Expanding the Characterization and Application of Clinical MRI Markers in Gulf War Illness
Abstract
Overarching Challenge: The proposed research will address the Gulf War Illness Research Program’s Overarching Challenges aimed at improving methods for defining and diagnosing Gulf War Illness (GWI) and determining if Veterans with GWI are at increased risk for developing neurological conditions. We will do this by developing an assessment tool for evaluating Veterans with GWI using magnetic resonance imaging (MRI) that will provide an index of observed brain pathology for use in both clinical and research settings. Objective and Rationale: The overall objective of the proposed study is to develop and validate an evidence-based assessment tool, the Gulf War illness Brain Injury Scale (GW-BIS), to systematically characterize the types and degree of brain pathology affecting Veterans with GWI. The rationale underlying the proposed study relates both to (1) the need for improved clinical assessment and characterization of brain pathology in Veterans with GWI, and (2) the need for standard, consistent MRI measures for use in research studies to advance understanding and integration of MRI findings associated with GWI across studies. Our study approach was developed based on findings from the large number of MRI studies that have previously reported significant group differences in brain structure and function between GWI cases and GW Veteran controls, as well as our own preliminary findings assessing Veterans with GWI. Despite many significant brain findings from diverse MRI studies, there still exists relatively little concrete, consistent information, guidelines, or metrics that can be used to assess GW Veterans in the clinic, or to compare and interpret MRI findings across studies. Our team’s experience and preliminary data in evaluating individual MRI scans of GW Veterans, however, indicate that GWI cases consistently exhibit prominent types and patterns of brain pathology that are observable on MRI, including regions of atrophy, white matter lesions, and morphology changes that distinguish Veterans with GWI from GW controls. In parallel, Veterans with GWI regularly report to us that, despite having difficult symptoms over many years that include headaches and serious cognitive and behavioral changes, they have been unable to obtain concrete information from their providers about their state of brain health. This stems, in part, from a lack of GWI clinical information for healthcare providers, including use of MRI for assessing brain pathology in GW Veterans. The overall approach of the proposed study is to conduct formal, systematic assessment of MRI scans by neuroradiologists to characterize and quantify observed brain abnormalities in two independent samples of 1991 Gulf War Veterans. MRI scans and associated data to be used for the study will be provided from a large multisite study and repository of MRI scans that includes both GWI cases and GW Veteran controls. To develop the assessment index, two trained neuroradiologists, blinded to Veterans’ GWI case/control status, will conduct structured, detailed assessments of brain scans from an initial sample of 100 Gulf War Veterans. Identified types of damage, patterns of damage, or location of damage that are most consistently found in Veterans with GWI but not GW controls will be used to develop the initial test scale. This test scale will then be evaluated and validated in our second sample of 100 GWI cases and controls to identify any discrepancies or refinements required for optimizing the GW-BIS assessment tool. GW-BIS metrics will then be further evaluated in relation to standard MRI research measures, GWI clinical characteristics (e.g., illness severity, symptom profile, cognitive decrements), and in relation to exposures during Gulf War deployment. Applicability: The GW-BIS will have immediate application both for clinical assessment of brain pathology in individual GW Veterans, and for research assessment of brain alterations in GW Veterans across diff
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110963
Entities
People
- Deborah Little
Organizations
- United States Army
- University of Texas Health Science Center at Houston