MR Spectroscopy (MRS) is a noninvasive tool used to measure the metabolism in the brain or other parts of the body. Thus, MRS offers doctors the opportunity to obtain chemical information from the brain non-invasively and non-surgically. Providers can then use the chemical information for diagnostics, for monitoring disease progression or the effects of therapeutic treatments, and for understanding the pathogenesis of disease. Dr. Eva-Maria Ratai, Assistant Professor at Harvard Medical School and Director of Clinical Magnetic Resonance Spectroscopy at Massachusetts General Hospital, is a leader in using MRS to investigate multiple types of central nervous system diseases. Through her research, Dr. Ratai hopes to advance understandings of central nervous system diseases through the application of advanced neuroimaging techniques, specifically MRI and MRS. Because of her strong focus on the advancement of these techniques, rather than a single disease, her work emncompasses multiple diagnoses as she hopes to improve patient care, diagnosis, and prognosis.

So why does MRS have a leg up over other tools? Neurochemical changes often precede anatomical changes. Therefore, Dr. Ratai can make predictions about diseases prior to dysfunction. Additionally, she is in the unique position of working  as both the Director of Clinical Magnetic Resonance Spectroscopy, where she has everyday exposure to pediatric and adult patients and as an investigator who, in her own research, is advancing imaging tools that will help improve diagnosis and prognosis for the diseases that can affect those patients. Because of her joint role of administrator and researcher, Dr. Ratai is able to witness the real life ramifications of her work in the lab, an experience she says, “has grounded me in the realization that I truly work for people.” It is certain that Dr. Ratai does not shy away from working for people, and furthermore help them. Her collaborations are extensive with as many as thirteen different collaborators working with her on any given project. It is through this dedication to patients, close collaboration across multiple fields, and the use of novel imaging tools that Dr. Ratai is challenging the future of medicine.

Current research includes:

• Tumors: Glioblastoma multiforme (GBM) is one  of the most aggressive and fatal brain cancer types a). Despite aggressive treatment strategies involving surgery, radiation, and cytotoxic chemotherapy, patients with recurrent glioblastoma have a median survival time of less than one year. Researchers have found that anti-angiogenic agents have shown some promise in prolonging and improving the quality of life for  some of these patients. However, a significant portion of the patients do not respond. It is therefore imperative to identify these patients early enough to switch to different treatment options and to protect patients from potentially toxic and inefficacious treatments. Dr. Ratai has recently shown that MR spectroscopy can accurately predict patient survival by distinguishing between actual tumor response and pseudo response. Future research could confirm the efficacy of Dr. Ratai’s methodology which could be implemented in clinical settings worldwide to improve current standard of care using MRI.

• Autism Spectrum Disorder (ASD): Dr. Ratai hopes to use MR Spectroscopy for noninvasive characterization of  biochemical and cellular metabolic states in vivo in order to advance our understanding of ASD. By providing robust biomarkers that can be systematically measured, she and her team hope to make sense of the complex interactions that causes ASD. Findings may lead to a clinical protocol using systemic markers as a pre-screen for targeted multimodal imaging for risk and diagnostic assessment.

• Pediatric Neuroradiology: Dr. Ratai’s research is helping to improve prognosis and diagnosis for patients as young as only a few days old. Hypoxic-ischemic brain injury is a major cause of perinatal mortality and morbidity. Because the prognosis for any given baby experiencing such injury is uncertain, reliable prognostic indicators are needed. Dr Ratai and her team are evaluating the efficacy of combined MR Spectroscopy and diffusion weighted imaging measurements in predicting outcomes in these neonates. Furthermore, using MR Spectroscopy, Dr. Ratai has been able to identify inborn errors of metabolism that could be behind the brain injury development.

• Neurodegenerative Diseases: Dr. Ratai is actively involved in several neurodegenerative diseases including Alzheimer’s disease, multiple sclerosis, spinocerebellar ataxias, adrenoleukodystrophy, and Amyotrophic Lateral sclerosis (ALS). She uses MR spectroscopy to develop advanced biomarkers for detection and diagnosis. Her research with ALS, for example, is focused on developing in vivo imaging biomarkers in patients to understand ALS etiology, to aid in early diagnosis, and to serve as a quick readout for dose-selection and molecular response of experimental treatments.

• Directing Clinical MRS: Dr. Ratai’s role as Director of Clinical Magnetic Resonance Spectroscopy at Massachusetts General Hospital has allowed her to train and guide providers and new researchers in the use of MRS. Especially because of the challenges in interpreting MRS, her expertise has been a valuable addition to the Radiology and Neurology team at the hospital. At the same time, she has helped to expand the use of MRS through her training. Describing readings from the MRS as a “fingerprint of chemicals,” Dr. Ratai often adopts the role of  detective to figure out as quickly as possible which disease is affecting patients in order to treat the patients most effectively.