Holy Family Hospital’s powerful 3T MRI performs specialized testing that helps radiologists predict what type of brain tumor a patient has prior to biopsy, and offer neurosurgeons a precise roadmap to avoid damage to speech and motor centers of the brain during surgery.
According to Radiolgist Mara Kunst, MD, who is fellowship trained in neuroradiology and director of neuroimaging at L&M Radiology at Holy Family Hospital, once an MRI has identified a mass within the body, three special types of MRI done prior to surgery assist neurosurgeons before, as well as during, biopsy and surgery.
Perfusion MRI identifies blood flow, and because cancerous tumors have the ability to create their own blood supply (angiogenesis), it helps determine whether the tumor is benign or cancerous.
Spectroscopy MRI helps measure the chemical metabolism of a tumor, which helps differentiate the type of tumor and its aggressiveness.
Functional MRI, also called fMRI, helps identify where each individual patient’s speech and motor centers. This information helps determine if surgery is possible, and if so, the information gives neurosurgeons a more precise roadmap to help minimize speech or motor damage during tumor biopsy and tumor removal.
To get functional MRI (fMRI) up and running required a substantial investment from the hospital administration, as well as six months of teamwork to perfect protocols, do background work, complete software updates, develop paradigms, and find test patients - including Dr. Kunst, her fellow radiologists, and MRI technicians.
"We have a powerful 3T MRI scanner outfitted with the latest neuroimaging software, but we also have great MRI techs who know how to treat patients,” said Dr. Kunst. “We want patients to be comfortable. This is not a passive exam. Patients are actively engaged."
During fMRI, patients are asked to tap their hands, crunch their feet, squint or move their lips over and over. This identifies where blood is flowing in the brain with movement in order to locate motor cortices.
To locate speech cortices, patients are asked questions, but told to think of their answers rather than say them, because if they move their lips, the motor cortices will become involved. Dr. Kunst supervises the exam to monitor the patient’s responses and data real-time.
“Holy Family is the only hospital in this area with a high field strength MRI. I compare it to a light bulb; if you want to see the fine print you have to turn the light up. With a 3T MRI you can see much more detail,” said Bruce Cook, MD, a senior neurosurgeon at New England Neurological Associates and Holy Family Hospital. “This advanced technology allows us to process beautiful images that help guide the surgery. We are able to do this at Holy Family Hospital because we have a closer working relationship with the radiologists, and they know exactly what we need.”
During her training, Neurosurgeon Katharine Cronk, MD who also practices at New England Neurological Associates in Lawrence and Lowell, used fMRI technology to locate speech and motor cortices prior to surgery to control seizures.
Recently, one of Cronk’s patients, Eileen of Haverhill, MA, underwent specialty MRI testing, including fMRI for a mass discovered in her brain.
Following Eileen’s series of MRIs, Dr. Cronk performed surgery, removed the tumor and sent it for biopsy. When the report came back, it confirmed, as the tests had indicated, that her tumor was cancer, and an aggressive type called glioblastoma.
“I had my surgery at Holy Family Hospital because I was told it’s the best hospital around for the type of tumor I had,” said Eileen. “I had no pain and I was home in two days. At Holy Family Hospital, the people were terrific and my care was excellent. I’m pretty lucky to have come back the way I have.”
Following surgery, Eileen underwent radiation therapy five times a week for six weeks, to eradicate any microscopic pieces of the tumor that could have remained after surgery. Then she started chemotherapy. She currently has an MRI every three months to monitor the tumor site for growth.
“The technology at Holy Family Hospital is outstanding, said Dr. Cronk. “There is no need to travel to Boston for these procedures.”