1
|
Lin Z, Meng Z, Wang T, Guo R, Zhao Y, Li Y, Bo B, Guan Y, Liu J, Zhou H, Yu X, Lin DJ, Liang ZP, Nachev P, Li Y. Predicting the Onset of Ischemic Stroke With Fast High-Resolution 3D MR Spectroscopic Imaging. J Magn Reson Imaging 2023; 58:838-847. [PMID: 36625533 DOI: 10.1002/jmri.28596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Neurometabolite concentrations provide a direct index of infarction progression in stroke. However, their relationship with stroke onset time remains unclear. PURPOSE To assess the temporal dynamics of N-acetylaspartate (NAA), creatine, choline, and lactate and estimate their value in predicting early (<6 hours) vs. late (6-24 hours) hyperacute stroke groups. STUDY TYPE Cross-sectional cohort. POPULATION A total of 73 ischemic stroke patients scanned at 1.8-302.5 hours after symptom onset, including 25 patients with follow-up scans. FIELD STRENGTH/SEQUENCE A 3 T/magnetization-prepared rapid acquisition gradient echo sequence for anatomical imaging, diffusion-weighted imaging and fluid-attenuated inversion recovery imaging for lesion delineation, and 3D MR spectroscopic imaging (MRSI) for neurometabolic mapping. ASSESSMENT Patients were divided into hyperacute (0-24 hours), acute (24 hours to 1 week), and subacute (1-2 weeks) groups, and into early (<6 hours) and late (6-24 hours) hyperacute groups. Bayesian logistic regression was used to compare classification performance between early and late hyperacute groups by using different combinations of neurometabolites as inputs. STATISTICAL TESTS Linear mixed effects modeling was applied for group-wise comparisons between NAA, creatine, choline, and lactate. Pearson's correlation analysis was used for neurometabolites vs. time. P < 0.05 was considered statistically significant. RESULTS Lesional NAA and creatine were significantly lower in subacute than in acute stroke. The main effects of time were shown on NAA (F = 14.321) and creatine (F = 12.261). NAA was significantly lower in late than early hyperacute patients, and was inversely related to time from symptom onset across both groups (r = -0.440). The decrease of NAA and increase of lactate were correlated with lesion volume (NAA: r = -0.472; lactate: r = 0.366) in hyperacute stroke. Discrimination was improved by combining NAA, creatine, and choline signals (area under the curve [AUC] = 0.90). DATA CONCLUSION High-resolution 3D MRSI effectively assessed the neurometabolite changes and discriminated early and late hyperacute stroke lesions. EVIDENCE LEVEL 1. TECHNICAL EFFICACY Stage 2.
Collapse
Affiliation(s)
- Zengping Lin
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ziyu Meng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tianyao Wang
- Radiology Department, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Rong Guo
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Siemens Medical Solutions USA, Inc., Urbana, Illinois, USA
| | - Yibo Zhao
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Yudu Li
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Bin Bo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Guan
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Liu
- Radiology Department, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Hong Zhou
- Department of Radiology, The First Affiliated Hospital of South China of University, South China of University, Hengyang, China
| | - Xin Yu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zhi-Pei Liang
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | | | - Yao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
2
|
Yurci A, Dokuzeylul Gungor N, Gurbuz T. Spectroscopy analysis of endometrial metabolites is a powerful predictor of success of embryo transfer in women with implantation failure: a preliminary study. Gynecol Endocrinol 2021; 37:415-421. [PMID: 33569995 DOI: 10.1080/09513590.2021.1883584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To investigate whether prior endometrium spectroscopy predicts the success of embryo transfer in patients with recurrent implantation failure (RIF). MATERIALS AND METHODS Twenty women with RIF who were scheduled for IVF-ET and six fertile women were included the study. All women with RIF and fertile controls underwent endometrium spectroscopy before embryo transfer. A multi-voxel spectroscopy sequence was used for the detection of choline (Cho), creatine (Cr), lactate, and lipids. Women with RIF were divided into two subgroups as successful (n = 8) and unsuccessful RIF (n = 12) according to both Cho and Cr metabolite characteristics and whether pregnancy was achieved. Associations between the metabolite intensities of the RIF subjects and the implantation rate (IR) and clinical pregnancy rate (CPR) were assessed. RESULTS While 8 of 20 RIF cases became pregnant, pregnancy could not be achieved in 12 cases. The common spectroscopy finding in all 8 cases who conceived was high Cho and low lactate. The main metabolite change detected in 12 patients who could not conceive was the increase in lactate and lipid signals. The cutoff value of Cho, Cr, lactate and lipid were 1.01 ppm, 1.44 ppm, 0.86 ppm and 1.22 ppm respectively in patients who achieved pregnancy following ET. A positive and significant correlation was found between Cho and Cr intensities and IR or CPR. CONCLUSIONS Receptive endometrium represents some specific metabolites in spectroscopy that can be used for prediction of the success or failure of embryo transfer in women suffering implantation failure.
Collapse
Affiliation(s)
- Arzu Yurci
- Memorial Kayseri Hospital IVF Center, Gynecology Obstetrics & Reproductive Medicine, Kayseri, Turkey
| | - Nur Dokuzeylul Gungor
- Bahcesehir University Goztepe Medical Park Hospital, Gynecology Obstetrics & Reproductive Medicine, Istanbul, Turkey
| | - Tugba Gurbuz
- Medistate Hospital Gynecology and Obstetric Clinic, Istanbul, Turkey
| |
Collapse
|
3
|
Guo R, Zhao Y, Li Y, Wang T, Li Y, Sutton B, Liang ZP. Simultaneous QSM and metabolic imaging of the brain using SPICE: Further improvements in data acquisition and processing. Magn Reson Med 2020; 85:970-977. [PMID: 32810319 DOI: 10.1002/mrm.28459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To achieve high-resolution mapping of brain tissue susceptibility in simultaneous QSM and metabolic imaging. METHODS Simultaneous QSM and metabolic imaging was first achieved using SPICE (spectroscopic imaging by exploiting spatiospectral correlation), but the QSM maps thus obtained were at relatively low-resolution (2.0 × 3.0 × 3.0 mm3 ). We overcome this limitation using an improved SPICE data acquisition method with the following novel features: 1) sampling (k, t)-space in dual densities, 2) sampling central k-space fully to achieve nominal spatial resolution of 3.0 × 3.0 × 3.0 mm3 for metabolic imaging, and 3) sampling outer k-space sparsely to achieve spatial resolution of 1.0 × 1.0 × 1.9 mm3 for QSM. To keep the scan time short, we acquired spatiospectral encodings in echo-planar spectroscopic imaging trajectories in central k-space but in CAIPIRINHA (controlled aliasing in parallel imaging results in higher acceleration) trajectories in outer k-space using blipped phase encodings. For data processing and image reconstruction, a union-of-subspaces model was used, effectively incorporating sensitivity encoding, spatial priors, and spectral priors of individual molecules. RESULTS In vivo experiments were carried out to evaluate the feasibility and potential of the proposed method. In a 6-min scan, QSM maps at 1.0 × 1.0 × 1.9 mm3 resolution and metabolic maps at 3.0 × 3.0 × 3.0 mm3 nominal resolution were obtained simultaneously. Compared with the original method, the QSM maps obtained using the new method reveal fine-scale brain structures more clearly. CONCLUSION We demonstrated the feasibility of achieving high-resolution QSM simultaneously with metabolic imaging using a modified SPICE acquisition method. The improved capability of SPICE may further enhance its practical utility in brain mapping.
Collapse
Affiliation(s)
- Rong Guo
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Yibo Zhao
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Yudu Li
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Tianyao Wang
- Department of Radiology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, People's Republic of China
| | - Yao Li
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Brad Sutton
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois.,Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Zhi-Pei Liang
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois
| |
Collapse
|
4
|
Li G, Li Y, Hu Y, Wu Q, Yu H, Deng H, Tang Z. Diffuse low-grade glioma mimicking ischaemic infarct: a case report. Int J Neurosci 2018; 128:886-890. [PMID: 29384395 DOI: 10.1080/00207454.2018.1435537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Diffuse Low-Grade Gliomas (LGGs) include World Health Organization (WHO) grade II diffuse astrocytoma, oligodendroglioma and oligoastrocytoma. Since the neurological symptoms of LGGs are often subtle and deceptive, LGGs are easily overlooked at their early stage. Here, we report a case of a 49-year-old female with symptoms and imaging manifestations mimicking ischaemic infarct. After treatments for ischaemic stroke, the symptoms initially fluctuated and then aggravated. In addition, we found that the locations of the lesions did not match the vascular distribution and no obvious abnormalities were observed by Computed Tomography (CT) angiography and transcranial Doppler. The results from the Magnetic Resonance Spectroscopy (MRS) and from the stereotactic biopsy directed to the final diagnosis of WHO grade II, isocitrate dehydrogenase (IDH)-wild-type diffuse astrocytoma. This is the first reported LGG case with a stroke-like onset. This case illustrates how easy it is to misdiagnose an LGG as a stroke if just using cerebral CT and magnetic resonance imaging. MRS and biopsy can assist with the differential diagnosis process thereby avoiding inappropriate or delayed treatments.
