Monday, 26 September 2011

High-field MRI expands the iceberg

Epub ahead of printBluestein et al. T1 and proton density at 7 T in patients with multiple sclerosis: an initial study. Magn Reson Imaging. 2011 Sep 19.

MRI of cortical lesions (gray matter on the surface of the brain*)due to MS has been hampered by the lesions' small size and low contrast to adjacent, normal-appearing tissue. 

* the cortex of the brain is where specialised cognitive tasks occurs; MS lesions in the cortex are responsible for cognitive dysfunction (memory impairment, etc.) that occurs in the majority of MS'ers.

In this study 8 MS'ers and 7 healthy control subjects were scanned at 7 Tesla (most conventional MRI scanners are 1.5 or 3 Tesla; Tesla refers to power of the magnet). 

Regions of interest were drawn in white matter, gray matter, cortical lesions, white matter lesions and cerebrospinal fluid. 

White matter and gray matter lesions were significantly higher in MS'ers than in controls. Large numbers of cortical and white matter lesions were noted in MS for the first time. 

Ultrahigh field MR imaging will be important for future investigations in MS research, particularly the detection of cortical lesions.

"The introduction of ultra high-field MRI will allow us to monitor the effects of MS in the cortex of the brain. Todate the lesions in this area have been invisible on MRI. We know from pathological studies that about 50% of the disease burden occurs in the gray matter. This study and other like it enlarges the iceberg that is MS; now we will be able to see more of the iceberg that is subclinical."

6 comments:

  1. Would this be for research purposes only?

    Or could this type of ultra high-field scanning be used for monitoring disease progress in "everyday" practice? (I assume it's more expensive than regular MRIs?)

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  2. Yet another chirpy post on a monday morning. How would you cope with cognitive problems Prof G? Not good for an academic. Not good for me as a patient now that the majority of patients will suffer cognitive problems. All the research papers do is confirm what those with the disease already no - it's much much worse than we were told at diagnosis. Really is time to move away from these observational studies to actually doing something about it. If you saw someone being mugged would take note / take a picture, or intervene?

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  3. Re: "Would this be for research purposes only?"

    At the moment research purposes only; at the moment the only 7T scanner looking into MS is in Nottingham with several on order for other centres. However, research today is clinical practice tomorrow; the wheels of technological innovation never stand still for very long.

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  4. Re: " If you saw someone being mugged would take note / take a picture, or intervene?"

    Intervene! This is why I would classify myself as an aggressive treater; better to treat aggressively early on in the disease than wait for damage to occur before escalating treatment. My colleagues in rheumatology and nephrology have learnt this decades ago; it is better to prevent irreversible damage to the joints and kidneys than replace them. It is a pity that in general neurologists don't treat the brain and spinal cord in MS the same way.

    What about progressive MS? We are in the game and trying to translate some of our animal studies into the clinic. Which is why we need you all the respond to the survey?

    http://multiple-sclerosis-research.blogspot.com/2011/09/are-you-up-for-having-lumbar-puncture.html

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  5. Prof G,

    I never doubted your commitment to the cause. Cognitive problems scare me! Hence the Mr Angry post above.

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  6. I want to thank you for blogging. This is a very informative blog and very helpful. Even though a lot of the research may take a while to have a patient impact the sheer volume research going on gives me hope.

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