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    You are here : Home » MS Research News » Medical Imaging

    Medical Imaging

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    More news can be found in New Pathways Magazine, our bi-monthly publication, and also check daily at MSRC: Latest MS News.

    Scientists get £164k to test future MS treatments

    MS MRIScientists at the University of Nottingham have been awarded £164,000 to test future treatments for people with multiple sclerosis (MS).

    A team at the university will use the grant from the MS Society to look at areas of the brain, known as grey matter, that have previously been very difficult to study.

    MS is a neurological condition, causing lesions in the brain and spinal cord, which lead to a range of symptoms – including severe fatigue, and problems with mobility and eyesight.

    The study will use advanced MRI technology at the university to monitor the grey matter, which has increasingly been shown to be important in MS.

    This new information will help researchers to more effectively identify and test new methods for treating damage caused by the condition.

    Dr Nikos Evangelou, clinical associate professor of neurology at the university, said: "This study will really advance our understanding of the damage caused in MS and how we might be able to treat it."

    Forty people with MS and ten people without the condition who live in Nottingham will be recruited to the trial, due to start in the next few months.

    Findings of the study are due to be published in the next two to three years.

    Dorothy Sutton, of the Nottingham Branch of the MS Society, said: "Anything that can speed up the discovery of new effective treatments for people with MS – especially those newly diagnosed – is really positive."

    Source: This Is Nottingham Copyright © 2012 Northcliffe Media Limited. (29/02/12)

    7T MRI depicts Multiple Sclerosis lesions

    MRIUltrahigh-field strength, T1-weighted magnetization-prepared rapid acquisition and multiple gradient echoes (MPRAGE) is highly sensitive for detecting multiple sclerosis (MS) plaques within the white and gray brain parenchyma, according to a study published online Feb. 20 in Archives of Neurology, one of the JAMA/Archives journals.

    In current clinical practice, T2-weighted MRI is commonly used to quantify the accumulated MS lesion load in the brain, whereas T1-weighted sequences are used to differentiate irreversible brain tissue damage, hyperintense lesions commonly called “black holes.” Black holes are associated with clinical worsening and cerebral atrophy. On spin-echo T1-weighted images, a proportion of T2 hyperintense lesions appears hypointense to the surrounding normal-appearing white matter for a long time, the researchers noted.

    Tim Sinnecker, of the NeuroCure Clinical Research Center, Charite University Medicine, Berlin, and colleagues enrolled 20 patients with relapsing-remitting MS and 14 healthy controls to undergo 7T MRI. A subgroup of 18 patients with MS also underwent 1.5T MRI.

    “Against the background of the unresolved dispute over the clinical significance of black holes, and the increasing appreciation of gray matter pathology in MS, we investigated whether the visibility of T1 and T2 lesions in both gray and white matter would be influenced by the improved signal-to-noise ratio at 7T,” the authors wrote. “In particular, we hypothesized that the application of MPRAGE would facilitate the detection of hypointense lesions in comparison with conventional MRI.”

    The 7T MPRAGE sequences detected a total number of 728 lesions, depicting more lesions than 7T FLASH (fast low-angle shot) and almost twice as much as 1.5T MPRAGE. Each of the 217 T1 hypointense lesions detected by the 7T MPRAGE sequences in the longitudinal subgroup persisted without major change in formation or size for at least one year and could thus be classified as a black hole, according to Sinnecker and colleagues.

    Because the lesions did not change appearance over one year, the researchers suggested that they may express brain parenchymal destruction rather than temporary edema.

    The researchers noted that the lesions were visualized with greater distinction concerning shape and appearance on the 7T MPRAGE images than via the 7T FLASH.

    “To our knowledge, the present study is the first to demonstrate that, at ultrahigh-field strength, every T2 hyperintense lesion detected on T2-weighted FLASH sequences directly corresponds to a T1 hypointense lesion on a MPRAGE sequence,” the researchers concluded.

    Source: Healthy Imaging © ©2012 TriMed Media Group (21/02/12)

    Studying communication within the brain with cutting-edge MRI techniques

    NeuronsInnovative magnetic resonance imaging (MRI) techniques that can measure changes in the microstructure of the white matter likely to affect brain function and the ability of different regions of the brain to communicate are presented in an article in the groundbreaking new neuroscience journal Brain Connectivity, a bimonthly peer-reviewed publication from Mary Ann Liebert, Inc.. The article is available free online.*

    Brain function depends on the ability of different brain regions to communicate through signaling networks that travel along white matter tracts. Using different types and amounts of tissue staining to measure how water molecules interact with the surrounding brain tissue, researchers can quantify changes in the density, orientation, and organization of white matter. They can then use this information to generate image maps of these signaling networks, a method called tractography.