Collapse
Affiliation(s)
- Gaigai Li
- a Department of Neurology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Yanyan Li
- a Department of Neurology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Yang Hu
- a Department of Neurology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Qian Wu
- a Department of Neurology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Haihan Yu
- a Department of Neurology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Hong Deng
- a Department of Neurology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Zhouping Tang
- a Department of Neurology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| |
Collapse
|
5
|
McNamara RK, Asch RH, Lindquist DM, Krikorian R. Role of polyunsaturated fatty acids in human brain structure and function across the lifespan: An update on neuroimaging findings. Prostaglandins Leukot Essent Fatty Acids 2018; 136:23-34. [PMID: 28529008 PMCID: PMC5680156 DOI: 10.1016/j.plefa.2017.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/14/2017] [Accepted: 05/08/2017] [Indexed: 01/07/2023]
Abstract
There is a substantial body of evidence from animal studies implicating polyunsaturated fatty acids (PUFA) in neuroinflammatory, neurotrophic, and neuroprotective processes in brain. However, direct evidence for a role of PUFA in human brain structure and function has been lacking. Over the last decade there has been a notable increase in neuroimaging studies that have investigated the impact of PUFA intake and/or blood levels (i.e., biostatus) on brain structure, function, and pathology in human subjects. The majority of these studies specifically evaluated associations between omega-3 PUFA intake and/or biostatus and neuroimaging outcomes using a variety of experimental designs and imaging techniques. This review provides an updated overview of these studies in an effort to identify patterns to guide and inform future research. While the weight of evidence provides general support for a beneficial effect of a habitual diet consisting of higher omega-3 PUFA intake on cortical structure and function in healthy human subjects, additional research is needed to replicate and extend these findings as well as identify response mediators and clarify mechanistic pathways. Controlled intervention trials are also needed to determine whether increasing n-3 PUFA biostatus can prevent or attenuate neuropathological brain changes observed in patients with or at risk for psychiatric disorders and dementia.
Collapse
Affiliation(s)
- Robert K McNamara
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45219, United States.
| | - Ruth H Asch
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45219, United States
| | - Diana M Lindquist
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45267, United States
| | - Robert Krikorian
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45219, United States
| |
Collapse
|
6
|
Ruan L, Wang Y, Chen SC, Zhao T, Huang Q, Hu ZL, Xia NZ, Liu JJ, Chen WJ, Zhang Y, Cheng JL, Gao HC, Yang YJ, Sun HZ. Metabolite changes in the ipsilateral and contralateral cerebral hemispheres in rats with middle cerebral artery occlusion. Neural Regen Res 2017; 12:931-937. [PMID: 28761426 PMCID: PMC5514868 DOI: 10.4103/1673-5374.208575] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cerebral ischemia not only causes pathological changes in the ischemic areas but also induces a series of secondary changes in more distal brain regions (such as the contralateral cerebral hemisphere). The impact of supratentorial lesions, which are the most common type of lesion, on the contralateral cerebellum has been studied in patients by positron emission tomography, single photon emission computed tomography, magnetic resonance imaging and diffusion tensor imaging. In the present study, we investigated metabolite changes in the contralateral cerebral hemisphere after supratentorial unilateral ischemia using nuclear magnetic resonance spectroscopy-based metabonomics. The permanent middle cerebral artery occlusion model of ischemic stroke was established in rats. Rats were randomly divided into the middle cerebral artery occlusion 1-, 3-, 9- and 24-hour groups and the sham group. 1H nuclear magnetic resonance spectroscopy was used to detect metabolites in the left and right cerebral hemispheres. Compared with the sham group, the concentrations of lactate, alanine, γ-aminobutyric acid, choline and glycine in the ischemic cerebral hemisphere were increased in the acute stage, while the concentrations of N-acetyl aspartate, creatinine, glutamate and aspartate were decreased. This demonstrates that there is an upregulation of anaerobic glycolysis (shown by the increase in lactate), a perturbation of choline metabolism (suggested by the increase in choline), neuronal cell damage (shown by the decrease in N-acetyl aspartate) and neurotransmitter imbalance (evidenced by the increase in γ-aminobutyric acid and glycine and by the decrease in glutamate and aspartate) in the acute stage of cerebral ischemia. In the contralateral hemisphere, the concentrations of lactate, alanine, glycine, choline and aspartate were increased, while the concentrations of γ-aminobutyric acid, glutamate and creatinine were decreased. This suggests that there is a difference in the metabolite changes induced by ischemic injury in the contralateral and ipsilateral cerebral hemispheres. Our findings demonstrate the presence of characteristic changes in metabolites in the contralateral hemisphere and suggest that they are most likely caused by metabolic changes in the ischemic hemisphere.
Collapse
Affiliation(s)
- Lei Ruan
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yan Wang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Shu-Chao Chen
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Tian Zhao
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Qun Huang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zi-Long Hu
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Neng-Zhi Xia
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jin-Jin Liu
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Wei-Jian Chen
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yong Zhang
- Department of Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jing-Liang Cheng
- Department of Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Hong-Chang Gao
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yun-Jun Yang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Hou-Zhang Sun
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| |
Collapse
|
7
|
Payne GS, Harris LM, Cairns GS, Messiou C, deSouza NM, Macdonald A, Saran F, Leach MO. Validating a robust double-quantum-filtered (1) H MRS lactate measurement method in high-grade brain tumours. NMR IN BIOMEDICINE 2016; 29:1420-6. [PMID: 27514007 PMCID: PMC5042032 DOI: 10.1002/nbm.3587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 05/23/2023]
Abstract
(1) H MRS measurements of lactate are often confounded by overlapping lipid signals. Double-quantum (DQ) filtering eliminates lipid signals and permits single-shot measurements, which avoid subtraction artefacts in moving tissues. This study evaluated a single-voxel-localized DQ filtering method qualitatively and quantitatively for measuring lactate concentrations in the presence of lipid, using high-grade brain tumours in which the results could be compared with standard acquisition as a reference. Paired standard acquisition and DQ-filtered (1) H MR spectra were acquired at 3T from patients receiving treatment for glioblastoma, using fLASER (localization by adiabatic selective refocusing using frequency offset corrected inversion pulses) single-voxel localization. Data were acquired from 2 × 2 × 2 cm(3) voxels, with a repetition time of 1 s and 128 averages (standard acquisition) or 256 averages (DQ-filtered acquisition), requiring 2.15 and 4.3 min respectively. Of 37 evaluated data pairs, 20 cases (54%) had measureable lactate (fitted Cramér-Rao lower bounds ≤ 20%) in either the DQ-filtered or the standard acquisition spectra. The measured DQ-filtered lactate signal was consistently downfield of lipid (1.33 ± 0.03 ppm vs 1.22 ± 0.08 ppm; p = 0.002), showing that it was not caused by lipid breakthrough, and that it matched the lactate signal seen in standard measurements (1.36 ± 0.02 ppm). In the absence of lipid, similar lactate concentrations were measured by the two methods (mean ratio DQ filtered/standard acquisition = 1.10 ± 0.21). In 7/20 cases with measurable lactate, signal was not measureable in the standard acquisition owing to lipid overlap but was quantified in the DQ-filtered acquisition. Conversely, lactate was undetected in seven DQ-filtered acquisitions but visible using the standard acquisition. In conclusion, the DQ filtering method has proven robust in eliminating lipid and permits uncontaminated measurement of lactate. This is important validation prior to use in tissues outside the brain, which contain large amounts of lipid and which are often susceptible to motion.
