Terra.X upgrade providing whole-brain clinically-approved 7T MRI for clinically impactful research

We represent thirty research groups from the East of England region, including co-investigators from the University of Cambridge, the University of East Anglia, and from three major NHS trusts (Cambridge University Hospitals, Cambridge and Peterborough, and Royal Papworth Hospital). We rely on an ultra-high field 7T Terra MRI scanner which is the only imaging modality able to probe the brain of patients at sub-millimetre resolutions directly in vivo. This is essential for clinical research in dementia, epilepsy, stroke, traumatic brain injury and psychiatry and for neuroscience research because it shows vitally-important but subtle changes in brain morphology, microstructure, metabolism and blood supply. Our 7T MRI has been used for >4,900 scans in 58 studies so far: investigating mechanisms of disease, monitoring the effectiveness of new treatments, and revealing the role of the brain’s mesoscopic laminar/columnar circuit functional units. However, progress in research is increasingly being held back by technical and regulatory limitations from our 8-year-old “Terra” scanner. To enable the next decade of 7T MRI health research, we request a comprehensive hardware and software upgrade to the new “Terra.X” scanner which enables high-fidelity whole-brain imaging rather than being limited to studying cortical areas and which enables diagnostic imaging as a certified medical device unlike our current research-only Terra scanner. This will particularly benefit active programmes for: Dementia research: Rowe, O’Brien, Su, Lambon-Ralph study the causes and treatment potential for Alzheimer’s disease, Lewy Body disease including Parkinson’s disease, and frontotemporal dementias. Terra.X will increase our power to study the small but critical pathology of brainstem nuclei such as locus coeruleus and substantia nigra, as well as cortical pathology including early loss of mid cortical layers. Terra.X will enable whole-brain quantitative multi-parametric mapping (MPM of T1, T2* and MT contrasts) without the artefacts seen on the current Terra MRI. Epilepsy research: Cope aims to improve access to curative neurosurgery for severe epilepsy. We have shown that parallel transmit 7T MRI (7T-pTx) is ten times more cost effective per epilepsy-causing abnormality detected than the current NHS standard-of-care approach using invasive depth-electrode recordings, besides being substantially safer and more comfortable. This is already helping patients from East Anglia, London, and Liverpool. Terra.X will improve the quality of our whole-brain sub-millimetre 3D-EDGE, FLAIR and TSE protocols to better screen for epilepsy-causing abnormalities. These can occur in cortex, temporal lobes or elsewhere, and are often invisible to hospital 3T MRIs. Terra.X’s medical device certification means that we will be able to offer this innovative screening to NHS patients and not only to research participants as at present. Stroke research: Markus studies the causes of cerebral small vessel disease to design new/better treatments. Terra.X will improve imaging of the lenticulostriate arteries and their walls to differentiate between clotting, haemorrhage, and/or inflammation as causes of lacunar stroke. Traumatic brain injury (TBI) research: Newcombe, Stamatakis and Menon lead the UK-wide TBI-REPORTER consortium probing the mechanisms of injury and creating a platform to test emerging therapies. Terra.X will enable high-fidelity whole-brain susceptibility and diffusion imaging including in temporal lobes and brainstem which are important sites of injury but obscured on current Terra MRI. The Terra.X will be accessible to any funded UK research team: from the NHS, academia or industry. This investment will help the MRC meet its strategic ambition to develop cutting-edge infrastructure for research into human health.