    Andrew Alexander and colleagues from University of Wisconsin, Madison, describe three quantitative MRI (qMRI) techniques that are enabling the characterization of the microstructural properties of white matter: diffusion MRI, magnetization transfer imaging, and relaxometry. This approach can be used to study and compare the properties of brain tissue across populations and to shed light on mechanisms underlying aging, disease, and gender differences in brain function, for example. The authors present their findings in the article "Characterization of Cerebral White Matter Properties Using Quantitative Magnetic Resonance Imaging Stains."

    "White matter is the material that provides for the wiring and connectivity between brain regions. This exciting paper describes three new methodologies to measure the integrity of white matter in normal and diseased brain. These methods show promise in multiple sclerosis, depression, aging, and human development," says Bharat Biswal, PhD, Co-Editor-in-Chief of Brain Connectivity and Associate Professor, University of Medicine and Dentistry of New Jersey.

    *Article Abstract

    Source: Medical News Today © MediLexicon International Ltd 2004-2012 (10/02/12)

    Early MRI predicts 5-year response in MS

    MS MRIMRI scans taken one year after starting disease-modifying therapy in relapsing-remitting multiple sclerosis were strongly predictive of outcomes after five years, an Italian researcher said here.

    The nonresponder rate at five years was nearly twice as high among patients in a retrospective study whose one-year MRI scans showed more than two gadolinium-enhancing T1 lesions (32% versus 18%, P=0.009), according to Marzia Romeo, MD, of the San Raffaele Hospital in Milan.

    Other significant early predictors of nonresponse in the 668-patient study included being a woman, having high disability scores, and having multifocal brain lesions, Romeo reported at the joint meeting of the European and American Committees for Treatment and Research in Multiple Sclerosis.

    Romeo and her colleagues pulled records for all patients with relapsing-remitting MS treated at San Raffaele from 1996 to 2005. To be included in the study, patients must have received beta-interferon or glatiramer acetate (Copaxone) as first-line therapy.

    Patients who completed five years of follow-up -- there were 668 in all -- were included. However, only 396 had MRI scans taken at the one-year mark after starting treatment.

    Romeo and colleagues classified those patients' five-year outcomes into three categories: responders, nonresponders, and partial responders. They defined those categories as follows:

    Responders: EDSS disability score progression of less than 1.5 and no relapse during treatment (n=223)
    Partial responders: EDSS score progression less than 1.5 but at least one relapse during treatment (n=299)
    Nonresponders: EDSS score progression of 1.5 or more over a six-month period and persisting at the five-year evaluation, or switched to a second-line therapy such as mitoxantrone (n=146)
    Just over half of patients (51%) remained on the same disease-modifying therapy throughout follow-up. Of the remainder, three-quarters switched to the other first-line disease-modifying drug and the rest were put on a second-line agent.

    Some 44% of nonresponders had moved to a second-line drug and 39% to the other first-line treatment.

    Among full and partial responders, none were switched to second-line drugs; 22% of full responders and 52% of partial responders, however, had changed first-line treatments.

    Among the 396 patients with one-year MRI scans, the number of active lesions was a powerful predictor of long-term response.

    The odds ratio for nonresponse at five years for patients with more than two active lesions at one year was 5.7 (95% CI, 2.5 to 13.2), Romeo indicated.

    She said the findings indicated that multifocal onset, a high EDSS score, and an "active MRI presentation" together were powerful indicators of nonresponse.

    "In this population, an induction therapy should be considered," she said.

    Session co-moderator Heinz Wiendl, MD, of the University of Muenster in Germany, commented afterward that the "topography" of MS lesions was also an issue and asked Romeo if her group had looked into it.

    "I would be more worried about multiple fulminant brainstem lesions" than lesions in less sensitive areas of the brain, he said.

    Romeo acknowledged that this was an important consideration that the study had not addressed.

    No external funding for the study was reported.

    Romeo had no disclosures. Some co-authors reported relationships with Bayer Schering, Merck Serono, sanofi-aventis, Biogen Dompe, Novartis, and Teva.