Collapse
Affiliation(s)
- G S Payne
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK.
| | - L M Harris
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - G S Cairns
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - C Messiou
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - N M deSouza
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - A Macdonald
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - F Saran
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - M O Leach
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| |
Collapse
|
8
|
McNamara RK, Jandacek R, Rider T, Tso P, Chu WJ, Weber WA, Welge JA, Strawn JR, Adler CM, DelBello MP. Effects of fish oil supplementation on prefrontal metabolite concentrations in adolescents with major depressive disorder: a preliminary 1H MRS study. Nutr Neurosci 2016; 19:145-55. [PMID: 24915543 DOI: 10.1179/1476830514y.0000000135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To use proton magnetic resonance spectroscopy ((1)H MRS) to investigate the effects of fish oil (FO) supplementation on cortical metabolite concentrations in adolescents with major depressive disorder (MDD). METHODS Metabolite concentrations were determined by (1)H MRS in the anterior cingulate cortex and bilateral dorsolateral prefrontal cortex (DLPFC) of adolescents with MDD before and following 10-week open-label supplementation with low (2.4 g/day, n = 7) or high (16.2 g/day, n = 7) dose FO. Depressive symptom severity scores and erythrocyte fatty acid levels were also determined. RESULTS Baseline erythrocyte eicosapentaenoic acid (EPA) composition was positively correlated, and arachidonic acid (AA) and the AA/EPA ratio were inversely correlated, with choline (Cho) concentrations in the right DLPFC. Docosahexaenoic acid (DHA) composition was inversely correlated with myo-inositol (mI) concentrations in the left DLPFC. Erythrocyte EPA and DHA composition increased, and AA decreased, significantly following low-dose and high-dose FO supplementation. In the intent-to-treat sample, depressive symptom severity scores decreased significantly in the high-dose group (-40%, P < 0.0001) and there was a trend in the low-dose group (-20%, P = 0.06). There were no significant baseline-endpoint changes in metabolite levels in each voxel. In the low-dose group there were changes with large effect sizes, including a decrease in mI in the left DLPFC (-12%, P = 0.18, d = 0.8) and increases in glutamate + glutamine (Glx) (+12%, P = 0.19, d = 0.8) and Cho (+15%, P = 0.08, d = 1.2) in the right DLPFC. In the high-dose group, there was a trend for increases in Cho in the right DLPFC (+10%, P = 0.09, d = 1.2). DISCUSSION These preliminary data suggest that increasing the LCn-3 fatty acid status of adolescent MDD patients is associated with subtle changes in Glx, mI, and Cho concentrations in the DLPFC that warrant further evaluation in a larger controlled trial.
Collapse
Affiliation(s)
- Robert K McNamara
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Ronald Jandacek
- b Department of Pathology , University of Cincinnati , Cincinnati , OH , USA
| | - Therese Rider
- b Department of Pathology , University of Cincinnati , Cincinnati , OH , USA
| | - Patrick Tso
- b Department of Pathology , University of Cincinnati , Cincinnati , OH , USA
| | - Wen-Jang Chu
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Wade A Weber
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Jeffrey A Welge
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Jeffrey R Strawn
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Caleb M Adler
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Melissa P DelBello
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| |
Collapse
|
9
|
van de Looij Y, Dean JM, Gunn AJ, Hüppi PS, Sizonenko SV. Advanced magnetic resonance spectroscopy and imaging techniques applied to brain development and animal models of perinatal injury. Int J Dev Neurosci 2015; 45:29-38. [PMID: 25818582 DOI: 10.1016/j.ijdevneu.2015.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 11/16/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) and magnetic resonance imaging (MRI) are widely used in the field of brain development and perinatal brain injury. Due to technical progress the magnetic field strength (B0) of MR systems has continuously increased, favoring (1)H-MRS with quantification of up to 18 metabolites in the brain and short echo time (TE) MRI sequences including phase and susceptibility imaging. For longer TE techniques including diffusion imaging modalities, the benefits of higher B0 have not been clearly established. Nevertheless, progress has also been made in new advanced diffusion models that have been developed to enhance the accuracy and specificity of the derived diffusion parameters. In this review, we will describe the latest developments in MRS and MRI techniques, including high-field (1)H-MRS, phase and susceptibility imaging, and diffusion imaging, and discuss their application in the study of cerebral development and perinatal brain injury.
Collapse
Affiliation(s)
- Yohan van de Looij
- Division of Child Development & Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland; Laboratory for Functional and Metabolic Imaging (LIFMET), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Justin M Dean
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Petra S Hüppi
- Division of Child Development & Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - Stéphane V Sizonenko
- Division of Child Development & Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| |
Collapse
|
10
|
PET imaging in ischemic cerebrovascular disease: current status and future directions. Neurosci Bull 2014; 30:713-32. [PMID: 25138055 DOI: 10.1007/s12264-014-1463-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/10/2014] [Indexed: 01/08/2023] Open
Abstract
Cerebrovascular diseases are caused by interruption or significant impairment of the blood supply to the brain, which leads to a cascade of metabolic and molecular alterations resulting in functional disturbance and morphological damage. These pathophysiological changes can be assessed by positron emission tomography (PET), which permits the regional measurement of physiological parameters and imaging of the distribution of molecular markers. PET has broadened our understanding of the flow and metabolic thresholds critical for the maintenance of brain function and morphology: in this application, PET has been essential in the transfer of the concept of the penumbra (tissue with perfusion below the functional threshold but above the threshold for the preservation of morphology) to clinical stroke and thereby has had great impact on developing treatment strategies. Radioligands for receptors can be used as early markers of irreversible neuronal damage and thereby can predict the size of the final infarcts; this is also important for decisions concerning invasive therapy in large ("malignant") infarctions. With PET investigations, the reserve capacity of blood supply to the brain can be tested in obstructive arteriosclerosis of the supplying arteries, and this again is essential for planning interventions. The effect of a stroke on the surrounding and contralateral primarily unaffected tissue can be investigated, and these results help to understand the symptoms caused by disturbances in functional networks. Chronic cerebrovascular disease causes vascular cognitive disorders, including vascular dementia. PET permits the detection of the metabolic disturbances responsible for cognitive impairment and dementia, and can differentiate vascular dementia from degenerative diseases. It may also help to understand the importance of neuroinflammation after stroke and its interaction with amyloid deposition in the development of dementia. Although the clinical application of PET investigations is limited, this technology had and still has a great impact on research into cerebrovascular diseases.
Collapse
|
11
|
Lin AQ, Shou JX, Li XY, Ma L, Zhu XH. Metabolic changes in acute cerebral infarction: Findings from proton magnetic resonance spectroscopic imaging. Exp Ther Med 2013; 7:451-455. [PMID: 24396424 PMCID: PMC3881070 DOI: 10.3892/etm.2013.1418] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/09/2013] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to investigate the clinical role of proton magnetic resonance spectroscopy (1H-MRS) in the diagnosis of acute cerebral infarction. Using databases available at the Fifth Affiliated Hospital of Zhengzhou University (Zhengzhou, China), the medical records of 47 patients with acute cerebral infarction treated between April 2010 and March 2012 were retrospectively reviewed. The patients underwent routine magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI) and multiple-voxel 1H-MRS examination within 12 h after the onset of stroke. The patients then received normal medical treatment for 2 weeks and underwent follow-up 1H-MRS examination at 1–2 months after stroke. The concentrations of the main metabolites [N-acetylaspartic acid (NAA), creatine (Cr), choline (Cho) and lactate (Lac)] in the infarct center, the infarction border region and the contralateral brain areas (control) were analyzed. The 47 patients experienced changes in NAA, Cho and Lac levels at different stages after stroke. In the infarction center, the NAA/Cr and NAA/Cho ratios decreased, while the Lac/Cr ratio increased within 12 h compared with those in the contralateral side. Within 6–12 h after stroke, the Lac/Cr ratio increased and the NAA/Cho ratio decreased compared with those <6 h after stroke. During the 1–2 months post-stroke, significant reductions in the NAA/Cr, NAA/Cho, Cho/Cr and Lac/Cr ratios were observed in the infarction center. In the infarction border region, the Lac/Cr ratio increased significantly at 12 h and decreased during the 1–2 months after stroke. The NAA/Cr, NAA/Cho and Cho/Cr ratios were significantly increased in the infarction border regions of patients who received thrombolytic therapy for 1–2 months compared with those in patients who did not undergo thrombolysis. Our results highlight the usefulness of 1H-MRS-based metabolomics as a feasible and efficient prognostic tool for assessing the treatment effect of acute cerebral infarction.
