Imaging

Neurology: “We have a life together with these patients”

There is no single method for imaging neurological diseases. However, the advent of 7 tesla (7T) magnetic resonance imaging has been a game changer for many patients.

3 min

Doris Pischitz

Published on March 27, 2023

Perspectives spoke with Professor Maxime Guye, MD, PhD, who is deputy director of the Centre for Magnetic Resonance in Biology and Medicine (CRMBM) at Aix-Marseille University (AMU) and director of the medical site of CRMBM at the Timone University Hospital in Marseille, France.

Professor Guye coordinates the 7T Aix-Marseille Initiative, a project around the 7T magnetic resonance imaging (MRI) research scanner hosted and operated by CRMBM. His research interests are ultra-high field MRI in neurology, combining and comparing multimodal MRI methods with electrophysiological recordings, and brain connectivity.

Since when have you been using 7 tesla (7T) research MRI and what are your research areas?

We started using a 7T MRI research scanner at the CRMBM in 2015. Our center is part of the Timone University Hospital; its research focuses on the central nervous system, the cardiovascular system and the musculoskeletal system. My team uses the 7T system for neuroscience research. In Marseille, there are several big institutes that focus on epilepsy: the Institute of Neuroscience, particularly the Institute de Neurosciences des Systèmes, and clinical departments for neurosurgery and functional neurosurgery at the university hospital. We also have the Institut de Neurobiologie de la Méditerranée, which is a big institute working on the use of MRI in epilepsy.

Could you please relate one or two patient cases where 7T research MRI has been particularly helpful?

You mentioned epilepsy, which is also your area of expertise. How does epilepsy impact the lives of your patients?

Epilepsy is a heterogeneous disease characterized by recurring seizures. In its benign forms, patients may be able to perfectly control it with medication and lead a normal life. But one third of patients are drug resistant and they continue to have seizures despite taking anti-epileptic drugs. The consequences can be psychological, cognitive, and social. Seizures can occur any time, so patients can’t live a normal life, walk, work, drive, etc. In addition, their life expectancy is reduced. And there is a risk to life: People can die from seizures. What is also very important for the quality of life is the impact of the side effects of the anti-epileptic drugs. This is probably one of the factors that most correlates with poor quality of life. Quality of life may improve if you eliminate all these problems – side effects, comorbidities, frequency of seizures, and seizure severity.

Prof. Guye is talking to a patient. — Professor Guye’s research focuses on ultra-high field MRI in neurology, particularly epilepsy. Patients with drug-resistant focal epilepsy may benefit from exact localization of the brain lesion and subsequent surgery.

What role does MRI play in the diagnosis and treatment of these patients today?

Particularly in patients with focal epilepsies, it is very important to find a lesion. If the patient has a lesion in the brain, it means the epilepsy will probably be long-lasting, because the lesion won't disappear spontaneously. Some lesions generate a lot of epileptic activity in the brain, and these are often associated with drug resistance. We know that in these cases, the prognosis in terms of drug sensitivity would be very bad. So, when we find such a lesion, it's an indication for early surgery. And the other consequence is that if you find this kind of lesion, you can have a good surgical outcome in most cases. But of course, a lesion is not a summary of the epileptogenic zone in these patients. So that's why we must always combine the discovery of the lesion in the brain with the other exams: electroencephalogram (EEG), magnetoencephalography (MEG), and clinical presentation. We fuse this information to guide surgical strategies.

How important is scanning speed in your research?

Speed is not really an asset at 7T. I think the main impact of deep learning reconstruction can be saving time for ultra-high-resolution imaging. But it could of course also help preventing motion artefacts.

How would multinuclear MR and the ability to image e.g., sodium, support neurological diagnoses?

_{[Explanation multinuclear MR]}

What is multinuclear MR?

Multinuclear, or X-nuclei, MR covers MR that does not image hydrogen, but, for example, sodium or phosphor. X-nuclei MR may be helpful in gaining physiological information and information on energy metabolism.

How does 7T MRI perform in standard (non-neurological) examinations? What would be your hopes for a next-generation 7T system in this field?

I would say 7 tesla can possibly be useful in any inflammatory vascular or tumoral lesion that shows insufficient information at 3T. Obviously in cases of normal MRI at 3T, but also in cases where 3T does not provide enough information for a good diagnosis. So for vascular lesions, for small vessel diseases, it can be a tool to look at microbleeds, microinfarcts to have better imaging of the vessel wall, for instance. And for tumors it can be useful for small lesions, small tumors like pituitary adenomas, but also for better defining gliomas or grading gliomas and for better defining the margins of the glioma.[1–6]

How important will 7T MRI be in the future? Does it have a future in broad clinical application?

In my institution, the role is twofold. One is in research; clearly, it's a wonderful tool for developing new relevant biomarkers for early diagnosis, and for improving the prognosis of neurological and psychiatric diseases. And on the other hand, for clinical routine, in the indications we discussed: epilepsy and any lesions for which the diagnosis at 3T is not clear. Also in neurosurgery, because when you can more exactly delineate the margin of a lesion for a neurosurgeon, it is very valuable information.

What continues to drive you as a physician and as a researcher?

This is a personal question, of course. We have a life together with these patients, we share the good news, the bad news. We follow a patient for years actually; sometimes from childhood to adulthood, because drug resistant epilepsy often starts in childhood. We sometimes share the side effects, sometimes the surgical complications are very hard. When a patient has a complication during stereoelectroencephalography, we really try to be together with the family, with the patient. So, there is some joy, but there are also some sad situations. When we can make this patient free of seizures, free of the disease, we win together.

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By Doris Pischitz

Doris Pischitz is an editor in corporate communications at Siemens Healthineers. The team specializes in topics related to healthcare, medical technology, disease areas, and digitalization.

[1] Rotta J, Perosa V, Yakupov R, Kuijf HJ, Schreiber F, Dobisch L, et al. Detection of Cerebral Microbleeds With Venous Connection at 7-Tesla MRI. Neurology. 202196(16):e2048–e2057.
[2] Ni J, Auriel E, Martinez-Ramirez S, Keil B, Reed AK, Fotiadis P, et al. Cortical localization of microbleeds in cerebral amyloid angiopathy: an ultra high-field 7T MRI study. J Alzheimers Dis. 2015;43(4):1325–30.

[3] Song JW, Moon BF, Burke MP, Kamesh Iyer S, Elliott MA, et al. MR Intracranial Vessel Wall Imaging: A Systematic Review. J Neuroimaging. 2020;30(4):428–442.
[4] Yao A, Rutland JW, Verma G, Banihashemi A, Padormo F, Tsankova NM, et al. Pituitary adenoma consistency: direct correlation of ultrahigh field 7T MRI with histopathological analysis. Eur J Radiol. 2020;126:108931.
[5] Rutland JW, Delman BN, Gill CM, Zhu C, Shrivastava RK, Balchandani P. Emerging Use of Ultra-High-Field 7T MRI in the Study of Intracranial Vascularity: State of the Field and Future Directions. AJNR Am J Neuroradiol. 2020;41(1):2–9.
[6] Bian W, Hess CP, Chang SM, Nelson SJ, Lupo JM. Susceptibility-weighted MR imaging of radiation therapy-induced cerebral microbleeds in patients with glioma: a comparison between 3T and 7T. Neuroradiology. 2014;56(2):91–6.

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