MRI brain scans
27 July 2015
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Learn how RMH researchers are using technology to better diagnose and treat patients with Multiple Sclerosis.

Multiple Sclerosis (MS) used to be a disease with no cure and no treatments. In the last decade there has been a rapid rollout of new drugs that are changing how this disease is managed and offering patients new hope.

However determining which drugs are working with individual MS patients has been hit and miss. Until now.

Scientists at the Royal Melbourne Hospital have developed an Australian-first software that can detect minute changes in the brain in patients with MS, which can tell doctors whether a treatment is working or not – long before symptoms associated with the drug failing to work become noticeable in the form of symptoms.

The trial of the software in 161 patients , to be published this week (beg 27/7), means that doctors can for the first time manage the treatment of MS earlier and in a way that will see patients only prescribed drugs that are only beneficial, rather than on drugs that have no effect – crucial in a progressive disease like MS.

The software – which revealed new brain lesions in 25% of patients who had been classified as stable (ie no new lesions) has been so successful it is now being used in live scans to provide information to neurologists on the patient’s treatment efficacy.

Approximately 23,000 Australians have MS, and it is estimated that every year the number of people diagnosed increases by 4%.

Traditionally patients with MS, have their disease progression tracked with MRI scans. However, according to Royal Melbourne Hospital, Consultant Neuroradiologist, Dr Frank Gaillard, the size of demyelinating plaques in the brain (the lesions that are the hallmark of the disease) can be incredibly small and determining whether there a few new plaques when mixed in among numerous preexisting (sometimes numbering in the hundreds) is virtually impossible.

“Essentially it’s like playing “spot the difference” – detecting whether has the patient developed new lesions, when there are a large number already present is difficult. Yet it is crucial information if the treating doctors are to know whether the disease is progressing, or whether a current treatment is working,” he said.

“This is particularly important as there now are increasing numbers of disease modifying drugs for MS available to neurologists. Ideally individuals with MS are on medications that halt development of new lesions. Developing new lesions is the hallmark of disease progression and in many instances results in change in therapy.”

The software looks at MRI scans of patients typically taken a year apart – and highlights any potential new lesions within the brain. Once these have been highlighted the radiologist can review further scans of the brain in that area to determine whether it is further evidence of the disease progressing or not.

The retrospective trial – of more than 160 patient scans – found new lesions in one in every four patients who had been deemed stable, when in fact their disease had been progressing.

In 79% of these cases, treating neurologists reported that they would have altered their management at the time, had the presence of these new lesions been present. Not only is this software more accurate than traditional interpretation, it also allows the interpretation to occur more rapidly, reducing reporting times almost by half.

The software is currently being trialed at The Royal Melbourne Hospital in a prospective study to determine which MS patients need to have their treatments reviewed.

The study is published this week in the American Journal of Neuroradiology (AJNR).

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