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Shigemura T, Kishida S, Eguchi Y, Ohtori S, Nakamura J, Kojima M, Masuda Y, Takahashi K. Proton magnetic resonance spectroscopy of the thalamus in patients with osteoarthritis of the hip. Bone Joint Res 2012. [DOI: 10.1302/2046-3758.1.1.2000018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The purpose of this study was to assess N-acetyl aspartate changes in the thalamus in patients with osteoarthritis of the hip using proton magnetic resonance spectroscopy. Methods Nine patients with osteoarthritis of the hip (symptomatic group, nine women; mean age 61.4 years (48 to 78)) and nine healthy volunteers (control group, six men, three women; mean age 30.0 years (26 to 38)) underwent proton magnetic resonance spectroscopy to assess the changes of N-acetyl aspartate in the thalamus. Results The ratio of N-acetyl aspartate to creatine plus phosphocreatine in the thalamus contralateral to the symptomatic hip in patients with osteoarthritis of the hip was significantly lower than the ratio of N-acetyl aspartate to creatine plus phosphocreatine in the thalamus in the control group (1.611 (1.194 to 1.882) vs 1.355 (1.043 to 1.502), p < 0.001). And, a strong negative correlation was detected between the ratio of N-acetyl aspartate to creatine plus phosphocreatine in the thalamus contralateral to the symptomatic hip in patients with osteoarthritis of the hip and pain duration (r = -0.83, p = 0.018). Conclusions We evaluated the ratio of N-acetyl aspartate to creatine plus phosphocreatine in the thalamus of patients with osteoarthritis of the hip by using proton magnetic resonance spectroscopy. We concluded that the ratio of N-acetyl aspartate to creatine plus phosphocreatine in the thalamus contralateral to the symptomatic hip in patients with osteoarthritis of the hip were significantly lower than those in the thalamus of the control group, and that pain duration was strongly related to the decrease of the ratio of N-acetyl aspartate to creatine plus phosphocreatine.
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Affiliation(s)
- T. Shigemura
- Graduate School of Medicine, Chiba University, Department
of Orthopaedic Surgery, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - S. Kishida
- Graduate School of Medicine, Chiba University, Department
of Orthopaedic Surgery, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Y. Eguchi
- Matsudo City Hospital, 4005
Kamihongo, Matsudo, 271-8511, Japan
| | - S. Ohtori
- Graduate School of Medicine, Chiba University, Department
of Orthopaedic Surgery, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - J. Nakamura
- Graduate School of Medicine, Chiba University, Department
of Orthopaedic Surgery, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - M. Kojima
- Chiba University Hospital, Department
of Radiology, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Y. Masuda
- Chiba University Hospital, Department
of Radiology, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - K. Takahashi
- Graduate School of Medicine, Chiba University, Department
of Orthopaedic Surgery, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Modrego PJ, Fayed N. Longitudinal magnetic resonance spectroscopy as marker of cognitive deterioration in mild cognitive impairment. Am J Alzheimers Dis Other Demen 2011; 26:631-6. [PMID: 22323830 PMCID: PMC10845573 DOI: 10.1177/1533317511433809] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Amnestic mild cognitive impairment (MCI) is highly predictive of Alzheimer's disease but the pace of deterioration varies across patients. We hypothesize that magnetic resonance spectroscopy (MRS) could be a useful surrogate marker to monitor progression of cognitive impairment in patients with amnestic MCI. METHODS A cohort of patients with amnestic MCI underwent single-voxel (1)H-MRS at baseline and at 2-year follow-up. We included 16 patients who converted to dementia of Alzheimer type and other 16 who did not. Changes in cognitive function were compared with the changes in the metabolite levels assessed in vivo. RESULTS At baseline the converters had lower mean N-acetyl-aspartate (NAA)/creatine (Cr) ratios in the posteromedial parietal cortex (1.41) than nonconverters (1.47). Most patients tended to lose points in the Mini-Mental test after 2-year follow-up in parallel with decreases in NAA levels (r = .53; P = .002) in the posteromedial parietal cortex as well. The converters showed significant decreases in NAA levels and Cr ratios, whereas the nonconverters did not (P = .001 and .02, respectively) in this area. CONCLUSION We conclude that MRS is a technique sensitive enough to monitor cognitive changes and progression to dementia in patients with amnestic MCI.
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Affiliation(s)
- Pedro J Modrego
- Department of Neurology, Hospital Miguel Servet, Zaragoza, Spain.
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Caramelli P, Teixeira AL, Buchpiguel CA, Lee HW, Livramento JA, Fernandez LL, Anghinah R. Diagnosis of Alzheimer's disease in Brazil: Supplementary exams. Dement Neuropsychol 2011; 5:167-177. [PMID: 29213741 PMCID: PMC5619476 DOI: 10.1590/s1980-57642011dn05030004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 06/22/2011] [Indexed: 11/21/2022] Open
Abstract
This article presents a review of the recommendations on supplementary exams employed for the clinical diagnosis of Alzheimer's disease (AD) in Brazil published in 2005. A systematic assessment of the consensus reached in other countries, and of articles on AD diagnosis in Brazil available on the PUBMED and LILACS medical databases, was carried out. Recommended laboratory exams included complete blood count, serum creatinine, thyroid stimulating hormone (TSH), albumin, hepatic enzymes, Vitamin B12, folic acid, calcium, serological reactions for syphilis and serology for HIV in patients aged younger than 60 years with atypical clinical signs or suggestive symptoms. Structural neuroimaging, computed tomography or - preferably - magnetic resonance exams, are indicated for diagnostic investigation of dementia syndrome to rule out secondary etiologies. Functional neuroimaging exams (SPECT and PET), when available, increase diagnostic reliability and assist in the differential diagnosis of other types of dementia. The cerebrospinal fluid exam is indicated in cases of pre-senile onset dementia with atypical clinical presentation or course, for communicant hydrocephaly, and suspected inflammatory, infectious or prion disease of the central nervous system. Routine electroencephalograms aid the differential diagnosis of dementia syndrome with other conditions which impair cognitive functioning. Genotyping of apolipoprotein E or other susceptibility polymorphisms is not recommended for diagnostic purposes or for assessing the risk of developing the disease. Biomarkers related to the molecular alterations in AD are largely limited to use exclusively in research protocols, but when available can contribute to improving the accuracy of diagnosis of the disease.
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Affiliation(s)
- Paulo Caramelli
- Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Antonio Lúcio Teixeira
- Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | | | - Hae Won Lee
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo and Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - José Antônio Livramento
- Medical Investigation Laboratory (LIM 15), School of Medicine, University of São Paulo, São Paulo SP, Brazil
| | - Liana Lisboa Fernandez
- Department of Basic Health Sciences, Federal University of Health Sciences Foundation of Porto Alegre, Porto Alegre RS, Brazil
| | - Renato Anghinah
- Referral Center for Cognitive Disorders (CEREDIC), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo SP, Brazil
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Current strategies in the discovery of small-molecule biomarkers for Alzheimer’s disease. Bioanalysis 2011; 3:1121-42. [DOI: 10.4155/bio.11.62] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
With the number of patients suffering from Alzheimer’s disease rapidly increasing, there is a major requirement for an accurate biomarker capable of diagnosing the disease early. Much of the research is focused on protein and genetic approaches; however, small molecules may provide viable marker molecules. Examples that support this approach include known abnormalities in lipid metabolism, glucose utilization and oxidative stress, which have been demonstrated in patients suffering from the disease. Therefore, by-products of this irregular metabolism may provide accurate biomarkers. In this review we present the current approaches previously published in the literature used to investigate potential small-molecule and metabolite markers, and report their findings. A wide range of techniques are discussed, including separation approaches (LC, GC and CE), magnetic resonance technologies (NMR and magnetic resonance spectroscopy), and immunoassays.
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Modrego PJ, Fayed N, Sarasa M. Magnetic resonance spectroscopy in the prediction of early conversion from amnestic mild cognitive impairment to dementia: a prospective cohort study. BMJ Open 2011; 1:e000007. [PMID: 22021723 PMCID: PMC3191389 DOI: 10.1136/bmjopen-2010-000007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) of an amnestic type is a common condition in older people and highly predictive of Alzheimer's disease (AD). To date, there is no clear consensus regarding the best antecedent biomarker to predict early conversion to AD. OBJECTIVE The aim of the study is to demonstrate that (1)H magnetic resonance spectroscopy (MRS) of the brain in MCI patients may predict early conversion to dementia within the 2-year period after baseline assessment. METHODS A cohort of patients fulfilling the criteria of amnestic MCI were enrolled consecutively. At baseline the patients underwent neuropsychological examination, standard blood tests and APOE genotype. (1)H-MRS (1.5 T) of the brain was carried out by exploring two areas: the posteromedial bilateral parietal lobe and left medial occipital lobe. The patients were followed up to detect conversion to probable AD according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association group criteria. RESULTS After a 2-year follow-up, 27 (38%) patients converted to AD. The mean N-acetyl-aspartate/creatine (NAA/Cr) ratio in the posteromedial bilateral parietal cortex was 1.38 in converters versus 1.49 in non-converters (p<0.0001). An NAA/Cr ratio equal to or lower than 1.43 in this area predicted conversion to probable AD at 74.1% sensitivity and 83.7% specificity (area under the curve: 0.84; 95% CI 0.73 to 0.92). The cross-validated accuracy of classification was 82%, which reaches 85% when the APOE4 genotype and memory test are included in the analysis. In the left medial occipital lobe, the predictive value was somewhat lower with 85.2% sensitivity and 61.4% specificity (area under the curve: 0.8; 95% CI 0.69 to 0.89). Neither the APOE4 genotype nor leuco-araiosis was predictive of conversion to dementia. CONCLUSION MRS is a valuable biomarker to predict early conversion to dementia in patients with amnestic MCI.
