Brain structure in people at ultra-high risk of psychosis, patients with first-episode schizophrenia, and healthy controls: a VBM study

Early intervention research in schizophrenia has suggested that brain structural alterations might be present in subjects at high risk of developing psychosis. The heterogeneity of regional effects of these changes, which is established in schizophrenia, however, has not been explored in prodromal or high-risk populations. We used high-resolution MRI and voxel-based morphometry (VBM8) to analyze grey matter differences in 43 ultra high-risk subjects for psychosis (meeting ARMS criteria, identified through CAARMS interviews), 24 antipsychotic-naïve first-episode schizophrenia patients and 49 healthy controls (groups matched for age and gender). Compared to healthy controls, resp., first-episode schizophrenia patients had reduced regional grey matter in left prefrontal, insula, right parietal and left temporal cortices, while the high-risk group showed reductions in right middle temporal and left anterior frontal cortices. When dividing the ultra-high-risk group in those with a genetic risk vs. those with attenuated psychotic symptoms, the former showed left anterior frontal, right caudate, as well as a smaller right hippocampus, and amygdala reduction, while the latter subgroup showed right middle temporal cortical reductions (each compared to healthy controls). Our findings in a clinical psychosis high-risk cohort demonstrate variability of brain structural changes according to subgroup and background of elevated risk, suggesting frontal and possibly also hippocampal/amygdala changes in individuals with genetic susceptibility. Heterogeneity of structural brain changes (as seen in schizophrenia) appears evident even at high-risk stage, prior to potential onset of psychosis.

In vivo detection of acute pain-induced changes of GABA+ and Glx in the human brain by using functional 1H MEGA-PRESS MR spectroscopy

In vivo(1)H MR spectroscopic detection of pain associated metabolic changes in the human brain may allow for an objective evaluation of the perceived pain intensity and assessment of the involved neurotransmitters. Ultimately, it may lead to a deeper understanding of the mechanisms that underlie neuronal pain processing. The present study reports results of time-resolved measurements of acute heat pain induced changes of the excitatory (Glx) and inhibitory (GABA+) neurotransmitter turnover in the anterior cingulate cortex (ACC) and occipital cortex (OC) by using (1)H MEGA-PRESS spectroscopy. In ACC and OC, the ratio Glx/tCr increased by median values of 21.5% (p < 0.001) and 15.7% (p < 0.001), respectively. At the same time, GABA+/tCr decreased by median values of 15.1% (p = 0.114) in ACC and 12.7% (p < 0.001) in OC. To our knowledge, this study demonstrates for the first time the possibility of quantifying pain-induced neurotransmitter changes in the brain by using functional (1)H MEGA-PRESS. The increase of Glx/tCr may be ascribed to an elevated glutamatergic turnover, while the decrease of GABA+/tCr may reflect reduced activity of the inhibitory system in ACC and OC during pain processing.

Interrelations of muscle functional MRI, diffusion-weighted MRI and (31) P-MRS in exercised lower back muscles

Exercise-induced changes of transverse proton relaxation time (T2 ), tissue perfusion and metabolic turnover were investigated in the lower back muscles of volunteers by applying muscle functional MRI (mfMRI) and diffusion-weighted imaging (DWI) before and after as well as dynamic (31) P-MRS during the exercise. Inner (M. multifidus, MF) and outer lower back muscles (M. erector spinae, ES) were examined in 14 healthy young men performing a sustained isometric trunk-extension. Significant phosphocreatine (PCr) depletions ranging from 30% (ES) to 34% (MF) and Pi accumulations between 95% (left ES) and 120%-140% (MF muscles and right ES) were observed during the exercise, which were accompanied by significantly decreased pH values in all muscles (∆pH ≈ -0.05). Baseline T2 values were similar across all investigated muscles (approximately 27 ms at 3 T), but revealed right-left asymmetric increases (T2 ,inc ) after the exercise (right ES/MF: T2 ,inc  = 11.8/9.7%; left ES/MF: T2 ,inc  = 4.6/8.9%). Analyzed muscles also showed load-induced increases in molecular diffusion D (p = .007) and perfusion fraction f (p = .002). The latter parameter was significantly higher in the MF than in the ES muscles both at rest and post exercise. Changes in PCr (p = .03), diffusion (p < .01) and perfusion (p = .03) were strongly associated with T2,inc , and linear mixed model analysis revealed that changes in PCr and perfusion both affect T2,inc (p < .001). These findings support previous assumptions that T2 changes are not only an intra-cellular phenomenon resulting from metabolic stress but are also affected by increased perfusion in loaded muscles.