Collapse
Affiliation(s)
- Ai-Qin Lin
- Nursing School, Zhengzhou Railway Vocational and Technical College, Zhengzhou, Henan 450052, P.R. China
| | - Ji-Xin Shou
- Department of Neurology, Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xue-Yuan Li
- Department of Neurology, Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Lin Ma
- Department of Neurology, Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xiao-Han Zhu
- Nursing School, Zhengzhou Railway Vocational and Technical College, Zhengzhou, Henan 450052, P.R. China
| |
Collapse
|
12
|
McNamara RK, Jandacek R, Tso P, Weber W, Chu WJ, Strakowski SM, Adler CM, Delbello MP. Low docosahexaenoic acid status is associated with reduced indices in cortical integrity in the anterior cingulate of healthy male children: a 1H MRS Study. Nutr Neurosci 2013; 16:183-90. [PMID: 23582513 DOI: 10.1179/1476830512y.0000000045] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Docosahexaenoic acid (DHA, 22:6n-3) is the principal omega-3 fatty acid in mammalian brain gray matter, and emerging preclinical evidence suggests that DHA has neurotrophic and neuroprotective properties. This study investigated relationships among DHA status, neurocognitive performance, and cortical metabolism measured with proton magnetic resonance spectroscopy (1H MRS) in healthy developing male children (aged 8-10 years, n = 38). Subjects were segregated into low-DHA (n = 19) and high-DHA (n = 19) status groups by a median split of erythrocyte DHA levels. Group differences in 1H MRS indices of cortical metabolism, including choline (Cho), creatine (Cr), glutamine + glutamate + γ-aminobutyric acid (Glx), myo-inositol (mI), and n-acetyl aspartate (NAA), were determined in the right and left dorsolateral prefrontal cortex (R/L-DLPFC, BA9) and bilateral anterior cingulate cortex (ACC, BA32/33). Group differences in neurocognitive performance were evaluated with the Kaufman Brief Intelligence Test and identical-pairs version of the continuous performance task (CPT-IP). Subjects in the low-DHA group consumed fish less frequently (P = 0.02), had slower reaction times on the CPT-IP (P = 0.007), and exhibited lower mI (P = 0.007), NAA (P = 0.007), Cho (P = 0.009), and Cr (P = 0.01) concentrations in the ACC compared with the high-DHA group. There were no group differences in ACC Glx or any metabolite in the L-DLPFC and R-DLPFC. These data indicate that low-DHA status is associated with reduced indices of metabolic function in the ACC and slower reaction time during sustained attention in developing male children.
Collapse
Affiliation(s)
- Robert K McNamara
- Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Effects of hypothermia on brain injury assessed by magnetic resonance imaging after cardiopulmonary resuscitation in a porcine model of cardiac arrest. Am J Emerg Med 2013; 31:86-93. [DOI: 10.1016/j.ajem.2012.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 06/17/2012] [Accepted: 06/19/2012] [Indexed: 11/19/2022] Open
|
14
|
Affiliation(s)
- Wolf-Dieter Heiss
- From the Max Planck Institute for Neurological Research, Cologne, Germany
| |
Collapse
|
15
|
Zhang M, Lu J, Jiao L, Ma Q, Li K. Proton magnetic resonance spectroscopy in patients with symptomatic unilateral internal carotid artery / middle cerebral artery stenosis or occlusion. J Magn Reson Imaging 2011; 34:910-6. [PMID: 21774028 DOI: 10.1002/jmri.22706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 06/06/2011] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To explore the value of proton magnetic resonance spectroscopy imaging ((1)H-MRSI) in patients with stenosis or occlusion of the internal carotid artery (ICA) / middle cerebral artery (MCA). MATERIALS AND METHODS Fifty noninfarcted patients with stenosis or occlusion of unilateral ICA/MCA were included in our study. In the meantime, 25 patients with cerebral infarction and 25 healthy control subjects were enrolled. All patients and healthy control subjects underwent (1)H-MRSI. Cerebral metabolic changes were studied in the noninfarcted patients and compared with the infarcted patients as well as healthy control subjects. RESULTS In 50 noninfarcted patients N-acetylaspartate (NAA) decreased and choline increased in the ischemic hemisphere compared with the contralateral side and control subjects. Lactate peaks were observed in 12 patients. The metabolic changes were relatively slight but were associated with metabolic disruption in infarcted patients. There were relationships between metabolic abnormalities and neurological status of the noninfarcted patients. CONCLUSION (1)H-MRSI can demonstrate abnormal metabolic changes in cerebral tissues with no infarction, while with ICA/MCA may show stenosis or occlusion at an early stage, which may help guide treatment decisions and preoperative evaluation.
Collapse
Affiliation(s)
- Miao Zhang
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | | | | | | | | |
Collapse
|
16
|
van de Looij Y, Chatagner A, Hüppi PS, Gruetter R, Sizonenko SV. Longitudinal MR assessment of hypoxic ischemic injury in the immature rat brain. Magn Reson Med 2010; 65:305-12. [DOI: 10.1002/mrm.22617] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 07/29/2010] [Accepted: 08/06/2010] [Indexed: 01/31/2023]
|
17
|
Edema cerebral difuso en una paciente con encefalopatía vascular por el virus de la varicela-zoster: una complicación inesperada. Neurologia 2010. [DOI: 10.1016/s0213-4853(10)70037-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
18
|
Montero Tinnirello J, Rodriguez Pecci M, de la Fuente Aguado J, Santos Armentia E. Mild cerebral oedema in a patient with vascular encephalopathy due to varicela-zoster virus: an unexpected complication. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
19
|
Kelsey CR, Mukundan S, Wang Z, Hahn CA, Soher BJ, Kirkpatrick JP. Assessing neurotoxicity from the low-dose radiation component of radiosurgery using magnetic resonance spectroscopy. Neuro Oncol 2010; 12:145-52. [PMID: 20150381 DOI: 10.1093/neuonc/nop040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of the study was to determine if biochemical changes indicative of injury, assessed using magnetic resonance spectroscopic imaging (SI), are observed after stereotactic radiosurgery (SRS). The study included patients who underwent SI immediately before and 1, 30, and 90 days following SRS. Short TE spectra (TR/TE 1000/35 ms) were acquired at the SRS isocenter with a 2D PRESS-CSI sequence on a single 1.5 T scanner. The SRS isodose lines were overlaid on the magnetic resonance imaging slice utilized for SI data acquisition. N-Acetyl aspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios were computed for multiple voxels located between the 25 and 50 cGy isodose lines (low dose) and the 200 and 350 cGy isodose lines (medium dose). An analysis of variance and paired t-tests compared metabolite levels at different time points. Twelve patients were enrolled, although 3 were excluded secondary to poor spectral data quality or deviations from the prescribed SI protocol. The median number of voxels analyzed from the low- and medium-dose region was 7 and 4, respectively. No significant changes in metabolite peak height ratios over time were seen in the low-dose region, for either NAA/Cr (P = .89) or Cho/Cr (P = .85). There was no difference in Cho/Cr peak height ratios in the medium-dose region (P = .62). There was an increase in the NAA/Cr peak height ratio in the medium-dose region between day -1 and day +30 (P = .003), followed by a decline to baseline between days +30 and +90 (P = .03). We did not observe a significant decline in NAA/Cr or change in Cho/Cr peak heights in uninvolved brain parenchyma after SRS.
Collapse
Affiliation(s)
- Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
INTRODUCTION The completion of an integrated PET/MR prototype system for brain imaging is the latest step in the evolution of positron emission tomography. Early images with this new imaging system demonstrate that high-resolution multiparametric studies can be combined without significant loss of performance of either imaging modality. OBJECTIVE This new technology will make fusion of morphological and biological information much easier, yield real-time assessment of complementary variables and will provide dynamic information for kinetic modelling. Simultaneous acquisition of various metabolic and functional parameters may open new insights into the organization of the brain and its changes in disease. DISCUSSION A new field may open up for molecular and cellular imaging, where new targets--e.g. angiogenesis, gene transfer, function and migration of transplanted cells--can be imaged in the morphological context and within a functional environment. This application might have a special impact on the translation of treatment concepts from experimental models into clinical application. If the added value of the hybrid system for diagnosis and treatment monitoring is established, a cost-effective PET/MR combination might attain wider clinical application.
