“Iraq and Afghanistan veterans are returning from combat zones where the IED is the enemy’s weapon of choice. The brain trauma from those blasts may not manifest immediately but may result in a degenerative condition known as Chronic Traumatic Encephalopathy. It shares some symptoms with post traumatic stress such as paranoia, depression, and bursts of anger.
Not only is having the best modern technology a necessity for our veterans, it will grow our understanding of these conditions to see the problem beyond just the symptoms. The invisible wounds of war have only been dealt with through counseling and drugs. We can take the holistic approach that affords our veterans the full care for such devastating injuries.
It is possible now to detect minute problems in the brain — indicators of a degenerative condition — and treat them more effectively. It is encouraging to see the VA Medical Center invest in technology that will be sorely needed as OEF/OIF veterans return home from our nation’s longest wars. It’s an investment in healing.”
— Swords to Plowshares
SF Chronicle – A room in the basement of the San Francisco Veterans Affairs Medical Center is undergoing renovations for a new, $8 million magnetic resonance imaging machine, which will join an arsenal of some of the most powerful research scanners in the world.
The machine, known as a 7T – “T” standing for tesla, a unit of magnetic field – will offer researchers a more in-depth look than the VA center’s current MRIs provide into the details of the brain and the roles biological markers play in developing dementia, Alzheimer’s disease, post-traumatic stress disorder and other cognitive problems.
New, ultra-high resolution MRIs help researchers view details in the brain that they used to be able to see only after a patient died, such as subtle changes in brain structure and function and other abnormalities associated with Alzheimer’s disease. The hope is that by seeing such signs earlier, doctors will be able to detect the disease earlier.
The new, 35-ton Siemens MRI machine at the San Francisco VA Medical Center will be one of only about 35 installed systems worldwide. It is expected to arrive at the hospital by the end of the year, and will be tested and tinkered with for another six months before researchers put it to use.
The San Francisco VA already has a 1.5T, two 3Ts – a state-of-art version of which was installed in January – and a 4T that has been involved in studies at the research center since 2004. The higher tesla unit levels correlate with stronger magnetic strength and brighter, more detailed pictures.
“These tools are the cutting edge,” said Stuart Hoffman, scientific program manager for brain injury, rehabilitation research and development service at the Department of Veterans Affairs in Washington. “It’s our hope having these tools available to our clinicians and researchers will improve current care and provide new insight.”
The San Francisco VA’s Center for Imaging of Neurodegenerative Diseases is the only center in the VA system devoted exclusively to MRI imaging of the brain. Its driving force is Dr. Michael Weiner, director of the center and professor of radiology, psychiatry and neurology at UCSF.
Weiner, an Air Force veteran who served in Vietnam, started using MRIs for brain research at the San Francisco VA in the mid-1980s when the technology was new. He said UCSF also has an older version 7T, but the VA’s will be devoted solely to neurodegenerative diseases.
“We’re very excited about the 7T because we think it will enable us to look at very small structures in the brain,” Weiner said. “We’ll be able to see things we can’t see with the (other machines). We think it’s going to be the only 7T MRI that will focus on neurodegenerative diseases affecting veterans.”
Alzheimer’s disease, a progressive, fatal brain disease, is the sixth-leading cause of death and affects 1 in 8 older Americans. PTSD is the fifth-most-common psychiatric disorder in the United States. Other diseases being studied at the center include traumatic brain injury, epilepsy and Parkinson’s disease.
There is no drug that can cure or prevent Alzheimer’s. Last week, drug development for Alzheimer’s suffered a blow when a promising drug produced by Pfizer Inc., in partnership with Johnson & Johnson, failed to slow the progression of the disease in one of four late-stage clinical trials.
“The general feeling is we need to study patients at an earlier stage, before they develop dementia,” said Weiner, who remains hopeful that the drug and other therapies will provide a breakthrough. “The real goal is prevention.”
To that end, Weiner and his colleagues at the VA plan to recruit 50,000 people over age 55 for a project called the Bay Area Alzheimer’s Prevention Project to study such diseases as Parkinson’s, depression, stroke and frontotemporal dementia.
Their idea is to develop a registry primarily of healthy adults, with or without a history of dementia, who will undergo psychological and medical tests with the goal of enrolling them in prevention trials.
The new project will join other studies already in progress, most significantly the Alzheimer’s Disease Neuroimaging Initiative, a $140 million clinical trial funded by the National Institutes of Health involving more than 1,000 patients at 57 centers in the United States and Canada.
The study, which started in 2004 and is scheduled to end in 2017, has already produced hundreds of research papers, said Weiner, who is the principal investigator for the initiative.
As part of the Alzheimer’s Disease Neuroimaging Initiative, the Defense Department is funding a related study of the aging brain in Vietnam War veterans. Researchers want to know whether and how traumatic brain injury and PTSD are connected to Alzheimer’s.
San Francisco resident William Stone, who served in the National Guard during the Vietnam War but did not see combat, said he had agreed to participate in the study at the VA center because he wants to help in the fight against Alzheimer’s and other brain disorders.
“The Weiner study is the one chance you have to find out your mental health that you wouldn’t ordinarily get a shot at,” said Stone, 71. “It’s valuable to me and to my family.”
Stone said he has recently stopped participating in the MRI portion of the project because he felt uncomfortable being confined in the machine, but continues to do the blood tests and neuropsychological exams. Participants are sometimes required to spend up to two hours inside the machine.
The MRI machines, which are relatively narrow and create a series of clicking and clanking sounds, use radio waves and magnets made up of miles of superconducting wire that sits in a bath of liquid helium to create images of the brain.
The research studies already in progress rely on the San Francisco VA’s existing MRI machines. As for the 7T scanner, Weiner said he expects to work with the new device for six months before deciding how to get the most out of it.
James Meng, director of MRI research development for Siemens, said a design challenge for ultra-high resolution MRIs such as the 7T is that the higher the magnetic field, the smaller the “bore” – the tunnel where the patient has to fit through. He said the highest-resolution machines, such as an 11.7T being delivered next year to the National Institutes of Health, cannot fit a whole human body.
Weiner is amazed by how far technology has come since he started imaging the brain nearly a quarter of a century ago.
“It’s almost at the level of microscopy,” he said, “meaning the machines can almost – but not quite – see individual cells.”