American Journal of Neuroradiology 21:1220-1227 (7 2000)
© 2000 American Society of Neuroradiology
ARTICLE
Serial Proton MR Spectroscopy of Contrast-enhancing Multiple Sclerosis Plaques: Absolute Metabolic Values over 2 Years during a Clinical Pharmacological Study
a From the Department of Neuroradiology, University Hospital, Tübingen, Germany (I.M.); the Departments of Neuroradiology (I.M., W.R., E.W.R., W.S.) and Neurology (L.K.), University Hospital, Basel, Switzerland; the MR-Center and Biocenter, University of Basel, Basel, Switzerland (W.R., G.H., J.S.).
BACKGROUND AND PURPOSE: The time courses of total creatine (Cr), N-acetylaspartate (NAA), choline (Cho), and myo-inositol have not previously been investigated in the follow-up of contrast-enhancing multiple sclerosis (MS) plaques. Therefore, over a period of 2 years, we compared the absolute concentrations of these metabolites between patients treated with a placebo or 15 ± deoxyspergualin (DSG) and between clinical groups with relapsing-remitting or secondary-progressive MS.
METHODS: Sixteen patients, recruited from a pharmacological study of DSG, and 11 healthy control subjects were investigated by a stimulated-echo acquisition mode sequence (TR/TE = 3000/20). The selected volume initially contained a contrast-enhancing plaque, which was followed up for a period of 2 years.
RESULTS: In contrast-enhancing plaques, Cho was significantly elevated and showed a significant reduction after both 3 and 12 months. The initially normal Cr significantly increased between 3 and 12 months, and was negatively correlated with plaque volume on T1-weighted MR images. NAA initially showed normal values, a significant decrease at 1 month, and a slow recovery over 2 years. Myo-inositol did not show a clear tendency. The placebo group did not differ from the treated group, nor did the relapsing-remitting group differ from the secondary-progressive group.
CONCLUSION: The contradictory time courses of Cr and NAA show that an absolute quantification in proton MR spectroscopy in MS is necessary to avoid a false interpretation of reduced NAA/Cr ratios. The increase in Cr is probably due to remyelination. The initial dip and later recovery of NAA seem to be related to diminishing edema and remyelination.
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