Collapse
|
21
|
Lei H, Berthet C, Hirt L, Gruetter R. Evolution of the neurochemical profile after transient focal cerebral ischemia in the mouse brain. J Cereb Blood Flow Metab 2009; 29:811-9. [PMID: 19223915 DOI: 10.1038/jcbfm.2009.8] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evolution of the neurochemical profile consisting of 19 metabolites after 30 mins of middle cerebral artery occlusion was longitudinally assessed at 3, 8 and 24 h in 6 to 8 microL volumes in the striatum using localized 1H-magnetic resonance spectroscopy at 14.1 T. Profound changes were detected as early as 3 h after ischemia, which include elevated lactate levels in the presence of significant glucose concentrations, decreases in glutamate and a transient twofold glutamine increase, likely to be linked to the excitotoxic release of glutamate and conversion into glial glutamine. Interestingly, decreases in N-acetyl-aspartate (NAA), as well as in taurine, exceeded those in neuronal glutamate, suggesting that the putative neuronal marker NAA is rather a sensitive marker of neuronal viability. With further ischemia evolution, additional, more profound concentration decreases were detected, reflecting a disruption of cellular functions. We conclude that early changes in markers of energy metabolism, glutamate excitotoxicity and neuronal viability can be detected with high precision non-invasively in mice after stroke. Such investigations should lead to a better understanding and insight into the sequential early changes in the brain parenchyma after ischemia, which could be used for identifying new targets for neuroprotection.
Collapse
Affiliation(s)
- Hongxia Lei
- Laboratory of Functional and Metabolic Imaging, Institute of the Physics of Biological System, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | | | | | | |
Collapse
|
22
|
Cvoro V, Wardlaw JM, Marshall I, Armitage PA, Rivers CS, Bastin ME, Carpenter TK, Wartolowska K, Farrall AJ, Dennis MS. Associations between diffusion and perfusion parameters, N-acetyl aspartate, and lactate in acute ischemic stroke. Stroke 2009; 40:767-72. [PMID: 19150873 DOI: 10.1161/strokeaha.108.525626] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In acute ischemic stroke, the amount of neuronal damage in hyperintense areas on MR diffusion imaging (DWI) is unclear. We used spectroscopic imaging to measure N-acetyl aspartate (NAA, a marker of normal neurons) and lactate (a marker of ischemia) to compare with diffusion and perfusion values in the diffusion lesion in acute ischemic stroke. METHODS We recruited patients with acute ischemic stroke prospectively and performed MR diffusion weighted (DWI), perfusion, and spectroscopic imaging. We coregistered the images, outlined the visible diffusion lesion, and extracted metabolite, perfusion, and apparent diffusion coefficient (ADC) values from the diffusion lesion. RESULTS 42 patients were imaged, from 1.5 to 24 hours after stroke. In the DWI lesion, although NAA was reduced, there was no correlation between NAA and ADC or perfusion values. However, raised lactate correlated with reduced ADC (Spearman rho=0.32, P=0.04) and prolonged mean transit time (MTT, rho=0.31, P=0.04). Increasing DWI lesion size was associated with lower NAA and higher lactate (rho=-0.44, P=0.003; rho=0.49, P=0.001 respectively); NAA fell with increasing times to imaging (rho=-0.3, P=0.03), but lactate did not change. CONCLUSIONS Although larger confirmatory studies are needed, the correlation of ADC and MTT with lactate but not NAA suggests that ADC and MTT are better markers of the presence of ischemia than of cumulative neuronal loss. Further studies should define more precisely the rate of neuronal loss and relationship to diffusion and perfusion parameters with respect to the depth and duration of ischemia.
Collapse
Affiliation(s)
- Vera Cvoro
- Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Pichiecchio A, Tavazzi E, Maccabelli G, Precupanu CM, Romani A, Roccatagliata L, Luccichenti G, Bergamaschi R, Bastianello S. What insights have new imaging techniques given into aggressive forms of MS--different forms of MS or different from MS? Mult Scler 2008; 15:285-93. [PMID: 19039023 DOI: 10.1177/1352458508098561] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
"Aggressive" multiple sclerosis (MS) is still a challenging diagnosis, in spite of the relevant progresses concerning the comprehension of the disease mechanisms, especially through pathology studies and the advent of conventional magnetic resonance imaging (MRI). Some reviews have been already published on their clinical and therapeutical aspects, but no systematic review is available in literature about the neuroradiological features, using both conventional and advanced techniques. In particular, advanced MRI techniques, namely diffusion-weighted and tensor imaging, magnetization transfer imaging, and proton magnetic resonance spectroscopy, are giving new insights to find specific and appropriate radiological parameters that can help in targeting the diagnosis. We report a review of literature on the neuroradiological findings of aggressive forms of MS, focusing specifically on the role of advanced MRI techniques in the diagnostic phase and during follow-up.
Collapse
Affiliation(s)
- A Pichiecchio
- Neuroradiology Unit, Neurological Institute IRCCS Fondazione C. Mondino, Pavia, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Single-voxel magnetic resonance spectroscopy of brain tissue adjacent to arachnoid cysts of epileptic patients. Neurologist 2008; 14:382-9. [PMID: 19008744 DOI: 10.1097/nrl.0b013e318177819c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intracranial arachnoid cysts (ACs) are usually asymptomatic, benign developmental anomalies. The most frequent clinical manifestations are cranial expansion, hydrocephaly, headache, epileptic seizures, psychomotor retardation, and aphasia. It is unknown whether there is a correlation between intracranial AC and epileptic seizures without obvious intracranial pressure signs. In vivo magnetic resonance spectroscopy is a technique used for the noninvasive investigation of the various metabolites of cerebral biochemical reactions. Magnetic resonance spectroscopy is also being used increasingly commonly in epileptogenic situations as a noninvasive technique. The purpose of this study was to evaluate the proton magnetic resonance spectroscopic pattern of the contents of tissue adjacent to AC and to determine whether there are any characteristic spectral patterns that may be helpful in evaluating whether these lesions are epileptogenic foci. In conclusion, although the number of cases was limited, this finding may be seen as indicating that there is no association between AC and epilepsy.
Collapse
|
25
|
Muñoz Maniega S, Cvoro V, Armitage PA, Marshall I, Bastin ME, Wardlaw JM. Choline and creatine are not reliable denominators for calculating metabolite ratios in acute ischemic stroke. Stroke 2008; 39:2467-9. [PMID: 18617668 DOI: 10.1161/strokeaha.107.507020] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Choline and creatine are commonly used as denominators for other metabolites in ischemic stroke spectroscopy, assuming that they do not change. We investigated their concentration variation over time after stroke. METHODS Choline and creatine concentrations were measured by proton MR spectroscopic imaging in 51 patients at 5 times up to 3 months after stroke. RESULTS Choline and creatine levels changed significantly in the ischemic region. Choline was significantly reduced during the first 2 weeks after stroke onset (P=0.034). Creatine was significantly reduced during the whole period of the study (P=0.011). CONCLUSIONS Choline and creatine concentrations are not reliable denominators for metabolite ratios in acute stroke because their levels vary significantly in ischemic brain regions.
Collapse
Affiliation(s)
- Susana Muñoz Maniega
- University of Edinburgh, Division of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
| | | | | | | | | | | |
Collapse
|
26
|
Nagar VA, Ye J, Xu M, Ng WH, Yeo TT, Ong PL, Lim CCT. Multivoxel MR Spectroscopic Imaging – Distinguishing Intracranial Tumours from Non-neoplastic Disease. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v36n5p309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Introduction: Multi-voxel MR spectroscopic imaging (MRSI) provides chemical metabolite information that can supplement conventional MR imaging in the study of intracranial neoplasia. Our purpose was to use a robust semi-automated spectroscopic analysis to distinguish intracranial tumours from non-neoplastic disease.
Materials and Methods: Twenty intracranial tumours and 15 patients with non-neoplastic disease confirmed on histological examination or serial neuroimaging were studied with 2-dimensional MRSI using point-resolved spectroscopic (PRESS) imaging localisation. Using semi-automated post-processing software, spectra were analysed for peak heights of choline (Cho), creatine (Cr), N-acetyl aspartate (NAA), lactate (Lac) and lipid (Lip). Normalised Cho (nCho) ratios, computed by dividing maximum Cho in the lesion by the normal-appearing brain, were compared between intracranial tumours and non-neoplastic disease. Results: Meningiomas displayed homogenously elevated Cho. Malignant tumours, especially large glioblastoma multiforme, displayed inhomogeneity of metabolites within the tumour. All tumours had elevation of nCho >1 (mean 1.91 ± 0.65), and non-neoplastic diseases had tumour nCho <1 (mean 0.91 ± 0.46), which was significantly lower (P <0.05). Two patients with non-neoplastic lesions, one with subacute cerebral infarction and the other with cryptococcoma, had elevated Cho compared to normal tissue (false positive rate 13%).
