Powerful New Scanner Improves Diagnosis, Treatment of TBI, PTSD

by U.S. Medicine

November 1, 2011

WASHINGTON — A cutting-edge scanner that combines a whole-body, simultaneous positron emission topography (PET) and magnetic resonance imaging (MRI) could be invaluable in helping them better understand what changes are occurring in the brains of those suffering from TBI and PTSD, federal scientists said.

Biograph mMR – NIH Photo

“We are interested in trying to understand what brain changes are associated with traumatic brain injury and PTSD in the servicemen and servicewomen coming back from Iraq and Afghanistan. It is only the second one in this country, and it is being installed here at the Clinical Center at NIH,” Walter Koroshetz, MD, deputy director of the National Institute of Neurological Disorders and Stroke, told U.S. Medicine.

Currently, many patients undergo separate MRI and PET scans. The Biograph mMR, however, will allow a more complete picture of abnormal metabolic activity in the brain in a shorter time frame than the separate procedures. The machine will be used primarily for TBI brain imaging research, although researchers at the NIH Clinical Center also will use the Biograph mMR in studies of patients with other brain disorders, cardiovascular disease and cancer.

The machine was purchased through the Center for Neuroscience and Regenerative Medicine (CNRM), a DoD-funded collaboration between the NIH and the Uniformed Services University of the Health Sciences. Congress established CNRM in 2008 to bring together the expertise of physicians and scientists at NIH and USU to develop innovative approaches to brain injury diagnosis and recovery.

“A major challenge in the diagnosis and treatment of both military and civilian brain injury patients is the lack of sufficient tools to evaluate the type and extent of injury in a given patient,” Regina C. Armstrong, Ph.D., director of the CNRM, said in a statement. “We expect the NIH investigators have the expertise to take maximal advantage of this technology by designing novel neuroimaging protocols and molecular probes that can significantly improve how TBI research is performed.”

Diagnosing head injuries

Scientists are hoping to be able to see markers of injury in the brain with the MRI/PET that they cannot with current scans.

“The NIH has strong scientists who can develop new PET compounds,” said Koroshetz. “We are hoping to engage them to develop radioligands that will show biologic changes that are important, such as inflammation, axonal outgrowth, new synapse formation, membrane repair or abnormal protein aggregation in the brain after head injury. So, we are hoping to see with this PET/MRI scanner processes of injury and recovery that no one could see before.”

Powerful New Scanner Improves Diagnosis, Treatment of TBI, PTSD Cont.

The new device has other advantages. In addition to combining the MRI and the PET Scan, the tool allows for more comprehensive results. Additionally, traditional PET scanners involve computed tomography imaging, which uses radiation, while the new Biograph mMR does not.

Koroshetz said study protocols are available for participation by servicemembers who have had a recent head injury or blast injury. Patients or providers interested in more information on these protocols can contact CNRM at 1-855-824-2676 or visit http://www.usuhs.mil/cnrm/bicr/index.html.

“It’s free. The evaluations people get here are at no cost to them. There are funds to actually travel people in, if they are not in the area,” he said.

Overall, the hope is that the new imaging equipment will enable researchers to better follow the process of recovery after TBI, whatever the cause, Koroshetz explained.

Diagnosis of TBI can be difficult, and researchers have been diligently seeking out the best tools to improve that process. The Biograph mMR is one technology being used, but others also have been tested.

A study published this summer in the New England Journal of Medicine, for example, looked at a brain scanning method called diffusion tensor imaging (DTI). In that study, military and academic researchers used DTI to examine a group of soldiers diagnosed with mild TBI while serving in Iraq and Afghanistan. While conventional brain scans appeared normal in all but one of the soldiers, the more precise DTI scans detected clear signs of brain damage in about one-third.

Still, DTI scans were unable to detect signs of brain damage in more than two-thirds of the soldiers, though they all had been diagnosed through other methods with mTBI.

 “DTI will never replace a clinical evaluation, but we hope that it will become a useful tool for diagnosis and for guiding rehabilitation,” said Christine MacDonald, Ph.D., the study’s first author, in a news release on the study.





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