Advanced Clinical Neuro MR Imaging
at the Medical College of Georgia

MCG is the only medical center in the CSRA (Central Savannah River Area) to offer a variety of advanced magnetic resonance imaging.

Advanced MR Imaging differs from typical MRI, which only provides structural information regarding organs such as the brain, spinal cord, and various structures of the head and neck. Physicians specializing in the diagnosis of neurological diseases with high-tech imaging (neuroradiologists) oversee the performance of these special studies which are generally only available at major academic medical centers in the United States such as the Medical College of Georgia. Here is a brief description of these techniques and a few examples of each:

FUNCTIONAL MRI-This is a method of evaluating regional changes in blood flow associated with various types of activity (referred to as activation tasks). Such activity may include sensorimotor tasks, language tasks, or memory tasks. By observing regional changes in blood flow and analyzing data from these images, maps of activation can be generated which display the active areas in the brain responsible for these various important functions (e.g., movement, speech, emotions, and memory). This method has been used by neuroradiologists to aid neurosurgeons in treatment planning prior to surgical removal of brain tumors, vascular malformations, cortical malformations and other intracranial mass lesions in order to avoid surgical removal of vital brain tissue involved in these important functions and thus reduce overall surgical risk.

Example of a language task with fMRI showing activation (yellow arrows) far removed from an enhancing tumor (blue arrows):

Example of a patient with a left parietal tumor (red arrows) performing a left hand motor task; primary right motor cortical activation (green arrows) is seen, but displacement of left hemispheric activation (blue arrows) is also demonstrated. Some of the left hemispheric activation borders on the margins of the tumor. Knowing this will help a neurosurgeon decide how much of a tumor can be safely removed without causing a postoperative permanent neurological deficit (e.g., paralysis, numbness, or difficulty with movement).

DIFFUSION TENSOR IMAGING -This new method allows neuroradiologists to visualize and characterize white matter tracts in the brain. This technique is very useful in diseases such as multiple sclerosis. Variations of this diffusion technique have recently been  commonly used to diagnose acute strokes, but the ability to closely examine white matter in the brain is relatively new.

Apparent diffusion coefficient (ADC) map on the left and fractional anisotropy (FA) map on the right of a normal volunteer, demonstrating normal white matter tracts in the brain (on the color scale, red regions are higher in [ADC or FA, respectively] value than blue regions).

In addition, diffusion tensor imaging allows tractography, which enables depiction of white matter tracts in the brain, as demonstrated below (displaying the genu and splenium of the corpus callosum):

MAGNETIC RESONANCE SPECTROSCOPY ---This is a method to examine the brain metabolites to evaluate the nature of brain mass lesions which may be nonspecific in appearance on conventional structural MRI, even with contrast. This is often used to confirm absence or presence of tumor, although other applications also exist.

The following proton magnetic resonance spectroscopy study demonstrates a right occipital lobe tumor, with associated typical metabolic abnormalities (reduction in NAA and slightly elevated choline peak); the normal left occipital lobe spectrum is on the right, and the abnormal tumor spectrum is on the left side of the image below:

MCG currently has two 1.5 tesla MRI scanners in addition to a third in an adjacent affiliated VA hospital. We are acquiring a new state-of-the-art 3.0 T MRI scanner, which will be operational in approximately six months.

We are involved in multiple research projects at MCG involving advanced MR imaging as well, involving multiple sclerosis, brain tumors, and epilepsy. A partial list of recent publications and presentations at national meetings by members of our department in the field of MR imaging include the following:

RECENT MCG PUBLICATIONS/NATIONAL PRESENTATIONS IN MR IMAGING:

Stuve TA, Pillai JJ, Friedman L, Lewin JS, Findling RL, Swales TP, Schulz SC. Magnetic resonance imaging of developmental brain abnormalities in adolescent patients with schizophrenia or bipolar disorder. Schizophrenia Research(Abstract) 1999;36:212

Kim SJ, Park YD, Hessler R, Pillai JJ, Lee MR, Smith JR. The correlation between neuroimaging and neuropathologic findings in Rasmussen
encephalitis. Epilepsia 2001 Suppl. 7:167-8.

Pillai JJ, Araque JM, Allison JD, Lavin T. Functional MRI study of semantic and phonological language processing in bilingual subjects (Abstract) Radiology Nov. 2001; 221 (Supplement): 487 (Paper 1063 presented at the 2001 Radiological Society of North America Scientific Assembly and Annual Meeting).

Pillai JJ, Friedman L, Stuve TA, Trinidad S, Jesberger JA, Lewin JS, Findling RL, Swales TP, and Schulz SC. Increased presence of white matter hyperintensities in adolescent patients with bipolar disorder. Psychiatry Research: Neuroimaging >Vol. 114, Issue 1 (Feb. 15, 2002): 51-56.

Meador KJ, Allison JD, Loring DW, Lavin TB, Pillai JJ. Topography of somatosensory processing: cerebral lateralization and focused attention. J Int Neuropsychol Soc. 2002 Mar;8(3):349-59.

