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Comparison of conventional and diffusion-weighted MRI and proton MR spectroscopy in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like events

  • Diagnostic Neuroradiology
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Abstract

The mechanism of neurological disturbances in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is controversial. We studied 12 patients with MELAS using conventional and diffusion weighted MRI (DWI) and MR spectroscopy (MRS), to look at the physiopathology of the stroke-like events. Although conventional MRI showed lesions in all patients, DWI was more sensitive. One patient did not show high signal on DWI 48 h after a from stroke-like episode, but MRS demonstrated a lactate peak in left occipital lobe; 2 weeks after the attack, high signal was demonstrated on the right frontal lobe where MRS had shown a lactate peak. Our findings suggest a possible predictive ability of 1H-MRS, in showing early MELAS lesions and supports the hypothesis that mitochondrial metabolic dysfunction may precedes abnormalities on DWI.

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References

  1. Pavlakis SG, Phillips PC, DiMauro S, et al (1984) Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke like episodes: a distinctive clinical syndrome. Ann Neurol 16: 481–488

    PubMed  Google Scholar 

  2. Ohama E, Ohara S, Ikuta F, et al (1987) Mitochondrial angiopathy in cerebral blood vessels of mitochondrial encephalomyopathy. Acta Neuropathol 74: 226–233

    CAS  PubMed  Google Scholar 

  3. Molnar MJ, Valikovics A, Molnar S, et al (2000) Cerebral blood flow and glucose metabolism in mitochondrial disorders. Neurology 55: 544–548

    PubMed  Google Scholar 

  4. Castillo M, Kwock L, Green C (1995) MELAS syndrome: imaging and proton MR spectroscopic findings. AJNR 16: 233–239

    CAS  Google Scholar 

  5. Barkovich AJ, Good WV, Koch TK, et al (1993) Mitochondrial disorders: analysis of their clinical and imaging characteristics. AJNR 14: 1119–1137

    CAS  PubMed  Google Scholar 

  6. Goto Y, Nonaka I, Horai S (1097) A new mutation associated with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). Biochim Biophys Acta 1097: 238–240

    Google Scholar 

  7. Kotsimbos N, Jean-Francois MJB, Huizing M, et al (1994) Rapid and non-invasive screening of patients with mitochondrial myopathy. Hum Mutat 4: 132–135

    CAS  PubMed  Google Scholar 

  8. Abe K, Terakawa H, Takanashi M, et al (2000) Proton magnetic resonance spectroscopy of patients with parkinsonism. Brain Res Bull 52: 589–595

    Article  CAS  PubMed  Google Scholar 

  9. Oppenheim C, Galanaud D, Samson Y, et al (2000) Can diffusion weighted magnetic resonance imaging help differentiate stroke from stroke-like events in MELAS? J Neurol Neurosurg Psychiatry 69: 248–250

    Article  CAS  PubMed  Google Scholar 

  10. Majoie CB, Akkerman EM, Blank C, et al (2002) Comparison of conventional MR imaging with diffusion-weighted and diffusion tensor imaging: case report. AJNR 23: 813–816

    Google Scholar 

  11. Pavlakis SG, Kingsley PB, Kaplan GP, et al (1998) Magnetic resonance spectroscopy. Use in monitoring MELAS treatment. Arch Neurol 55: 849–852

    Article  CAS  PubMed  Google Scholar 

  12. Yoneda M, Maeda M, Kimura H, Fujii A, Katayama K, Kuriyama M (1999). Vasogenic edema in MELAS: a serial study with diffusion-weighted MR imaging. Neurology 53: 2182–2184

    Google Scholar 

  13. Kamada K, Takeuchi F, Houkin K, et al (2001) Reversible brain dysfunction in MELAS: MEG, and 1H MRS analysis. J Neurol Neurosurg Psychiatry 70: 675–678

    Article  CAS  PubMed  Google Scholar 

  14. Abe K, Inui T, Hirono N, Mezaki T, Kobayashi Y, Kameyama M (1990) Fluctuating MR images with mitochondrial encephalopathy, lactic acidosis, stroke-like syndrome (MELAS). Neuroradiology 32: 77

    CAS  PubMed  Google Scholar 

  15. Clark JM, Marks MP, Adalsteinsson E, et al (1996) MELAS: clinical and pathologic correlations with MRI, Xenon/CT, and MR spectroscopy. Neurology 46: 223–227

    CAS  PubMed  Google Scholar 

  16. Schlaug G, Siewert B, Benfield A, Edelman RR, Warach S (1997) Time course of the apparent diffusion coefficient (ADC) abnormality in human stroke. Neurology 49: 113–119

    CAS  PubMed  Google Scholar 

  17. Le Bihan D, Breton E, Lallemand D, et al (1986) MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 161: 401–407

    PubMed  Google Scholar 

  18. Moseley ME, Cohen Y, Mintorovitch J, et al (1990) Early detection of regional cerebral ischemia in cats: comparison of diffusion- and T2-weighted MRI and spectroscopy. Magn Reson Med 14: 330–346

    CAS  PubMed  Google Scholar 

  19. Schaefer PW, Buonanno FS, Gonzalez RG, et al (1997) Diffusion weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia. Stroke 28: 1082–1085

    CAS  PubMed  Google Scholar 

  20. Loubinoux I, Volk A, Borredon J, et al (1997) Spreading of vasogenic edema and cytotoxic edema assessed by quantitative diffusion and T2 magnetic resonance imaging. Stroke 28: 419–426

    CAS  PubMed  Google Scholar 

  21. Kuroiwa T, Nagaoka T, Ueki M, et al (1998) Different apparent diffusion coefficient: water content correlations of gray and white matter during early ischemia. Stroke 29: 859–865

    CAS  PubMed  Google Scholar 

  22. Kucinski T, Vaterlein O, Glauche V, et al (2002) Correlation of apparent diffusion coefficient and computed tomography density in acute ischemic stroke. Stroke 33: 1786–1791

    Article  PubMed  Google Scholar 

  23. Fiehler J, Foth M, Kucinski T, et al (2002) Severe ADC decreases do not predict irreversible tissue damage in humans. Stroke 33: 79–86

    PubMed  Google Scholar 

  24. Yoneda Y, Tokui K, Hanihara T, Kitagaki H, Tabuchi M, Mori E (1999) Diffusion-weighted magnetic resonance imaging: detection of ischemic injury 33 minutes after onset in a stroke patient. Ann Neurol 45: 794–797

    Article  CAS  PubMed  Google Scholar 

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Abe, K., Yoshimura, H., Tanaka, H. et al. Comparison of conventional and diffusion-weighted MRI and proton MR spectroscopy in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like events. Neuroradiology 46, 113–117 (2004). https://doi.org/10.1007/s00234-003-1138-2

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  • DOI: https://doi.org/10.1007/s00234-003-1138-2

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