MW, 'Arterial spin labeling identifies tissue salvage and good clinical recovery after acute ischemic stroke', Journal of Neuroimaging, 23 391-396 (2013) [C1]
Citations Scopus - 17Web of Science - 17
Co-authors Mark Parsons, Peter Stanwell, Christopher Levi
2013 Lin L, Bivard A, Parsons MW, 'Perfusion Patterns of Ischemic Stroke on Computed Tomography Perfusion', JOURNAL OF STROKE, 15 164-173 (2013)
DOI 10.5853/jos.2013.15.3.164
Citations Web of Science - 7
Co-authors Mark Parsons
2012 Parsons MW, Spratt NJ, Bivard A, Campbell B, Chung K, Miteff F, et al., 'A randomized trial of tenecteplase versus alteplase for acute ischemic stroke', New England Journal of Medicine, 366 1099-1107 (2012) [C1]
DOI 10.1056/NEJMoa1109842
Citations Scopus - 214Web of Science - 201
Co-authors Patrick Mcelduff, Neil Spratt, Christopher Levi, Mark Parsons
2012 Bivard A, Parsons M, 'ASPECTaSaurus (a dinosaur)?', Int J Stroke, 7 564-564 (2012) [C1]
DOI 10.1111/j.1747-4949.2012.00854.x
Citations Scopus - 6Web of Science - 6
Co-authors Mark Parsons
2011 Bivard A, Spratt NJ, Levi CR, Parsons MW, 'Acute stroke thrombolysis: Time to dispense with the clock and move to tissue-based decision making?', Expert Review of Cardiovascular Therapy, 9 451-461 (2011) [C1]
Citations Scopus - 11Web of Science - 9
Co-authors Christopher Levi, Neil Spratt, Mark Parsons
2011 Bivard A, Spratt NJ, Levi CR, Parsons MW, 'Perfusion computer tomography: Imaging and clinical validation in acute ischaemic stroke', Brain, 134 3408-3416 (2011) [C1]
Citations Scopus - 65Web of Science - 66
Co-authors Mark Parsons, Neil Spratt, Christopher Levi
2011 Parsons MW, Bivard A, McElduff P, Spratt NJ, Levi CR, 'Defining the extent of irreversible brain ischemia using perfusion computed tomography', Cerebrovascular Diseases, 31 238-245 (2011) [C1]
DOI 10.1159/000321897
Citations Scopus - 64Web of Science - 60
Co-authors Patrick Mcelduff, Mark Parsons, Christopher Levi, Neil Spratt
Show 56 more journal articles

Conference (52 outputs)

