Serial Proton MR Spectroscopy of Contrast-enhancing Multiple Sclerosis Plaques: Absolute Metabolic Values over 2 Years during a Clinical Pharmacological Study
Irina Mader
,a,
Werner Rosera,
Ludwig Kapposa,
Gisela Hagberga,
Joachim Seeliga,
Ernst W. Raduea and
Wolfgang Steinbricha
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.).
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FIG 1. A and B, Two representative sections, one showing an acute MS plaque on a contrast-enhanced T1-weighted image (A) and another indicating the position of the VOI superimposed on a T2-weighted image (B)
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FIG 2. Series of STEAM spectra (TE = 20) of an initially contrast-enhancing plaque over a period of 2 years (TR = 3000, mixing time = 30 milliseconds). No baseline correction has been applied. The indicated resonances are NAA, Cr, Cho, and myo-inositol (m-Ino). Cho shows a clear reduction at month 3; Cr shows an elevation in month 12
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FIG 3. The absolute concentrations of the metabolites as a function of time. The mean of the healthy control subjects ± 1 SEM is indicated by the horizontal bars.
A, Time course of NAA. After a reduction in month 1, a slow recovery is visible until month 22.
B, Time course of Cr. There is a significant elevation from month 3 to months 6 and 12.
C, Time course of Cho. Note the significant decrease from month 0 to month 3.
D, Time course of myo-inositol. No systematic changes are recognizable.
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FIG 4. Absolute concentration of metabolites as a function of plaque size.
A, The concentration of NAA (in mM/L) correlated with total plaque volume on T2-weighted images, expressed as a percentage of the VOI (in %). There is a negative correlation between NAA and total plaque volume on T2-weighted images (r = -0.26, P < .05).
B, The concentration of NAA (in mM/L) correlated with chronic plaque volume on T2-weighted images, expressed as a percentage of the VOI (in %). There is a stronger negative correlation between NAA and chronic plaque volume on T2-weighted images than in A (r = -0.38, P < .01).
C, The concentration of Cr (in mM/L) correlated with the volume of acute contrast-enhancing plaques on T1-weighted images, expressed as a percentage of the VOI (in %). Note the negative correlation between Cr and acute contrast-enhancing plaque volume on T1-weighted images (r = -0.9, P < .03).
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