Proton magnetic resonance spectroscopy in corticobasal degeneration and progressive supranuclear palsy

Abstract

Background: Corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP) each have distinctive clinical features, but diagnosis is often uncertain. Our purpose was to evaluate whether localized, single-voxel proton magnetic resonance spectroscopy ( 1 H-MRS) could distinguish between typical CBD and PSP patients. Methods:The study included 10 patients with CBD, nine with PSP and eight agematched normal healthy subjects. A single-voxel method of 8 cm 3 (2 ¥ 2 ¥ 2 cm) was used for 1 H-MRS. The volume of interest was selected at the frontoparietal cortex and the lentiform nucleus.Results: Patients with CBD had significantly reduced ratios of N-acetylaspartate to choline-containing compounds (NAA/Cho), N-acetylaspartate to creatine and phosphocreatine (NAA/Cr) in the frontoparietal cortex and lentiform nucleus compared with the normal subjects. Patients with PSP had significantly reduced NAA/Cho and NAA/Cr ratios in the lentiform nucleus, but not in the frontoparietal cortex compared with normal subjects. There was a significant difference in the NAA/Cho in the frontoparietal lobe between CBD and PSP patients.Conclusion: 1 H-MRS may indicate different regional patterns of neuronal involvement in CBD and PSP. We suggest that this could be helpful in the differentiation and diagnostic evaluation of CBD and PSP patients.

Neuroimaging Advances in Parkinson's Disease and Atypical Parkinsonian Syndromes

“…NAA/Choline and NAA/Cr levels were reduced in CBS patients in the frontoparietal cortex, LN and centrum semiovale vs. controls (149,159). Lower NAA/Choline levels in the frontoparietal lobe may help differentiate CBS cases from PSP (149).…”

“…In PSP, reductions in the NAA/Cr ratios in the LN, brainstem, centrum semiovale, frontal, and precentral cortex, as well as reductions in the NAA/choline values in the LN are observed relative to controls (148,149). A more prominent decline in NAA/Cr ratio was noted in the putamen vs. PD and MSA (150).…”

“…• Structural MRI Atrophy patterns align with the "true" underlying pathology The predominant clinical syndrome in CBS relates closely to regional atrophy patterns In general, asymmetric cortical atrophy in frontoparietal lobe contralateral to more affected side in CBD/CBS vs. NC ↓ in bilateral premotor cortex, superior parietal lobules, and striatum in CBS vs. NC ↓ in dorsofrontal and parietal cortex and ↑ global brain atrophy in CBS vs. PSP; ↓ in midbrain in PSP vs. CBS (6,121,123,129,152,153,155,156) • DWI/DTI MRI ↑ D and ↓ FA in posterior truncus of corpus callosum in CBS vs. PD and NC ↓ FA in long frontoparietal connecting tracts, intraparietal associative fibers, corpus callosum, and sensorimotor cortical projections in CBS vs. NC (59,152,158) • Proton MRS ↓ NAA/Choline and NAA/Cr ratios in contralateral frontoparietal cortex, LN and centrum semiovale in CBS vs. NC ↓ NAA/Cr ratio in frontal cortex and asymmetrically in putamen in CBS vs. PD, MSA and vascular parkinsonism (149,150,159) • PET and SPECT b Glucose metabolism: CBS-related spatial covariance pattern may show asymmetric, bilateral hypometabolism involving frontal and parietal cortex, thalamus, and caudate nucleus, with ↑ abnormalities contralaterally (267) Dopaminergic system: b ↓ striatal presynaptic DAT binding with hemispheric asymmetry vs. PD. (226,227) Tau: ↑ asymmetric binding contralateral to the clinically affected side in putamen, globus pallidus, thalamus, and midbrain vs. NC, and in motor cortex, corticospinal tract, and basal ganglia vs.…”

Imaging biomarkers in Parkinson’s disease and Parkinsonian syndromes: current and emerging concepts

“…Using 3D MRS, Gröger et al noted higher NAA/Cr ratio in the rostral (versus caudal) SN in atypical PS and controls, whereas this pattern was reversed in PD suggesting pathological neuronal loss in the rostral SNpc [92]. PSP patients showed reductions in NAA/Cr ratios in the LN, brainstem, centrum semiovale, frontal and pre-central regions relative to controls [93, 94], although more severe reductions were noted in the putamen (versus PD and MSA) [86] and frontal cortex (versus PD) [88, 95]. Lower NAA/Cr ratios were also noted in the putamen and pontine base in MSA patients compared to PD and controls [96].…”

“…Lower NAA/Cr ratios were also noted in the putamen and pontine base in MSA patients compared to PD and controls [96]. CBS subjects showed reductions in NAA/Choline or NAA/Cr levels in the frontoparietal cortex, LN and centrum semiovale contralateral to the more affected side [94, 97]. NAA/Cr reductions in CBS were pronounced in the frontal cortex and putamen relative to PD, MSA and vascular parkinsonism with clear putaminal asymmetry [95].…”