Conclusion: Using semi-automated MRSI method, a simplified normalised Cho algorithm provides a method to distinguish intracranial tumours from non-neoplastic disease.
Key words: Brain neoplasm, Magnetic resonance imaging, Nuclear magnetic resonance, Spectroscopy
Collapse
Affiliation(s)
| | - Jieru Ye
- National Neuroscience Institute, Singapore
| | - Maosheng Xu
- Affiliated First Hospital of Zhejiang Chinese Medical University, PR China
| | - Wai-Hoe Ng
- National Neuroscience Institute, Singapore
| | | | | | | |
Collapse
|
27
|
Hascalik S, Celik O, Erdem G, Ara C, Kirimlioglu H. Proton magnetic resonance spectroscopy findings of a sacrococcygeal schwannoma. Int J Gynecol Cancer 2006; 16 Suppl 1:344-8. [PMID: 16515619 DOI: 10.1111/j.1525-1438.2006.00224.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Schwannoma is tumor of peripheral nerves, originating from Schwann cells. It is a rare nerve sheath tumor, which frequently occurs in the intracranial acoustic nerve and spinal nerves. We report on a 28-year-old woman who suffered from a large pelvic mass that was diagnosed to be sacrococcygeal schwannoma. The features of proton magnetic resonance spectroscopy (MRS) study are discussed. The magnetic resonance imaging instrument was a 1.5 T, Gyroscan Intera with a body coil as a radiofrequency transmitter and a signal receiver. T2-weighted images were obtained under the following conditions-turbo spin echo (TSE) T2: turbo spin echo repeat time (TR) = 4500 msec, echo time (TE) = 96 msec. Single voxel MRS was performed by the point-resolved spectroscopy technique with a long TE (136 msec). MRS measurement was performed on two different parts of the tumor. As well as strongly elevated choline and lipid signals, the tumor spectrum showed increased N-acetylaspartate resonances. MRS can be used effectively in the preoperative diagnosis of retroperitoneal and pelvic masses, which demonstrate unusual clinical features.
Collapse
Affiliation(s)
- S Hascalik
- Department of Obstetrics and Gynecology, Medical Faculty, Inonu University, Malatya, Turkey.
| | | | | | | | | |
Collapse
|
28
|
Hascalik S, Celik O, Sarac K, Meydanli MM, Alkan A, Mizrak B. Metabolic Changes in Pelvic Lesions: Findings at Proton MR Spectroscopic Imaging. Gynecol Obstet Invest 2005; 60:121-7. [PMID: 15920339 DOI: 10.1159/000086003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Accepted: 02/28/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the in vivo magnetic resonance spectroscopic (MRS) features of pelvic lesions using long echo time and to characterize the spectral patterns of various pathological entities. MATERIALS AND METHODS 17 patients with surgically and histopathologically confirmed pelvic lesions underwent long echo-time MRS, and the results obtained were analyzed. Before laparotomy, choline (Cho), lactate, lipid and creatine (Cr) levels of all lesions were measured by single voxel MRS (point-resolved spectroscopy technique, TE 136 ms). Voxels were placed in the center of the lesions. The MRS results of lesions were compared with the final histopathological diagnoses. RESULTS Spectroscopy analysis of serous, mucinous and undifferentiated carcinoma of the ovary revealed Cho, lactate and lipid signals, but granulosa-theca cell tumor showed only a lipid signal. The Cho signal was obtained from only 3 patients with mature cystic teratoma but none of the other benign ovarian tumors and pelvic abscesses. A lipid signal was detected in 3 patients diagnosed with pelvic abscess and all benign ovarian tumors. In addition to the lipid signal, a lactate signal was detected in the spectra of two pelvic abscesses. One case of endometrioma and 1 case of teratoma did not show any signal. CONCLUSION MRS demonstrates significant differences in metabolite concentration between benign and malignant ovarian tumors and pelvic abscesses. MRS may therefore be helpful in the differential diagnosis of adnexal lesions.
Collapse
Affiliation(s)
- Seyma Hascalik
- Department of Obstetrics and Gynecology, Inonu University Medical Faculty, Malatya, Turkey.
| | | | | | | | | | | |
Collapse
|
29
|
Appenzeller S, Li LM, Costallat LTL, Cendes F. Evidence of reversible axonal dysfunction in systemic lupus erythematosus: a proton MRS study. ACTA ACUST UNITED AC 2005; 128:2933-40. [PMID: 16195241 DOI: 10.1093/brain/awh646] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to investigate axonal dysfunction in patients with systemic lupus erythematosus (SLE) using proton magnetic resonance spectroscopy (1H-MRS). We studied prospectively 90 SLE patients (mean age of 32.5 years) and 23 normal volunteers (mean age of 33.8 years). We performed single voxel proton MRS using point resolved spectroscopy sequence over the superior-posterior region of the corpus callosum. We measured signals from N-acetyl compounds [N-acetylaspartate (NAA)] at 2.01 p.p.m., choline-based compounds (Cho) at 3.2 p.p.m. and creatine and phosphocreatine containing compounds (Cr) at 3.0 p.p.m. and determined NAA/Cr ratios. After 12 months, MRI and MRS were repeated in 50 patients and 9 volunteers. Patients were divided according to disease activity (measured by SLE disease activity index) during initial and follow-up MRS. We performed paired t-test and ANOVA with Tukey's post hoc comparisons to evaluate group differences. At study entry, 29 patients had active SLE with involvement of central nervous system (CNS) and 28 patients had active SLE without CNS manifestations. A total of 14 patients had inactive SLE with past CNS presentation, and 19 had inactive SLE without history of CNS involvement. NAA/Cr ratios were significant lower in patients with active SLE, independently of CNS involvement, when compared with patients with inactive SLE (P = 0.005) and controls (P = 0.01). We observed a significant increase in NAA/Cr ratio in 15 patients who had active SLE at initial MRS and inactive SLE at follow-up (P = 0.04). In 10 patients with active SLE both at initial and at follow-up MRS we observed a reduction in NAA/Cr ratio (P = 0.02). By contrast, there was a significant reduction of NAA/Cr ratio in 15 patients who had inactive SLE at initial MRS and active SLE at follow-up (P = 0.001). In 10 patients with inactive SLE both at initial and at follow-up MRS NAA/Cr ratio did not change (P = 0.2). This study shows evidence of axonal dysfunction in patients with active SLE, independently of CNS manifestations that may be reversible, at least in part, during periods of inactivity of disease.
Collapse
|
30
|
Makoroff KL, Cecil KM, Care M, Ball WS. Elevated lactate as an early marker of brain injury in inflicted traumatic brain injury. Pediatr Radiol 2005; 35:668-76. [PMID: 15830194 DOI: 10.1007/s00247-005-1441-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2004] [Revised: 01/28/2005] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Traumatic brain injury is a major cause of disability and death in the pediatric population. The metabolic and neurochemical abnormalities that underlie traumatic brain injury remain poorly understood, but hypoxia-ischemic injury might play an important role. OBJECTIVE This study evaluated children with inflicted traumatic brain injury using magnetic resonance spectroscopy (MRS). We postulated that children with hypoxic-ischemic injury indicated by elevated lactate in the acute phase of injury will have worse early neurological status and short-term clinical outcomes than those without lactate upon MRS. MATERIALS AND METHODS This prospective study employed proton MRS to sample bilaterally the frontal lobes and the parasagittal cortex within the parietal and occipital lobes of 11 patients with inflicted traumatic brain injury who were undergoing a clinical MRI examination. Patients' measured clinical course while hospitalized included initial neurological evaluation, presence of seizure activity, need for admission to the pediatric intensive care unit (PICU), number of days hospitalized, presence of retinal hemorrhages and presence of bone fractures. Measurement of outcome was determined using the Pediatric Overall Performance Category Scale (POPCS; 1=good performance; 6=death). RESULTS Four children demonstrated elevated lactate and diminished N-acetyl aspartate (a neuronal marker) within several regions, indicating global ischemic injury (lactate-positive global group). These four children all had seizure activity and abnormal initial neurological examinations and required admission to the PICU. The mean POPCS for this group was 3.25. In four other children, lactate was detected within at least one region, indicating a focal ischemic injury (lactate-positive focal group); two of these children had seizure activity, and two had an abnormal initial neurological examination. The mean POPCS score was 1.5 for this group. The remaining three children had no evidence of lactate upon MRS (lactate-negative group). These children did not have seizure activity, did not require admission to the PICU, nor did they have initial abnormal neurological examinations. The mean POPCS score was 1.3 for this group. SUMMARY Patients with inflicted traumatic brain injury and evidence of hypoxic-ischemic injury as indicated by elevated lactate on MRS tend to have worse early neurological status and early outcome scores. Lactate levels as sampled by MRS might predict early clinical outcome in inflicted traumatic brain injury.
