My current four areas of research activity are fundamental, with a strong imaging component, and  applied, all in collaboration with previous PhD students, Post-Doctoral students and clinical colleagues (Patrick Freund, Arman Eshaghi, Olga Ciccarelli and Jeremy Chataway):

1-Collaboration with Professor Patrick Freund in Zurich is to better understand how the anatomy and the function of the spinal cord and the brain change in neurological disorders involving the spinal cord, developing neuroimaging biomarkers that are sensitive and accurate in predicting functional outcome, registering more quickly the impact of therapeutic treatments and rehabilitative interventions. 

2-Working with Dr Arman Eshaghi and the MAGNIMS network, developed MRI-based measures that provide fine-grained assessment of MS worsening at anatomical locations, complementing state-of-the art whole brain outcome measures, and outperforming whole brain measures when predicting disability progression. In 2020, in collaboration with the Montreal Neurological Institute in Canada and several industrial pharmaceutical partners, we have used computational tools to explore the pattern and sequence of progression of abnormalities across the brain with MRI. Using machine learning models we have found that MRI-derived categories can complement clinical categories to guide treatment decisions and potentially be used in prospective clinical trials. 

3-Clinical application of new techniques with Professor Olga Ciccarelli:   Pioneering the application of machine learning to MRI to provide an 'individualised' prediction of treatment response in patients with MS;  we are currently working on a large NIHR-funded programme which aims to translate this prediction model to routine, clinical practice.   We have improved the diagnosis of MS through simplification of  MRI diagnostic criteria, and have demonstrated that the use of a 3T scanner does not improve the diagnosis of MS. We have found that a new biomarker (the central vein sign) distinguishes between MS and neuromyelitis optica spectrum disorder.   We are working towards improving MS prognosis through 15- and 30-year follow-ups in patients with a clinically isolated syndrome.  Generally we are using advanced imaging techniques to provide insights into the mechanisms of disability in MS and are developing new imaging outcome measures for clinical trials which reflect the underlying brain structure.  We have validated the use of brain volumetric scanning to calculate spinal cord atrophy and have translated it to clinical trials design;  we have developed brain sodium imaging and translated it into neuroprotective trials in progressive MS.

4-Clinical trials in MS, worked with Professor Jeremy Chataway on MS-STAT1 after which the phase 3 trial (MS-STAT2), centred on disability outcomes, was developed, co-funded by the NIHR HTA Board, UK and US MS societies.  There is an embedded MRI subproject from the UK and US MS societies looking at evolving advanced MRI scanning in this group.   A multi-arm, multi-stage platform trial in progressive MS will start in 2021 (funding has been agreed by the UK MS Society).