Harnessing MR

Research published this week demonstrated MRI’s potential in two mysterious and devastating illnesses, as well as ongoing concerns with its inappropriate use.

Gulf War Illness has haunted nearly 200,000 veterans of the first Gulf War. To date, there are few answers and many questions. Researchers at Georgetown University Medical Center leveraged diffusion tensor MRI to detect changes in the brains of affected individuals not seen in unaffected veterans, offering a potential biomarker for the disease.

Specifically, results showed significant correlation between severity of symptoms and axonal damage in the right inferior fronto-occipital fasciculus. While the findings are preliminary, the changes appear distinct from other neurodegenerative diseases, and may offer a target for therapy, according to the authors.

Italian researchers used MRI to demonstrate cortical abnormalities in the brains of migraine sufferers, some of which are present at birth and some that develop over time. Massimo Fillippi, MD, of University Ospedale San Raffaele in Milan, and colleagues turned to a new approach—surface-based measures of cortical thickness, rather than the traditional model of voxel-based morphometry.

Additional research is needed to fully understand the meaning of cortical abnormalities in the pain processing areas of migraine patients, he noted. The researchers are conducting a longitudinal study of the patient group to see if their cortical abnormalities are stable or tend to worsen over the course of the disease. Other research could determine whether cortical abnormalities are a migraine biomarker.

As clinical research progresses, retrospective analyses continue to demonstrate inappropriate use of MRI, with fewer than half of lumbar MR exams performed at University of Alberta Hospital and Ottawa Hospital classified as appropriate.

As the costs and questionable outcomes of inappropriate use add up, the radiology community needs to define its role—bystander, gatekeeper or clinical collaborator? Wise choices can help secure radiology’s role in value-based healthcare models, while maintaining the status quo may persist for just a short time and ultimately impede radiologists’ position as valued stakeholders in healthcare decision making.

Is your organization expanding MRI applications? Is it targeting the modality to home in on appropriate use? Please let us know. And have a terrific weekend.

Lisa Fratt, editor