Collapse
Affiliation(s)
- Kathi L Makoroff
- Department of Pediatrics, Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
| | | | | | | |
Collapse
|
31
|
|
32
|
Celik O, Hascalik S, Sarac K, Meydanli MM, Alkan A, Mizrak B. Magnetic resonance spectroscopy of premalignant and malignant endometrial disorders: a feasibility of in vivo study. Eur J Obstet Gynecol Reprod Biol 2005; 118:241-5. [PMID: 15653212 DOI: 10.1016/j.ejogrb.2004.06.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Revised: 06/02/2004] [Accepted: 06/30/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the potential clinical utility of in vivo proton magnetic resonance spectroscopy (MRS) in patients with various endometrial lesions. METHODS Twelve patients with untreated uterine bleeding were included in this study. In-vivo proton MRS was performed using a 1.5 T MR scanner. The metabolite levels were classified into three classes in comparison with the noise level by visual examination. All the patients have endometrial biopsy. For each type of lesions, chemical compound were described. RESULTS Pathological examination resulted in three endometrial cancer, two simple hyperplasias, one complex hyperplasia, two partial hydatiform mole, two proliferative endometrium and two secretory endometrium. In women with endometrial carcinoma, high choline and lipid signals were detected, whereas no creatine and no lactate signals were found. In women with endometrial hyperplasia, choline signal was detectable in all cases but one case showed lactate signal in addition to choline. In women with partial hydatidiform mole, the only detectable signal was choline. Lipid signals were detected in none of the cases with endometrial hyperplasia and partial hidatidiform mole. In women with either secretory or proliferative endometrium, choline and lactate signals were detectable in all cases but one case showed solely choline. Lipid signals were not detected in any of subjects with secretory or proliferative endometrium. CONCLUSION The observed difference is the presence of lipid signal only in endometrial carcinoma.
Collapse
Affiliation(s)
- Onder Celik
- Department of Obstetrics and Gynecology, Turgut Ozal Medical Center, School of Medicine, Inonu University, 44069 Malatya, Turkey.
| | | | | | | | | | | |
Collapse
|
33
|
Stengel A, Neumann-Haefelin T, Singer OC, Neumann-Haefelin C, Zanella FE, Lanfermann H, Pilatus U. Multiple spin-echo spectroscopic imaging for rapid quantitative assessment of N-acetylaspartate and lactate in acute stroke. Magn Reson Med 2004; 52:228-38. [PMID: 15282804 DOI: 10.1002/mrm.20171] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Monitoring the signal levels of lactate (Lac) and N-acetylaspartate (NAA) by chemical shift imaging can provide additional knowledge about tissue damage in acute stroke. Despite the need for this metabolic information, spectroscopic imaging (SI) has not been used routinely for acute stroke patients, mainly due to the long acquisition time required. The presented data demonstrate that the application of a fast multiple spin-echo (MSE) SI sequence can reduce the measurement time to 6 min (four spin echoes per echo train, 32 x 32 matrix). Quantification of Lac and NAA in terms of absolute concentrations (i.e., mmol/l) can be achieved by means of the phantom replacement approach, with correction terms for the longitudinal and transversal relaxation adapted to the multiple spin-echo sequence. In this pilot study of 10 stroke patients (symptom onset < 24 hr), metabolite concentrations obtained from MSE-SI add important information regarding tissue viability that is not provided by other sequences (e.g., diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI)). Metabolic changes extended beyond the borders of the apparent diffusion coefficient (ADC) lesion in nine of the 10 patients, showing a rise in Lac concentrations up to 18 mmol/l, while NAA levels sometimes dropped below the detection level. Considerable differences among the patients in terms of the Lac concentrations and the size of the SI-ADC mismatch were observed.
Collapse
Affiliation(s)
- Astrid Stengel
- Department of Neurology, J.W. Goethe University, Frankfurt am Main, Germany
| | | | | | | | | | | | | |
Collapse
|
34
|
Celik O, Sarac K, Hascalik S, Alkan A, Mizrak B, Yologlu S. Magnetic resonance spectroscopy features of uterine leiomyomas. Gynecol Obstet Invest 2004; 58:194-201. [PMID: 15286450 DOI: 10.1159/000080020] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2003] [Accepted: 05/28/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the in vivo magnetic resonance spectroscopy features of uterine leiomyomas using long echo time and to characterize the spectral patterns of these lesions. METHODS We calculated metabolites in 15 patients with uterine leiomyomas and myometrium of 20 healthy control subjects using single-voxel proton MR spectroscopy (point resolved spectroscopy technique, TE:136 ms). Voxels were placed at the center of the uterine leiomyomas. The peak areas of creatine, choline, lipid and lactate were determined. The MR spectroscopy results of uterine leiomyomas were compared with the spectroscopy results obtained from the myometrium of healthy control subjects. RESULTS The characteristically obtained signal was choline, which was detected not only in 14 of the 15 leiomyomas (93.3%) but also in 18 of the 20 myometrium of control subjects (90%). The lipid signals were determined in 9 of 15 patients with uterine leiomyomas (60%) and 8 of 20 control subjects (40%). The lactate signal was obtained from six of 15 patients with leiomyomas (40%) but only two of myometrium (10%). The creatine signal was obtained from 4 of 15 patients with leiomyomas (26.6%) and 5 of 20 myometrium (25%). Among the tested parameters only lactate peak was statistically significant (p < 0.05). CONCLUSION Proton MR spectroscopic imaging may be helpful for the investigation of the underlying pathophysiology of uterine leiomyomas. The presence of lactate and lipid signals in the spectrum may be a useful indicator of metabolic pathway of uterine leiomyomas.
Collapse
Affiliation(s)
- Onder Celik
- Department of Obstetrics and Gynecology, Inonu University, School of Medicine, Turgut Ozal Medical Center, TR-44069 Malatya, Turkey.
| | | | | | | | | | | |
Collapse
|
35
|
Méndez-Cendón JC. [Clinical applications of in vivo proton magnetic resonance spectroscopy in the study of astrocytomas: state of the art]. Neurocirugia (Astur) 2004; 15:258-68; discussion 268-9. [PMID: 15239012 DOI: 10.1016/s1130-1473(04)70481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We review the current state in literature of the use of magnetic resonance spectroscopy in the assessment and characterization of cerebral astrocytomas. Special attention will be paid to the presurgical grading of astrocytomas and to the role of spectroscopy in differentiating these tumors from other neoplastic and nonneoplastic brain lesions.
Collapse
Affiliation(s)
- J C Méndez-Cendón
- Sección de Neurorradiología. Servicio de Radiodiagnóstico. Hospital Vírgen de la Salud. Complejo Hospitalario de Toledo
| |
Collapse
|
36
|
Negoro K, Tada Y, Ogasawara JI, Kawai M, Morimatsu M, Hashida M, Yamauchi SI. Proton magnetic resonance spectroscopy in corticobasal degeneration and progressive supranuclear palsy. Geriatr Gerontol Int 2004. [DOI: 10.1111/j.1447-0594.2004.00124.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Shih MT, Singh AK, Wang AM, Patel S. Brain lesions with elevated lactic acid peaks on magnetic resonance spectroscopy. Curr Probl Diagn Radiol 2004; 33:85-95. [PMID: 14997165 DOI: 10.1016/j.cpradiol.2003.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Magnetic resonance (MR) spectroscopy is a noninvasive imaging tool that provides information on various metabolite concentrations within brain lesions. The biochemical information obtained with MR spectroscopy, along with the morphologic appearance of a lesion on MR imaging, allows for better characterization and improved diagnostic ability. Lactic acid is an end product of anaerobic metabolism. Under conditions of anaerobic metabolism or inflammation, lactate levels become elevated and a characteristic peak at 1.3 ppm is detected on MR spectroscopy. This review will discuss the significance of lactate as a metabolite and will describe various brain lesions and disease conditions in which elevated lactate levels are detected.
