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TODAY news for Thursday, August 24, 2006

Loma Linda University Children's Hospital news

$2.3 million grant awarded to vital pediatric neurological study

On the image’s left side is a child’s normal-looking brain. On the right is the very same brain, but now peppered with ominous black spots (see photo below). Those spots indicate hemorrhaging caused by a traumatic brain injury (TBI) that are invisible to conventional neuroimaging methods such as computerized tomography (CT) and magnetic resonance imaging (MRI)—but not to the eyes of two new, advanced, and previously unconventional imaging techniques.

Under the leadership of Stephen Ashwal, MD (pediatric neurology); Barbara Holshouser, MD (radiology); and Karen Tong, PhD (radiology), the School of Medicine received a grant of $2.3 million in late April to fund a research program studying how two new imaging methods—susceptibility-weighted imaging (SWI) and proton magnetic resonance spectroscopic imaging (MRSI)—are vital to accurately diagnosing traumatic brain injury (TBI) and diffuse axonal injury (DAI) in children.

Awarded this grant by the National Institute of Neurological Disease and Stroke (NINDS), the project is the culmination of nearly 10 years of research—and the beginning of a five-year study. The study, “Pediatric TBI and DAI: Normal Appearing Brain is not Normal,” scored extremely high in its evaluation by NINDS, receiving a rank in the 2.8 percentile.

The study looks at children who have suffered from TBI and DAI. According to the study’s abstract, this “leading cause of death and disability in children” may go unrecognized and untreated because conventional imaging techniques can underestimate the full extent of damage to the brain.

“The fundamental concept that we’ve developed is that on [conventional] imaging a normal-appearing brain may be abnormal,” Dr. Ashwal shared in a recent interview. An image showing a normal-looking—yet critically injured—brain can severely impact a doctor’s ability to predict a patient’s long-term outcome, leaving both parents and child in a place of deep uncertainty and concern.

“This is going to be very important,” Dr. Ashwal continued, “because it will help collect a lot of neuroimaging and psychological information that I think physicians taking care of infants and children with traumatic brain injury will be able to use to better understand the severity of brain damage.” This will lead to a greater comprehension of which areas in the brain are affected, then possible treatments, and also provide physicians a much better way to estimate detailed outcome.

Loma Linda University Medical Center and LLU Children’s Hospital is one of the very few hospitals in the country to have access to SWI technology. Dr. Ashwal’s hope is that this grant and the ensuing five-year study will raise awareness of how essential SWI and MRSI are for saving children’s lives, and that these studies will lead to new standards of care of how children should be evaluated after serious TBI.

Dr. Ashwal also stressed that such studies are only possible because of the unique combination of individuals here at Loma Linda who have worked for many years to develop this program. This has included specialists in advanced neuroimaging (Karen Tong, MD, and Barbara Holshouser, PhD); clinical psychology (Mary-Catherin Freier, PhD, and Joy Gardner, PhD); pediatric neurosurgery (Renatta Osterdock, MD, and Alex Zouros, MD); pediatric surgery (Joanne Baerg, MD); pediatric critical care medicine (Matt Gross, MD); pediatric rehabilitation medicine (Murray Brandstater, MD); biostatistics (Floyd Petersen, PhD); and neuropathology (Ravi Raghavan).

To read the abstract for this study, access www.llu.edu/llu/ medicine/news/pedsgrant-abstract.html. This article can be accessed online at www.llu.edu/ llu/medicine/news.html.

By Scott Arany

TODAY news for Thursday, August 24, 2006