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Abstract

MR proton spectroscopy in multiple sclerosis.

R I Grossman, R E Lenkinski, K N Ramer, F Gonzalez-Scarano and J A Cohen
American Journal of Neuroradiology November 1992, 13 (6) 1535-1543;
R I Grossman
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
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R E Lenkinski
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
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K N Ramer
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
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F Gonzalez-Scarano
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
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J A Cohen
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
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Abstract

PURPOSE To elucidate the natural history of visualized MR abnormalities in patients with multiple sclerosis using proton spectroscopy.

METHODS MR imaging and proton spectroscopy (1H spectroscopy) were performed on 16 patients with clinically definite multiple sclerosis. All patients received gadopentetate dimeglumine (Gd-DTPA).

RESULTS Decreased levels of N-acetylaspartate (NAA) were demonstrated in 17 out of 21 lesions. No correlation was found between decreased NAA and Gd-DTPA enhancement. In five out of seven enhancing lesions, abnormal 1H spectra with extra peaks (termed marker peaks) at 2.1-2.6 ppm (ranging in absolute concentration from 10-50 mM protons) were observed. In nine out of 14 unenhancing lesions, no elevated marker peaks were observed. In the five other unenhancing lesions, the levels of these marker peaks were generally lower than the enhancing group. No correlation was found between the NAA levels and the levels of the marker peaks. We suggest two distinct biochemical processes: 1) decreased NAA reflecting neuronal cell loss, and 2) elevated marker peaks reflecting ongoing demyelination.

CONCLUSIONS Based upon these observations we infer that 1) the majority of enhancing lesions are demyelinating with extra peaks at 2.1-2.6 ppm representing a marker of this process, 2) enhancing lesions without this marker most likely represent edematous regions without significant demyelination, and 3) demyelination may be long in duration compared with transient blood-brain barrier disruption manifested by Gd-DTPA enhancement. Our results suggest that 1H spectroscopy has the ability to further categorize MR-demonstrated enhancing and unenhancing lesions in patients with multiple sclerosis and that it may be more sensitive than contrast enhancement in revealing the true time course of demyelination.

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American Journal of Neuroradiology
Vol. 13, Issue 6
1 Nov 1992
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MR proton spectroscopy in multiple sclerosis.
R I Grossman, R E Lenkinski, K N Ramer, F Gonzalez-Scarano, J A Cohen
American Journal of Neuroradiology Nov 1992, 13 (6) 1535-1543;

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MR proton spectroscopy in multiple sclerosis.
R I Grossman, R E Lenkinski, K N Ramer, F Gonzalez-Scarano, J A Cohen
American Journal of Neuroradiology Nov 1992, 13 (6) 1535-1543;
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  • Total brain N-acetylaspartate: A new measure of disease load in MS
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