American Journal of Neuroradiology 23:389-392, March 2002
© 2002 American Society of Neuroradiology
BRAIN
Identification of a By-Product of Nitric Oxide Synthase Activity in Human Acute Brain Injury with in Vivo Proton Magnetic Resonance Spectroscopy
a Department of Radiology, the University of Sydney, and the School of Medicine, Monash University, Australia
b Medical Imaging Division, the Canberra Hospital, Australia
c Department of Psychiatry, Austin and Repatriation Medical Centre, Australia
d Department of Pathology, St Vincent’s Hospital, Melbourne, Australia
Address reprint requests to Morry Silberstein MD, Assistant Dean, Monash Medical School, Commercial Rd, Prahran VIC 3181, Australia
BACKGROUND AND PURPOSE: Laboratory studies have been used to identify nitric oxide as a notable mediator in neuronal death after acute brain injury. To our knowledge, this has not previously been confirmed with in vivo study in humans. Our purpose was to seek in vivo evidence for the induction of nitric oxide synthase (NOS) in human acute brain injury by using proton MR spectroscopy.
METHODS: In vitro proton MR spectra were obtained in neural extracts from 30 human cadavers, and in vivo spectra were obtained in 20 patients with acute brain injury and in a similar number of control subjects.
RESULTS: We identified a unique peak at 3.15 ppm by using in vivo proton MR spectroscopy in eight of 20 patients with acute brain injury but not in 20 healthy volunteers (P < .002). On the basis of in vitro data, we have tentatively assigned this peak to citrulline, a NOS by-product.
CONCLUSION: To our knowledge, our findings suggest, for the first time, that excitotoxicity may occur in human acute brain injury. Confirmation with the acquisition of spectra in very early acute cerebral injury would provide a rationale for the use of neuroprotective agents in these conditions, as well as a new noninvasive method for quantification.