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A better window into the brain

Magnetic Resonance Imaging (MRI) scans of brain and spinal cord perform a vital role in the diagnosis and care of people with MS. However, earlier diagnosis, treatment decisions, clinical trials for progressive MS, and research could all benefit from the development of more sophisticated imaging techniques.

MS Research Australia recently teamed up with the Centre for Advanced Imaging at the University of Queensland to run a workshop on Advanced Imaging in MS. The workshop brought together experts in both imaging and MS to discuss a range of techniques and explore their use in research and in the clinic.

The Centre for Advanced Imaging houses state-of-the-art imaging equipment including one of only two 7 Tesla human MRI scanners in Australia (most clinical MRI scanners have a magnet strength of 1.5 or 3 Tesla). The centre is staffed by a multi-disciplinary team including biologists, chemists, mathematicians and engineers.

This made the Centre for Advanced Imaging an ideal partner for MS Research Australia to achieve one of its key strategic goals to leverage strong collaborative networks within the field of MS and other comparable fields of endeavour to advance research into MS.

It is now recognised that lesions seen using standard MRI scans correlate poorly with the level of clinical disability seen in individuals with MS. Studies using post-mortem brain tissue also show that damage occurs in the grey matter in MS and even ‘normal appearing white matter’ seen in MRI scans may be affected.

Thus there is a pressing need to improve techniques to ‘see’ what is happening in the brains of people with MS in real time.

Participants at the workshop discussed how measures of brain tissue loss (atrophy), particularly in certain areas of the brain, are increasingly being used to monitor the course of MS in clinical trials. However, atrophy measures, are currently less useful for monitoring individual patients due to the high variability and need for repeat scans over longer time periods.

The development and use of radioactive chemicals for use in positron emission tomography (PET) scans is gaining momentum, and Australia has been strong in this area. Professor Andrew Katsifis from the Royal Prince Alfred Hospital in Sydney and international keynote speaker Professor Paola Piccini from Imperial College London, UK, described the development and use of a new generation of PET markers for microglia, the resident inflammatory cells of the brain. Microglia are thought to play a key role in progressive MS, but also appear to be activated very early in the course of the disease.

With progress being made in the development of experimental medications that aim to promote myelin repair and protect the neuronal axons from permanent damage, there is a great need for reliable scanning tools to accurately measure myelin and axon integrity.

Great headway was made at the workshop in meshing the needs of MS researchers with the capabilities of the scanning specialists and several possible collaborative research avenues were identified.

Professor David Reutens, Director of the Centre for Advanced Imaging and Professor Bill Carroll, Chair of the MS Research Australia International Research Review Board, were extremely pleased with the level of ‘intellectual ferment’ stimulated by the workshop. The workshop revealed the strengths that Australia can apply to the pursuit of the key biological and clinical questions needed to improve diagnosis, treatment and prevention of disease progression in MS.

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A better window into the brain