Year Citation Altmetrics Link
2017 Tian H, Levi CR, Lin L, Cheng X, Aviv R, Spratt NJ, et al., 'Ischaemic stroke patients without a visible acute vessel occlusion may not benefit from alteplase therapy', INTERNATIONAL JOURNAL OF STROKE (2017)
Co-authors Neil Spratt
2017 Bivard A, Krishnamurthy V, Lillicrap T, Benedicte B, Garcia-Esperon C, Holliday E, et al., 'Transient ischemic attack results in delayed brain atrophy and cognitive change', INTERNATIONAL JOURNAL OF STROKE (2017)
Co-authors Mark Parsons, Liz Holliday, Christopher Levi
2017 Visser M, Goodin P, Lillicrap T, Krishnamurthy V, Attia J, Pagram H, et al., 'Modulation of resting-state networks in stroke survivors with severe post-stroke fatigue', INTERNATIONAL JOURNAL OF STROKE (2017)
Co-authors John Attia, Michael Nilsson
2016 Agarwal S, Bivard A, Warburton E, Parsons M, Levi C, 'COLLATERALS AND PERFUSION IMAGING AS A TISSUE CLOCK IN ACUTE STROKE', INTERNATIONAL JOURNAL OF STROKE (2016)
Co-authors Mark Parsons, Christopher Levi
2016 Bivard A, Krishnamurthy V, Levi C, Parsons M, 'Perfusion CT Identifies Ischemic Stroke Patients With a Good Natural History Regardless of Treatment', STROKE, Los Angeles, CA (2016)
Co-authors Mark Parsons, Christopher Levi
2016 Krishnamurthy V, Bivard A, Lin L, Spratt N, Levi C, Parsons M, 'Whole Brain CT Perfusion in Suspected Transient Ischemic Attack and Minor Stroke', CEREBROVASCULAR DISEASES (2016)
Co-authors Christopher Levi, Neil Spratt, Mark Parsons
2016 Kawano H, Bivard A, Lin L, Spratt N, Miteff F, Parsons M, Levi C, 'Contrast Peak Density in Collateral Vessels May Be an Important Factor in Tissue Fate in Acute Ischemic Stroke', CEREBROVASCULAR DISEASES (2016)
Citations Web of Science - 2
Co-authors Christopher Levi, Neil Spratt, Mark Parsons
2016 Demeestere J, Parsons M, Bivard A, Campbell B, McElduff P, Hsu C, et al., 'Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation Trial (TASTE)', CEREBROVASCULAR DISEASES (2016)
Co-authors Christopher Levi, Mark Parsons
2015 Bhaskar S, Bivard A, Parsons M, Nilsson M, Attia J, Stanwell P, Levi C, 'Delay of late-venous phase cortical vein filling in acute ischemic stroke patients', Vienna, Austria (2015) [E3]
Co-authors John Attia, Mark Parsons, Michael Nilsson, Christopher Levi, Peter Stanwell
2015 Parsons M, Bivard A, Campbell B, McElduff P, Hsu C, Butcher K, et al., 'Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation (TASTE) Trial', CEREBROVASCULAR DISEASES, Kuala Lumpur, MALAYSIA (2015) [E3]
Co-authors Mark Parsons, Christopher Levi, Patrick Mcelduff
2015 Bivard A, Huang X, Muir K, Levi C, Kalladka D, Moreton F, et al., 'Pooled analysis of Scottish and Australian randomized trials of tenecteplase versus alteplase in stroke', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Neil Spratt, Christopher Levi, Mark Parsons
2015 Yassi N, Malpas CB, Campbell BCV, Moffat B, Steward C, Parsons MW, et al., 'Contralesional thalamic atrophy and functional disconnection after stroke: A multimodal mri study', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Mark Parsons
2015 Parsons M, Bivard A, Campbell B, McElduff P, Hsu C, Butcher K, et al., 'Tenecteplase versus alteplase for stroke thrombolysis evaluation trial', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Patrick Mcelduff, Christopher Levi, Mark Parsons
2015 Kawano H, Levi C, Inatomi Y, Pagram H, Kerr E, Bivard A, et al., 'International bench marking for acute stroke codes: Thrombolytic therapy access in Australia and Japan', INTERNATIONAL JOURNAL OF STROKE (2015) [E3]
Co-authors Mark Parsons, Christopher Levi, Neil Spratt
2014 Lin L, Bivard A, Krishnamurthy V, Levi C, Parsons M, 'Comparison of Whole-Brain CTP and Limited-Coverage CTP', CEREBROVASCULAR DISEASES (2014) [E3]
Co-authors Mark Parsons, Christopher Levi
2014 Lin L, Bivard A, Levi C, Parsons M, 'How to Measure Cross-Modality Reperfusion with Acute CTP and 24-Hour MRP', CEREBROVASCULAR DISEASES (2014) [E3]
Co-authors Christopher Levi, Mark Parsons
2014 Bivard A, Krishnamurthy V, Levi C, Mcelduff P, Miteff F, Spratt N, et al., 'Stroke Thrombolysis: Tissue Is More Important Than Time', CEREBROVASCULAR DISEASES (2014) [E3]
Co-authors Mark Parsons, Christopher Levi, Patrick Mcelduff, Neil Spratt
2014 Bivard A, Krishnamurthy V, Levi C, Mcelduff P, Miteff F, Spratt N, et al., 'Does the Presence of CTP Mismatch Predict Better Outcomes in Thrombolysis-Treated Patients?', CEREBROVASCULAR DISEASES (2014) [E3]
