Your Donations in Action: Jeffrey Ware, MD

Clinical Evaluation of Acute Brain Injury with Resting State Functional MRI


Prognostic assessment of acute brain injuries and disorders of consciousness remains a major clinical challenge due to limitations in clinical assessment and conventional neuroimaging. Recently, the use of resting state fMRI to interrogate functional brain network integrity has shown promise in improving neuroprognostication.

However, its application in clinical practice remains limited due to a number of factors including cumbersome data analysis typically requiring substantial oversight, and challenges in interpretation at the individual patient level.

2017 Siemens Healthineers/RSNA Research Fellow Grant recipient, Jeffrey Ware, MD, University of Pennsylvania, Neuroradiology Division, investigated the “Implementation and Validation of a Clinical Resting State Functional MRI Protocol for Prognostic Evaluation of Acute Brain Injury.”

Dr. Ware and his team developed an automated and clinically feasible resting state fMRI analysis protocol requiring minimal oversight, allowing for a global assessment of functional brain network integrity in individual patients. To validate this protocol, they retrospectively applied it to an existing cohort of comatose patients with acute brain injuries.

In a simulated clinical setting, neuroradiologists blinded to clinical status and conventional neuroimaging findings rendered an interpretation of network integrity based on the output of the resting state fMRI pipeline. The researchers then examined the reliability of radiological resting state fMRI assessment and also compared it with patient clinical status and subsequent neurological outcome to determine the clinical and prognostic significance.

“This research is currently ongoing and if successful, this project will be an important step forward in clinical translation of resting state fMRI and would allow for more widespread clinical use to improve imaging-based prognostication of patients with severe brain injuries due to trauma, cardiac arrest or other causes,” Dr. Ware said. “Regardless of the outcome, this project will inform future efforts to translate resting state fMRI into clinical practice.”