    Wiendl reported relationships with Biogen Idec, Novartis, Bayer Healthcare, sanofi-aventis, Serono, TEVA, Medac, Lundbeck, and Novo Nordisk.

    Primary source: ECTRIMS/ACTRIMS Triennial Meeting

    Source reference:
    Romeo M, et al "Brain MRI activity after disease-modifying treatment may predict disability progression after 5 years in relapsing-remitting multiple sclerosis patients" ECTRIMS/ACTRIMS 2011; Abstract 29.#

    Source: MedPage Today © 2011 Everyday Health, Inc.(21/10/11)

    Diagnostic breakthrough in MS achieved with advanced Fonar Upright® MRI

    Upright MRIIn a newly published paper, medical researchers at FONAR Corporation report a diagnostic breakthrough in multiple sclerosis (MS), based on observations made possible by the company's unique FONAR UPRIGHT® Multi-Position™ MRI.

    The findings reveal that the cause of multiple sclerosis may be biomechanical and related to earlier trauma to the neck, which can result in obstruction of the flow of cerebrospinal fluid (CSF), which is produced and stored in the central anatomic structures of the brain known as the ventricles. Since the ventricles produce a large volume of CSF each day (500 cc), the obstruction can result in a build up of pressure within the ventricles, resulting in leakage of the CSF into the surrounding brain tissue. This leakage could be responsible for generating the brain lesions of multiple sclerosis.

    The paper, titled "The Possible Role of Cranio-Cervical Trauma and Abnormal CSF Hydrodynamics in the Genesis of Multiple Sclerosis," has just been published and appears in the latest issue of the journal Physiological Chemistry and Physics and Medical NMR (Sept. 20, 2011, 41: 1-17). It is co-authored by MRI researchers Raymond V. Damadian and David Chu.

    Commenting on the study, the lead researcher and president of FONAR, Raymond V. Damadian stated, "These new observations have uncovered biomechanical barriers that appear to give rise to multiple sclerosis, and, even more excitingly, these barriers may be therapeutically addressable." Damadian is the medical doctor who discovered the abnormal signals from tissue that are the basis of every MRI image made today and who went on to invent the MRI and build the world's first MRI by hand at New York's Downstate Medical Center.

    The findings are based on viewing the real-time flow of cerebrospinal fluid in a series of eight randomly chosen patients with multiple sclerosis.

    The cerebrospinal fluid, known as CSF, lubricates the brain and spinal cord. Utilizing FONAR's patented Advanced UPRIGHT® Multi-Position™ MRI technology, the team was able to view the flow of cerebrospinal fluid in and out of the brain with the patients lying down and upright. These invaluable dual observations have only been possible since the invention of an MRI capable of imaging the patient upright.

    Damadian and co-researcher, Chu, discovered obstructions of the CSF flow in all eight patients in the study and, in seven out of eight patients, the obstruction was more pronounced when the patient was in the upright position. The UPRIGHT® MRI also revealed that these obstructions were the result of structural deformities of the cervical spine, induced by trauma earlier in life.

    The research was initiated when Damadian and Chu scanned a patient with multiple sclerosis. In reviewing the MRI scans, Damadian noted that one of the MS lesions in the patient's brain was directly connected with the CSF within the ventricles of the brain, which are the structures in which the body continuously produces CSF fluid. It does so through a network of blood vessels within the ventricles known as the choroid plexus. This network generates a large volume of CSF daily, approximately 500 cc.

    Damadian knew that in multiple sclerosis the lesions are typically concentrated adjacent to the ventricles and are peri-ventricular in distribution (i.e. surrounding the ventricle). He had also determined that the patient had a history of severe trauma to the cervical spine. When a careful history of subsequent patients in the study was taken, it revealed that all but one had also experienced some form of serious traumatic injury to the cervical spine.

    When viewing MRI scans of the first patient, Damadian hypothesized that any obstructions of the continuous circulation of the daily volume of CSF out of the brain to the spinal cord and back could cause increased pressure within the ventricles, which could result in leakage of the fluid into the brain tissue surrounding the ventricles.

    Damadian knew that CSF fluid contains proteins, which are made up of polypeptides, in fact, that the fluid contains more than 300 polypeptides. Nine of the proteins they form are known to be antigens that stimulate the production of antibodies. He wondered if these proteins, leaking into the brain tissue, could be initiating the antigen-antibody complexes in the brain that cause the pathology and symptoms of multiple sclerosis.

