“When time is Brain” Advanced imaging techniques for stroke management XIX Symposium Neuroradiologicum October 10 th, 2010 Bologna Italy

2 / GE Title or job number / 6/8/2016 Why is Stroke important? Disease 1Unipolar Depression 2Ischemic Heart Disease 3Cerebrovascular disease 4Dementia 5Alcohol Use disorders 6Hearing loss 7COPD 8Diabetes 9Lung cancer 10Road traffic Accidents WHO –leading causes of burden of disease High income countries 15 Million strokes annually 5.5 Million deaths Leading cause of disability in many developed markets $2.2 TRILLION US costs projected by 2050 Only 1 approved therapy $40M healthcare costs saved for every 1000 strokes prevented

3 / GE Title or job number / 6/8/2016 Stroke burden to health economies drives policy development DoH Recommendations Patients scanned as rapidly as possible Skilled radiological and clinical interpretation available. In working hours patients -next scan slot; out of hours - within 60 mins TIA - Carotid imaging performed immediately at initial assessment TIA- MRI (DWI, GRE, MRA) standard imaging protocol Performed within 24 hours 32 Hyper-acute unit (HUB) with on-site 24 hour stroke team and 24 hour radiology including advanced imaging. Virtual networks for rural communities Nationally recognised quality assured and transferable education and learning programs UK Stroke Strategy £170M FRANCE +90 Stroke centers RUSSIA 23 Stroke centers 08/09 ITALY Regional Stroke Initiative SPAIN National Stroke Plan Requirement for integrated & coordinated strategy & response CHINA Stroke prevention initiative

4 / GE Title or job number / 6/8/2016 Priorities in Stroke management Primary prevention –Risk factor management, community education Secondary prevention especially TIA and Arrhythmia management Acute Stroke Management –Optimised system of care –Maximize time and resources through networked solutions –Expand therapeutic options –Expand therapeutic window Recovery & Rehabilitation –Seamless integration –Hyper-acute -> Acute -> Recovery -> Rehabilitation –Patient centric strategies

5 / GE Title or job number / 6/8/2016 Advanced imaging techniques enabling stroke management. Prevention Carotid Ultrasound –Stenosis –IMT TIA assessment –MR–DWI Interventional Neuroradiology – Aneurysm and AVM management –Carotid stenting Rehabilitation fMRi Deficit detection Guide recovery strategy DTI Depicts white matter involvement Prognostic indicator Acute Management MRA - CTA Occlusion location Re-canalisation ICH Haematoma expansion CTP, MR PI-DWI mismatch Penumbra delineation & quantification Interventional Neurorad i.a. thromobolysis Mechanical thrombectomy TCD Ultrasound Sonothrombolysis

6 / GE Title or job number / 6/8/2016 Agenda Introduction: What are the challenges and future of stroke management? Marc Barlow, Head of Strategic Disease Marketing GE Healthcare, Chalfont St Giles, UK Interest of CT perfusion for stroke management: Volume Helical Shuttle and Gemstone™ Spectral Imaging Dr Shawn Halpin, University Hospital of Wales, Cardiff, UK Clinical interest of multimodality software "Integrated Registration" - Radiosurgery of brain AVM using CyberKnife Pr René Anxionnat, CHU Nancy, Nancy, France MR for rehabilitation after stroke Pr Steve Williams, Professor of Imaging Sciences, Institute of Psychiatry, London, UK Chairman: Marc Barlow