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Affiliation(s)
- Pedro J Modrego
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
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Abstract
Magnetic resonance spectroscopy (MRS) and the related technique of magnetic resonance spectroscopic imaging (MRSI) are widely used in both clinical and preclinical research for the non-invasive evaluation of brain metabolism. They are also used in medical practice, although their ultimate clinical value continues to be a source of discussion. This chapter reviews the general information content of brain spectra and commonly used protocols for both MRS and MRSI and also touches on data analysis methods and quantitation. The main focus is on proton MRS for application in humans, but many of the methods are also applicable to other nuclei and studies of animal models as well.
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Abstract
With an increasingly aging population we are faced with the problem of an increasing number of dementia patients. In addition to clinical, neuropsychological and laboratory procedures, MRI plays an important role in the early diagnosis of dementia. In addition to various morphological changes functional changes can also help in the diagnosis and differential diagnosis of dementia. Overall the diagnosis of dementia can be improved by using parameters from MR spectroscopy. This article focuses on MR spectroscopic changes in the physiological aging process as well as on changes in mild cognitive impairment a precursor of Alzheimer's dementia, in Alzheimer's dementia, frontotemporal dementia, vascular dementia and Lewy body dementia.
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Affiliation(s)
- T Hauser
- Abteilung E010, Radiologie, Deutsches Krebsforschungszentrum (DKFZ) Heidelberg , Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland.
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Sood S, Gupta A, Tsiouris AJ. Advanced magnetic resonance techniques in neuroimaging: diffusion, spectroscopy, and perfusion. Semin Roentgenol 2010; 45:137-46. [PMID: 20171345 DOI: 10.1053/j.ro.2009.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Choi JK, Carreras I, Dedeoglu A, Jenkins BG. Detection of increased scyllo-inositol in brain with magnetic resonance spectroscopy after dietary supplementation in Alzheimer's disease mouse models. Neuropharmacology 2010; 59:353-7. [PMID: 20399219 DOI: 10.1016/j.neuropharm.2010.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 03/12/2010] [Accepted: 03/18/2010] [Indexed: 11/26/2022]
Abstract
There is evidence that inositol isomers may help protect against formation of toxic fibrils of Abeta fragments in Alzheimer's disease mouse models. Scyllo-inositol is one of the more promising inositol isomers for the potential treatment of Alzheimer's disease (AD) and can be detected using MRS in human subjects. In this manuscript we demonstrate using MRS, in two different mouse models of AD (APP x PS1 and APP x PS1 x tau), that we could detect increased scyllo-inositol in the hippocampus and frontal cortex in mice fed water supplemented with 16.5 mg/L of scyllo-inositol equivalent to about 3.3 mg/kg/day. We used both brain extracts using solution MRS as well as intact brain tissue using high resolution magic angle spinning (HRMAS) to ensure that any membrane-associated scyllo-inositol would be detected. By brain extracts we detected a 3.0 fold increase in scyllo-inositol in the scyllo-fed AD mice compared to normal diet (p < 0.001). Using HRMAS we detected a 2.2-2.4-fold increase in scyllo-inositol (p < 0.001). Scyllo-inositol treatment was associated with an increase in glutamine in hippocampus. The concentrations of scyllo-inositol were higher in the hippocampus than in the frontal cortex. Mice have a smaller concentration of scyllo-inositol than humans (ca. 100 microM vs. 500 microM in humans). Given the ease with which scyllo-inositol can be measured in human MRS data with high signal to noise ratios, these data suggest that MRS will prove useful for evaluation of inositol treatment trials in AD subjects.
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Affiliation(s)
- Ji-Kyung Choi
- A A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Boston, MA 02114, USA.
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Park EJ, Lyra KP, Lee HW, Caramelli P, Otaduy MCG, Leite CC. Correlation between hippocampal volumes and proton magnetic resonance spectroscopy of the posterior cingulate gyrus and hippocampi in Alzheimer's disease. Dement Neuropsychol 2010; 4:109-113. [PMID: 29213672 PMCID: PMC5619168 DOI: 10.1590/s1980-57642010dn40200006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Prior studies have reported hippocampal volume loss, decrease in
N-Acetylaspartate (NAA) concentration and increased myo-inositol (mI)
concentration in patients with Alzheimer’s disease (AD). The purpose of this
study was to evaluate hippocampal volumes of AD patients and their correlation
with metabolic changes detected by proton spectroscopy (1H MRS) of hippocampal
formations and the posterior cingulate region.
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Affiliation(s)
- Eun Joo Park
- Department of Radiology, School of Medicine of the University of São Paulo, São Paulo SP, Brazil
| | - Katarina P Lyra
- Department of Radiology, School of Medicine of the University of São Paulo, São Paulo SP, Brazil
| | - Hae Won Lee
- Department of Radiology, School of Medicine of the University of São Paulo, São Paulo SP, Brazil
| | - Paulo Caramelli
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Maria C G Otaduy
- Department of Radiology, School of Medicine of the University of São Paulo, São Paulo SP, Brazil
| | - Claudia Costa Leite
- Department of Radiology, School of Medicine of the University of São Paulo, São Paulo SP, Brazil
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1H-MRS for the diagnosis of acute disseminated encephalomyelitis: insight into the acute-disease stage. Pediatr Radiol 2010; 40:106-13. [PMID: 19847418 DOI: 10.1007/s00247-009-1372-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/23/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute disseminated encephalomyelitis (ADEM) is a demyelinating disorder of the central nervous system (CNS). Differentiating ADEM from other inflammatory disorders, such as multiple sclerosis, is not always conclusive using conventional MRI. OBJECTIVE To evaluate longitudinal magnetic resonance spectroscopy (MRS) changes that distinguish ADEM from other inflammatory disorders. MATERIALS AND METHODS MRI/MRS scans were performed in seven patients with ADEM during the acute and chronic phases of the disease. RESULTS Partial recovery was detected between the acute and chronic phases in choline/creatine ratio. Major elevation of lipids and reduction in myo-inositol/creatine ratio was detected in all patients during the acute phase, followed by a reduction in lipids peak and elevation above normal in myo-inositol/creatine ratio during the chronic phase. CONCLUSION Consistent and unique MRS changes in metabolite ratios between the acute and chronic presentations of the disease were found. To the best of our knowledge, these patterns have not been described in other inflammatory disorders and might assist in the early diagnosis of ADEM.
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Modrego PJ, Fayed N, Errea JM, Rios C, Pina MA, Sarasa M. Memantine versus donepezil in mild to moderate Alzheimer's disease: a randomized trial with magnetic resonance spectroscopy. Eur J Neurol 2009; 17:405-12. [PMID: 19874395 DOI: 10.1111/j.1468-1331.2009.02816.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE To compare memantine with the most prescribed cholinesterase inhibitor (donepezil) from a clinical viewpoint when administered in early phases of Alzheimer disease (AD), and to find out whether memantine may produce changes in brain metabolite concentrations in comparison with donepezil. METHODS In this comparative rater-blinded parallel group randomized trial we recruited a consecutive sample of patients with probable mild to moderate AD. At baseline we carried out neuropsychological assessment with mini-mental, Clinical Dementia Rating Scale (CDR), Blessed Dementia Rating Scale, Alzheimer's Disease Assessment Scale, cognitive part (ADAS-cog), neuropsychiatric inventory (NPI), and disability assessment for dementia (DAD), as well as (1)H magnetic resonance spectroscopy (MRS) in several areas of the brain. Patients were randomized to receive either donepezil or memantine for 6 months. After this elapse of time we repeated the same procedures and observed the changes in clinical scales (ADAS-cog, NPI, DAD), as well as the changes in metabolite levels in every area of exploration (temporal, pre-frontal, posterior cingulated (PCG), and occipital), especially those of N-acetyl-aspartate (NAA) which is regarded as a surrogate marker of neuronal density. RESULTS A total of sixty-three patients completed the trial. We did not see significant differences in clinical scales and metabolite levels between those on donepezil (n = 32) and those on memantine (n = 31). In general, more patients worsened than improved on either of the drugs. The changes in the NAA/creatine ratio in the PCG correlated significantly with the changes in the ADAS-cog (P = 0.004). CONCLUSIONS Donepezil and memantine have similar modest clinical and spectroscopic effect on mild to moderate AD. MRS could be useful to monitor progression of the disease.
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Affiliation(s)
- P J Modrego
- Department of Neurology, Hospital Miguel Servet, Zaragoza, Spain.
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Cuellar H, Gómez-Ramos P, Riascos R, De Alba L. Neuroimaging Studies in Alzheimer's Disease. Neuroradiol J 2009; 22:525-33. [DOI: 10.1177/197140090902200503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 10/07/2009] [Indexed: 11/16/2022] Open
Abstract
Alzheimer's Disease (AD) is a progressive neurodegenerative disease associated with memory loss and gradual behavioral, functional and cognitive impairment. Conventional imaging studies, such as magnetic resonance or computed tomography have played a secondary role in AD diagnosis: While other causes of memory loss and cognitive deficit can be evaluated by these imaging methods, AD structural changes are not detected until very late in the course of the disease. Recent and more precise techniques have been developed to detect subtle changes not visualized with those imaging methods. This article presents a review of the neuroimaging techniques used as a diagnostic aid for AD.