Hessler RB, Kim S, Park YD, Pillai JJ, Lee MR, Smith JR. (2002) The histopathology of Rasmussens syndrome: radiological correlation with histopathologic findings using a standardized grading system. J Neuropathol Exp Neurol 61(5):469 (Abstract).

Kim SJ, Park YD, Pillai JJ, Lee MR, Smith JR. A longitudinal MRI study in children with Rasmussen syndrome. Pediatr Neurol. 2002 Oct;27(4):282-8.

Lee KH, Meador KJ, Park YD, King DW, Murro AM, Pillai JJ, Kaminski RJ. Pathophysiology of altered consciousness during seizures: subtraction SPECT study. Neurology . 2002 Sep 24;59(6):841-6.

Pillai JJ. Software Review: Brain Atlas for Functional Imaging: Clinical and Research Applications , by Wieslaw L. Nowinski, A. Thirunavuukarasuu, and David N. Kennedy (New York, Thieme, 2001), Journal of Magnetic Resonance Imaging 2002;16(3):328-329.

Pillai JJ, Hessler RB, Allison JD, Park YD, Lee MR, Lavin T. Advanced magnetic resonance imaging in cortical dysplasia with and without neoplasm: a report of two cases. AJNR Am J Neuroradiol . 2002 Nov; 23(10):1686-1691.

Pillai JJ. Book Review: Teaching Atlas of Spine Imaging (Ruth G. Ramsey; 1999 Thieme Medical Publishers, New York, NY ), Journal of Magnetic Resonance Imaging 2002; 16(5):618-619.

Loring DW, Meador KJ, Allison JD, Pillai JJ, Lavin T, Lee GP, Balan A, Dave V. Now you see it, now you don’t: statistical and methodological considerations in fMRI. Epilepsy & Behavior 3 (2002): 539-547.

Pillai JJ, Kwock L. Brain Magnetic Resonance Spectroscopy. IN Haaga J, Lanzieri C, Gilkeson R (eds): Computed Tomography and Magnetic Resonance Imaging of the Whole Body, 4^th Ed. ( 2003, Mosby, Inc., St. Louis, MO).

Carlson GD, Gorden CD, Oliff HS, Pillai JJ, LaManna JC. Sustained Spinal Cord Compression: part I. time dependent effect on long-term pathophysiology. J Bone Joint Surg Am. 2003 Jan; 85-A(1):86-94.

Kim SJ, Park YD, Pillai J.  What is the fate of disconnected brain tissue in a child with Rasmussen syndrome? A case report. Neuroradiology 2003;45:250-252.

Pillai JJ, Allison JD, Sethuraman S, Araque JM, Thiruvaiyaru D, Ison CB, Loring DW, Lavin T.MR Imaging Study of Language-Related Differences in Bilingual Cerebellar Activation (Abstract)-presented at the American Society of Neuroradiology Annual Meeting, Washington, D.C. 2003.

Pillai JJ, Allison JD, Sethuraman S, Araque JM, Thiruvaiyaru D, Ison CB, Loring DW, Lavin T.Functional MR imaging study of language-related differences in bilingual cerebellar activation. AJNR Am J Neuroradiol. 2004 Apr;25(4):523-32

Pillai JJ, McClain M, Kurkjian J, Politsky J, King DW, Smith JR. The Role of Diffusion MR Imaging and Ictal SPECT Imaging in the Lateralization of Temporal Lobe Epilepsy (Abstract). Presented at the 2003 Radiological Society of North America Annual Scientific Meeting and Assembly, Chicago, IL (December 2, 2003)

Pillai JJ, Araque JM, Allison JD, Sethuraman S, Loring DW, Thiruvaiyaru D, Ison CB, Balan A, Lavin T. Functional MRI study of semantic and phonological language processing in bilingual subjects: preliminary findings. Neuroimage. 2003 Jul;19(3):565-76.

Lee GP, Meador KJ, Loring DW, Allison JD, Brown WS, Paul LK, Pillai JJ and Lavin TB. Neural Substrates of Emotion as Revealed by Functional Magnetic Resonance Imaging. Cognitive and Behavioral Neurology 2004; 17(1)

Pillai JJ. Book Review in Journal of Magnetic Resonance Imaging (2004 issue)  20 (1): 167-168: New Frontiers of MR-based Techniques in Multiple Sclerosis. M. Filippi & G. Comi (Eds.). Springer Verlag-Italia, Milano 2003

"Functional MR Imaging of Postsurgical Language Plasticity Following Brain Tumor Resection." Pillai JJ, Allison JD, Fick JR, Lavin TB, Balan A. Paper 217, p.166. Proceedings of the American Society of Neuroradiology 42nd Annual Meeting (Seattle, WA, June 9,2004).

"Functional MR Imaging Evaluation of Postsurgical Motor Plasticity."  Pillai JJ, Allison JD, Fick JR, King DW, Smith JR, Lee MR. Paper 218, pp.166-167. Proceedings of the American Society of Neuroradiology 42nd Annual Meeting (Seattle, WA, June 9,2004).