An Interview with E. Mark Haacke, Ph.D.

Matt Ahearn: Thanks for joining us today Dr. Haacke. Will you provide us with an overview of STAGE is and how it works?

Dr. Haacke: STAGE is a powerful, rapid, multi-contrast imaging method that allows us to scan the entire brain in roughly 5 minutes. STAGE provides 15 different types of image contrasts, 7 of which are quantitative. 

It’s critically important to have quantitative data rather than just a pretty picture. For instance, effective quantitative data will show you exactly what changed in a patient’s situation between an initial scan and a second scan a year later. 

We also collect other conventional images, called flare and DWI. When we marry all of that together, the total scanning protocol time is less than 10 minutes for the brain, which is really quite amazing. 

Matt Ahearn: Tell us more about the quantifying capabilities of STAGE. 

Dr. Haacke: STAGE can quantify something as simple as the volume of a lesion. However, MR shows many specific tissue properties that are also quantifiable. For example, the water content in the brain can be measured. A normal brain is 80% water, but if that percentage changes over time, this can be indicative of brain atrophy and the development of disease. 

There are also measures we call T1 longitudinal relaxation time and T2 transverse relaxation time, and there are diffusion parameters and float changes in the blood vessels. If we can quantify how quickly the blood is flowing, we can later track a slow in blood flow and show a correlation perhaps with dementia. So there are many different types of quantitative measures in MRI.

Matt Ahearn: Where did the original vision for STAGE come from?

Dr. Haacke: The original concept behind STAGE and what we call a “multiple flip angle idea” dates back to about 25 years ago when I had one of my PhD students working on this problem. However, we didn’t have the same type of magnet technology in MRI’s that we have today. I would say the current systems are 10 times more powerful than they were when we began this original work. 

Magnet advancements have opened the door for many improvements, which led us to continue our work on this problem. And when we revisited this question several years ago, we began getting really positive results. 

The motivation for this work has been to create a standardized type of imaging. This is very important because you want to be able to scan a brain anywhere in the world, on any manufacturer’s magnet, at any field strength and be able to make the same diagnostic determination and quantification calculations.

We’ve been running STAGE on all the major manufacturers on various field strengths from 0.35 Tesla to 1.5 Tesla, 3 Tesla, and even 7 Tesla. The advantage of STAGE is that it creates clear, uniform contrast images which high field magnets don’t always produce. STAGE corrects some problems that exist in the field by not only offering better images, but new information. 

Standardized imaging means that you could get scanned on a 3T Phillips scanner in New York and then fly to Detroit and get scanned on a 3T Siemens scanner and get the same answer. We’d be able to tell you that your brain looks just as healthy in Detroit as it did in New York. 

But once we standardize the imaging, we can do something else critically important. This is the day of big data and people are realizing now that they should be saving data for AI analysis. But in order for that to be possible, the data must be standardized. If everyone is collecting the data a little bit differently, AI algorithms won’t work. 

Matt Ahearn: How did these ideas led to the formation of SpinTech as a company?

Dr. Haacke: We formed SpinTech 3 years ago to commercialize the innovative ideas that were coming out of my other company Magnetic Resonance Innovation, which I’m president of. MRInnovations was creating so many interesting ideas from the academic side that we realized we were now leaders in the field in many areas. So, we thought it was the right time to take our ideas into the commercialization realm. We are now considering merging the two companies. If we do that, we’ll have 20 patents and around 15 people between the two. 

Ward Detwiler, the current president of SpinTech, has raised several million dollars in support for SpinTech and I’ve raised several million in grant research for MRInnovations. 

Our current focus is on getting our ideas FDA approved. We had our first product FDA approved several years ago and we’re currently in the process of submitting our approval for STAGE. We have a number of other products already lined up for approval to keep us busy in 2021 and 2022.

Matt Ahearn: There seems to be a growing demand for diagnostic imaging. It’s estimated that the are 10 to 15 million MRI brain scans done in the U.S. alone. In what way is SpinTech offering a unique solution to this problem? 

Dr. Haacke: First, the ability to image faster. Most scan sites can image the brain in 15 to 20 minutes. But with STAGE, that could be cut down to less than 10 minutes for a quick protocol. If you wanted to run a few other conventional images, it might take you 15 minutes. 

Saving just 5 minutes on every patient over three 20-minute periods means saving 15 minutes per hour. This allows for one more patient per hour or an extra $500/hour. That adds up pretty quickly: possibly $5K extra per day over 200 days could translate to a million extra per year. 