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Affiliation(s)
- H. Cuellar
- Department of Radiology, “José E. González” University Hospital, Universidad Autónoma de Nuevo León; Monterrey, México
| | - P. Gómez-Ramos
- Department of Anatomy, Histology and Neurosciences, Faculty of Medicine, Universidad Autónoma de Madrid; Madrid, Spain
| | - R. Riascos
- Department of Radiology, The University of Texas Medical Branch; Galveston, TX, USA
| | - L. De Alba
- Department of Radiology, “José E. González” University Hospital, Universidad Autónoma de Nuevo León; Monterrey, México
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Guerrini L, Belli G, Mazzoni L, Foresti S, Ginestroni A, Della Nave R, Diciotti S, Mascalchi M. Impact of cerebrospinal fluid contamination on brain metabolites evaluation with 1H-MR spectroscopy: a single voxel study of the cerebellar vermis in patients with degenerative ataxias. J Magn Reson Imaging 2009; 30:11-7. [PMID: 19557841 DOI: 10.1002/jmri.21804] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To investigate the impact of cerebrospinal fluid (CSF) contamination on metabolite evaluation in the superior cerebellar vermis with single-voxel (1)H-MRS in normal subjects and patients with degenerative ataxias. MATERIALS AND METHODS Twenty-nine healthy volunteers and 38 patients with degenerative ataxias and cerebellar atrophy were examined on a 1.5 Tesla scanner. Proton spectra of a volume of interest placed in the superior vermis were acquired using a four TE PRESS technique. We calculated N-acetyl aspartate (NAA)/creatine (Cr), choline (Cho)/Cr, and NAA/Cho ratios, T(2) relaxation times and concentrations of the same metabolites using the external phantom method. Finally, concentrations were corrected taking into account the proportion of nervous tissue and CSF, that was determined as Volume Fraction (VF). RESULTS In healthy subjects, a significant difference was observed between metabolite concentrations with and without correction for VF. As compared to controls, patients with ataxias showed significantly reduced NAA/Cr and NAA concentrations, while only corrected Cr concentration was significantly increased. The latter showed an inverse correlation with VF. CONCLUSION CSF contamination has a not negligible effect on the estimation of brain metabolites. The increase of Cr concentration in patients with cerebellar atrophy presumably reflects the substitutive gliosis which takes place along with loss of neurons.
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Affiliation(s)
- Laura Guerrini
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Choi JK, Jenkins BG, Carreras I, Kaymakcalan S, Cormier K, Kowall NW, Dedeoglu A. Anti-inflammatory treatment in AD mice protects against neuronal pathology. Exp Neurol 2009; 223:377-84. [PMID: 19679126 DOI: 10.1016/j.expneurol.2009.07.032] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 07/17/2009] [Accepted: 07/23/2009] [Indexed: 11/25/2022]
Abstract
Prior studies suggest that non-steroidal anti-inflammatory drugs (NSAIDs) may lower the incidence of Alzheimer's disease (AD) and delay onset or slow progression of symptoms in mouse models of AD. We examined the effects of chronic NSAID treatment in order to determine which elements of the pathological features might be ameliorated. We compared the effects of the NSAIDs ibuprofen and celecoxib on immunohistological and neurochemical markers at two different ages in APPxPS1 mice using measurements of amyloid plaque deposition, Abeta peptide levels, and neurochemical profiles using magnetic resonance spectroscopy (MRS). At 6 months of age, few neurochemical changes were observed between PSAPP mice and WT mice using MRS. Ibuprofen, but not celecoxib, treatment significantly decreased the Abeta(42/40) ratio in frontal cortex at 6 months, but overall amyloid plaque burden was unchanged. Consistent with prior findings in mouse models, at 17 months of age, there was a decrease in the neuronal markers NAA and glutamate and an increase in the astrocytic markers glutamine and myo-inositol in AD mice compared to WT. Ibuprofen provided significant protection against NAA and glutamate loss. Neither of the drugs significantly affected myo-inositol or glutamine levels. Both ibuprofen and celecoxib lowered plaque burden without a significant effect on Abeta(1-42) levels. NAA levels significantly correlated with plaque burden. These results suggest that selective NSAIDs (ibuprofen and possibly celecoxib) treatment can protect against the neuronal pathology.
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Affiliation(s)
- Ji-Kyung Choi
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Long LL, Li XR, Huang ZK, Jiang YM, Fu SX, Zheng W. Relationship between changes in brain MRI and (1)H-MRS, severity of chronic liver damage, and recovery after liver transplantation. Exp Biol Med (Maywood) 2009; 234:1075-85. [PMID: 19546351 DOI: 10.3181/0903-rm-118] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) and (1)H magnetic resonance spectroscopy ((1)H-MRS) have been used in clinics for diagnosis of chronic liver diseases. This study was designed to investigate the relationship between MRI/MRS outcomes and the severity of liver damage. Of 50 patients examined, the MRI signal intensity in the globus pallidus as determined by pallidus index (PI) increased as the disease severity (scored by Child Pugh ranking) worsened (r = 0.353, P < 0.05). The changes in PI values were also linearly associated with Mn concentrations in whole blood (MnB) (r = 0.814, P < 0.01). MRS analysis of four major brain metabolites (i.e., Cho, mI, Glx, and NAA) revealed that the ratios of Cho/Cr and mI/Cr in cirrhosis and CHE patients were significantly decreased in comparison to controls (P < 0.05), whereas the ratio of Glx/Cr was significantly increased (P < 0.05). The Child Pugh scores significantly correlated with mI/Cr (-0.484, P < 0.01) and Glx (0.369, P < 0.05), as well as MnB (0.368, P < 0.05), but not with other brain metabolites. Three patients who received a liver transplant experienced normalization of brain metabolites within 3 months of post-transplantation; the MR imaging of Mn in the globus pallidus completely disappeared 5 months after the surgery. Taken together, this clinical study, which combined MRI/MRS analysis, autopsy exam and liver transplant, clearly demonstrates that liver injury-induced brain Mn accumulation can reversibly alter the homeostasis of brain metabolites Cho, mI and Glx. Our data further suggest that liver transplantation can restore normal brain Mn levels.
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Affiliation(s)
- Li-Ling Long
- Department of Radiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
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Kantarci K, Petersen RC, Przybelski SA, Weigand SD, Shiung MM, Whitwell JL, Negash S, Ivnik RJ, Boeve BF, Knopman DS, Smith GE, Jack CR. Hippocampal volumes, proton magnetic resonance spectroscopy metabolites, and cerebrovascular disease in mild cognitive impairment subtypes. ACTA ACUST UNITED AC 2009; 65:1621-8. [PMID: 19064749 DOI: 10.1001/archneur.65.12.1621] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although a majority of patients with amnestic mild cognitive impairment (aMCI) progress to Alzheimer disease, the natural history of nonamnestic MCI (naMCI) is less clear. Noninvasive imaging surrogates for underlying pathological findings in MCI would be clinically useful for identifying patients who may benefit from disease-specific treatments at the prodromal stage of dementia. OBJECTIVE To determine the characteristic magnetic resonance imaging (MRI) and proton MR spectroscopy (1H MRS) profiles of MCI subtypes. DESIGN Case-control study. SETTING Community-based sample at a tertiary referral center. PATIENTS Ninety-one patients with single-domain aMCI, 32 patients with multiple-domain aMCI, 20 patients with single- or multiple-domain naMCI, and 100 cognitively normal elderly subjects frequency-matched by age and sex. MAIN OUTCOME MEASURES Posterior cingulate gyrus 1H MRS metabolite ratios, hippocampal volumes, and cerebrovascular disease on MRI. RESULTS Patients with single-domain aMCI were characterized by small hippocampal volumes and elevated ratios of myo-inositol to creatine levels. Patients with naMCI on average had normal hippocampal volumes and 1H MRS metabolite ratios, but a greater proportion (3 of 20 patients [15%]) had cortical infarctions compared with patients with single-domain aMCI (6 of 91 [7%]). For characterization of MCI subtypes, 1H MRS and structural MRI findings were complementary. CONCLUSIONS The MRI and 1H MRS findings in single-domain aMCI are consistent with a pattern similar to that of Alzheimer disease. Absence of this pattern on average in patients with naMCI suggests that cerebrovascular disease and other neurodegenerative diseases may be contributing to the cognitive impairment in many individuals with naMCI.
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Affiliation(s)
- Kejal Kantarci
- Department of Diagnostic Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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68
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Arana E, Martines-Bisbal MC, Celda B. Dementia spectroscopy and diagnostic yield. Br J Radiol 2009; 82:172; author reply 172. [DOI: 10.1259/bjr/18917365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
This article resumes on a selected set of topics and collects promising and recent research advances in the field of multimodal temporal data analysis, high-field magnetic resonance spectroscopy, trends in computer-aided diagnosis and advances in cardiac diagnostic imaging. The first section briefly points to promising work on statistical models for tracking, detection, and segmentation in multimodal temporal imagery. Section III gives a brief snapshot of slice selective free induction decay (FID) acquisition for 7 tesla high-field MR imaging. Section IV outlines highlights in comparative validation of computer-aided diagnosis and associated image analysis algorithms spanning a variety of application domains from the heart to the eye. Lastly, Section V describes advances in the analysis of real-time three-dimensional (3-D) echocardiography for computing myocardial strain.
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Affiliation(s)
- Andrew F Laine
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA.
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70
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Griffith HR, Stewart CC, den Hollander JA. Proton magnetic resonance spectroscopy in dementias and mild cognitive impairment. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 84:105-31. [PMID: 19501715 DOI: 10.1016/s0074-7742(09)00406-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
With the anticipated increase in dementias due to the aging demographic of industrialized nations, biomarkers for neurodegenerative diseases are increasingly important as new therapies are being developed for clinical trials. Proton MR spectroscopy ((1)H MRS) appears poised to be a viable means of tracking brain metabolic changes due to neurodegenerative diseases and potentially as a biomarker for treatment effects in clinical therapeutic trials. This review highlights the body of literature investigating brain metabolic abnormalities in Alzheimer's disease, amnestic mild cognitive impairment, frontotemporal dementia, vascular dementia, Lewy body dementia, and Parkinson's disease dementia. In particular, the review addresses the viability of (1)H MRS to discriminate among dementias, to measure disease progression, and to measure the effects of pharmacological treatments. While findings to date are encouraging, more study is needed in longitudinal patterns of brain metabolic changes, correspondence with changes in clinical markers of disease progression, and sensitivity of (1)H MRS measures to treatment effects. Such developments will hopefully benefit the search for effective treatments of dementias in the twenty-first century.
