A valuable new tool for assessing brain atrophy is now available to patients at Brain & Spine Imaging Center.

Used in conjunction with high-resolution imaging, SIENA (Structural Image Evaluation using Normalization of Atrophy) produces quantitative brain volume measurements that can precisely track brain shrinkage in patients with multiple sclerosis (MS).

Multiple sclerosis is believed to be caused by inflammation in the brain and spinal cord. Symptoms may include blurred vision, loss of balance, poor coordination, slurred speech, tremors, numbness, and extreme fatigue. Washington state has one of the highest MS rates in the nation.

“Until now, MRIs have generated only adjectives,” said Olympia neurologist James McDowell, MD, who was instrumental in bringing the SIENA program to Brain & Spine Imaging Center. “Radiologists would look at the scans and give us reports that included things like ‘Moderate atrophy’ or ‘Somewhat worse than a year ago.’ But SIENA gives us numbers. And when we have specifics, we are much better equipped to prescribe the most effective medication.”

McDowell first heard about SIENA at a neurology conference, where researchers were discussing drug treatments for MS patients. They had used SIENA to assess the effects of various drugs and were impressed by the results the program provided.

McDowell shared what he’d learned with Ralph Koenker, MD – a neuro-radiologist at National Specialty Imaging Associates, a San Francisco area radiology group that interprets scans conducted at Brain & Spine Imaging Center.

Koenker flew to the United Kingdom and met with Oxford University researchers who had developed the SIENA program.

“This computerized approach is quite sophisticated,” Koenker said. “We use carefully tuned thin-section MRI scans to generate a three-dimensional virtual model of the brain; in turn, this high resolution MRI data is electronically sent to our specially configured computer which runs the UNIX based SIENA program. Highly accurate numbers indicating the amounts of gray and white matter are then provided.” Koenker said the ability to compare white matter loss over time is very important in helping physicians determine whether more aggressive treatment plans should be implemented.

Brain & Spine Imaging Center began using the SIENA program in December 2009. There is no additional charge for MRIs that utilize the SIENA software.

“Brain & Spine is one of only 10 to 15 facilities in the nation that offers SIENA,” Koenker said. “This is something you typically see only at university hospitals.”

Koenker said SIENA “may also have implications for treating patients with Alzheimer’s and dementia.”