WHAT CAN MRI DO FOR ATAXIAS? Gülin Öz. The information provided by speakers in any presentation made as part of the 2012 NAF Annual Membership Meeting.

WHAT CAN MRI DO FOR ATAXIAS?

Gülin Öz

DISCLAIMER

The information provided by speakers in any presentation made as part of the 2012 NAF Annual Membership Meeting is for informational use only.

NAF encourages all attendees to consult with their primary care provider, neurologist, or other health care provider about any advice, exercise, therapies, medication, treatment, nutritional supplement, or regimen that may have been mentioned as part of any presentation.

Products or services mentioned during these presentations does not imply endorsement by NAF.

PRESENTER DISCLOSURES

Speaker: Gülin Öz

No relationships to disclose or list

Conventional MRI is a picture of water

No radioactivity

An MRI is a picture ofthe protons in water.

Oxygen

Hydrogen is aspinning proton.

H2O

O

HH

Clinical MRI Scanners 0.5 - 1.5 Tesla

High field MRI Scanners 3 - 7 Tesla Clearer images, more detailed info

MRI SCANNERSTesla = strength of

magnetic field

Versatility of MRI

• MRI can non-invasively image: anatomy

blood vessels / flow

brain networks

biochemistry:

• chemical levels

• metabolic rates

brain activation

Images provided by J. T. Vaughan, Ph.D.

Imaging Anatomy

Imaging Blood Vessels

MRA:MagneticResonanceAngiography

Imaging Connectivity: Diffusion Imaging

Functional MRI (fMRI)

BOLD (blood oxygenation dependent) effect

Blood flow ↑

Deoxyhemoglobin ↓

Signal ↑

N-acetylaspartate 10.0 mmol/gglutamate 7.6 mmol/gglutamine 1.3 mmol/ginositol 5.4 mmol/g

MR image

MR spectrum

Concentration of metabolites

MR Spectroscopy (MRS)

Use of MRI in ataxias

• MRI is currently used in clinical care of ataxias as..

..diagnostic aid (detection of cerebellar atrophy)

ATROPHY in SCAs

control SCA2

MRI research in ataxias

• Recent focus areas:

anatomy / quantitative morphology

brain networks

brain chemistry

MORPHOLOGIC IMAGING in SCAs

Schulz et al, 2010

Different patterns of atrophy in different ataxias

Degree of tissue loss reflects disease severity

DIFFUSION IMAGING IN ATAXIA

Prakash et al, 2009

Loss of connectivity can be detected & quantified

Control

MSA/C

4 3 2 1 ppm

NEUROCHEMICAL CHANGES IN SPORADIC ATAXIA

4 3 2 1 ppm

N-acetylaspartate

myo-inositol

Oz et al, 2011

Chemical changes can be detected & quantified

TREATMENT MONITORING WITH MRS Research with SCA1 mice

Age (weeks)

6

7

8

9

10

11

6 12

[Ta

urin

e] (

μm

ol/g

)

Oz et al, 2011

Chemical levels can be used to monitor disease reversal

healthy mice

mice with ataxia

Treatment

treated mice with ataxia

Future of MRI in ataxias

• Novel MRI technology can help with:

understanding disease processes

differential diagnosis

monitoring drug effects in clinical trials (serial testing no problem – no radioactivity)

Useful Website about MRI

Basics of MRI by Joseph Hornak:

http://www.cis.rit.edu/htbooks/mri/ (includes section ‘Your MRI Exam’)

Check out research studies @

NAF website (www.ataxia.org)

CRC-SCA website (http://rarediseasesnetwork.epi.usf.edu/CRC‐SCA/)