1. Public Health Julie C. Chapman, PsyD Director of Neuroscience War Related Illness & Injury Study Center Veterans Affairs Medical Center, Washington, DC Assistant Professor of Neurology Georgetown University School of Medicine Advanced Neuroimaging Methods Nearing Clinical Translation

2. Public Health Patrick M. Sullivan, MA Research Assistant Chapman Laboratory War Related Illness & Injury Study Center Veterans Affairs Medical Center, Washington, DC Advanced Neuroimaging Methods Nearing Clinical Translation

3. Public Health Disclaimer The views expressed in this presentation are those of the author and DO NOT reflect the official policy of the Department of Veterans Affairs or the United States Government

4. Public Health Diffusion Tensor Imaging: What’s the big hairy deal?  DTI has been primarily used in research  However, DTI is currently used in some clinical settings  How can DTI be helpful to healthcare providers?  A basic understanding of DTI aids literature review  Scientific findings influence the way we practice  DTI studies of mild TBI provide a good example

5. Public Health mTBI Diagnosis: A History  Dubious perception of mTBI with persisting symptoms  Little physiologic evidence of injury:  Clinical brain scansPhysical examination  Neuropsychologic data: differences between those with and without mTBI  Litigation inherently will be involved in some cases of mTBI.

6. Public Health mTBI Diagnosis: A History  1980’s Positron Emission Tomography (PET) studies:  Humayun et al. (1984)  Rao et al. (1989)  PET studies found differences between groups with and without TBI.  Objective physiologic differences

7. Public Health mTBI and DTI  Functional imaging method  Invasive  Costly  Structural imaging method  Non-Invasive  Less Costly PETDTI

8. Public Health DTI Studies with differences between mTBI and Healthy Control Groups  Bazarian et al. 2007  Benson et al. 2007  Kraus et al. 2007  Niogi et al. 2008  Rutgers et al. 2008  Wilde et al. 2008  MacDonald et al. 2011

9. Public Health DTI as a Clinical Tool Goals for:  Diagnosis: Assist in the identification of diagnostic markers  Monitoring: Following the course of progressive diseases (i.e., MS, Alzheimer’s Disease)  Treatment:  identifying sites of disease-related abnormalities to guide treatment  Tracking the effects of treatment over time

10. Public Health Blast Injury Outcomes (BIO) Study mTBI + PTSD vs. Control Group Chapman Lab Fractional Anisotropy Tapetum_LT

11. Public Health Blast Injury Outcomes (BIO) Study

12. Public Health Blast Injury Outcomes (BIO) Study Preliminary Analysis, 2010

13. Public Health Type 2 Diabetes Mellitus Study DM2 + Obese vs. Obese Groups Chapman Lab Fractional Anisotropy Fornix

14. Public Health mTBI and Obesity Study Obese only vs. Control Group Mehos & Chapman Axial Diffusivity Cingulate Gyrus_LT

15. Public Health mTBI and Obesity Study Obese only vs. Control Group Mehos & Chapman Axial Diffusivity Genu of CC_LT

16. Public Health Volumetric Analysis A method to compare the volume of specific brain regions between patients or groups Athinoula A. Martinos Center for Biomedical Imaging

17. Public Health Volumetric Analysis  High anatomic validity (gold standard)  Extensive use of algorithms/atlas templates reduce anatomic validity Manually Drawn MethodsAutomated Methods

18. Public Health Volumetric Analysis  Time-intensive  Inter-rater reliability concerns  Allows high throughput & efficient workflow  Eliminates multiple rater effects Manually Drawn MethodsAutomated Methods

19. Public Health Volumetric Analysis  Automatic technique relies on distinguishing gray matter, white matter, and CSF  T1-weighted MRI images have good contrast between these types of tissue

20. Public Health Automated Volumetric Analysis  Automated tools for reconstruction of the brain’s cortical surface from structural MRI data

21. Public Health Automated Volumetric Analysis  Uses an algorithm to:  Strip away skull and facial tissue  Find border between the gray matter and subcortical white matter  Find border between the gray matter and the pia.

22. Public Health Automated Volumetric Analysis  Registers image to atlas template  automatically parcels brain into regions based on:  Atlas template  Anatomic properties of the subject brain.

23. Public Health Clinical Use of Volumetric Analysis  Automated programs accept standard clinical MRI images and produce objective results independent of rater effects.  The automatically parcellated brain regions are each measured for total volume.

24. Public Health Clinical Use of Volumetric Analysis  These amounts can be averaged into groups and group differences can be computed.  Volumetric differences are seen in many disease conditions such as Alzheimer’s, epilepsy, and depression

25. Public Health DTI and Volumetric Analysis  Potential to improve quality of care for Veterans  Close to Translation Line  Impact Clinical Practice

26. Public Health Contact Us EMAIL: Julie.Chapman@va.gov or Chapman.Research@va.gov VISIT OUR WEBSITE: www.warrelatedillness.va.gov/dc/