Evaluation of in vivo cerebral metabolism on proton magnetic resonance spectroscopy in patients with impaired glucose tolerance and type 2 diabetes mellitus

doi:10.1016/j.jdiacomp.2007.03.007

Journal of Diabetes and its Complications

Volume 22, Issue 4, July–August 2008, Pages 254-260

https://doi.org/10.1016/j.jdiacomp.2007.03.007 Get rights and content

Abstract

The aim of this study was to investigate possible metabolic alterations in cerebral tissues on magnetic resonance spectroscopy (MRS) in patients with impaired glucose tolerance (IGT) and with type 2 diabetes mellitus (T2-DM).

Twenty-five patients with T2-DM, 13 patients with IGT, and 14 healthy volunteers were included. Single-voxel spectroscopy (TR: 2000 ms, TE: 31 ms) was performed in all subjects. Voxels were placed in the frontal cortex, thalamus, and parietal white matter. N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, and myo-inositol (MI)/Cr ratios were calculated.

Frontal cortical Cho/Cr ratios were increased in patients with IGT compared to control subjects. Parietal white matter Cho/Cr ratios were significantly higher in patients with IGT when compared to patients with T2-DM. In the diabetic group, frontal cortical MI/Cr ratios were increased, and parietal white matter Cho/Cr ratios were decreased when compared to the control group. Frontal cortical NAA/Cr and Cho/Cr ratios and parietal white matter Cho/Cr ratios were decreased in diabetic patients with poor glycemic control (A1C>10%). A1C levels were inversely correlated with frontal cortical NAA/Cr and Cho/Cr ratios and with parietal white matter Cho/Cr ratios.

T2-DM and IGT may cause subtle cerebral metabolic changes, and these changes may be shown with MRS. Increased Cho/Cr ratios may suggest dynamic change in membrane turnover in patients with IGT. Diabetic patients with poor glycemic control may be associated with neuronal dysfunction/damage in brain in accordance with A1C levels and, in some, extend with insulin resistance.

Introduction

It is becoming increasingly evident that the brain is one of the targets for diabetic end organ damage (Biessels et al., 1994, Brands et al., 2003). The underlying mechanism causing brain damage in diabetes has not been fully explained. It seems that the fluctuation in blood glucose level, as well as acute and/or chronic metabolic and vascular impairment, such as deficits in cerebral blood flow, may cause functional and structural cerebral changes in diabetic patients (Biessels et al., 2002, Brands et al., 2004).

Magnetic resonance spectroscopy (MRS) is a very powerful diagnostic modality that gives information on neuronal/axonal viability, cellular energetic, and cellular membrane status (Bitsch et al., 1999). It may provide neurochemical information on subtle and overt brain parenchymal changes. This information is used to discriminate normal and pathological tissues. Therefore, it is increasingly being used to diagnose and manage various cerebral diseases (Alkan et al., 2004, Alkan et al., 2004, Alkan et al., 2003). However, few studies investigated brain metabolite changes using MRS technique in patients with diabetes mellitus, and these changes have not been documented in detail (Biessels et al., 2001, Kreis & Ross, 1992, Perros et al., 1997). Moreover, no one has yet investigated brain metabolite changes in patients with impaired glucose tolerance (IGT). This study was designed to contribute to a better understanding of cerebral metabolism on MRS in patients with IGT and type 2 diabetes mellitus (T2-DM).

Section snippets

Materials and methods

Twenty-five patients with T2-DM, 13 patients with IGT, and 14 age- and gender-matched healthy volunteers were included in this cross-sectional study. None of the subjects had systemic or cerebrovascular disease, head trauma, and overt cognitive dysfunction (in the diabetic group, three patients were diagnosed as having cerebrovascular disease and one patient was diagnosed as having meningioma; all of them were excluded from the study). The procedures used were in accordance with the guidelines

Results

Mean age of patients with T2-DM, patients with IGT, and control subjects were 49.8±12.4, 44.5±11.3, and 41.5±8.1 years, respectively. Study groups and the control group did not differ significantly regarding their mean ages and gender distributions. Clinical and laboratory characteristics of the study groups and the control group are given in Table 1. Conventional MR imaging was normal in all subjects.

Parietal white matter, frontal cortex, and thalamic metabolite measurements are presented in

Discussion

Clinical features, epidemiology, and pathophysiology of the peripheral diabetic neuropathy are well established. However, adverse effects of the diabetes on the central nervous system are less described and the underlying pathophysiology is largely unknown (Brands et al., 2003). Neuropsychological studies of diabetics reveal cognitive impairment, including complex information processes such as learning and memory (Tun, Nathan, & Perlmuter, 1990). Neuroradiological studies report mild cerebral

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Original articleEvaluation of in vivo cerebral metabolism on proton magnetic resonance spectroscopy in patients with impaired glucose tolerance and type 2 diabetes mellitus

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Magnetic Resonance Imaging

European Journal of Radiology

Magnetic Resonance Imaging

Eurpean Journal of Pharmacology

Eurpean Journal of Pharmacology

Journal of Magnetic Resonance

Metabolism

MRI of the brain in diabetes mellitus

Neuroradiaology

Magnetic resonance spectroscopy of brain hemangiopericytomas: High myoinositol concentrations and discrimination from meningiomas

Journal of Neurosurgery

Cerebral metabolism in streptozotocin-diabetic rats: An in vivo magnetic resonance spectroscopy study

Diabetologia

Cerebral function in diabetes mellitus

Diabetologia

Inflammatory CNS demyelination: Histopathologic with in vivo quantitative proton MR spectroscopy

AJNR American Journal of Neuroradiology

Diabetic encephalopathy: An underexposed complication of diabetes mellitus

Nederlands Tijdschrift voor Geneeskunde

Magnetic resonance spectroscopy of pediatric brain

Topics Magnetic Resonance Imaging

Original article
Evaluation of in vivo cerebral metabolism on proton magnetic resonance spectroscopy in patients with impaired glucose tolerance and type 2 diabetes mellitus