Co-authors Neil Spratt, Patrick Mcelduff, Christopher Levi, Mark Parsons
2014 Bivard A, Krishnamurthy V, Levi C, Mcelduff P, Miteff F, Spratt N, et al., 'Better Stroke Outcomes Despite Worse Baseline Stroke Severity with Combined Clinical and CTP Assessment', CEREBROVASCULAR DISEASES (2014) [E3]
Co-authors Neil Spratt, Mark Parsons, Christopher Levi, Patrick Mcelduff
2014 Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Stroke thrombolysis: Tissue is more important than time', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Neil Spratt, Patrick Mcelduff, Christopher Levi, Mark Parsons
2014 Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Does the presence of CTP mismatch predict better outcomes in thrombolysis-treated patients?', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Mark Parsons, Patrick Mcelduff, Christopher Levi, Neil Spratt
2014 Lin L, Bivard A, Krishnamurthy V, Levi C, Parsons M, 'Whole-brain CT perfusion measures the acute ischaemic lesion accurately and precisely', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Christopher Levi, Mark Parsons
2014 Bivard A, Krishnamurthy V, Levi C, McElduff P, Miteff F, Spratt N, et al., 'Better stroke outcomes despite worse baseline stroke severity - The value of a combined clinical and advanced CT selection approach to thrombolysis', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Mark Parsons, Neil Spratt, Christopher Levi, Patrick Mcelduff
2014 Yassi N, Campbell B, Desmond PM, Parsons M, Davis SM, Bivard A, 'Baseline peri-infarct n-acetylaspartic acid correlates with regional white matter atrophy after ischaemic stroke', INTERNATIONAL JOURNAL OF STROKE (2014) [E3]
Co-authors Mark Parsons
2013 Bivard A, Parsons M, 'Defining Acute Ischemic Stroke Tissue Pathophysiology Using Whole Brain 320 Slice Ct Perfusion', STROKE (2013)
Co-authors Mark Parsons
2013 Yassi N, Campbell BC, Christensen S, Sharma G, Bivard A, Lin L, et al., 'Reduced Cerebral Blood Flow on Acute Whole Brain CT Perfusion Best Predicts Hemorrhagic Transformation', STROKE, Honolulu, HI (2013) [E3]
Co-authors Mark Parsons, Christopher Levi
2013 Campbell BC, Christensen S, Yassi N, Sharma G, Bivard A, Lin L, et al., 'Comparison of Automated Whole Brain CT Perfusion Analysis with Perfusion-Diffusion MRI in Ischemic Stroke', STROKE, Honolulu, HI (2013) [E3]
Co-authors Christopher Levi, Mark Parsons
2013 Bivard A, Parsons M, 'Defining Acute Ischemic Stroke Tissue Pathophysiology Using Whole Brain 320 Slice Ct Perfusion', STROKE, Honolulu, HI (2013) [E3]
Co-authors Mark Parsons
2013 Bivard A, Parsons M, 'Whole Brain Perfusion In Tia', STROKE, Honolulu, HI (2013) [E3]
Co-authors Mark Parsons
2013 Bivard A, Krishnamurthy V, Stanwell P, Levi C, Davis S, Parsons M, '3T MR Spectroscopy assessment of metabolic changes in the recently salvaged human ischemic penumbra', CEREBROVASCULAR DISEASES (2013) [E3]
Co-authors Mark Parsons, Peter Stanwell, Christopher Levi
2013 Bivard A, Stanwell P, Spratt N, Levi C, Krishnamurthy V, Davis S, Parsons M, 'Arterial spin labelling versus bolus-tracking CT and MR in hyper-acute ischemic stroke', CEREBROVASCULAR DISEASES (2013) [E3]
Co-authors Christopher Levi, Mark Parsons, Peter Stanwell, Neil Spratt
2013 Bivard A, Stanwell P, Krishnamurthy V, Levi CR, Davis SM, Parsons M, 'Automated mismatch assessment of arterial spin labeling compared to conventional bolus tracking perfusion mismatch', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Peter Stanwell, Christopher Levi, Mark Parsons
2013 Bivard A, Yassi N, Stanwell P, Krishnamurthy V, Levi CR, Davis SM, Parsons M, 'Spectroscopy of hyperperfused and mildly hypoperfused tissue following ischemic stroke', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Christopher Levi, Mark Parsons, Peter Stanwell
2013 Lillicrap T, Tahtali M, Neely A, Wang X, Levi CR, Parsons M, et al., 'Validation of a finite element model of heat transfer in the stroke-affected brain against data from humans and non-human primates', INTERNATIONAL JOURNAL OF STROKE (2013) [E3]
Co-authors Mark Parsons, Christopher Levi
2013 Bivard A, Stanwell P, Krishnamurthy V, Levi C, Davis S, Parsons M, 'Automated mismatch assessment of arterial spin labeling compared to conventional bolus tracking perfusion mismatch', International Journal of Stroke, Darwin, NT (2013) [E3]