MR-compatible pedal ergometer for reproducible exercising of the human calf muscle

A pneumatic MR-compatible pedal ergometer was designed to perform dynamic contraction exercises of the human calf muscle in a whole-body 3T MR scanner. The set-up includes sensors for monitoring mechanical parameters, such as pedal angle, cadence as well as applied force and power. Actual parameter values during the exercise were presented to the volunteer as a visual feedback to enable real-time self-adjustment of pedal deflection and cadence to the target reference value. Time-resolved dynamic (31)P-MR spectroscopic measurements of phosphocreatine (PCr), inorganic phosphate (Pi) and pH were performed in a pilot experiment before, during, and after the exercise by a single volunteer. Two different load strengths were applied in these experiments (15% and 25% of the maximum voluntary contraction, MVC). As expected, mechanical and metabolic parameters differed for the two load levels. Small variations of the cadence, power and metabolic changes (time constants of PCr depletion and Pi accumulation) during the experiments demonstrate a highly reproducible mechanical output by the volunteer mediated by the ergometer.

Superior temporal metabolic changes related to auditory hallucinations: a (31)P-MR spectroscopy study in antipsychotic-free schizophrenia patients

Structural deficits in the superior temporal cortex and transverse temporal gyri appear to be related to auditory hallucinations in schizophrenia, which are a key symptom of this disorder. However, the cellular and neurochemical underpinnings are poorly understood and hardly studied in vivo. We used (31)P-MRS (magnetic resonance spectroscopy) with chemical shift imaging to assess the association between left superior temporal cortex metabolism and severity of auditory hallucinations in 29 schizophrenia patients off antipsychotics. Hallucinations scores derived from the Scale for the Assessment of Positive Symptoms showed significant positive correlations with both measures of phospholipids (phosphomonoesters and phosphodiesters), and energy (inorganic phosphate and phosphocreatine, but not adenosine tri-phosphate) metabolism in left superior temporal gyrus/Heschl gyrus voxels. There was no correlation of metabolites in these regions with formal thought disorder, a symptom also linked to superior temporal pathology, thus suggesting symptom specificity. Our findings provide a link between established structural deficits and neurochemical pathology related to membrane pathology and markers of general metabolic turnover.

Effects of olanzapine on 31P MRS metabolic markers in schizophrenia

Antipsychotic drug action might include mechanisms related to normalising phospholipid and high-energy metabolism. We applied brain metabolic imaging with (31)P magnetic resonance spectroscopy ((31)P MRS) and two-dimensional chemical shift imaging to assess changes of metabolism of phospholipids and high-energy phosphates in schizophrenia patients at baseline (four antipsychotic-naïve and three off antipsychotics) and at follow-up, after 6 weeks of treatment with olanzapine. Results indicate a significant increase of adenosine-triphosphate (ATP) in the right inferior temporal cortex and a trend towards ATP decrease in the left cerebellum. This suggests a shift in high-energy phosphates (rather than phospholipids), possibly related to normalisation of functioning in these areas.

Antipsychotic drug effects on left prefrontal phospholipid metabolism: a follow-up 31P-2D-CSI study of haloperidol and risperidone in acutely ill chronic schizophrenia patients

INTRODUCTION

³¹Phosphorous magnetic resonance spectroscopy (2D chemical shift imaging, CSI) allows multiregional study of membrane phospholipids and high-energy phosphates in vivo. Increased membrane lipid turnover and impaired energy supply have repeatedly been shown in first-episode schizophrenia patients, and might be a target of drug actions other than dopamine receptors. Here, we explored differential metabolic effects of a typical vs. an atypical antipsychotic on brain phospholipids.

METHODS

We applied 2D-CSI MR spectroscopy in 17 recurrent-episode schizophrenia patients off antipsychotics at baseline and at follow-up after 6 weeks, during which 7 patients were treated with haloperidol (10-16 mg/d) and 10 with risperidone (4-6 mg/d). Psychopathology changes were assessed using PANSS, BPRS and CGI scores.

RESULTS

Follow-up analysis using repeated measure ANOVA revealed different effects of both antipsychotic agents: while risperidone generally increased metabolite levels, haloperidol showed a tendency to decrease them. This diverging effect was significant for ATP levels in the left lateral frontal cortex. Furthermore, risperidone increased ATP in the left dorsolateral prefrontal cortex, left anterior temporal cortex and left insular cortex, basal ganglia, and anterior cerebellum, along with left frontal and prefrontal increase of PCr, PDE and PME in these brain regions.