    The disease results in the destruction of the coverings, or myelin sheaths, that insulate the nerve fibers of the brain. The destruction prevents the nerves from functioning normally and produces the symptoms of multiple sclerosis. The destruction is the origin of the multiple sclerosis lesions seen on the MRI images.

    But, unlike nerve tissue, the myelin sheaths can regenerate – once the cause of their destruction is eliminated. The paper suggests that surgical or biomechanical remediation of the obstruction of the flow of CSF in the cervical spine could relieve the increased CSF pressure within the ventricles and eliminate the resultant leakage of fluid into the surrounding brain tissue and the inflammation of the myelin sheaths that it generates. Once the leakage has been stopped, the myelin sheaths could be repaired by the body's myelogenesis process with the prospect of a return to normal nerve function for these nerves.

    Images in the recumbent and upright positions of one of the MS patients from the study follow. Note the presence of ventral CSF flow when the patient (MS patient #6) is recumbent but the loss of ventral CSF flow when the patient is upright.

    Unlike traditional lie-down MRIs, patients walk into the UPRIGHT™ MRI and sit in the scanner. In the diagnosis of usual spine problems such as back pain, the patients are asked to place themselves in the position that causes their back symptoms. Then an upright MRI image is generated. As a result, the spinal pathology that is causing the patient's back pain can be more accurately and more completely identified and defined. Since the seat in the MRI can be tilted to any position and also flattened into a bed in the horizontal position, the researchers were able to view the patients in the MS study in both the recumbent and upright positions.

    The study was part of ongoing research at the UPRIGHT® MRI CENTER at FONAR Corporation, which invented the UPRIGHT® MRI scanner. Research at the center, which is located in Melville, New York, has already provided unique diagnostic views of the upright spine with the weight of the body on it, including the spine with the patient bending forward and backward, radiation-free monitoring of scoliosis, upright imaging of pelvic floor problems in women, such as a prolapsed bladder or uterus, sit-down imaging of the prostate without the usual endorectal coil, and a walk-in, sit-down 10-minute scan that allows for cost-effective MRI scanning of patients undergoing chemotherapy to monitor tumor responses biweekly.

    The complete study that led to the diagnostic breakthrough in multiple sclerosis can be accessed at the company website at www.fonar.com/pdf/PCP41_damadian.pdf

    About the Researchers

    Raymond V. Damadian is the medical doctor who first proposed scanning medical patients by NMR (nuclear magnetic resonance, the original name of the MRI) based on his discovery of the principle on which all modern MRI is based – the different NMR signals that tissues emit in a magnetic field. The amplitude of these signals accounts for the pixel brightness in every MRI image. He discovered that the NMR signal amplitudes of cancer tissue differ markedly from the NMR signal amplitudes of the normal tissues because of the differences in their rate of decay. He simultaneously discovered that the NMR signal amplitudes also differ markedly among the normal tissues themselves because of the differences in their rates of decay. These signal amplitude differences enabled cancer tissues and other tissues to be visualized in MRI images because the signal differences generate the needed brightness differences (contrast) in the picture elements (pixels) needed to visualize detail in the MRI image. The contrast in pixel brightness allows the cancer pixels in the image to be distinguished from the surrounding normal pixels. It also allows the different normal tissues to be distinguished from each other and achieve the exceptional anatomic detail MRI pictures are known for.

    Damadian went on to build the first MRI scanner by hand, assisted by two post-doctoral students, at New York's Downstate Medical Center and achieved the first MRI scan of a healthy human body in 1977 and a human body with cancer in 1978. For these discoveries he received the National Medal of Technology from President Reagan in 1988, was inducted into the National Inventors Hall of Fame in 1989 as the inventor of the MRI and was named Inventor of the Year in 2007 for his invention of the FONAR UPRIGHT® Multi-Position™ MRI. He founded FONAR to bring MRI diagnosis to patients. The company manufactured and installed the world's first commercial MRI in 1980. Damadian is currently FONAR's president and chief research officer.

    David Chu is the head MRI scientist at FONAR who specializes in the imaging of the cerebrospinal fluid with advanced cines, or movies, which allow for observation of CSF flow in real time. The technology, which the company calls TrueFlow™ Imaging, made the diagnostic breakthrough in multiple sclerosis possible.

    Source: FONAR Corporation (06/10/11)

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