1H MR spectroscopy of the brain in multiple sclerosis subtypes with analysis of the metabolite concentrations in gray and white matter: initial findings

Abstract

Many MR spectroscopy (MRS) studies of multiple sclerosis (MS) have focussed on metabolism in normal-appearing white matter (NAWM) and in white matter lesions (WML). In this study, eight patients suffering from primary or secondary progressive MS (PPMS/SPMS) and seven patients with relapsing/remitting MS (RRMS) were examined by (1)H-MRS to assess metabolite levels in gray matter (GM) as well. (1)H-MRS chemical-shift imaging of a cerebral volume of interest of 8x8x2 cm(3) above the lateral ventricles revealed differences between the metabolite concentrations in the three groups varying from almost significant [NAWM, choline (cho); P=0.0547] to highly significant [GM, N-acetylaspartate (NAA); P=0.0003]. In PPMS/SPMS patients, the decreases in choline, creatine (Cr) and N-acetylaspartate compared with six healthy controls were significant in GM and to a lesser extent, in NAWM. No significant differences in metabolite concentrations were found between RRMS and controls. In WML, all metabolites were reduced compared with white matter in controls (Cho: P=0.0020; Cr and NAA: P<0.0001, both). In conclusion, the concentrations of Cho, Cr and NAA are reduced in PPMS/SPMS patients, especially in GM and in WML. Despite contrary observations in previous studies, increases in the concentrations of Cr and/or Cho were not observed.

MR Spectroscopy in Multiple Sclerosis - A New Piece of the Puzzle or Just a New Puzzle

“…However, following characteristics of the NAWM of CIS and R R M S p a t i e n t s c o u l d b e i d e n t i f i e d ( t a b l e 2 , r e f e r e n c e s a r e l i s t e d c h r o n o l o g i c a l l y b y publication date). Twenty-four MRS studies were published with decreased ratios of NAA to Cr or Cho, or decreased NAA absolute concentrations in the NAWM in a total of 56 CIS or 418 RRMS patients (Davie et al, 1994;Husted et al, 1994;Peters et al, 1995;Fu et al, 1998;Schiepers et al, 1997;Foong J et al, 1999;Sarchielli et al, 1999;van Walderveen et al, 1999;Suhy et al, 2000;de Stefano et al, 2001;Tedeschi et al, 2001;Kapeller et al, 2001;Chard et al, 2002;de Stefano et al, 2002;Casanova et al 2003;Inglese et al, 2004;Adalsteinsson et al, 2004;He et al, 2005;Staffen et al, 2005;Tiberio et al, 2006;Sijens et al, 2006;Pascual et al, 2007;.…”

“…Twenty-nine MRS studies were published with no significant Cho changes in the NAWM in a total of 190 CIS or 513 RRMS patients (Husted et al, 1994;Peters et al, 1995;Schiepers et al, 1997;Davie et al, 1997;Sarchielli et al, 1999;Foong J et al, 1999;Sarchielli et al, 1999;Brex et al, 1999;van Walderveen et al, 1999;Suhy et al, 2000;de Stefano et al, 2001;Kapeller et al, 2001;Chard et al, 2002;de Stefano et al, 2002;Kapeller et al, 2002;Casanova et al 2003;Inglese et al, 2004;Adalsteinsson et al, 2004;Fernando et al, 2004;Ruiz-Pena et al, 2004;Vrenken et al, 2005;Mathiesen et al, 2005;Khan et al, 2005;Sijens et al, 2006;Khan et al, 2008;Bellmann-Strobl et al, 2009;AboulEnein et al, 2010).…”

Quantitative Cervical Spinal Cord 3T Proton MR Spectroscopy in Multiple Sclerosis

“…These abnormal conditions have been demonstrated both in lesions and in normal-appearing white matter (NAWM) and normal-appearing gray matter (NAGM). [1][2][3][4][5][6][7][8][9][10] T1-and T2-weighted MR imaging is currently the diagnostic reference to define and monitor MS, but it has poor specificity and sensitivity in detecting pathophysiologic MS changes correlated with clinical disability. 6,[11][12][13][14][15] For some years, brain proton MR spectroscopy ( 1 H-MR spectroscopy) has been used to study MS by offering a unique opportunity to evaluate biochemical changes that could shed light on the complex pathophysiology of the disease and potentially define new markers correlated with the clinical evolution of MS. 1,16 Many cerebral quantitative MR spectroscopy studies in patients with MS have evaluated the correlation of the specific single metabolites with specific physiologic events during the MS disease course.…”

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

“…The inner 36 voxels were analyzed and separated into the two central columns mainly containing grey matter (12 voxels) and the remainder of 24 voxels filled with white matter (Fig. 1, right side) [15]. Grey matter and white matter patient metabolite levels were determined relative to grey matter creatine as internal reference (set at 6.2 mM) [15].…”

“…1, right side) [15]. Grey matter and white matter patient metabolite levels were determined relative to grey matter creatine as internal reference (set at 6.2 mM) [15].…”