CONCLUSION

Risperidone seems to stimulate neuronal and synaptic phospholipid remodeling in left frontal and prefrontal regions, and to a lesser extent also in temporal and insular cortices. We discuss these effects with respect to clinical effects on negative and cognitive symptoms, as well as interaction of phospholipid metabolism with glutamatergic neurotransmission.

Effect of contrast agent on the results of in vivo ¹H MRS of breast tumors - is it clinically significant?

Choline (Cho) signal identification and quantification in (1)H MRS are used in breast cancer diagnosis. However, an influence of the gadolinium-based contrast agent on the Cho amplitude has been reported experimentally. This study aims to identify the impact of gadolinium-based contrast agents on Cho detection and quantification in postcontrast breast MRS. Consecutive patients were recruited prospectively and randomly allocated to two groups. Group A received a neutral (gadolinium diethylenetriaminepentaacetic acid bis-methylamide) and group B an ionic (gadolinium diethylenetriaminepentaacetic acid) contrast agent, each at a dosage of 0.1 mmol/kg. First, the presence of Cho was identified visually. Then, the normalized Cho intensity in malignant lesions was quantified. Multivariate analysis was applied to identify independent influencing factors on Cho. Sixty-three lesions were investigated [A, n = 34; B, n = 29; 43 malignant (one bilaterally malignant), 20 benign]. Cho was identified visually in 14 of 20 malignant tumors in group A and 12 of 22 malignant tumors in group B (p = 0.477). Normalized Cho differed significantly (p = 0.001) between groups A (mean, 26.8 ± 6.0 AU) and B (mean, 18.2 ± 12.5 AU). No linewidth differences were identified (p > 0.05). Multivariate analysis revealed only group membership (A versus B) as an independent predictor of Cho (p = 0.017). The results suggest stronger negative effects of an ionic relative to a neutral gadolinium-based contrast agent on breast tumor MRS in vivo. These results should be considered when conducting and comparing quantitative Cho measurements in the breast.

31P-MR spectroscopy in monozygotic twins discordant for schizophrenia / schizoaffective disorders

Introduction

Magnetic resonance spectroscopy (MRS) using 2D-chemical shift imaging (CSI) allows the quantification of brain metabolites in vivo across several brain regions. Previous studies using 31Phosphorus MRS have shown alterations of phospholipid compounds and high-energy phosphates like ATP in prefrontal and temporal regions in schizophrenia.

Aim

We used a monozygotic (MZ) co-twin study design to examine whether metabolic alterations are due to genetic effects or the expression of disease phenotype.

Methods

31P-MRS with 2D-CSI was applied at 1.5 T in 8 MZ twin pairs (3 male, 5 female; mean age 33.8, SD 13.1) discordant for a DSM-IV and ICD-10 diagnosis of either schizophrenia (4 pairs), acute schizophreniform psychosis (1 pair), or schizoaffective disorder (3 pairs)) and 8 age- and gender-matched healthy control MZ twins (mean age: 32.9, SD 14.3). Metabolic profiles were compared using oneway ANOVAs.

Results

Voxel-wise comparisons between affected twins and healthy control twins revealed increased PDE concentrations in right cerebellum and increased ATP concentrations in right frontal cortex, insular cortex and bilateral cerebellum. Alterations in energy metabolism were shown in healthy co-twins compared to healthy control twins with an increase in PDE concentrations in right posterior lateral cerebellum, an increase in ATP concentration in left lateral prefrontal cortex as well as left anterior/ lateral temporal cortex and an increase in PCr in left lateral prefrontal cortex.

Conclusions

Our findings suggest that metabolic alterations in schizophrenia result from a combination of both genetic effects and disease manifestation, which can be further explored in larger twin samples.

WITHDRAWN: Erratum to "1H-MR spectroscopic detection of metabolic changes in pain processing brain regions in the presence of non-specific chronic low back pain" [NeuroImage 54/2 (2011) 1315-1323]

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.neuroimage.2010.11.069. The duplicate article has therefore been withdrawn.