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Affiliation(s)
- H Randall Griffith
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA
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71
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Schillaci O, Travascio L, Bruni C, Bazzocchi G, Testa A, Garaci F, Melis M, Floris R, Simonetti G. Molecular Imaging and Magnetic Resonance Imaging in Early Diagnosis of Alzheimer's Disease. Neuroradiol J 2008; 21:755-71. [DOI: 10.1177/197140090802100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 09/07/2008] [Indexed: 11/15/2022] Open
Abstract
Alzheimer's disease (AD), a progressive neurodegenerative disorder, is the most common cause of dementia in the elderly. Magnetic resonance (MR) or computed tomography (CT) imaging is recommended for routine evaluation of dementias. The development of molecular imaging agents and the new techniques of MR for AD are critically important for early diagnosis, neuropathogenesis studies and assessing treatment efficacy in AD. Neuroimaging using nuclear medicine techniques such as SPECT, PET and MR spectroscopy has the potential to characterize the biomarkers for Alzheimer's disease. The present review summarizes the results of radionuclide imaging and MR imaging in AD.
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Affiliation(s)
- O. Schillaci
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, “Tor Vergata” University of Rome; Rome, Italy
| | - L. Travascio
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, “Tor Vergata” University of Rome; Rome, Italy
| | - C. Bruni
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, “Tor Vergata” University of Rome; Rome, Italy
| | - G. Bazzocchi
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, “Tor Vergata” University of Rome; Rome, Italy
| | - A. Testa
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, “Tor Vergata” University of Rome; Rome, Italy
| | - F.G. Garaci
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, “Tor Vergata” University of Rome; Rome, Italy
| | - M. Melis
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, “Tor Vergata” University of Rome; Rome, Italy
| | - R. Floris
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, “Tor Vergata” University of Rome; Rome, Italy
| | - G. Simonetti
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, “Tor Vergata” University of Rome; Rome, Italy
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Azevedo D, Tatsch M, Hototian SR, Bazzarella MC, Castro CC, Bottino CMC. Proton spectroscopy in Alzheimer's disease and cognitive impairment no dementia: a community-based study. Dement Geriatr Cogn Disord 2008; 25:491-500. [PMID: 18441524 DOI: 10.1159/000128275] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2008] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe the findings of proton magnetic resonance spectroscopy ((1)H-MRS) in Alzheimer's disease (AD) and cognitive impairment, no dementia (CIND) elderly from a community-based sample. METHODS Thirteen patients with AD, 12 with CIND and 15 normal individuals were evaluated. The (1)H-MRS was performed in the right temporal, left parietal and medial occipital regions studying the metabolites N-acetylaspartate (NAA), creatine (Cr), choline (Cho) and myoinositol (mI). The clinical diagnosis was based on standardized cognitive tests - MMSE and CAMDEX - and the results correlated with the (1)H-MRS. RESULTS Parietal Cho was higher in control individuals and lower in CIND subjects. AD and control groups were better identified by temporal and parietal mI combined with the temporal NAA/Cr ratio. CIND was better identified by parietal Cho. CONCLUSION The (1)H-MRS findings confirmed the hypothesis that metabolic alterations are present since the first symptoms of cognitively impaired elderly subjects. These results suggest that combining MRS from different cerebral regions can help in the diagnosis and follow-up of community elderly individuals with memory complaints and AD.
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Affiliation(s)
- Dionísio Azevedo
- Old Age Research Group, Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
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73
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Fayed N, Dávila J, Oliveros A, Castillo J, Medrano JJ. Utility of different MR modalities in mild cognitive impairment and its use as a predictor of conversion to probable dementia. Acad Radiol 2008; 15:1089-98. [PMID: 18692749 DOI: 10.1016/j.acra.2008.04.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 03/25/2008] [Accepted: 04/01/2008] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES Mild cognitive impairment has been regarded as a pre-Alzheimer condition, but some patients do not develop dementia. The authors' objective was to determine whether findings from a combined use of H1 magnetic resonance spectroscopy (MRS), perfusion imaging (PI), and diffusion-weighted imaging (DWI) would predict conversion from amnesic mild cognitive impairment to dementia and to compare the diagnostic accuracy in discriminating patients with probable Alzheimer disease (AD), mixed dementia (MD), Lewy body dementia (LBD), pre-Alzheimer disease mild cognitive impairment (MCI), vascular MCI (VaMCI), and anxious or depression patients with cognitive impairment (DeMCI). MATERIALS AND METHODS A longitudinal cohort of 119 consecutive and incident subjects (73 women, 46 men; age 70+/-9.5 years) who fulfilled the criteria of amnesic MCI was followed for a mean period of 29 months. At baseline, a neuropsychological examination and standard blood test were performed, and different areas were examined by proton MRS, PI, and DWI. Among the group of patients considered to have AD, we also included patients with MD because these patients have a neurodegenerative component. RESULTS After the follow-up period, 54 patients were considered as converted to dementia (49 with AD; 5 with LBD), 28 patients as MCI, 22 patients as DeMCI, and 15 patients as VaMCI. We found that N-acetylaspartate (NAA)/creatine (Cr) ratios in posterior cingulated gyri (PCG) predict the conversion to probable AD with a sensitivity of 82% and specificity of 72%, and NAA/Cr ratios in the left occipital cortex (LOC) had a sensitivity of 78% and specificity of 69%. When we used spectroscopy in the PCG and LOC to differentiate the types of MCI and dementias, we found significance differences in NAA/Cr, NAA/myoinositol (mI), NAA/choline (Cho), mI/NAA, and Cho/Cr ratios. The apparent diffusion coefficient (ADC) values in the right hippocampus showed differences in patients with LBD and DeMCI (P=.003), LBD with MCI (P=0.48), and LBD and VaMCI (P=.009). CONCLUSIONS NAA/Cr ratios in PCG and LOC can predict the conversion from MCI to dementia with high sensitivity and specificity. MRS can differentiate AD from MCI, but cannot differentiate the types of MCI. DWI in the right hippocampus presents higher values of ADC in LBD and allows differentiating it from MCI.
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74
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Proteome-based identification of plasma proteins associated with hippocampal metabolism in early Alzheimer's disease. J Neurol 2008; 255:1712-20. [PMID: 19156487 DOI: 10.1007/s00415-008-0006-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 05/15/2008] [Accepted: 05/20/2008] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND METHODS There is an urgent need for peripheral surrogates of Alzheimer's disease (AD) that accurately reflect disease state and severity as well as correlate with key features of its neuropathology. The aim of this study was to identify plasma proteins associated with known in vivo markers of disease activity. In an earlier proteomic study of plasma, we discovered a panel of 15 proteins that were differentially expressed in AD and further validated complement factor-H (CFH) and alpha-2-macroglobulin (A2M) as AD-specific plasma biomarkers. In the present study, we extended these findings by testing the associations of these plasma proteins with neuro-imaging measures of disease progression in AD. We combined (1)H-magnetic resonance spectroscopy of the hippocampus and MRI-based hippocampal volumetry with proteomic analysis of plasma in early AD and mild cognitive impairment (MCI) to achieve this goal. Using (1)H-magnetic resonance spectroscopy, we derived estimates of the hippocampal metabolite ratio N-acetylaspartate/myo-inositol (NAA/mI), a biochemical measure that is associated with cognitive decline in early AD. We also undertook a proteomic analysis of plasma in these individuals using two-dimensional gel electrophoresis (2DGE). RESULTS We observed that two plasma proteins previously shown to be differentially expressed in AD, complement factor-H (CFH) and alpha-2-macroglobulin (A2M) showed significant positive correlations with hippocampal NAA/mI ratio in AD. CONCLUSIONS The association of plasma CFH and A2M with hippocampal NAA/mI in this cohort of AD subjects suggests that these proteins may reflect disease progression in early AD. These findings warrant validation in large population-based datasets.
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75
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Jiang YM, Long LL, Zhu XY, Zheng H, Fu X, Ou SY, Wei DL, Zhou HL, Zheng W. Evidence for altered hippocampal volume and brain metabolites in workers occupationally exposed to lead: a study by magnetic resonance imaging and (1)H magnetic resonance spectroscopy. Toxicol Lett 2008; 181:118-25. [PMID: 18692119 DOI: 10.1016/j.toxlet.2008.07.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 07/05/2008] [Accepted: 07/05/2008] [Indexed: 11/28/2022]
Abstract
Environmental and occupational exposure to lead (Pb) remains to be a major public health issue. The purpose of this cross-sectional study was to use non-invasive magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy ((1)H MRS) techniques to investigate whether chronic exposure to Pb in an occupational setting altered brain structure and function of Pb-exposed workers. The Pb-exposed group consisted of 15 workers recruited from either a Pb-smelting factory or a Pb-battery manufacturer. The control group had 19 healthy volunteers who had no history of Pb exposure in working environment or at home. The average airborne Pb concentrations in fume and dust were 0.43 and 0.44 mg/m(3), respectively, in the smeltery, and 0.10 and 1.06 mg/m(3), respectively, in the Pb battery workshop. The average blood Pb concentrations (BPb) in Pb-exposed and control workers were 63.5 and 8.7 microg/dL, respectively. The MRI examination showed that brain hippocampal volume among Pb-exposed workers was significantly diminished in comparison to age-matched control subjects (p < 0.01), although the extent of this reduction was relatively small (5-6% of the control values). Linear regression analyses revealed significant inverse associations between BPb and the decreased hippocampal volume on both sides of brain hemisphere. Among five brain metabolites investigated by MRS, i.e., N-acetyl-aspartate (NAA), creatine (Cr), choline (Cho), inosine (mI), glutamate/glutamine (Glx) and lipids (Lip), a significant decrease in NAA/Cr ratio (7% of controls, p < 0.05) and a remarkable increase in Lip/Cr ratio (40%, p < 0.01) were observed in the brains of Pb-exposed workers as compared to controls. Furthermore, the increased Lip/Cr ratio was significantly associated with BPb (r = 0.46, p < 0.01). Taken together, this study suggests that occupational exposure to Pb may cause subtle structural and functional alteration in human brains. The MRI and MRS brain imaging techniques can be used as the non-invasive means to evaluate Pb-induced neurotoxicity.
