1. WHAT CAN MRI DO FOR ATAXIAS? Gülin Öz

2.  The information provided by speakers in any presentation made as part of the 2012 NAF Annual Membership Meeting is for informational use only.  NAF encourages all attendees to consult with their primary care provider, neurologist, or other health care provider about any advice, exercise, therapies, medication, treatment, nutritional supplement, or regimen that may have been mentioned as part of any presentation.  Products or services mentioned during these presentations does not imply endorsement by NAF.

3.  Speaker: Gülin Öz  No relationships to disclose or list

5. Conventional MRI is a picture of water No radioactivity

6. An MRI is a picture of the protons in water. Oxygen Hydrogen is a spinning proton. H2OH2O

7. O HH

8. Clinical MRI Scanners 0.5 - 1.5 Tesla High field MRI Scanners 3 - 7 Tesla Clearer images, more detailed info MRI SCANNERS Tesla = strength of magnetic field

9. Versatility of MRI MRI can non-invasively image: anatomy blood vessels / flow brain networks biochemistry: chemical levels metabolic rates brain activation

10. Images provided by J. T. Vaughan, Ph.D. Imaging Anatomy

11. Imaging Blood Vessels MRA: Magnetic Resonance Angiography

12. Imaging Connectivity: Diffusion Imaging

13. Functional MRI (fMRI) BOLD (blood oxygenation dependent) effect Blood flow ↑ Deoxyhemoglobin ↓ Signal ↑

14. N-acetylaspartate10.0  mol/g glutamate 7.6  mol/g glutamine 1.3  mol/g inositol 5.4  mol/g MR image MR spectrum Concentration of metabolites MR Spectroscopy (MRS)

15. Use of MRI in ataxias MRI is currently used in clinical care of ataxias as....diagnostic aid (detection of cerebellar atrophy)

16. ATROPHY in SCAs control SCA2

17. MRI research in ataxias Recent focus areas: anatomy / quantitative morphology brain networks brain chemistry

18. MORPHOLOGIC IMAGING in SCAs Schulz et al, 2010 Different patterns of atrophy in different ataxias Degree of tissue loss reflects disease severity

19. DIFFUSION IMAGING IN ATAXIA Prakash et al, 2009 Loss of connectivity can be detected & quantified

20. Control MSA/C 4 3 2 1 ppm NEUROCHEMICAL CHANGES IN SPORADIC ATAXIA 432 1 ppm N-acetylaspartate myo-inositol Oz et al, 2011 Chemical changes can be detected & quantified

21. TREATMENT MONITORING WITH MRS Research with SCA1 mice Age (weeks) 6 7 8 9 10 11 612 [Taurine] (μmol/g) Oz et al, 2011 Chemical levels can be used to monitor disease reversal healthy mice mice with ataxia Treatment treated mice with ataxia

22. Future of MRI in ataxias Novel MRI technology can help with: understanding disease processes differential diagnosis monitoring drug effects in clinical trials (serial testing no problem – no radioactivity)

23. Useful Website about MRI Basics of MRI by Joseph Hornak: http://www.cis.rit.edu/htbooks/mri/ (includes section ‘Your MRI Exam’) Check out research studies @ NAF website (www.ataxia.org) CRC-SCA website (http://rarediseasesnetwork.epi.usf.edu/CRC ‐ SCA/)