New methods of measuring and analysing MRI could help doctors identify the right multiple sclerosis treatment option for their patients and distinguish the symptoms of Parkinson’s disease from other movement disorders earlier than before. Experts from the Masaryk University Faculty of Medicine and CEITEC, together with their colleagues from the University of Minnesota, have been developing these methods over the past few years. They will now start working on their application in everyday practice.
Thanks to an EU Horizon 2020 grant from the Marie Skłodowska-Curie Actions (Excellent Science) programme, which was won four years ago by the neurologist and the current MU Rector Martin Bareš, the researchers could receive training in the US and transfer cutting-edge imaging techniques to the Czech Republic. The Microbradam project allowed them to visit the US and extend their cooperation with experts from research institutions in Finland and Italy.
One of the experts who developed the new methods of brain imaging in the project is the neurologist Pavel Filip, a former PhD student of Bareš who now works at the 1st Department of Neurology at St. Anne’s University Hospital and MU Faculty of Medicine.
“To put it simply, we were developing methods that would allow the MRI imaging of different processes and changes in the brain that have been observed until now. These devices detect the state of the molecules in the human body, and the new methods allow us to record changes related to the movement of molecules at frequencies that regular protocols are blind to. This allows us to detect pathological changes that do not show when you use the regular MRI settings,” he explains.
Earlier diagnosis and the right treatment
This allows experts to identify changes in the nerve fibre sheaths or slight changes in the white brain matter, which are not visible in regular MRI images and protocols. For patients with multiple sclerosis, for example, this could mean earlier diagnosis and better selection of treatment.
“Drugs that alleviate the symptoms and slow down the progress of the disease are quite expensive and you cannot predict how well and how quickly your patient will react to the selected drug. As a doctor, this means you sometimes have to wait to see whether the therapy works. However, if you could check the effectiveness of the treatment on MRI images, it would be much easier to respond to the needs of individual patients,” explains Filip.
The research group around Martin Bareš has been collaborating for a long time with researchers from the US University of Minnesota, who developed the new measurement protocols that are more sensitive to certain diagnoses. Experts in Brno and other countries then tested these protocols on various diseases. As Filip says, “We started with a small sample of patients and healthy individuals to verify whether they work. To date, we have measured hundreds of people and are now trying to make the method suitable for use with regular hospital machines.
Until now, we have only used it with the MRI machines at the Masaryk University CEITEC institute, which are highly advanced and can process more difficult tasks than most hospital machines.” The methods that Filip helped develop are so complex that they require a more complex analysis than the MRI machine is capable of. Processing the complete imaging protocol can take up to 36 hours per patient on a supercomputer.
Filip worked on this analytical part of the process. “It’s not that usual for a doctor to deal with this as it’s usually a technician’s job. But I have always liked computers and as a PhD student, I spent six months at a research centre in Paris where I studied the basics of machine data processing. Besides medical knowledge, this required a better understanding of the physics of the measuring process and it’s enough for me to be able to set a biology-based hypothesis and use it to design a measurement protocol.
Due to the complex analysis required, it will take several years for the new methods to become more commonly available. Besides improving the methods, researchers are also examining whether they could be used to monitor other issues, such as signs of ageing.
“More and more people are living to an advanced age and it would be ideal if you could not only keep them mobile but also keep their memory in good shape for as long as possible. We would like to see whether the new approach allows us to identify the point when metabolic and other changes start to impact the brain and the number of functional brain cells starts to decrease. Therapy started at this point could be more effective than therapy that starts when you already tend to forget a lot,” says Filip about other possible applications. Further possibilities include distinguishing between patients with Parkinson's disease and patients with other types of tremor who require different treatment.
Pavel Filip divides his time between research and working at an outpatient neurology clinic. He thinks this is the perfect combination to prevent burnout, which is common in his specialisation, as working with patients with severe brain diseases can understandably be disheartening at times. “However, if you start your patients on the right treatment, you can see the results fairly quickly. Research work is exciting and interesting but can also sometimes be boring, and sometimes you spend a hundred hours working on a theory that doesn’t pan out in the end,” he says.
He often visits the University of Minnesota and attends research conferences. “This means that I don’t have the time for a lot of things but if you do research, you must see it as your hobby in a way,” says Filip, adding that one of the reasons he decided to study the brain was the fact that researchers are still rather hazy on how it actually works.