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Affiliation(s)
- Yue-Ming Jiang
- Department of Occupational Health and Toxicology, Guangxi Medical University, Nanning, Guangxi, China
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76
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Kantarci K, Knopman DS, Dickson DW, Parisi JE, Whitwell JL, Weigand SD, Josephs KA, Boeve BF, Petersen RC, Jack CR. Alzheimer disease: postmortem neuropathologic correlates of antemortem 1H MR spectroscopy metabolite measurements. Radiology 2008; 248:210-20. [PMID: 18566174 DOI: 10.1148/radiol.2481071590] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the neuropathologic correlates of antemortem hydrogen 1 ((1)H) magnetic resonance (MR) spectroscopy metabolite measurements in subjects with Alzheimer disease (AD)-type pathology. MATERIALS AND METHODS This study was approved by the institutional review board and was compliant with HIPAA regulations. Informed consent was obtained from each subject. The authors identified 54 subjects who underwent antemortem (1)H MR spectroscopy and were clinically healthy or had AD-type pathology with low to high likelihood of AD according to National Institute on Aging-Reagan neuropathologic criteria at autopsy. They investigated the associations between (1)H MR spectroscopy metabolite measurements and Braak neurofibrillary tangle stage (Braak stage), neuritic plaque score, and AD likelihood, with adjustments for subject age, subject sex, and time between (1)H MR spectroscopy and death. RESULTS Decreases in N-acetylaspartate-to-creatine ratio, an index of neuronal integrity, and increases in myo-inositol-to-creatine ratio were associated with higher Braak stage, higher neuritic plaque score, and greater likelihood of AD. The N-acetylaspartate-to-myo-inositol ratio proved to be the strongest predictor of the pathologic likelihood of AD. The strongest association observed was that between N-acetylaspartate-to-myo-inositol ratio and Braak stage (R(N)(2) = 0.47, P < .001). CONCLUSION Antemortem (1)H MR spectroscopy metabolite changes correlated with AD-type pathology seen at autopsy. The study findings validated (1)H MR spectroscopy metabolite measurements against the neuropathologic criteria for AD, and when combined with prior longitudinal (1)H MR spectroscopy findings, indicate that these measurements could be used as biomarkers for disease progression in clinical trials.
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Affiliation(s)
- Kejal Kantarci
- Departments of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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77
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Barba I, Fernandez-Montesinos R, Garcia-Dorado D, Pozo D. Alzheimer's disease beyond the genomic era: nuclear magnetic resonance (NMR) spectroscopy-based metabolomics. J Cell Mol Med 2008; 12:1477-85. [PMID: 18554316 PMCID: PMC3918063 DOI: 10.1111/j.1582-4934.2008.00385.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Alzheimer's disease (AD) is a complex disease, with no definitive biomarkers available that allow clinical diagnosis; this represents a major problem for the advance of efficient drug discovery programs. A successful approach towards the understanding and treatment of AD should take into consideration this complex nature. In this sense, metabolic networks are subject to severe stoichiometric restrictions. Metabolomics amplifies changes both in the proteome and the genome, and represents a more accurate approximation to the phenotype of an organism in health and disease. In this article, we will examine the current rationale for metabolomics in AD, its basic methodology and the available data in animal models and human studies. The discussed topics will highlight the importance of being able to use the metabolomic information in order to understand disease mechanisms from a systems biology perspective as a non-invasive approach to diagnose and grade AD. This could allow the assessment of new therapies during clinical trials, the identification of patients at risk to develop adverse effects during treatment and the final implementation of new tools towards a more personalized medicine.
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Affiliation(s)
- Ignasi Barba
- Laboratory of Experimental Cardiology, Cardiology Service, Institut de Recerca Hospital Vall d'Hebron, Barcelona, Spain
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78
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Abstract
Present data support the concept that (1)H magnetic resonance spectroscopy ((1)H MRS) may become an adjunct to clinical evaluation for differential diagnosis of dementia in the future. The value of (1)H MRS in monitoring the disease progression in dementia is expected to be in areas where group effects are sought such as monitoring effectiveness of therapies in drug trials. Elevation of myoinositol to creatine (mI/Cr) and choline to creatine (Cho/Cr) and reduction in the neuronal integrity marker N-acetylaspartate to creatine (NAA/Cr) levels in individuals with mild cognitive impairment and pre-symptomatic Alzheimer's disease suggests that (1)H MRS may also be valuable in predicting future development of dementia and monitoring early disease progression for preventive therapies. Investigations of in vivo (1)H MRS as a marker for differential diagnosis and progression of dementia, however, has been limited to clinically confirmed cohorts and remains to be validated by histopathology at autopsy. Overall, MRS is a promising investigational technique in ageing and dementia at this time. The potential clinical application of MRS in ageing and dementia, however, is growing with technical advances in the field.
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Affiliation(s)
- K Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Lenfeldt N, Hauksson J, Birgander R, Eklund A, Malm J. Improvement after cerebrospinal fluid drainage is related to levels of N-acetyl-aspartate in idiopathic normal pressure hydrocephalus. Neurosurgery 2008; 62:135-41, discussion 141-2. [PMID: 18300900 DOI: 10.1227/01.neu.0000311070.25992.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study uses proton magnetic resonance spectroscopy to investigate whether or not idiopathic normal pressure hydrocephalus is associated with neuronal dysfunction or ischemia in the brain. We evaluate whether or not proton magnetic resonance spectroscopy is useful for predicting improvement after long-term external lumbar drainage (ELD) of cerebrospinal fluid. METHODS Eighteen patients (mean age, 73 yr; six women) and 10 matching controls participated. Participants were characterized by clinical features, cognitive and motor function tests, and cerebrospinal fluid hydrodynamics (patients only). Signals from N-acetyl-aspartate (NAA), choline, lactate, and creatine (Cr) (reference) were sampled once in controls and twice in patients (before and after a 3-day ELD of approximately 135 mL/24 h) by proton magnetic resonance spectroscopy (1.5 T) from a 7.2-mL volume in the frontal white matter. Improvement was defined by video recordings of the patients' gait. RESULTS Sixteen patients finished the ELD (one patient had meningitis, and one patient had catheter insertion failure) with a mean drain volume of 395 mL. NAA/Cr ratios were lower in patients than in controls (1.60 versus 1.84, P = 0.02), but no difference was found for choline/Cr ratios. No lactate signals were detected. Fifty percent of patients improved after ELD. They had higher NAA/Cr ratios than nonimproved patients (1.70 versus 1.51, P = 0.01), but no differences were found in choline/Cr ratios or drain volume. CONCLUSION NAA/Cr ratios were decreased in patients with idiopathic normal pressure hydrocephalus, which is consistent with neuronal dysfunction in the frontal white matter. Improved patients had NAA/Cr ratios close to normal, indicating that enough functional neurons are a prerequisite for the cerebrospinal fluid drainage to have an effect.
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Affiliation(s)
- Niklas Lenfeldt
- Department of Clinical Neuroscience, Center for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden.
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80
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Okada T, Sakamoto S, Nakamoto Y, Kohara N, Senda M. Reproducibility of magnetic resonance spectroscopy in correlation with signal-to-noise ratio. Psychiatry Res 2007; 156:169-74. [PMID: 17900878 DOI: 10.1016/j.pscychresns.2007.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 03/10/2007] [Accepted: 03/21/2007] [Indexed: 11/18/2022]
Abstract
An increased amount of myoinositol (mI) relative to creatine (Cr) by proton MR spectroscopy ((1)H-MRS) measurement gives a useful aid for the diagnosis of Alzheimer's disease (AD). Previous results of test-retest measurement of mI, however, have shown variability more than twice as large as for other metabolites. The aims of this study were to analyze test-retest variability of (1)H-MRS measurements in correlation with signal-to-noise ratio (SNR). Ten subjects clinically suspected of mild AD were examined twice (2-14 days apart) with (1)H-MRS measurements of voxels placed at anterior and posterior cingulate cortex. The percent differences between two measurements (%differences) of mI/Cr showed a significant linear trend to decrease as average SNR increased, but %differences of N-acetylaspartate (NAA)/Cr and choline (Cho)/Cr did not. The average of %differences was 10.5, 15.0 and 20.8 for NAA/Cr, Cho/Cr, and mI/Cr, respectively, indicating a prominent deterioration of mI/Cr measurement reproducibility, which decreased to 6.96, 15.4 and 9.87, respectively, when the analysis was limited to measurements with SNR over 25. The results indicate that MRS measurements with high SNR should be used to obtain reliable assessments of mI/Cr as accurate diagnostic indicator of AD in clinical MR examinations.
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Affiliation(s)
- Tomohisa Okada
- Department of Molecular Imaging, Institute of Biomedical Research and Innovation, 2-2 Minatojima Minamimachi, Chuouku, Kobe, 650-0047, Japan.
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Menon S, Bharadwaj R, Chowdhary AS, Kaundinya DV, Palande DA. RAPID IDENTIFICATION OF NON-SPORING ANAEROBES USING NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY AND AN IDENTIFICATION STRATEGY. Indian J Med Microbiol 2007. [DOI: 10.1016/s0255-0857(21)02046-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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82
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de Graaf RA, Rothman DL, Behar KL. High resolution NMR spectroscopy of rat brain in vivo through indirect zero-quantum-coherence detection. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2007; 187:320-6. [PMID: 17587617 PMCID: PMC2788487 DOI: 10.1016/j.jmr.2007.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 06/01/2007] [Accepted: 06/01/2007] [Indexed: 05/14/2023]
Abstract
The time evolution of zero-quantum-coherences (ZQCs) is insensitive to magnetic field inhomogeneity. Using a 2D indirect ZQC detection method it is shown that high-resolution (1)H NMR spectra can be obtained from rat brain in vivo at 11.74T that are immune to magnetic field inhomogeneity. Simulations based on the density matrix formalism, as well as in vitro measurements are used to demonstrate the features of 2D ZQC NMR spectra. Unique spectral information which is normally not directly available from regular (1)H NMR spectra can be extracted and used for compound identification or improved prior knowledge during spectral fitting.
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Affiliation(s)
- Robin A de Graaf
- Departments of Diagnostic Radiology and Biomedical Engineering, Magnetic Resonance Research Center, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520, USA.
