Multimodal MRI scanning of NHS patients referred from clinics for brain disorders
Research type
Research Study
Full title
Multimodal MRI studies of brain structure and function in patients referred from NHS clinics for brain disorders
IRAS ID
180425
Contact name
Timothy Rittman
Contact email
Sponsor organisation
Cambridge University Hospitals NHS Foundation Trust and the University of Cambridge
Duration of Study in the UK
1 years, 0 months, 0 days
Research summary
MRI scanning is one of the core investigations in the diagnosis of diseases affecting the brain and as such is widely requested from NHS outpatient clinics. Historically MRI used for clinical purposes has focused on studies of brain structure, typically looking for atrophy (brain shrinkage) in the context of diseases causing dementia, or changes in the brain white matter than can indicate vascular disease.
Advances in hardware and software mean that MRI can now provide significant additional information about the brain. Scanners with higher magnetic field strength (3 Tesla and above) provide higher resolution images that allow detection of disease effects not just on brain regions but on subdivisions of these regions. Different scan protocols permit the study of connections within the brain, both in terms of structural (the wiring) and functional (the networks of brain cells underpinning brain functions eg memory) connectivity.
These advanced MRI technologies have identified disease-related changes in the brain in numerous research studies covering most brain disorders including neurodegenerative diseases (eg Alzheimer’s disease, Parkinson’s disease), stroke, multiple sclerosis and depression. However, while the evidence from research indicates that this additional scan information can provide disease-relevant information that may aid future diagnosis and management, such technologies are not implemented in routine NHS practice.The opportunity now exists to implement such MRI technologies in clinical practice at minimal cost in terms of scan time, patient inconvenience, scanner demands, and cost to the NHS. This is made possible by the NHS commissioning arrangements for clinically requested MRI brain scans, consisting of a standard tariff for a 30 minute scan appointment. Scanner hardware advances have shortened considerably the scan time required to obtain the images needed for clinical purposes, meaning that there is sufficient time within the allocated – and NHS costed – 30 minutes to acquire additional high resolution scan data and information on brain connectivity, without compromising the acquisition of scan data needed for clinical reporting.
Implementation of this advanced MRI proposal will have major downstream advantages for clinical practice and research. For the former, it provides the platform for “pull through” into the clinical domain of research findings on disease-related brain changes that are not visible on routine “clinical specification” MRI, for the betterment of future diagnosis and prognosis. In terms of research, this proposal will deliver high volumes of scan data on patient cohorts, which will aid understanding of disease natural history and which may be amenable to “Big Data” approaches that seek to uncover clinically meaningful measures of disease from detailed analysis of large datasets from clinical populations.
The PI has successfully pioneered the implementation of such a protocol in clinical practice, in the form of the REC-approved study (REC Reference: 12/LO/1438) involving application of research-specification scan protocols to patients referred for diagnostic scanning from NHS memory clinics in Sussex. This study has been running since 2013 under the sponsorship of the University of Sussex, with costs covered by the commissioned memory clinic services, and to date over 1000 patients have been scanned successfully using this protocol (The move of the PI from Sussex to Cambridge means that there has been a transfer of PI responsibilities to another academic in Sussex).
The current REC application differs from the Sussex proposal in that i) the superior scanners available in Cambridge permit implementation of more detailed MRI scanning which will encompass not only high resolution MRI and studies of functional connectivity (as is undertaken in the ethics- approved Sussex study) but also studies of structural connectivity, and ii) the Cambridge proposal has the future potential to extend beyond application to the Memory Clinic into other diagnostic NHS clinics.
REC name
London - Camden & Kings Cross Research Ethics Committee
REC reference
15/LO/1811
Date of REC Opinion
10 Nov 2015
REC opinion
Favourable Opinion