Another area that we’re excited about is the ability to process all this 3D data. Radiologists are collecting a substantial amount of data everyday through thousands of pictures. We’d like to utilize AI to do things like quantify the number of micro bleeds that a patient would have for dementia, Alzheimer’s disease, stroke, or traumatic brain injury (TBI). 

We’d also like to automate the calculation of the substantial migration volume in Parkinson’s disease and how much iron is there and how much neuromelanin they’ve lost. Doing that will completely change the diagnosis for Parkinson’s and other movement disorders. So we believe our work truly has tremendous social benefit. 

Matt Ahearn: Is there anything else on the market similar to what you’re doing?

Dr. Haacke: There are many other people researching in similar areas. As a researcher myself, I know that you can have a lot of fun doing research and publishing papers. But that doesn’t mean you’ll ever make a product. 

There are others looking into multi contrast methods and iron measurements in Parkison’s and similar questions. But we are the leaders and trendsetters in this direction. 

For instance, we had a recent paper published and one of the images from it made the front cover of a well-known journal called NeuroImage, which was quite exciting for us. Our work has garnered a lot of worldwide attention. 

So even though there are many people doing interesting imaging research, we’ve taken the concerted effort to take it well beyond where anyone else has. 

Matt Ahearn: As the platform continues to grow and expand its reach, do you see STAGE being able to better detect critical biomarkers? If so, how will this lead to better patient outcomes?

Dr. Haacke: Right now, we are developing STAGE and related products specifically to better diagnose patients. We are not aiming to simply produce better pictures, but we want to produce quantitative data so the doctors can draw better conclusions. A more conclusive diagnosis means more effective treatments for patients. 

This is particularly true for stroke, TBI, dementia, Parkinson’s, and Multiple sclerosis. We have structural, functional, and other quantitative biomarkers that we are developing to address all of these diseases. 

Critically understanding the changes in the brain leads to more successful treatment. For example, by the time a Parkinson’s patient begins to have symptoms, they’ve already lost 50% of the neuromelanin in his brain.

But if we can measure the neuromelanin and the iron content changes associated with that, we may be able to assess how far the disease has progressed. There may be certain drugs or treatments that will work better at different stages of the disease. 

So if we can closely follow the development of the disease quantitatively, then we can equip the neurologist with the necessary information to decide the best treatment. 

Furthermore, if we perform a scan on a patient that gives us a neuromelanin map of the midbrain and we find that they have lost 40% of melanin already, then we could possibly take action to prevent them from losing any more neuromelanin. If it takes a 50% to 60% loss to become symptomatic and we could prevent further loss now, then there’s a chance we could keep them from ever developing Parkinson’s. 

There are all sorts of similar questions that can be asked once we are equipped with the quantitative capability. 

While we continue to do a lot research, we expect the FDA approval to propel us toward even more applications. Often, one can learn 10 times more by getting a product into clinical hands. When it’s being used every day, the doctors will notice things we never noticed. 

Matt Ahearn: What has been the reactions to STAGE thus far?

Dr. Haacke: I’d like to tell a funny story. One time we were imaging some MS patients, and they are often good research collaborators because they really want to know what’s wrong with them. They are used to many different scans and often have to remain in the magnet for an hour. 

Well we ran our STAGE protocol on one MS patient and then took him out after about 10 minutes. The patient seemed a bit upset so we asked him what was wrong. He said, “Why did you take me out so soon? Usually they scan me for an hour. Put me back in the magnet. I want to get my money’s worth.” 

So STAGE is not just efficient for the radiologist, it also patient friendly. The standardization is also important to the patient because they want to know concrete data about if their condition is getting better or worse, or what their condition even is. Most patients enjoy seeing side by side what happened a year ago and what’s going on today. But ultimately, the greatest benefit is more accurate diagnosis leading to more positive patient outcomes.

Matt Ahearn: What’s on the horizon for SpinTech as you look to 2021 and beyond?

Dr. Haacke: After completing our FDA submission for STAGE, the next big push will be the FDA submission for micro bleed detect in 2021. In 2022, we’ll focus on Parkinson’s, and then in 2023, we plan to turn to other parts of the body. 

Nearly everyone will experience some back pain in their lifetime, so we’d like to develop STAGE for the spine. Another area of interest is imaging the knee. Many people will injure their knee at one point or another and we think there’s a lot of room for improvement in how we image the knee and diagnose the problem. 

Our vision is to become comprehensive in what we service. We hope to eventually become the premier company for software processing and MRI.

In closing, we are all very excited about this work. It’s not just because we are creating a good business product, but also because it is one of the best feelings to know that we can make a difference in the lives of people around the world.