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83
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Choi JK, Dedeoglu A, Jenkins BG. Application of MRS to mouse models of neurodegenerative illness. NMR IN BIOMEDICINE 2007; 20:216-37. [PMID: 17451183 DOI: 10.1002/nbm.1145] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The rapid development of transgenic mouse models of neurodegenerative diseases, in parallel with the rapidly expanding growth of MR techniques for assessing in vivo, non-invasive, neurochemistry, offers the potential to develop novel markers of disease progression and therapy. In this review we discuss the interpretation and utility of MRS for the study of these transgenic mouse and rodent models of neurodegenerative diseases such as Alzheimer's (AD), Huntington's (HD) and Parkinson's disease (PD). MRS studies can provide a wealth of information on various facets of in vivo neurochemistry, including neuronal health, gliosis, osmoregulation, energy metabolism, neuronal-glial cycling, and molecular synthesis rates. These data provide information on the etiology, natural history and therapy of these diseases. Mouse models enable longitudinal studies with useful time frames for evaluation of neuroprotection and therapeutic interventions using many of the potential MRS markers. In addition, the ability to manipulate the genome in these models allows better mechanistic understanding of the roles of the observable neurochemicals, such as N-acetylaspartate, in the brain. The argument is made that use of MRS, combined with correlative histology and other MRI techniques, will enable objective markers with which potential therapies can be followed in a quantitative fashion.
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Affiliation(s)
- Ji-Kyung Choi
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
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84
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Galanaud D, Nicoli F, Confort-Gouny S, Le Fur Y, Ranjeva JP, Viola A, Girard N, Cozzone PJ. [Indications for cerebral MR proton spectroscopy in 2007]. Rev Neurol (Paris) 2007; 163:287-303. [PMID: 17404517 DOI: 10.1016/s0035-3787(07)90402-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Magnetic resonance spectroscopy (MRS) is being increasingly performed alongside the more conventional MRI sequences in the exploration of neurological disorders. It is however important to clearly differentiate its clinical applications aiming at improving the differential diagnosis or the prognostic evaluation of the patient, from the research protocols, when MRS can contribute to a better understanding of the pathophysiology of the disease or to the evaluation of new treatments. The most important applications in clinical practice are intracranial space occupying lesions (especially the positive diagnosis of intracranial abscesses and gliomatosis cerebri and the differential diagnosis between edema and tumor infiltration), alcoholic, hepatic, and HIV-related encephalopathies and the exploration of metabolic diseases. Among the research applications, MRS is widely used in multiple sclerosis, ischemia and brain injury, epilepsy and neuro degenerative diseases.
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Affiliation(s)
- D Galanaud
- Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR CNRS 6612, Faculté de Médecine et Hôpital La Timone, Marseille, France
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85
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Ward KL, Tkac I, Jing Y, Felt B, Beard J, Connor J, Schallert T, Georgieff MK, Rao R. Gestational and lactational iron deficiency alters the developing striatal metabolome and associated behaviors in young rats. J Nutr 2007; 137:1043-9. [PMID: 17374674 PMCID: PMC1892181 DOI: 10.1093/jn/137.4.1043] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Gestational and early postnatal iron deficiency occurs commonly in humans and results in altered behaviors suggestive of striatal dysfunction. We hypothesized that early iron deficiency alters the metabolome of the developing striatum and accounts for abnormalities in striatum-dependent behavior in rats. Sixteen metabolite concentrations from a 9-11 microL volume within the striatum were serially assessed in 10 iron-deficient and 10 iron-sufficient rats on postnatal days 8, 22 (peak anemia), and 37 (following recovery from anemia) using (1)H NMR spectroscopy at 9.4 tesla. Chin-elicited bilateral forelimb placing and vibrissae-elicited unilateral forelimb placing were also assessed on these days. Iron deficiency altered metabolites indexing energy metabolism, neurotransmission, glial integrity, and myelination over time (P < 0.05). Successful development of behaviors was delayed in the iron-deficient group (P < or = 0.01). Alterations in creatine, glucose, glutamine, glutamate, N-acetylaspartate, myo-inositol, and glycerophosphorylcholine + phosphorylcholine concentrations accounted for 77-83% of the behavioral variability during peak anemia on postnatal day 22 in the iron-deficient group. Correction of anemia normalized the striatal metabolome but not the behaviors on postnatal day 37. These novel data imply that alterations in the metabolite profile of the striatum likely influence later neural functioning in early iron deficiency.
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Affiliation(s)
- Kay L Ward
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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86
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Jack CR, Marjanska M, Wengenack TM, Reyes DA, Curran GL, Lin J, Preboske GM, Poduslo JF, Garwood M. Magnetic resonance imaging of Alzheimer's pathology in the brains of living transgenic mice: a new tool in Alzheimer's disease research. Neuroscientist 2007; 13:38-48. [PMID: 17229974 DOI: 10.1177/1073858406295610] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease (AD) is the most common cause of dementia in the elderly. Cardinal pathologic features of AD are amyloid plaques and neurofibrillary tangles, and most in the field believe that the initiating events ultimately leading to clinical AD center on disordered metabolism of amyloid beta protein. Mouse models of AD have been created by inserting one or more human mutations associated with disordered amyloid metabolism and that cause early onset familial AD into the mouse genome. Human-like amyloid plaque formation increases dramatically with age in these transgenic mice. Amyloid reduction in humans is a major therapeutic objective, and AD transgenic mice allow controlled study of this biology. Recent work has shown that amyloid plaques as small as 35 microm can be detected using in vivo magnetic resonance microimaging (MRMI) at high magnetic field (9.4 T). In addition, age-dependent changes in metabolite concentration analogous to those that have been identified in human AD patients can be detected in these transgenic mice using single-voxel (1)H magnetic resonance spectroscopy ((1)H MRS) at high magnetic field. These MR-based techniques provide a new set of tools to the scientific community engaged in studying the biology of AD in transgenic models of the disease. For example, an obvious application is evaluating therapeutic modification of disease progression. Toward the end of this review, the authors include results from a pilot study demonstrating feasibility of using MRMI to detect therapeutic modification of plaque progression in AD transgenic mice.
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Affiliation(s)
- Clifford R Jack
- Mayo Clinic, Department of Radiology, 200 First Street SW, Rochester, MN 55905, USA.
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87
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Moffett JR, Ross B, Arun P, Madhavarao CN, Namboodiri AMA. N-Acetylaspartate in the CNS: from neurodiagnostics to neurobiology. Prog Neurobiol 2007; 81:89-131. [PMID: 17275978 PMCID: PMC1919520 DOI: 10.1016/j.pneurobio.2006.12.003] [Citation(s) in RCA: 1003] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 12/07/2006] [Accepted: 12/11/2006] [Indexed: 01/02/2023]
Abstract
The brain is unique among organs in many respects, including its mechanisms of lipid synthesis and energy production. The nervous system-specific metabolite N-acetylaspartate (NAA), which is synthesized from aspartate and acetyl-coenzyme A in neurons, appears to be a key link in these distinct biochemical features of CNS metabolism. During early postnatal central nervous system (CNS) development, the expression of lipogenic enzymes in oligodendrocytes, including the NAA-degrading enzyme aspartoacylase (ASPA), is increased along with increased NAA production in neurons. NAA is transported from neurons to the cytoplasm of oligodendrocytes, where ASPA cleaves the acetate moiety for use in fatty acid and steroid synthesis. The fatty acids and steroids produced then go on to be used as building blocks for myelin lipid synthesis. Mutations in the gene for ASPA result in the fatal leukodystrophy Canavan disease, for which there is currently no effective treatment. Once postnatal myelination is completed, NAA may continue to be involved in myelin lipid turnover in adults, but it also appears to adopt other roles, including a bioenergetic role in neuronal mitochondria. NAA and ATP metabolism appear to be linked indirectly, whereby acetylation of aspartate may facilitate its removal from neuronal mitochondria, thus favoring conversion of glutamate to alpha ketoglutarate which can enter the tricarboxylic acid cycle for energy production. In its role as a mechanism for enhancing mitochondrial energy production from glutamate, NAA is in a key position to act as a magnetic resonance spectroscopy marker for neuronal health, viability and number. Evidence suggests that NAA is a direct precursor for the enzymatic synthesis of the neuron specific dipeptide N-acetylaspartylglutamate, the most concentrated neuropeptide in the human brain. Other proposed roles for NAA include neuronal osmoregulation and axon-glial signaling. We propose that NAA may also be involved in brain nitrogen balance. Further research will be required to more fully understand the biochemical functions served by NAA in CNS development and activity, and additional functions are likely to be discovered.
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Affiliation(s)
- John R Moffett
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Building C, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA.
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88
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Anderson VC, Litvack ZN, Kaye JA. Magnetic resonance approaches to brain aging and Alzheimer disease-associated neuropathology. Top Magn Reson Imaging 2007; 16:439-52. [PMID: 17088693 DOI: 10.1097/01.rmr.0000245458.05654.d0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The noninvasive, nonradioactive, quantitative nature of magnetic resonance techniques has propelled them to the forefront of neuroscience and neuropsychiatric research. In particular, recent advances have confirmed their enormous potential in patients with Alzheimer disease (AD). Structural and functional magnetic resonance (MR) imaging have demonstrated significant correlation with clinical outcomes and underlying pathology and are used increasingly in the AD clinic. This review will highlight the role of high-resolution structural MR imaging and functional magnetic resonance imaging in the identification of atrophic and hemodynamic changes in AD and their potential as diagnostic biomarkers and surrogates of therapeutic response. Advanced MR techniques based on diffusion, perfusion, and neurochemical abnormalities in the aging brain will be presented briefly. These newer techniques continue to expand our understanding of neuropathology in the aging brain and are likely to play an important clinical role in the future.
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Affiliation(s)
- Valerie C Anderson
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR 97239, USA.
