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January 3, 2017

Imaging as the Nidus of Precision Cerebrovascular HealthA Million Brains Initiative

Author Affiliations
  • 1Neurovascular Imaging Research Core, University of California-Los Angeles, Los Angeles
  • 2Comprehensive Stroke Center, Department of Neurology, Geffen School of Medicine, University of California-Los Angeles, Los Angeles
JAMA Neurol. Published online January 3, 2017. doi:10.1001/jamaneurol.2016.4896

The Precision Medicine Initiative (PMI) and Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative are simultaneous, yet distinct, National Institutes of Health (NIH) programs recently launched to transform our understanding and treatment of common disorders, including stroke.1,2 The potential of precision medicine for stroke has been touted and considered a key goal of the 1-million-volunteer PMI Cohort Program and Million Hearts efforts, yet the role of brain imaging has been effectively nonexistent.3 The PMI and BRAIN Initiative and related activities have largely emphasized genomics, novel biomarkers and innovative data without mention of imaging. In stroke, a leading cause of disability worldwide, imaging is routinely acquired and paramount, yet where are the million brains? Studying a million hearts may be important to prevent stroke, yet the diverse manifestations of stroke occur in the brain, not the heart. Precision medicine for stroke and cerebrovascular disorders must be rooted in data germane to the clinical practice, not replicated or translated from other disciplines.46 Every aspect of cerebrovascular medicine currently emanates from phenotypic characterization with imaging. Imaging of the brain is always the initial step in discerning stroke diagnosis, subtype, etiology, and appropriate therapies. Other data types are undoubtedly informative, yet the multidimensional array of data stems from imaging as the nidus. The implementation of precision stroke care will depend on expertise from within the clinical subspecialty. Similarly, maintenance of cerebrovascular health will rely on longitudinal or serial imaging of a population. It would be an egregious oversight for the PMI and BRAIN Initiative to neglect neurovascular imaging rather than promote key goals in precision cerebrovascular health (Box) and leverage an emerging, tremendous opportunity for patient-centered big data.7

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