Advanced Neuro MRITuesday 18th March 2014 Austin Court, Birmingham

Organised by the IPEM MR Special Interest GroupRobert Flintham (Part II Trainee in MRI Physics Neuro MRI is a constantly-evolving field. Many advanced neurodeveloped in the research environment to study the structure and function of the brain are now part of routine clinical practice. Techniques such as MR spectroscopy, fMRI, DWI, DTI and perfusion MRI are used in conjunction with standneurological conditions, assess response to treatment and predict long

Cutting-edge academic research

The three invited speakers each gave a unique perspective on The first of these, Prof Peter Jezzardresearch-only techniques currently in development at the University of Oxford; metabolic imaging, vessel-selective arterial spin labelling (VS(DANTE) for improved vessel wall imaging and characterisation.development before they can be translated into a clinical environment, they of what could be achieved in clinical envirvessel selective angiography also produced some very exciting imagesfrom the audience. Other fascinating presentations of techniques currently confined to the research environmwere given by speakers from the University of Bristol. assess Alzheimer’s disease (Bryony Woodweighted imaging for discrimination of ageing processes (time since ischaemic stroke onset (showed exciting new potential applications of currently available MR techniques, each with a different clinical question in mind.

Advanced MR in the clinical environment

The second invited speaker, Dr Nigel Daviesvivo Magnetic Resonance Spectroscopy (MRS) and its use in brain tumour imaging, a technique which is both an ongoing area of research and is already informing clinical decision making on the type and extent of tumours imaged within the brain.

Left: Single Voxel Spectrum from a paediatric brain. Right: Metabolite map acquiredChemical Shift Imaging (CSI), in which spectra are acquired fromthe imaging volume. Images provided courtesy of Dr Nigel Davies (

Advanced Neuro MRI

Organised by the IPEM MR Special Interest Group Part II Trainee in MRI Physics, Birmingham)

evolving field. Many advanced neuro techniques which were developed in the research environment to study the structure and function of the brain are now part of routine clinical practice. Techniques such as MR spectroscopy, fMRI, DWI, DTI and perfusion MRI are used in conjunction with standard MR imaging to aid in the diagnosis of neurological conditions, assess response to treatment and predict long-term outcome.

edge academic research

The three invited speakers each gave a unique perspective on advanced neuro MR techniques. Prof Peter Jezzard (FMRIB, University of Oxford) introduced three main

only techniques currently in development at the University of Oxford; metabolic imaging, selective arterial spin labelling (VS-ASL) and a novel black-blood imaging technique

(DANTE) for improved vessel wall imaging and characterisation. While these techniques require development before they can be translated into a clinical environment, they of what could be achieved in clinical environments with currently available technology. vessel selective angiography also produced some very exciting images that drew great interest

Other fascinating presentations of techniques currently confined to the research environmrom the University of Bristol. These covered volumetric imaging to

Bryony Wood), the use of T1/T2 relaxometry for discrimination of ageing processes (Risto Kauppinen

time since ischaemic stroke onset (Bryony McGarry and Harriet Rogers). showed exciting new potential applications of currently available MR techniques, each with a different clinical question in mind.

n the clinical environment: Current applications and clinical research

Dr Nigel Davies (Birmingham), gave a thorough introduction to Magnetic Resonance Spectroscopy (MRS) and its use in brain tumour imaging, a technique

which is both an ongoing area of research and is already informing clinical decision making on the type and extent of tumours imaged within the brain.

Left: Single Voxel Spectrum from a paediatric brain. Right: Metabolite map acquiredShift Imaging (CSI), in which spectra are acquired from multiple voxel

Images provided courtesy of Dr Nigel Davies (Brain Tumour Research Group, Birmingham Children’s Hospital)

techniques which were developed in the research environment to study the structure and function of the brain are now part of routine clinical practice. Techniques such as MR spectroscopy, fMRI, DWI, DTI and

ard MR imaging to aid in the diagnosis of term outcome.

advanced neuro MR techniques. (FMRIB, University of Oxford) introduced three main

only techniques currently in development at the University of Oxford; metabolic imaging, d imaging technique

While these techniques require development before they can be translated into a clinical environment, they provide an indication

urrently available technology. The 3D that drew great interest

Other fascinating presentations of techniques currently confined to the research environment These covered volumetric imaging to

T1/T2 relaxometry and diffusion n) and prediction of These presentations

showed exciting new potential applications of currently available MR techniques, each with a

: Current applications and clinical research

(Birmingham), gave a thorough introduction to in-

Magnetic Resonance Spectroscopy (MRS) and its use in brain tumour imaging, a technique which is both an ongoing area of research and is already informing clinical decision making on

Left: Single Voxel Spectrum from a paediatric brain. Right: Metabolite map acquired using

voxel locations through Brain Tumour Research Group,

A number of other talks covered clinical research into the use of susceptibility weighted imaging (SWI) and arterial spin labelling (ASL) to look at cerebral blood flow, which while not in current clinical use show the potential of these tools in predicting clinical outcomes for patients and complementing the morphological imaging already available. Two interesting talks were given by Dr Jonathan Ashmore (Kings College Hospital, London), evaluating surgical planning tools which are often met with enthusiasm; fMRI for language lateralisation and diffusion tractography for identification of white matter tracts. Important points were made about the large variability seen in these acquisition techniques and their processing, suggesting that tools such as these are not yet ready for clinical consideration without significant scientific input.

Dr Jonathan Ashmore (Kings College Hospital, London) delivering his talk on MR diffusion

tractography. Photo courtesy of Dr Cormac McGrath (Forster Green Hospital, Belfast)

An emerging field quite alien to the majority of MR physicists is that of MR-PET (the fusion of an MR scanner with a Positron Emission Tomography scanner for metabolic imaging). Dr Anna Barnes (UCL, London), who works with the first MR-PET scanner installed in the UK, discussed the development of their protocol for multi-parametric imaging in epilepsy patients. Of particular interest was the development of viewing tools to enable clinicians to interpret the data in a friendly way, a point which was revisited in discussions at the end of the day.

Building bridges: Translating advanced MR into clinical practice

The third invited speaker, Dr Dorothy Auer (Nottingham), gave an excellent talk on the “present and future perspectives” on advanced neuro MRI in the clinic. This presentation took a broad view of advancements in neuro MRI, taking the view of academics, clinicians, managers and patients and what the drivers are from each of these parties in guiding research. Barriers arising from these differing drivers to using the newest MR techniques clinically were highlighted, and this valuable discussion was continued at the end of the day. Dr Auer’s presentation made an important point to a physicist-dominated audience, that unless a technique can address a previously unanswered clinical question, or has the potential to change the way in which a patient is managed, or at the very least provide significant cost savings, then it is unlikely to find its way into the clinical domain.

Summary

This meeting gave an overview of advanced neuro MR techniques currently being developed and already in use in the research and clinical environments, and opened up useful discussion of the barriers faced when trying to translate these techniques into clinical practice. The bridges built and knowledge shared between the academics, hospital-based research staff and clinical staff present will prove invaluable in the development of this field and its incorporation into clinical pathways.