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89
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Wahlund LO, Almkvist O, Blennow K, Engedahl K, Johansson A, Waldemar G, Wolf H. Evidence-based evaluation of magnetic resonance imaging as a diagnostic tool in dementia workup. Top Magn Reson Imaging 2007; 16:427-37. [PMID: 17088692 DOI: 10.1097/01.rmr.0000245463.36148.12] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diagnostic utility of magnetic resonance imaging in dementia workups has increased recently. The basic use is to exclude space-occupying processes in the brain. However, magnetic resonance imaging offers major opportunities for studying atrophy of specific brain areas. A great interest has been put in whether atrophy in the medial temporal lobe can serve as an early diagnostic marker for Alzheimer disease. METHODS AND RESULTS In this evaluation, we used evidence-based techniques and reviewed more than 400 articles that address this issue. Our main finding is that a variety of methods in studying brain areas were used, and this made it difficult to extract conclusive information in a systematic way. CONCLUSION However, we were able to conclude that atrophy of the hippocampus can distinguish patients with Alzheimer disease from healthy subjects, but there was a lack of evidence because of insufficient studies concerning the usefulness of medial temporal lobe atrophy as a diagnostic marker in a more general setting.
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Affiliation(s)
- Lars-Olof Wahlund
- Department of Neurobiology, Caring Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.
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90
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Modrego PJ, Pina MA, Fayed N, Díaz M. Changes in metabolite ratios after treatment with rivastigmine in Alzheimer's disease: a nonrandomised controlled trial with magnetic resonance spectroscopy. CNS Drugs 2007; 20:867-77. [PMID: 16999455 DOI: 10.2165/00023210-200620100-00006] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Alzheimer's disease is associated with abnormalities in the levels of some brain metabolites, including decreases in N-acetyl-aspartate (NAA) and increases in myo-inositol and choline levels. Cholinesterase inhibitors have proven modest effects on cognition in patients with mild or moderate Alzheimer's disease; however, there is little information on the effects of these drugs on metabolic parameters in the brain. Magnetic resonance spectroscopy (MRS) provides a method of determining changes in such parameters. OBJECTIVE To assess the effect of rivastigmine on metabolite levels in different areas of the brain, and whether changes in metabolite levels correlate with clinical outcome, in patients with Alzheimer's disease compared with untreated patients with Alzheimer's disease. METHODS Twenty-four consecutive patients with mild or moderate Alzheimer's disease were enrolled in the study and were treated with rivastigmine at a target dosage of 12 mg/day for 4 months. A comparison group of ten consecutive untreated patients with Alzheimer's disease with similar cognitive impairment to the treatment group were also enrolled. Each patient underwent assessment using the Mini-Mental State Examination (Spanish version), the Blessed Dementia Rating Scale, the Clinical Dementia Rating scale, the Interview for Deterioration in Daily living activities in Dementia, the Alzheimer's Disease Assessment Scale cognitive and noncognitive subscales, and single-voxel MRS of the frontal, parietal and occipital cortices of the brain to assess levels of brain metabolites (NAA, creatine, choline and myo-inositol) and their ratios to creatine. All assessments were performed at baseline and after 4 months of treatment with rivastigmine, and at baseline and 1 month later in the comparison group. RESULTS Globally, although there was some mean improvement, no significant changes in the cognitive and noncognitive scale scores between baseline and post-treatment assessments were seen in patients who received rivastigmine. A significant increase in the NAA/creatine ratio in the frontal cortex (1.23 at baseline vs 1.3 after treatment; p = 0.026) and in the myo-inositol/creatine ratio in the occipital cortex (0.61 vs 0.65; p = 0.009) was seen in rivastigmine-treated patients. No other significant changes in the metabolite levels or their ratios to creatine were seen in these patients. After correction for multiple comparisons, the significant effects disappeared. Only in the frontal cortex did the changes in metabolite ratios correlate with changes on the clinical scales. In the comparison group, no significant differences between the metabolite levels or ratios to creatine seen with the two scans were detected. CONCLUSION Treatment with rivastigmine showed modest neuronal functional recovery in the frontal cortex only (being able to reverse disease-related decreases in NAA/creatine ratio in this area but unable to affect the disease-related increase in myo-inositol/creatine ratio in any cortex). Since the modest clinical changes correlated with the small changes in the metabolite rates, MRS could be useful in monitoring response to current or future treatments for Alzheimer's disease.
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91
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Huckman MS. Imaging dementing illnesses. Neuroradiol J 2006; 19:441-51. [PMID: 24351247 DOI: 10.1177/197140090601900405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 04/03/2006] [Indexed: 11/17/2022] Open
Abstract
Dementia is an impairment of mental ability representing a decline from that level previously reached by the individual. It is usually of insidious onset, associated with neurologic changes, and results in the inability to appropriately interact with one's environment. Dementias may be static, progressive, or reversible, and have many etiologies. One percent of the population above age 40 suffers from dementia and this figure rises to 7% above age 80 and 50% above age 90. Forty-five percent of dementias are due to Alzheimer disease (AD) followed closely by vascular dementia. A stage along the way to dementia is mild cognitive impairment (MCI). There are various definitions but the simplest ones refer to a person who has some memory problems but can continue to live independently. A more specific description refers to deficits in two or more areas of cognition >1.5 SD below mean for the individuals age and education. Although previously considered a part of normal aging, a recent study has shown MCI to be a precursor of Alzheimer disease (1). In a cohort of nuns and priests studied annually until they developed MCI or dementia and died. 180 brains in this study have already been autopsied (37 MCI, 60 with no impairment, 53 with dementia). Pathologists measured theamount of AD pathology and cerebral infarcts. Of 37 with MCI, more than half had AD by pathology, 1/3 had infarcts (5 with both) and 14 did not have either pathology. One third of the 180 with average age of 85 had no cognitive decline! Since this study showed MCI patients to have Alzheimer disease pathology in their brains, recognition of MCI clinically is important for institution of therapy, although there has not yet been an effective therapy developed.
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Affiliation(s)
- M S Huckman
- Rush University Medical Center; Chicago, Illinois, USA -
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92
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Zhu X, Schuff N, Kornak J, Soher B, Yaffe K, Kramer JH, Ezekiel F, Miller BL, Jagust WJ, Weiner MW. Effects of Alzheimer disease on fronto-parietal brain N-acetyl aspartate and myo-inositol using magnetic resonance spectroscopic imaging. Alzheimer Dis Assoc Disord 2006; 20:77-85. [PMID: 16772742 PMCID: PMC1820860 DOI: 10.1097/01.wad.0000213809.12553.fc] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previous magnetic resonance (MR) spectroscopy studies of Alzheimer disease (AD) reporting reduced N-acetyl aspartate (NAA) and increased myo-Inositol (mI) used single voxel techniques, which have limited ability to assess the regional distribution of the metabolite abnormalities. The objective of this study was to determine the regional distribution of NAA and mI alterations in AD by using MR spectroscopic imaging. Fourteen patients with AD and 22 cognitively normal elderly were studied using structural MR imaging and MR spectroscopic imaging. Changes of NAA, mI, and various metabolite ratios were measured in frontal and parietal lobe gray matter (GM) and white matter. This study found: (1) when compared with cognitively normal subjects, AD patients had increased mI and mI/creatine (Cr) ratios primarily in parietal lobe GM, whereas frontal lobe GM and white matter were spared; (2) in the same region where mI was increased, AD patients had also decreased NAA and NAA/Cr ratios, replicating previous findings; (3) however, increased mI or mI/Cr ratios did not correlate with decreased NAA or NAA/Cr ratios; and (4) using mI/Cr and NAA/Cr together improved sensitivity and specificity to AD from control as compared with NAA/Cr alone. In conclusion, decreased NAA and increased mI in AD are primarily localized in parietal lobe GM regions. However, the NAA and mI changes are not correlated with each other, suggesting that they represent different processes that might help staging of AD.
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Affiliation(s)
- Xiaoping Zhu
- Department of Radiology, VA Medical Center, University of California, San Francisco, CA 94121, USA.
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93
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Lehéricy S, Marjanska M, Mesrob L, Sarazin M, Kinkingnehun S. Magnetic resonance imaging of Alzheimer's disease. Eur Radiol 2006; 17:347-62. [PMID: 16865367 DOI: 10.1007/s00330-006-0341-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 05/12/2006] [Accepted: 05/22/2006] [Indexed: 10/24/2022]
Abstract
A modern challenge for neuroimaging techniques is to contribute to the early diagnosis of neurodegenerative diseases, such as Alzheimer's disease (AD). Early diagnosis includes recognition of pre-demented conditions, such as mild cognitive impairment (MCI) or having a high risk of developing AD. The role of neuroimaging therefore extends beyond its traditional role of excluding other conditions such as neurosurgical lesions. In addition, early diagnosis would allow early treatment using currently available therapies or new therapies in the future. Structural imaging can detect and follow the time course of subtle brain atrophy as a surrogate marker for pathological processes. New MR techniques and image analysis software can detect subtle brain microstructural, perfusion or metabolic changes that provide new tools to study the pathological processes and detect pre-demented conditions. This review focuses on markers of macro- and microstructural, perfusion, diffusion and metabolic MR imaging and spectroscopy in AD.
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Affiliation(s)
- Stéphane Lehéricy
- Department of Neuroradiology, Université Pierre et Marie Curie-Paris 6, Groupe Hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, Paris 75651, Cedex 13, France.
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94
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Ma K, Deutsch J, Villacreses NE, Rosenberger TA, Rapoport SI, Shetty HU. Measuring brain uptake and incorporation into brain phosphatidylinositol of plasma myo-[2H6]inositol in unanesthetized rats: an approach to estimate in vivo brain phosphatidylinositol turnover. Neurochem Res 2006; 31:759-65. [PMID: 16791473 DOI: 10.1007/s11064-006-9080-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2006] [Indexed: 10/24/2022]
Abstract
The in vivo rate of turnover of phosphatidylinositol (PtdIns) in brain is not known. In brain, certain receptor-mediated signal transduction involves metabolism of PtdIns and a method to measure its turnover in awake animals is useful in studying the effect of lithium and other therapeutic agents. In a method described here, rats were infused subcutaneously with myo-[2H6]inositol (Ins*) using an osmotic pump and, at 1 and 8 weeks, concentrations of free myo-inositol (Ins) and Ins* in plasma and brain were measured by GC-MS (chemical ionization). Also, PtdIns and PtdIns* together in brain were isolated, and Ins and Ins* from their headgroups were released enzymatically and specific activity of incorporated inositol was measured. The specific activity of inositol reached a steady state in plasma within 1 week of infusion, but not in brain even at 8 weeks. However, in brain, the specific activity of phosphatidylinositol was same as that of inositol at both time-points, suggestive of fast turnover of PtdIns. The animal experiment and the analytical methodology described here should be useful for measuring the rate of turnover of brain PtdIns in pathological and drug treatment conditions.
