Upright MRI Provides Diagnostic Breakthrough for Multiple Sclerosis

New findings using upright magnetic resonance imaging (MRI) scanning revealed that the cause of multiple sclerosis (MS) may be biomechanical and related to earlier trauma to the neck, which can result in obstruction of the flow of cerebrospinal fluid (CSF), which is produced and stored in the central anatomic structures of the brain known as the ventricles.

Since the ventricles produce a large volume of CSF each day (500 cc), the obstruction can result in a build-up of pressure within the ventricles, resulting in leakage of the CSF into the surrounding brain tissue. This leakage could be responsible for generating the brain lesions of multiple sclerosis.

In the study, medical researchers from Fonar Corp. (Melville, NY, USA) report a diagnostic breakthrough in multiple sclerosis (MS), based on observations made possible by the company’s unique Fonar Upright Multi-Position MRI. The article was published in the September 20, 2011, issue of the journal Physiological Chemistry and Physics and Medical NMR. It is coauthored by MRI researchers Raymond V. Damadian and David Chu.

Commenting on the study, the lead researcher and president of Fonar, Dr. Raymond V. Damadian stated, “These new observations have uncovered biomechanical barriers that appear to give rise to multiple sclerosis, and, even more excitingly, these barriers may be therapeutically addressable.” Dr. Damadian is the specialist who discovered the abnormal signals from tissue that are the basis of every MRI image made today and who went on to invent the MRI and build the world’s first MRI by hand at New York’s Downstate Medical Center. The findings are based on viewing the real-time flow of cerebrospinal fluid in a series of eight randomly chosen patients with multiple sclerosis.

Cerebrospinal fluid (CSF) lubricates the brain and spinal cord. Utilizing Fonar’s patented advanced upright multiposition MRI technology, the investigators was able to view the flow of cerebrospinal fluid in and out of the brain with the patients lying down and upright. These invaluable dual observations have only been possible since the invention by Fonar of an MRI capable of imaging the patient upright.

Dr. Damadian and coresearcher, Dr. Chu, found obstructions of the CSF flow in all eight patients in the study and, in seven out of eight patients, the obstruction was more pronounced when the patient was in the upright position. The Upright MRI also revealed that these obstructions were the result of structural deformities of the cervical spine, triggered by trauma earlier in life.

The research was initiated when Drs. Damadian and Chu scanned a patient with multiple sclerosis. In reviewing the MRI scans, Dr. Damadian noted that one of the MS lesions in the patient’s brain was directly connected with the CSF within the ventricles of the brain, which are the structures in which the body continuously generates CSF fluid. It does so through a network of blood vessels within the ventricles known as the choroid plexus. This network generates a large volume of CSF daily, approximately 500 cc.

Dr. Damadian knew that in MS the lesions are typically concentrated adjacent to the ventricles and are periventricular in distribution (i.e., surrounding the ventricle). He had also determined that the patient had a history of severe trauma to the cervical spine. When a careful history of subsequent patients in the study was taken, it revealed that all but one had also experienced some form of serious traumatic injury to the cervical spine.

When viewing MRI scans of the first patient, Dr. Damadian theorized that any obstructions of the continuous circulation of the daily volume of CSF out of the brain to the spinal cord and back could cause increased pressure within the ventricles, which could result in leakage of the fluid into the brain tissue surrounding the ventricles. He knew that CSF fluid contains proteins, which are made up of polypeptides, in fact, that the fluid contains more than 300 polypeptides. Nine of the proteins they form are known to be antigens that stimulate the production of antibodies. He questioned whether these proteins, leaking into the brain tissue, could be initiating the antigen-antibody complexes in the brain that cause the pathology and symptoms of multiple sclerosis.

The disease results in the destruction of the coverings, or myelin sheaths, that insulate the nerve fibers of the brain. The destruction prevents the nerves from functioning normally and produces the symptoms of MS. The destruction is the origin of the multiple sclerosis lesions seen on the MRI scan. However, unlike nerve tissue, the myelin sheaths can regenerate--once the cause of their destruction is eliminated. The study suggests surgical or biomechanical remediation of the obstruction of the flow of CSF in the cervical spine could relieve the increased CSF pressure within the ventricles and eliminate the resultant leakage of fluid into the surrounding brain tissue and the inflammation of the myelin sheaths that it generates. Once the leakage has been stopped, the myelin sheaths could be repaired by the body’s myelogenesis process with the outlook of a return to normal nerve function for these nerves.

Unlike conventional lie-down MRI units, patients walk into the Upright MRI and sit in the scanner. In the diagnosis of typical spine problems such as back pain, the patients are asked to place themselves in the position that causes their back symptoms. Then an upright MRI image is generated. As a result, the spinal pathology that is causing the patient’s back pain can be more accurately and more completely identified and defined. Since the seat in the MRI can be tilted to any position and also flattened into a bed in the horizontal position, the researchers were able to view the patients in the MS study in both the recumbent and upright positions.

The study was part of ongoing research at the Upright MRI Center at Fonar, where the scanner was developed. Research at the center, which is located in Melville (NY, USA), has already provided unique diagnostic views of the upright spine with the weight of the body on it, including the spine with the patient bending forward and backward, radiation-free monitoring of scoliosis, upright imaging of pelvic floor problems in women, such as a prolapsed bladder or uterus, sit-down imaging of the prostate without the usual endorectal coil, and a walk-in, sit-down 10-minute scan that allows for cost-effective MRI scanning of patients undergoing chemotherapy to monitor tumor responses biweekly.

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