1H-MR spectroscopic detection of metabolic changes in pain processing brain regions in the presence of non-specific chronic low back pain

Reliable detection of metabolic changes in the brain in vivo induced by chronic low back pain may provide improved understanding of neurophysiological mechanisms underlying the manifestation of chronic pain. In the present study, absolute concentrations of N-acetyl-aspartate (NAA), creatine (Cr), total choline (tCho), myo-inositol (mI), glutamate (Glu) and glutamine (Gln) were measured in three different pain processing cortical regions (anterior insula, anterior cingulate cortex, and thalamus) of ten patients with non-specific chronic low back pain by means of proton MR spectroscopy ((1)H-MRS) and compared to matched healthy controls. Significant decrease of Glu was observed in the anterior cingulate cortex of patients. Patients also revealed a trend of decreasing Gln concentrations in all investigated brain areas. Reductions of NAA were observed in the patient group in anterior insula and in anterior cingulated cortex, whereas mI was reduced in anterior cingulated cortex and in thalamus of patients. Reduced concentrations of Glu and Gln may indicate disordered glutamatergic neurotransmission due to prolonged pain perception, whereas decrease of NAA and mI may be ascribed to neuron and glial cell loss. No significant changes were found for Cr. The morphological evaluation of anatomic brain data revealed a significantly decreased WM volume of 17% (p<0.05) as well as a non significant trend for GM volume increase in the anterior insula of patients.

Time-resolved functional 1H MR spectroscopic detection of glutamate concentration changes in the brain during acute heat pain stimulation

Non-invasive in vivo detection of cortical neurotransmitter concentrations and their changes in the presence of pain may help to better understand the biochemical principles of pain processing in the brain. In the present study acute heat pain related changes of the excitatory neurotransmitter glutamate were investigated in the anterior insular cortex of healthy volunteers by means of time-resolved functional proton magnetic resonance spectroscopy ((1)H-MRS). Dynamic metabolite changes were estimated with a temporal resolution of five seconds by triggering data acquisition to the time course of the cyclic stimulus application. An overall increase of glutamate concentration up to 18% relative to the reference non-stimulus condition was observed during the application of short pain stimuli.

[Quantitation of glutamate in the brain by using MR proton spectroscopy at 1.5 T and 3 T]

PURPOSE

The influence of different magnetic field strengths on the quantification of glutamate was experimentally investigated by means of IN VITRO and IN VIVO (1)H-MR spectroscopic measurements at 1.5 T and 3 T.

MATERIALS AND METHODS

In vitro (1)H-MR measurements of aqueous solutions of NAA, glutamate, glutamine and GABA were performed on two clinical MR scanners at 1.5 T and 3 T using a single voxel PRESS sequence (TR/TE = 10 000 / 30 ms). IN VITRO brain measurements were also performed at both field strengths using a PRESS 2D- (1)H-CSI-sequence (TR/TE = 5000 / 30 ms) in 6 volunteers. Spectra at 1.5 T and 3 T were compared with respect to the overlap of the single compound spectra and the deviations between estimated and nominally adjusted concentrations. In vivo spectra at both field strengths were compared with respect to SNR (Glu), line width and Cramer-Rao values of the estimated glutamate intensities by using the LCModel. For the thalamus, insular and parietal cortex mean Glu/tCr ratios were estimated and compared between 1.5 T and 3 T as well as with corresponding values in the literature.

RESULTS

In general, an improved separation of signal maxima was observed in the IN VITRO spectra at 3 T. Except for GABA, all IN VITRO concentrations estimated at 3 T revealed lower deviations from their adjusted nominal concentration compared to 1.5 T: NAA (1.5 T: -5.5 %, 3 T: 0.7 %), glutamate (1.5 T: -18.1 %, 3 T: 12.3 %), glutamine (1.5 T: 44.8 %, 3 T: 9.2 %), GABA (1.5 T: - 24.8 %, 3 T: 33.8 %). The SNR of IN VIVO spectra at 3 T was nearly doubled compared to 1.5 T. The mean number of voxels with %SD (Glu)< 20 was distinctly lower at 1.5 T (53 %) than at 3 T (80 %). Estimated Glu/tCr ratios for thalamus, insular and parietal cortex lay in the upper range of the literature values.

CONCLUSION

The results indicate that the advantageous distribution of signal maxima at 3 T allows an improved separation of the individual spectra. Both the higher initial magnetization at 3 T and the improved sensitivity of the phased array matrix coil used in the 3 T study result in an increased SNR, which leads to better reliability of the individual detection as well as a more accurate quantification of glutamate.