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Affiliation(s)
- Kaizong Ma
- Brain Physiology and Metabolism Section, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
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95
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Engelhardt E, Moreira DM, Laks J, Cavalcanti JLS. Alzheimer's disease and proton magnetic resonance spectroscopy of limbic regions: a suggestion of a clinical-spectroscopic staging. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 63:195-200. [PMID: 16100961 DOI: 10.1590/s0004-282x2005000200001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare magnetic resonance proton spectroscopic with clinical data and to propose a spectroscopic staging of Alzheimer's disease (AD). METHOD Subjects (n = 46), normals (12) and with AD (34), paired to age (CDR0-CDR3); AD diagnosis according to DSM-IV/NINCDS-ADRDA criteria; 1H-MRS with Signa Horizon LX-GE, 1.5T; single voxel at hippocampal region/HCR and posterior cingulate area/PCA. RESULTS Statistically significant decrease (p < 0.01) only of Naa/Cr--at HCR among the CDR0, CDR1+CDR2, and CDR3, and at PCA between CDR0 and CDR1+CDR2 in relation to CDR3. CONCLUSION The HCR is the first to show Naa reduction (CDR1). The PCA suffers later (CDR3). These values decline progressively according to the severity stages. Considering the disparities between the HCR and PCA it is possible to suggest a spectroscopic (metabolite) staging (MS) of AD, as follows: MS0 (-CDR0) = both normal HCR and PCA, MS1-2 (approximately CDR1-2) = abnormal HCR and normal PCA, and MS3 (approximately CDR3) = both abnormal HCR and PCA. These results make possible the early diagnosis, to follow the degenerative process throughout the course, and to suggest a spectroscopic staging related to the clinical stages of AD.
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Affiliation(s)
- Eliasz Engelhardt
- Division of Cognitive and Behavioral Neurology, Instituto de Neurologia Deolindo Couto, Federal University of Rio de Janeiro, Rio de Janeiro RJ, Brazil.
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96
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Belli A, Sen J, Petzold A, Russo S, Kitchen N, Smith M, Tavazzi B, Vagnozzi R, Signoretti S, Amorini AM, Bellia F, Lazzarino G. Extracellular N-acetylaspartate depletion in traumatic brain injury. J Neurochem 2006; 96:861-9. [PMID: 16371008 DOI: 10.1111/j.1471-4159.2005.03602.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
N-Acetylaspartate (NAA) is almost exclusively localized in neurons in the adult brain and is present in high concentration in the CNS. It can be measured by proton magnetic resonance spectroscopy and is seen as a marker of neuronal damage and death. NMR spectroscopy and animal models have shown NAA depletion to occur in various types of chronic and acute brain injury. We investigated 19 patients with traumatic brain injury (TBI). Microdialysis was utilized to recover NAA, lactate, pyruvate, glycerol and glutamate, at 12-h intervals. These markers were correlated with survival and a 6-month Glasgow Outcome Score. Eleven patients died and eight survived. A linear mixed model analysis showed a significant effect of outcome and of the interaction between time of injury and outcome on NAA levels (p = 0.009 and p = 0.004, respectively). Overall, extracellular NAA was 34% lower in non-survivors. A significant non-recoverable fall was observed in this group from day 4 onwards, with a concomitant rise in lactate-pyruvate ratio and glycerol. These results suggest that mitochondrial dysfunction is a significant contributor to poor outcome following TBI and propose extracellular NAA as a potential marker for monitoring interventions aimed at preserving mitochondrial function.
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Affiliation(s)
- Antonio Belli
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
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97
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Kantarci K, Petersen RC, Boeve BF, Knopman DS, Tang-Wai DF, O'Brien PC, Weigand SD, Edland SD, Smith GE, Ivnik RJ, Ferman TJ, Tangalos EG, Jack CR. 1H MR spectroscopy in common dementias. Neurology 2006; 63:1393-8. [PMID: 15505154 PMCID: PMC2766798 DOI: 10.1212/01.wnl.0000141849.21256.ac] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the 1H MR spectroscopic (MRS) findings and intergroup differences among common dementias: Alzheimer disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and frontotemporal lobar degeneration (FTLD). METHODS The authors consecutively recruited 206 normal elderly subjects and 121 patients with AD, 41 with FTLD, 20 with DLB, and 8 with VaD. The 1H MRS metabolite ratio changes in common dementias were evaluated with respect to normal and also differences among the common dementias. RESULTS N-acetylaspartate (NAA)/creatine (Cr) was lower than normal in patients with AD, FTLD, and VaD. Myo-inositol (mI)/Cr was higher than normal in patients with AD and FTLD. Choline (Cho)/Cr was higher than normal in patients with AD, FTLD, and DLB. There were no metabolite differences between patients with AD and FTLD or between patients with DLB and VaD. NAA/Cr was lower in patients with AD and FTLD than DLB. MI/Cr was higher in patients with AD and FTLD than VaD. MI/Cr was also higher in patients with FTLD than DLB. CONCLUSIONS NAA/Cr levels are decreased in dementias that are characterized by neuron loss, such as AD, FTLD, and VaD. MI/Cr levels are elevated in dementias that are pathologically characterized by gliosis, such as AD and FTLD. Cho/Cr levels are elevated in dementias that are characterized by a profound cholinergic deficit, such as AD and DLB.
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Affiliation(s)
- Kejal Kantarci
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota
| | - Ronald C. Petersen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Peter C. O'Brien
- Department of Clinical Epidemiology, Mayo Clinic, Rochester, Minnesota
| | | | - Steven D. Edland
- Department of Clinical Epidemiology, Mayo Clinic, Rochester, Minnesota
| | - Glenn E. Smith
- Departments of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Robert J. Ivnik
- Departments of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Tanis J. Ferman
- Departments of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida
| | - Eric G. Tangalos
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Clifford R. Jack
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota
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98
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Träber F, Block W, Freymann N, Gür O, Kucinski T, Hammen T, Ende G, Pilatus U, Hampel H, Schild HH, Heun R, Jessen F. A multicenter reproducibility study of single-voxel 1H-MRS of the medial temporal lobe. Eur Radiol 2006; 16:1096-103. [PMID: 16416279 DOI: 10.1007/s00330-005-0108-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 11/22/2005] [Accepted: 11/29/2005] [Indexed: 10/25/2022]
Abstract
Proton magnetic resonance spectroscopy ((1)H-MRS) has provided evidence for a reduction of N-acetyl-aspartate (NAA) in the medial temporal lobe (MTL) in cerebral disorders such as Alzheimer's Disease. Within the (1)H-MRS study of the German Research Network on Dementia, we determined the multicenter reproducibility of single-voxel (1)H-MRS of the MTL. At five sites with 1.5T MR systems, single-voxel (1)H spectra from the MTL of an identical healthy subject were measured. The same subject was also examined at one of the sites five times to assess intracenter stability. The protocol included water-suppressed spectra with TE 272 ms and TE 30 ms and unsuppressed spectra for absolute quantification of metabolite concentrations. The intracenter reproducibility of absolute NAA concentration, expressed as coefficient of variation (CV), was 1.8%. CV for the concentrations of creatine (Cr), choline (Cho), and myoinositol (MI) and for the ratios NAA/Cr, NAA/Cho, and MI/NAA varied by 11-16%. Intercenter CV was 3.9% for NAA and were below 10% for all other metabolites and metabolic ratios. Our study demonstrates that quantitative assessment of NAA with single-voxel MRS can be performed with high intercenter reproducibility. This is the basis for applying (1)H-MRS in large-scale early recognition and treatment studies in MTL affecting disorders.
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Affiliation(s)
- Frank Träber
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany.
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Mascalchi M. Neurodegenerative Diseases with Associated White Matter Pathology. MR IMAGING IN WHITE MATTER DISEASES OF THE BRAIN AND SPINAL CORD 2005:377-388. [DOI: 10.1007/3-540-27644-0_26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Fukui S, Matsuno M, Inubushi T, Nosaka S. N-Acetylaspartate concentrations in the thalami of neuropathic pain patients and healthy comparison subjects measured with (1)H-MRS. Magn Reson Imaging 2005; 24:75-9. [PMID: 16410181 DOI: 10.1016/j.mri.2005.10.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Accepted: 10/18/2005] [Indexed: 11/23/2022]
Abstract
We investigated the absolute concentration of N-acetylaspartate (NAA) in the thalami of neuropathic pain patients and healthy comparison subjects by single-voxel proton magnetic resonance spectroscopy ((1)H-MRS). (1)H-MRS was performed with a 1.5-T MR system on a voxel in the thalamus bilaterally in 9 neuropathic pain patients and 14 healthy control subjects. We measured the absolute concentration of NAA using a linear combination model. The NAA concentration in the thalamus decreased significantly on the contralateral side in seven patients and on the ipsilateral side in two patients, as compared with the mean NAA concentration of the healthy control subjects. The NAA concentrations in two patients who did not respond to standard pain treatments were extremely decreased. Our results using (1)H-MRS suggest that neuropathic pain seems to be associated with an abnormal balance of the neural activity in the thalamus. The NAA concentration of the thalamus may be related to the efficacy of therapy. (1)H-MRS may serve as a useful noninvasive tool for evaluating thalamic neural activity in neuropathic pain patients.
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Affiliation(s)
- Sei Fukui
- Department of Anesthesiology, Shiga University of Medical Science, Tukinowa, Seta, Otsu, Shiga 520-2192, Japan.
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