DOI 10.1111/ijs.12214
Co-authors Mark Parsons, Christopher Levi, Peter Stanwell
2012 Bivard A, Parsons MW, 'A new measure of acute perfusion imaging in ischemic stroke- Severity', International Journal of Stroke, Darling Harbour, Sydney (2012) [E3]
Co-authors Mark Parsons
2012 Bivard A, Parsons MW, 'Defining acute ischemic stroke tissue pathophysiology using 320 slice CT perfusion', International Journal of Stroke, Darling Harbour, Sydney (2012) [E3]
Co-authors Mark Parsons, Christopher Levi
2012 Bivard A, Stanwell PT, Parsons MW, 'MR Spectroscopy: Bio-makers for post stroke recovery', International Journal of Stroke, Darling Harbour, Sydney (2012) [E3]
Co-authors Mark Parsons, Peter Stanwell
2012 Lin L, Bivard A, Kemp D, Parsons MW, Levi CR, 'Comparison of perfusion CT and MR in hyperacute stroke', International Journal of Stroke, Sydney, N.S.W. (2012) [E3]
Co-authors Mark Parsons, Christopher Levi
2012 Bivard A, Levi CR, Parsons MW, 'Assessing the variability of CTP post processing techniques to define the acute infarct core and penumbra', Abstract E-book. 2012 European Stroke Conference, Lisbon, Portugal (2012) [E3]
Co-authors Christopher Levi, Mark Parsons
2012 Bivard A, Stanwell PT, Levi CR, Parsons MW, 'Clinical utility of subacute Arterial Spin Labelling in stroke', Abstract E-book. 2012 European Stroke Conference, Lisbon, Portugal (2012) [E3]
Co-authors Mark Parsons, Peter Stanwell, Christopher Levi
2011 Bivard A, Parsons MW, 'The clinical reliability and predictability of acute CTP', International Journal of Stroke, Adelaide, SA (2011) [E3]
Co-authors Mark Parsons
2011 Bivard A, Parsons MW, 'Validation of arterial spin labeling in 24-hour stoke patients', International Journal of Stroke, Adelaide, SA (2011) [E3]
Co-authors Mark Parsons
2011 Bivard A, Spratt NJ, Levi CR, Parsons MW, 'CTP thresholds to detect acute ischeamic stroke tissue pathophysiology', International Journal of Stroke, Adelaide, SA (2011) [E3]
Co-authors Neil Spratt, Christopher Levi, Mark Parsons
2011 Beath A, Bivard A, McElduff P, Parsons MW, Levi CR, 'Clinical predictors of outcome in acute ischaemic stroke patients treated with intravenous tissue plasminogen activator (tPA)', International Journal of Stroke, Adelaide, SA (2011) [E3]
Co-authors Christopher Levi, Mark Parsons, Patrick Mcelduff
2011 Menon B, O'Brien W, Bivard A, Levi CR, Spratt NJ, Parsons MW, 'Detailed anatomic and physiologic assessment of leptomeningeal collaterals in acute ischemic stroke patients using dynamic time resolved 320 slice CT angiography', International Journal of Stroke, Adelaide, SA (2011) [E3]
Co-authors Mark Parsons, Neil Spratt, Christopher Levi
2011 Menon BK, O'Brien W, Bivard A, Levi CR, Spratt NJ, Parsons MW, 'Anatomic and physiologic assessment of leptomeningeal collaterals in acute ischemic stroke patients using dynamic time resolved 320 slice CT angiography', Stroke, Ottawa, Canada (2011) [E3]
Co-authors Mark Parsons, Christopher Levi, Neil Spratt
2011 Bivard A, Levi CR, Spratt NJ, Parsons MW, 'Delayed perfusion predicts the volume of the perfusion lesion', Stroke, Los Angeles, CA (2011) [E3]
Co-authors Neil Spratt, Christopher Levi, Mark Parsons
2011 Bivard A, Spratt NJ, Levi CR, Parsons MW, 'Perfusion CT predicts subsequent tissue and clinical outcome in hyperacute ischemic stroke', Cerebrovascular Diseases, Hamburg, Germany (2011) [E3]
Co-authors Neil Spratt, Mark Parsons, Christopher Levi
2011 Parsons MW, Bivard A, Campbell B, Chong KK, Miteff F, Bladin C, et al., 'Tenecteplase versus alteplase for acute ischaemic stroke: An imaging based efficacy trial', Cerebrovascular Diseases, Hamburg, Germany (2011) [E3]
Co-authors Mark Parsons, Christopher Levi
2010 Bivard A, McElduff P, Spratt NJ, Levi CR, Parsons MW, 'Validating perfusion-computed tomography in defining extent of irreversible brain ischemia', Circulation, Beijing (2010) [E3]
Co-authors Patrick Mcelduff, Christopher Levi, Neil Spratt, Mark Parsons
2010 Bivard A, McElduff P, Levi CR, Spratt NJ, Parsons MW, 'Defining the extent of irreversible brain ischemia using perfusion computed tomography', Stroke, San Antonio, Texas (2010) [E3]
Citations Web of Science - 1
Co-authors Christopher Levi, Mark Parsons, Neil Spratt, Patrick Mcelduff
Show 49 more conferences

