The Value, Development, and Future of Imaging Technology in MS: An Interview with Dr. Rohit Bakshi
Rohit Bakshi, MD, MA, is the Jack, Sadie and David Breakstone Professor of Neurology and Radiology at Harvard Medical School. He is the Director of the Laboratory for Neuroimaging Research and a Senior Neurologist at the Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital. He has built a research program involving quantitative MRI in multiple sclerosis. In 2015, he began his appointment as Editor-in-Chief of the Journal of Neuroimaging. Dr. Bakshi has delivered more than 200 invited academic lectures and authored more than 200 peer-reviewed articles.
How valuable is neuroimaging to the MS community?
MRI is a cornerstone of properly diagnosing MS. Patients would typically need to have an MRI scan performed before a diagnosis of MS can confidently be made. Once the diagnosis is confirmed, this technology serves as an integral part of standard patient care. MRI is an important tool to monitor disease activity and to learn if a patient is stable or doing worse. It also evaluates the effectiveness of a disease-modifying therapy to help the neurologist determine if a medication is working well or if the patient might be a candidate for a different treatment option.
Since its introduction in the 1980s, how dramatically has MRI technology improved over the past four decades, and how have these changes impacted the diagnosis and evaluation of MS disease activity?
MRI is far more sophisticated than it was 40 years ago. We’re now able to see the brain and spinal cord in much greater detail, enabling us to make more precise measurements and to view tissue damage resulting from MS in both the brain and spinal cord. In addition, we’re able to look at white matter fiber tracks of the brain, using MRI diffusion tensor imaging. Also known as “DTI,” this new technology is a research tool that became available within the past several years. Another relatively recent development is functional MRI, which allows us to see which areas of the brain are functioning normally. Through this technology, we can see which parts of the brain are “asleep” and which parts are “awake.”
What types of changes or improvements do you foresee with neuroimaging in the years ahead?
A new type of MRI scanner is 7.0 Tesla or “7T” MRI. This is a very sophisticated and powerful technology, showing us details of the brain that we’ve never seen before. For instance, the gray matter of the brain and gray matter lesions can’t be viewed well with traditional MRI. Also with 7T, we can see MS-related changes in the covering of the brain, known as the meninges. Here we can view inflammation and abnormal cells that may accumulate in the meninges of individuals with MS. At least 25 of these scanners are currently available in the United States, although most are only used for research. However, I expect to see more of this technology used for patient care in the not-too-distant future.
A different type of imaging is positron emission tomography or “PET” scanning. This technology continues to evolve and become more complex, giving us more detailed evaluative tools. These scans can show actual cells in the brain – and we can see those that are activated and those that are inactivated. For example, we can view microglia activity in MS, although we don’t yet know how changes in microglia activity relates to the disease. Microglia are a type of glial cell, a part of the immune system in the brain and spinal cord.
As new imaging techniques such as 7T MRI and PET are further developed and fine-tuned, the medical community should be able to learn more about diseases such as MS and the tissue changes that occur. This in turn enables researchers to understand each disease in more detail and ultimately may lead to important clues to develop more effective treatment strategies. I have much hope for the future of MS research and I know that advances in neuroimaging will play a vital role in this important initiative.