Gisborne’s Mātai Research Institute pioneering brain injury detection

(A) Standard clinical MRI image of a brain in a patient with Grinker's, where no abnormality is visible. (B) Normal brain dSIR image, for comparison. In this image, normal white matter in the central region of the image appears black (white arrows). (C) The dSIR image in the patient shows the white matter as white rather than the normal black appearance as shown in B. The white matter in the patient is highly abnormal (C).

A study undertaken by researchers at Gisborne’s Matai Medical Research Institute has taken a detailed look at a rare brain condition known as Grinker’s Myelinopathy.

The disorder is caused by oxygen deprivation to the brain, such as near-drowning, asphyxia, cardiac arrest, carbon monoxide poisoning, electrocution and drug overdoses.

Symptoms can occur days, weeks, or even months after the incident.

Neuropsychiatrist Gil Newburn, an expert on brain injury, conducted the clinical assessments of two patients in the study which used a new “ultra-high contrast” MRI (Magnetic Resonance Imaging) method called dSIR to show damage not visible on a traditional MRI.

This enabled Newburn and the team to suspect that what was previously thought of as an extremely rare condition might affect a much larger group.

This was based on several cases using the new method with two patients who suffered prolonged oxygen deprivation.

“The lack of visible signs on conventional MRI in disorders such as Grinker’s contributes to misunderstandings, such as the conception that individuals affected are merely lazy, seeking attention or feigning illness,” Newburn said.

“The attribution of symptoms to personal failings, rather than medical conditions, impedes access to necessary support and treatment.

By identifying pathological damage to the brain, we are in a position to offer more effective treatment.”

Gisborne's Mātai Research Institute is making major advancements in brain injury detection through a new ultra-high contrast MRI method. Photo / Liam Clayton

Since publishing the paper on Grinker’s, Newburn and the research team at Mātai have had a potential fourth case who has been left with chronic symptoms after cardiac surgery and has shown the same signs in the tMRI.

“It’s been known for a long time that people who have bypass surgery do have cognitive impairment showing up as a lack of concentration, for example, and they’ve almost invariably had brain imaging done which has shown up as normal.

“Now, by using dSIR, we think we may be able to see the damage.

“This provides a corroboration with the clinical assessment where the right information is sought,” Newburn says.

“Firstly, having knowledge is great. If you look at someone with hypoxic brain injury caused by near drowning, the surgical cases, the suicides who have survived, the cardiac arrest people who have been resuscitated - most of those patients will have symptoms.

“With dSIR, with further research, we may be able to say this is real and by knowing their brain is different, they can then make adjustments.”

This assessment tool will also allow further investigation and confirmation of injury in a broad range of patients with brain damage from a range of pathologies.

Newburn and the team will be working closely with Gisborne Hospital to continue the research identifying more patients with brain injuries when they first present at the ED. This will help to confirm anecdotal evidence of ongoing pathology in those with mild traumatic brain injury.

Gisborne, with a population of around 52,000, has a higher rate of traumatic brain injury than the baseline.

“We know that rural populations have a higher rate of brain injury, as do Māori populations,” Newburn says.

If they can identify brain damage in a patient early when they are first admitted to hospital, it is hoped they will be better able to understand their disease and treat it appropriately.

They are looking to get 50 cases and to build that number up so they get strong statistical data.

The research has been made possible, thanks to the development of the dSIR MRI method, which was pioneered by Emeritus Professor Graeme Bydder.

MRI produces images by applying a strong magnetic field and radio frequency to a part of the body or brain.

When the radio frequency is switched off, the protons in the body’s water and fat produce a radio signal as they return to their relaxed state.

Simple arithmetic, Matai’s third wave development, based on this discovery, rests on this new model it has developed called targeted MRI (tMRI).

Matai clinical lead Daniel Cornfield says the new sequence used what was essentially simple image arithmetic to process MRI scan sequences.