Other (1 outputs)

Year Citation Altmetrics Link
2013 'Review of Stroke Thrombolytics', ( issue.2 pp.90-98): Korean Stroke Society (2013)
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Grants and Funding

Summary

Number of grants 22
Total funding $4,553,974

Click on a grant title below to expand the full details for that specific grant.


20175 grants / $1,067,585

Subproject:HMRI MRSP Infrastructure (17) Brain and Mental Health - PRC for Stroke and Brain Injury$356,551

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Professor Neil Spratt, Professor Mark Parsons, Professor Michael Nilsson, Associate Professor Rohan Walker, Associate Professor Sarah Johnson, Doctor Andrew Bivard, Doctor Andrew Gardner, Conjoint Professor Chris Levi, Doctor Coralie English, Associate Professor Frini Karayanidis, Aprof JANE Maguire
Scheme NSW MRSP Infrastructure Grant
Role Investigator
Funding Start 2017
Funding Finish 2017
GNo GS170009
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

A new treatment to help recovery from stroke, including fatigue and quality of life$319,200

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Andrew Bivard, Conjoint Professor Chris Levi
Scheme Project Grant
Role Lead
Funding Start 2017
Funding Finish 2020
GNo G1701348
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

What type of leadership is required to improve the provision of evidenced-based best practice in acute stroke care?$50,000

Funding body: NSW Agency for Clinical Innovation (ACI)

Funding body NSW Agency for Clinical Innovation (ACI)
Project Team Associate Professor Christine Paul, Conjoint Professor Chris Levi, Professor Rebecca Mitchell, Doctor Andrew Bivard, Professor John Attia, Dr Martin Jude, Ms Annika Ryan
Scheme Research Project
Role Investigator
Funding Start 2017
Funding Finish 2018
GNo G1700672
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

HMRI ECR award$10,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Andrew Bivard
Scheme Project Grant
Role Lead
Funding Start 2017
Funding Finish 2017
GNo G1700564
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

20163 grants / $1,354,395

Telehealth and Advanced CT Imaging Combined Study (TACTICS)$992,098

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Conjoint Professor Chris Levi, Doctor Andrew Bivard, Professor John Attia, Professor Christopher Bladin, Professor Stephen Davis, Professor Geoff Donnan, Professor Craig Anderson, Dr Bruce Campbell, Professor Mark Parsons, Dr Rohan Grimley
Scheme Partnership Projects
Role Investigator
Funding Start 2016
Funding Finish 2021
GNo G1600728
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

HMRI MRSP Infrastructure (12-16) Brain and Mental Health Program – Stroke and Brain Injury$325,297

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Professor Neil Spratt, Professor Mark Parsons, Associate Professor Rohan Walker, Doctor Coralie English, Professor Michael Nilsson, Conjoint Professor Chris Levi, Doctor Andrew Bivard, Aprof JANE Maguire, Conjoint Professor Parker Magin, Associate Professor Sarah Johnson, Professor John Attia
Scheme NSW MRSP Infrastructure Grant
Role Investigator
Funding Start 2016
Funding Finish 2016
GNo G1600733
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

