Characterization of Cerebral Small Vessel Disease by Proton Spectroscopy and Morphological Magnetic Resonance

Abstract

This study sought to investigate whether clinical and neuropsychological impairment in cerebral small vessel disease (CSVD) can be evaluated by proton spectroscopy (¹H-MRS) and structural magnetic resonance (MR) imaging. Sixteen patients with CSVD and 15 healthy age-matched controls participated in the study. In addition to spectroscopic and structural MR examination all patients underwent a comprehensive clinical and neuropsychological investigation. Significant differences in between patients and controls were revealed by ¹H-MRS in the parietal white matter: decreased metabolic ratios of N-acetyl aspartate to choline (NAA/Cho; patients: 1.37 ± 0.17, control: 1.72 ± 0.25, p < 0.001) and of N-acetyl aspartate to creatin (NAA/Cr; patients: 1.41 ± 0.15, control: 1.66 ± 0.2, p < 0.01) indicated a pathological state. Evaluation of spectroscopic and neuropsychological data revealed a close relation between attentional impairment, i.e. delayed cerebral transmission time and decreased NAA/Cho and NAA/Cr (r = 0.62, p = 0.014). In sum, ¹H-MRS allowed a clear discrimination between patients with CSVD and age-matched normal controls. Moreover, comparisons of ¹H-MRS and neuropsychological data suggested that NAA metabolic levels, and particularly the delay in cerebral transmission time, could be potential predictors of the severeness of attentional impairment.

Postoperative Changes in Cerebral Metabolites Associated with Cognitive Improvement and Impairment after Carotid Endarterectomy: A 3T Proton MR Spectroscopy Study

“…12 The NAA/Cr ratio also correlates with cerebral oxygen metabolism of the gray matter in patients with steno-occlusive carotid artery disease. 16 In addition, a decrease in the NAA/Cr ratio is associated with a decrease in cognitive function in elderly populations, 18,21 patients with cerebral infarction, 17,22 and those with Alzheimer disease. 20 Thus, the present data suggested that neuronal damage caused by CEA results in postoperative cognitive impairment.…”

“…13 On the basis of these hypotheses, proton MR spectroscopy has been applied for the study of various pathologic conditions of the cen-tral nervous system. 11,12,[14][15][16][17][18][19][20][21][22] Several studies have also investigated relative changes in NAA and/or choline following CEA by using proton MR spectroscopy. [23][24][25][26] However, the clinical significance of such postoperative changes remains unknown.…”

“…Correlations between MR spectroscopic measures and neuropsychological function have been reported in patients with Alzheimer disease, mild cognitive impairment, idiopathic normal pressure hydrocephalus, and cerebral infarction. 14,[17][18][19][20][21][22] Thus, the purpose of the present prospective study was to determine whether a postoperative increase or decrease in cerebral metabolites measured by using proton MR spectroscopy was associated with improvement or impairment in cognitive function after CEA.…”

Regional Impairment of Cerebrovascular Reactivity and BOLD Signal in Adults After Stroke

“…Inclusion criteria were: (1) stroke history with full clinical recovery 15 and normal electromyogram recordings from 2 hand muscles (M. flexor pollicis longus, M. extensor digitorum communis); (2) brain infarction of, at least, the frontal lobe without hemorrhage; (3) no macroscopic lesion of the hand representation in primary sensorimotor cortex, SMA, CRB, basal ganglia, or thalamus on 3-dimensional (3D) T1-weighted images; (4) no severe cerebral small-vessels disease on T2-weighted images defined by a score Ͼ12 based on MR structural abnormalities; 16 and (5) no significant cerebrovascular stenosis (Ն70% based on NASCET measurement) assessed by Doppler and duplex sonography. Exclusion criteria of the study were: (1) excessive blood pressure Ͼ140/90 mm Hg at the time of examination; (2) tachycardia (pulse Ͼ120/min); (3) hypoxemia (PaO 2 Ͻ90 mm Hg); and (4) inappropriate task performance (see HV subsection).…”

Correlations between MRS and DTI in cerebral small vessel disease

“…Acute demyelination has been associated with an increase in choline levels (13), which reflect cholinecontaining compounds that are involved in membrane synthesis and degradation. Previous studies in patients with cerebral SVD have shown reductions in NAA and choline in lesions and normal appearing white matter, compared with controls (14,15). In order to shed light on the pathological basis of the imaging abnormalities noted on DTI in SVD, we investigated the relationship between DTI parameters and metabolite concentration ratios obtained at the same MRI examination.…”