Imaging the unborn brain

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“Prevention will always beat cure,” says Catherine Limperopoulos, BSc(OT)’92, MSc’97, PhD’02, a pioneer in MRI research of the developing brain. (Photo courtesy of Catherine Limperopoulous.)

“Prevention will always beat cure,” says Catherine Limperopoulos, BSc(OT)’92, MSc’97, PhD’02, a pioneer in MRI research of the developing brain. (Photo courtesy of Catherine Limperopoulos.)

By Medicine Focus

The award: Alumni Award of Merit presented by the School of Physical & Occupational Therapy for the 2016 Medicine Alumni Global Awards.

The recipient: Catherine Limperopoulos, BSc(OT)’92, MSc’97, PhD’02, a three-time alumna of the School.

The titles: Director, MRI Research of the Developing Brain and Director, Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children’s National Medical Center, Washington, DC; Associate Professor of Neurology and of Pediatrics, George Washington University School of Medicine.

The research: “My current research seeks to develop the earliest, safest and most reliable magnetic resonance imaging (MRI) biomarkers to identify the at-risk fetus and newborn. My research laboratory brings together a multidisciplinary team of scientists and physicians working together to develop leading-edge MRI tools capable of ‘picking up’ early warning signs of a fetus at risk for brain injury.”

The long-term goal: “To expedite the clinical application of these novel MR imaging biomarkers to improve detection, monitoring of the high-risk fetus and guide medical and therapeutic interventions aimed at preventing or circumventing injury and minimizing long-term developmental disability.”

Why this avenue is critically important:Currently, clinical (conventional) imaging technology is largely dependent on expert subjective pattern-recognition of structural brain injury that only the trained human eye can distinguish. However, by the time conventional imaging technology is able to pick up such abnormalities, brain injury has already been consolidated and is irreversible. What we are thus left with is damage control.”

On rarity: “The successful application of advanced MRI in the living fetus is currently limited to a handful of centers worldwide, including our own.”

The training: “My graduate training at SPOT provided me with an excellent framework for conducting scientifically rigorous and clinically relevant outcome research in the field of childhood disability. During this period, I also worked as an occupational therapist in the neonatal intensive care unit where I was able to appreciate first-hand the opportunities and limits of early intervention on brain plasticity (following early-life brain injury). I saw that prevention will always beat cure.”

The pathway: “In 2005, I was recruited back to McGill University and awarded a Canada Research Chair (CRC), CRC Tier 2 in Brain and Child Development. In 2010, I joined Children’s National to develop and direct an MRI Research Program for the Developing Brain. My research activities have focused on expanding and validating advanced MR imaging capabilities to the high-risk fetus in vivo.”

The successes: “The work led by my team has resulted in significant advances in our understanding of the elaborate maturational processes that take place in the healthy fetal brain, and how these critical maturational events can be derailed by developmental aberrations and acquired injury. We have developed the largest available repository of healthy fetal brain MRI studies through funded studies that are affording us with increasingly reliable and reproducible quantitative neuroimaging biomarkers from which to study the high-risk fetus. This allows us to detect the early quantitative antecedents of abnormal fetal brain development, localize regional changes, and monitor these changes over time.”

What’s next: “My hope is to continue to pioneer and refine the development of sophisticated, non-invasive fetal MRI techniques that can be used to diagnose and monitor every high-risk pregnancy. To succeed, this will require rapid streamlining and adoption of these emerging fetal imaging techniques in the clinical setting. This in turn will elevate the standard of care by offering advanced fetal MRI diagnostic capabilities in real-time to guide clinical management and preventative care of the high-risk fetus, and the development of prenatal interventions that are currently on the horizon.”

 

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