FIX study$37,000

Funding body: Ipsen Pty Ltd

Funding body Ipsen Pty Ltd
Project Team Doctor Andrew Bivard
Scheme Research Project
Role Lead
Funding Start 2016
Funding Finish 2018
GNo G1600236
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

20155 grants / $1,858,494

Helping stroke physicians choose who to thrombolyse - the "Targeting Optimal Thrombolysis Outcomes" (TOTO) study$1,069,514

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Doctor Liz Holliday, Aprof JANE Maguire, Associate Professor Vincent Thijs, Dr Simon Koblar, Conjoint Associate Professor Jonathan Sturm, Professor John Attia, Doctor Lisa Lincz, Doctor Andrew Bivard
Scheme Project Grant
Role Investigator
Funding Start 2015
Funding Finish 2019
GNo G1400237
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Arterial spin labeling perfusion MR imaging of tissue pathophysiology in stroke$402,604

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Doctor Andrew Bivard
Scheme Project Grant
Role Lead
Funding Start 2015
Funding Finish 2017
GNo G1400113
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

Advanced imaging for patient profiling in patients with stroke$321,376

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Doctor Andrew Bivard
Scheme Early Career Fellowships
Role Lead
Funding Start 2015
Funding Finish 2018
GNo G1400443
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

MIDAS: Modafinil in debilitating fatigue after stroke trial$50,000

Funding body: National Stroke Foundation Clinical Council

Funding body National Stroke Foundation Clinical Council
Project Team

A Bivard; C Levi; T Lillicrap; M Parsons

Scheme Seed Grant
Role Investigator
Funding Start 2015
Funding Finish 2015
GNo
Type Of Funding External
Category EXTE
UON N

DVCRI Research Support for Early Career Fellow (ECF15)$15,000

Funding body: University of Newcastle

Funding body University of Newcastle
Project Team Doctor Andrew Bivard
Scheme NHMRC ECF Support
Role Lead
Funding Start 2015
Funding Finish 2018
GNo G1600547
Type Of Funding Internal
Category INTE
UON Y

20145 grants / $157,500

Neuroimaging Biomarkers of Recovery: Longitudinal Imaging Study in the rehabilitation Phase post-Acute Ischemic Stroke (NEUROLISS)$50,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Andrew Bivard, Professor Mark Parsons, Conjoint Professor Chris Levi
Scheme Project Grant
Role Lead
Funding Start 2014
Funding Finish 2014
GNo G1401437
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Targeted neuro stimulation for patients recovering from ischemic stroke$38,000

Funding body: John Hunter Hospital Charitable Trust

Funding body John Hunter Hospital Charitable Trust
Project Team

A Bivard; C Levi.

Scheme Research Grant
Role Investigator
Funding Start 2014
Funding Finish 2015
GNo
Type Of Funding External
Category EXTE
UON N

Implementation and assessment of cutting edge contrast free perfusion imaging in ischemic stroke$27,500

Funding body: John Hunter Charitable Trust Grant

Funding body John Hunter Charitable Trust Grant
Project Team

A Bivard; P Stanwell; M Parsons

Scheme John Hunter Charitable Trust Grant
Role Investigator
Funding Start 2014
Funding Finish 2015
GNo
Type Of Funding External
Category EXTE
UON N

Individually tailoring stroke rehabilitation using advanced imaging$22,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Andrew Bivard, Professor Mark Parsons
Scheme Project Grant
Role Lead
Funding Start 2014
Funding Finish 2014
GNo G1401506
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

Recovery of ischemic tissue after stroke$20,000

Funding body: National Stroke Foundation

Funding body National Stroke Foundation
Project Team

A Bivard; P Stanwell; M Parsons.

