Treating disease at it's earliest stages – before symptoms are even apparent – is one of the goals behind much of the research now being conducted with the world's most powerful MRI machine, the 9.4-Tesla MRI, at the University of Illinois at Chicago (UIC).

More than 75 research subjects have now been scanned with this machine which employs a 45-ton magnet with a magnetic field that's about 100,000 times stronger than Earth's.

The goal isn't just to capture better images, it's to see tissue at the molecular level, to observe changes that signal the start of disease and to help guide more effective disease treatments.

"The potential is to personalize the delivery of healthcare. The reason for building the 9.4-Tesla was to get access to signals from elements in the periodic table other than protons," Keith Thulborn, MD, PhD, director of the UIC Center for Magnetic Resonance Research told Medical Device Daily. "Typical MR signal comes from protons, the nucleus of hydrogen in fat and water."

Tesla refers to the magnet's strength. The center's 9.4-T can resolve MRI signals down to 50 microns. Thulborn and his team have developed a three-part metabolic-imaging capability that is designed to measure tissue health.

The first is focused on sodium concentration, a measure of tissue viability. Sodium is generally pumped in and out of living cells. The 9.4-T scanner provides information about tissue at a scale that indicates if the cells are dying well before a tumor would begin to shrink, which is the typical indication when cancer therapy succeeds.

"Think about brain tumors; the oncologist is trying to kill cells," he said. "How do we know he's succeeding? You'd like to know the cells are dying, but a patient doesn't feel well with chemotherapy. Only by changes in the size of tumor does the physician know. Those changes take time as the patient continues to get more chemotherapy. But we can look at the changes in cell kill within a week, probably earlier than that. With the 9.4-T we have fast feedback on therapy. That way you can avoid giving too much chemotherapy that's not needed. Or you can see if a therapy isn't working. It comes via sodium imaging, a direct measure of cell density."

Thulborn pointed out that while the 9.4-T would aid an oncologist trying to kill tissue, the flip side is the neurologist who is trying to save tissue in the case of stroke.

"Should you intervene?" he said of the question that faces physicians everyday when treating people suffering a stroke. "If tissue is dead and you remove a clot, you risk hemorrhage and making the patient worse. Now the criteria for treatment with tPA is three hours. It's an arbitrary time period. Not all people know when stroke starts. Or the patient can be unconscious with no historical timing of symptoms. But measurement of sodium tissue concentration could guide treatment of stroke."

This powerful machine could also aid in the development of drugs.

"Clinical trials are often considered a success if, say, 60% of patients respond to a treatment," Thulborn said. "What if we could detect early in treatment, on an individual level, that 30% of patients show excellent response to treatment; 30% should perhaps combine this treatment with additional adjuvant therapy; and the non-responders should immediately receive other treatments? This personalized care has the potential to greatly improve outcomes by avoiding wasting time and expense on ineffective treatments."

In addition to work focusing on sodium concentration revealed with the 9.4-T, the team has also developed capabilities to measure oxygen consumption, a more dynamic measure of tissue health and viability than sodium,. The third measure, phosphocreatine, gives a dynamic view of energy stores within the cell, and reveals if a cell is metabolically stressed.

This list of potential applications if all three measures are employed seems endless.

After conducting a great deal of FDA safety testing with this powerful MRI, Thulborn said no adverse events have been reported.

"The FDA hasn't given us a clear idea of when safety testing would be done, but as soon as we can prove this information changes how you manage patients and improves outcomes, I think the FDA will be okay with increasing MRI field strength guidelines, which are currently at 2-T to 4-T for humans," he said.

What's ironic about the work he's doing on this powerful MRI machine is that he doesn't envision that this type of imaging device would ever become widely commercialized. Instead, the information gained may be able to be translated into standard MRI machines.

"We'd like to take the technology we're developing at 9.4-T back down to 3-T where you have a wider impact," he said.

Thulborn said he has worked with the MRI's manufacturer, GE Healthcare Technologies (Waukesha, Wisconsin) over the last 20 years, but the 9.4-T is not funded through GE and the company has no vested interest.

"They are, however, interested in the sodium imaging of tissue viability," he said. "They want to know that we can do this at 3-T and we think we can take the knowledge of what we can do at 9.4 T back down to 3-T."

But everyday application of this research is still many years away, he said, "because there's no commercial driving force. The 9.4-T is really still a science project, but the implications are very important."

Lynn Yoffee, 770-361-4789;

lynn.yoffee@ahcmedia.com