Inflammatory CNS Demyelination: Histopathologic Correlation with In Vivo Quantitative Proton MR Spectroscopy
Andreas Bitscha,
Harald Bruhna,
Vassilios Vougioukasa,
Argyris Stringarisa,
Hans Lassmanna,
Jens Frahma and
Wolfgang Brück
,a
a From the Departments of Neuropathology (V.V., A.S., W.B.) and Neurology (A.B.), of Georg-August University, Göttingen, Germany; Biomedical MRI Study Group at the Max Planck Institute of Biophysical Chemistry (H.B.), Göttingen, Germany; and the Neurological Institute (H.L.), Vienna, Austria.
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FIG 1. Bielschowsky's silver impregnation shows axonal density in the normal periplaque white matter (patient 1) (A), a reduction by 45% (patient 3) (B), and a reduction by 75% (patient 1) (C) within the plaques (magnification for all, x166). Prominent protoplasmic gliosis with large astrocytes (D) is seen by immunocytochemistry for GFAP (patient 1). Numerous GFAP-positive cell processes (E) indicate fibrillary gliosis (patient 3). Immunocytochemistry for MOG (F) shows an early active demyelinating lesion (patient 2). Macrophages carry MOG-positive degradation products in their cytoplasm. Dense macrophage infiltrate (G) is seen in the same lesion as shown in F (immunocytochemistry for Ki-MlP)
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FIG 2. T1-weighted gradient-echo MR images (3D fast low-angle shot, 4-mm partitions, 15/6 TR/TE, 20° flip angle) of patient 1 indicating VOIs selected for MRS.
A, Transverse section with VOIs centered at the left parieto-occipital lesion (20 x 20 x 20 mm3) and in a contralateral control region (16 x 30 x 16 mm3).
B, Sagittal section with a smaller VOI (16 x 16 x 16 mm3) encompassing the same lesion (note small defect in the skull and corresponding biopsy canal),
C, Coronal section depicting an ipsilateral VOI (20 x 20 x 20 mm3) in left frontoparietal cortex unsuspicious at MR imaging.
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FIG 3. Localized proton MR spectra (stimulated-echo acquisition mode, 3000/20/30 [TR/TE/TM]) of patient 1 from locations indicated in figure 2. Left occipitoparietal lesion (top) image using a 4-mL VOI and (second row) 8-mL VOI, an ipsilateral 8-mL VOI in unsuspicious left frontoparietal cortex (third row), and contralateral control (bottom). Major resonances are due to N-acetylaspartate (NAA), creatine and phosphocreatine (Cr), choline-containing compounds (Cho), myo-inositol (Ins), and lactate (Lac). Spectra are normalized for comparison
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