Scheme Research Grant
Role Investigator
Funding Start 2014
Funding Finish 2015
GNo
Type Of Funding Internal
Category INTE
UON N

20133 grants / $100,000

Assessment of hyperperfused tissue in subacute ischemic stroke patients$45,000

Funding body: John Hunter Charitable Trust Grant

Funding body John Hunter Charitable Trust Grant
Project Team

A Bivard; N Yassi; M Parsons

Scheme John Hunter Charitable Trust Grant
Role Investigator
Funding Start 2013
Funding Finish 2014
GNo
Type Of Funding External
Category EXTE
UON N

How healthy is a brain saved from ischemic stroke?$35,000

Funding body: The University of Melbourne

Funding body The University of Melbourne
Project Team

A Bivard; N Yassi.

Scheme ECR Grant
Role Investigator
Funding Start 2013
Funding Finish 2015
GNo
Type Of Funding External
Category EXTE
UON N

Spectroscopy of the reperfused penumbra$20,000

Funding body: National Stroke Foundation

Funding body National Stroke Foundation
Project Team

A Bivard; N Yassi.

Scheme Research Grant
Role Investigator
Funding Start 2013
Funding Finish 2014
GNo
Type Of Funding External
Category EXTE
UON N

20111 grants / $16,000

Beyond perfusion: the use of spectroscopy in the acute ischemic brain$16,000

Funding body: Hunter Medical Research Institute (HMRI)

Funding body Hunter Medical Research Institute (HMRI)
Project Team

A Bivard; P Stanwell; M parsons

Scheme Research Grant
Role Investigator
Funding Start 2011
Funding Finish 2012
GNo
Type Of Funding External
Category EXTE
UON N
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Research Supervision

Number of supervisions

Completed2
Current8

Total current UON EFTSL

PhD2.45

Current Supervision

Commenced Level of Study Research Title Program Supervisor Type
2017 PhD Lacunar Ischemic Strokes: Acute Imaging and Management PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2017 PhD Predicting recovery after stroke using neuroimaging PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
2016 PhD Lower Limb Robotic Exoskeleton (HELLEN) in Stroke Rehabilitation PhD (Physiotherapy), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2016 PhD Pathways to Recovery vs Relapse after Transient Ischaemic Attack PhD (Psychology - Science), Faculty of Science, The University of Newcastle Co-Supervisor
2016 PhD TIA as a model for secondary neurodegeneration PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2015 PhD Patient Profiling Using Advanced Imaging and Biomarkers in Acute Ischemic Stroke PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2014 PhD Optimizing Tissue Pathophysiology with Perfusion Imaging in Ischemic Stroke PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2010 PhD Transcranial Direct Current Stimulation: A Potential Modality for Stroke Rehabilitation PhD (Physiotherapy), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor

Past Supervision

Year Level of Study Research Title Program Supervisor Type
2017 PhD Individual Patient Profiling Using Clinical and Neuroradiological Biomarkers in Acute Ischemic Stroke: Application of Advanced Multimodal Neuroimaging PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2017 Masters Visibility of CT Early Ischemic Change Significantly Associates with Time from Stroke Onset to Baseline Scan M Philosophy (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
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Research Collaborations

The map is a representation of a researchers co-authorship with collaborators across the globe. The map displays the number of publications against a country, where there is at least one co-author based in that country. Data is sourced from the University of Newcastle research publication management system (NURO) and may not fully represent the authors complete body of work.

Country Count of Publications
Australia 98
Canada 12
United States 10
China 8
United Kingdom 8
More...
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News

UON researchers shine in 2017 NHMRC funding

October 11, 2017

University of Newcastle researchers have secured more than $6 million in the latest round of National Health and Medical Research Council (NHMRC) funding, including almost $2.5 million for a world-first research centre to test the effectiveness and safety around medicinal applications of a range of cannabinoids.

Hunter research gets greater support

August 31, 2017

The Greater Charitable Foundation has announced its latest round of philanthropic funding, with two UON research projects achieving success.

Drug provides new awakening for fatigued stroke survivors

May 5, 2017

An anti-fatigue therapy has yielded a significant reduction in chronic tiredness for stroke survivors involved in a 15-month clinical trial at the Hunter Medical Research Institute, with transformative quality-of-life benefits for many of the participants.

Dr Andrew Bivard

Position

Early Career Researcher
Stroke
School of Medicine and Public Health
Faculty of Health and Medicine

Contact Details

Email andrew.bivard@newcastle.edu.au
Phone (02) 4042 0135

Office

Room HMRI 3417
Building HMRI
Location HMRI

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