Advanced

AJNR - American Journal of Neuroradiology

Published ahead of print on January 15, 2009
doi: 10.3174/ajnr.A1425

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1425v1 30/4/716    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Oguz, K.K. Articles by Anlar, B. Search for Related Content PubMed PubMed Citation Articles by Oguz, K.K. Articles by Anlar, B.

American Journal of Neuroradiology 30:716-721, April 2009
© 2009 American Society of Neuroradiology

BRAIN

Assessment of Citrullinated Myelin by ¹H-MR Spectroscopy in Early-Onset Multiple Sclerosis

K.K. Oguz^a, A. Kurne^a, A.O. Aksu^a, E. Karabulut^b, A. Serdaroglu^d, S. Teber^e, S. Haspolat^f, N. Senbil^g, S. Kurul^h and B. Anlar^c

^a Department of Radiology, Hacettepe University, Ankara, Turkey
^b Department of Biostatistics, Hacettepe University, Ankara, Turkey
^c Department of Pediatric Neurology, Hacettepe University, Ankara, Turkey
^d Department of Pediatric Neurology, Gazi University, Ankara, Turkey
^e Department of Pediatric Neurology, Ankara University, Ankara, Turkey
^f Department of Pediatric Neurology, Akdeniz University, Antalya, Turkey
^g Department of Pediatric Neurology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
^h Department of Pediatric Neurology, Dokuz Eylul University, Izmir, Turkey

Please address correspondence to Kader Karli Oguz, MD, Hacettepe University, Department of Radiology, Sihhiye, Ankara, Turkey; e-mail:karlioguz{at}yahoo.com

BACKGROUND AND PURPOSE: Myelin instability and citrullinated myelin basic protein have been demonstrated in the brains of patients with chronic and fulminating forms of multiple sclerosis (MS). Our aim was to trace citrulline in the brains of patients with early-onset MS by using proton MR spectroscopy (¹H-MR spectroscopy).

MATERIALS AND METHODS: A short-echo single-voxel ¹H-MR spectroscopy by using the point-resolved proton spectroscopy sequence was performed in 27 patients with MS and 23 healthy subjects. Voxels of interest were chronic demyelinating lesions (CDLs, n = 25) and normal-appearing white matter (NAWM, n = 25) on T2-weighted imaging, and when available in patients with MS, enhancing demyelinating lesions (EDLs, n = 8). Frontal white matter (WM) was studied in control subjects. N-acetylaspartate, choline, and myo-inositol (mIns)-creatine (Cr) ratios and the presence of a citrulline peak were noted.

RESULTS: Citrulline peaks were more frequently observed in patients with MS than in control subjects (P = .035), located in the NAWM in 8/25 (32%), in CDLs in 7/25 (28%), and in EDLs of 1/8 (12.5%) patients with MS. The presence of citrulline and measured metabolite/Cr ratios was not related to age at imaging, age at disease onset, duration of disease, or number of relapses. There was no significant metabolic difference between the NAWM of patients with MS and the WM of the control subjects. mIns/Cr was significantly greater in CDLs compared with the NAWM of patients with MS and the WM of healthy subjects.

CONCLUSIONS: Citrulline was more frequently identified in the brains of patients with early-onset MS than in healthy subjects by ¹H-MR spectroscopy, suggesting an association of increased citrullination of myelin proteins with demyelinating diseases.