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New MRI Offers Advanced Imaging Capabilities for Shepherd Patients The new MRI scanner provides a number of advantages for patients. It can produce pictures that show the chemical makeup of some lesions in the brain, not just anatomical structures. Also, it can compensate for a patient’s small movements from coughing or muscle spasms during the procedure. Patients may notice scans take less time. Brain and cervical (neck) scans that once took 40 minutes now can be done about 10 minutes faster. For the medical team, differences are more detailed scans and spectroscopic images, which show brain chemicals. Shepherd Center is the second Atlanta-area facility to offer spectroscopy. Among the earliest beneficiaries of the new technology will be multiple sclerosis (MS) patients. While the cause and course of the disease are unclear, Shepherd MS Institute director Dr. Ben Thrower is very clear about his goals -- halting disability progression and preventing relapses. “Traditional MRI has been a tremendous help in diagnosing and treating MS, but there are limitations,” Dr. Thrower said. “MS lesions seen on standard MRI are like the tip of the iceberg in that there is more damage under the surface than what is shown on standard MRI. MR spectroscopy can show nerve fiber damage even in areas of seemingly ‘normal’ white matter (areas of the brain containing myelin, a nerve insulator).” In the recent past, a patient could suffer a lot of disability while traditional imaging would, frustratingly, show no change at all, Dr. Thrower said. “If you look at ‘normal’ white matter this way, you can see ‘normal’ really isn’t.” During an MS attack, white matter becomes inflamed in random patches called plaques. Next, the myelin breaks down. Myelin helps with the smooth, speedy transmission of electrochemical messages between the brain, spinal cord and rest of the body. The name of the disease comes from the many (multiple) patches of scar tissue (sclerosis). Magnetic resonance spectroscopy measures N-acetyl aspartate (NAA). NAA levels can help gauge how well nerve fibers, called axons, are working. A drop in NAA can indicate nerve damage — and NAA levels can fall while a traditional MRI image remains unchanged. A chemical picture of the brain can give doctors quick feedback on whether a therapy is working or a dosage needs to be adjusted. It’s possible that someday nerve damage could be addressed even before symptoms appear. For now, Shepherd Center is recommending baseline spectroscopy MRIs to patients who have secondary progressive MS. Those are the patients at greatest risk of disability. The first spectroscopic images will be like a single snapshot, Dr. Thrower said. They will compare ratios of NAA and creatine, another brain chemical. “If NAA and creatine levels drop, you’re looking to see some damage,” he said. Spectroscopic images also offer a way to measure an exciting possibility — improved nerve function. Reversing declines is no longer a pipe dream. Relapses are not a given, nor is progressive disability, Dr. Thrower said. In fact, his goal for patients is “wellness” — emotional, social, financial and physical health. Everyone, he notes, eventually will develop a health problem. But living well is something that can be achieved even in the absence of perfect health. The improved MRIs are tools to help achieve wellness. But they are only part of MS care. Most MS patients will continue to come in for yearly scans, MRI supervisor Carolyn Sharp said. Images will be far more detailed than in the past. “The yearly scans can help us make sure the treatment is keeping up with the disease. It’s just a very odd, evil disease, and no two patients are alike. But we can compare one scan to another (a previous scan of the same patient) and know more,” she said. The scans can detect new and active lesions, even if they do not produce symptoms. Though the new MRI is used primarily for MS patients, it’s available to any Shepherd patient. From blood clots to infections, problems can be swiftly scanned without leaving the hospital. |