Collapse
Affiliation(s)
- Marianne T Shih
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
| | | | | | | |
Collapse
|
38
|
Kadri M, Shu S, Holshouser B, Deming D, Hopper A, Peverini R, Ashwal S. Proton magnetic resonance spectroscopy improves outcome prediction in perinatal CNS insults. J Perinatol 2003; 23:181-5. [PMID: 12732853 DOI: 10.1038/sj.jp.7210913] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Prediction of neurologic outcome is difficult in neonates with acute nervous system injury. Previous studies using proton magnetic resonance spectroscopy ((1)H-MRS) have been used to predict short-term neurologic outcome in neonates with a variety of neurologic insults. We were interested in determining the effectiveness of combining clinical evaluation and spectroscopy obtained at the time of injury in predicting neurologic outcome at 24 months. STUDY DESIGN We studied 33 neonates with acute central nervous system injury, 5.8+/-3.7 days of injury, owing to hypoxic-ischemic encephalopathy. Neonates were assessed using clinical variables (initial arterial pH, initial blood glucose, Sarnat score, electroencephalography) and spectroscopy (NAA/Cho, NAA/Cre, Cho/Cre, and lactate). Neonates were divided into two outcome groups: good/moderate and poor. Differences between the groups were assessed using chi(2) and t-test analyses. We analyzed the best predictors of outcome using discriminant analysis and calculated sensitivity, specificity, positive, and negative predictive values for each variable independently and in combination. RESULTS There were significant differences between the good/moderate and poor outcome for the Sarnat score, EEG, lactate, and NAA/Cho. Spectroscopy combined with clinical variables improved sensitivity, but not specificity for predicting outcome. The presence of lactate had the best individual predictive value. Combination of the clinical with the MRS variables had the highest predictive value. CONCLUSION Proton magnetic resonance spectroscopy done early after injury improves the ability to predict neurologic outcome at 24 months of age.
Collapse
Affiliation(s)
- Munaf Kadri
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | | | | | | | | | | |
Collapse
|
39
|
Herminghaus S, Dierks T, Pilatus U, Möller-Hartmann W, Wittsack J, Marquardt G, Labisch C, Lanfermann H, Schlote W, Zanella FE. Determination of histopathological tumor grade in neuroepithelial brain tumors by using spectral pattern analysis of in vivo spectroscopic data. J Neurosurg 2003; 98:74-81. [PMID: 12546355 DOI: 10.3171/jns.2003.98.1.0074] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this study, 1H magnetic resonance (MR) spectroscopy was prospectively tested as a reliable method for presurgical grading of neuroepithelial brain tumors. METHODS Using a database of tumor spectra obtained in patients with histologically confirmed diagnoses, 94 consecutive untreated patients were studied using single-voxel 1H spectroscopy (point-resolved spectroscopy; TE 135 msec, TE 135 msec, TR 1500 msec). A total of 90 tumor spectra obtained in patients with diagnostic 1H MR spectroscopy examinations were analyzed using commercially available software (MRUI/VARPRO) and classified using linear discriminant analysis as World Health Organization (WHO) Grade I/II, WHO Grade III, or WHO Grade IV lesions. In all cases, the classification results were matched with histopathological diagnoses that were made according to the WHO classification criteria after serial stereotactic biopsy procedures or open surgery. Histopathological studies revealed 30 Grade I/II tumors, 29 Grade III tumors, and 31 Grade IV tumors. The reliability of the histological diagnoses was validated considering a minimum postsurgical follow-up period of 12 months (range 12-37 months). Classifications based on spectroscopic data yielded 31 tumors in Grade I/II, 32 in Grade III, and 27 in Grade IV. Incorrect classifications included two Grade II tumors, one of which was identified as Grade III and one as Grade IV; two Grade III tumors identified as Grade II; two Grade III lesions identified as Grade IV; and six Grade IV tumors identified as Grade III. Furthermore, one glioblastoma (WHO Grade IV) was classified as WHO Grade I/II. This represents an overall success rate of 86%, and a 95% success rate in differentiating low-grade from high-grade tumors. CONCLUSIONS The authors conclude that in vivo 1H MR spectroscopy is a reliable technique for grading neuroepithelial brain tumors.
Collapse
Affiliation(s)
- Sebastian Herminghaus
- Department of Neurosurgery and Institute of Neuroradiology, Johann W. Goethe University, Frankfurt am Main, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Lim SM, Choi HY, Suh JS, Lee JH, Lim KH, Suh DC, Lee HK, Lim TH, Ra YS. Localized 1H-MR spectroscopy in moyamoya disease before and after revascularization surgery. Korean J Radiol 2003; 4:71-8. [PMID: 12845301 PMCID: PMC2698073 DOI: 10.3348/kjr.2003.4.2.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate, using localized proton magnetic resonance spectroscopy ((1)H-MRS), the cerebral metabolic change apparent after revascularization surgery in patients with moyamoya disease. MATERIALS AND METHODS Sixteen children with moyamoya disease and eight age-matched normal controls underwent MR imaging, MR angiography, conventional angiography, and (99m)Tc- ECD SPECT. Frontal white matter and the basal ganglia of both hemispheres were subjected to localized (1)H-MRS, and after revascularization surgery, four patients underwent follow-up (1)H-MRS. RESULTS Decreased NAA/Cr ratios (1.35+/-0.14 in patients vs. 1.55+/-0.24 in controls) and Cho/Cr ratios (0.96+/-0.13 in patients vs. 1.10+/-0.11 in controls) were observed in frontal white matter. After revascularization surgery, NAA/Cr and Cho/Cr ratios in this region increased. In the basal ganglia, there is no abnormal metabolic ratios. CONCLUSION Localized (1)H-MRS revealed abnormal metabolic change in both hemispheres of children with moyamoya disease. Because of its non-invasive nature, (1)H-MRS is potentially useful for the preoperative evaluation of metabolic abnormalities and their postoperative monitoring.
Collapse
Affiliation(s)
- Soo Mee Lim
- Department of Diagnostic Radiology, College of Medicine, Ewha Womans University Hospital, Yangcheon-gu, Seoul, Korea.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Hutchinson PJ, O'Connell MT, Kirkpatrick PJ, Pickard JD. How can we measure substrate, metabolite and neurotransmitter concentrations in the human brain? Physiol Meas 2002; 23:R75-109. [PMID: 12051319 DOI: 10.1088/0967-3334/23/2/202] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cerebral injury and disease is associated with fundamental derangements in metabolism, with changes in the concentration of important substrates (e.g. glucose), metabolites (e.g. lactate) and neurotransmitters (e.g. glutamate and y-aminobutyric acid) in addition to changes in oxygen utilization. The ability to measure these substances in the human brain is increasing our understanding of the pathophysiology of trauma, stroke, epilepsy and tumours. There are several techniques in clinical practice already in use and new methods are under evaluation. Such techniques include the use of cerebral probes (e.g. microdialysis. voltammetry and spectrophotometry) and functional imaging (e.g. positron emission tomography and magnetic resonance spectroscopy). This review describes these techniques in terms of their principles and clinical applications.
Collapse
Affiliation(s)
- P J Hutchinson
- Department of Neurosurgery and Wolfson Brain Imaging Centre, Addenbrooke's Hospital, University of Cambridge, UK.
| | | | | | | |
Collapse
|
42
|
Chu WJ, Mason GF, Pan JW, Hetherington HP, Liu HG, San Pedro EC, Mountz JM. Regional cerebral blood flow and magnetic resonance spectroscopic imaging findings in diaschisis from stroke. Stroke 2002; 33:1243-8. [PMID: 11988598 DOI: 10.1161/01.str.0000015240.75199.be] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE This study evaluated blood flow and metabolite changes in cerebral diaschisis from internal capsule region infarction using regional cerebral blood flow (rCBF) single-photon emission computed tomography (SPECT) and 1H magnetic resonance spectroscopic imaging (MRSI). We hypothesized that complementary measures of diaschisis effects in white matter (characterized by 1H MRSI) and gray matter (characterized by changes in rCBF) can be measured and exhibit parallel changes. METHODS Five stroke patients and 16 normal controls underwent Tc-99m hexamethylpropyleneamine-oxime brain SPECT and 1H MRSI at 4.1 T. The metabolites N-acetyl aspartate (NAA) and creatine (Cr) were measured using 1H MRSI. The tissue content was expressed as the percent of gray or white matter in each MRSI voxel to allow comparison of the differential effects of diaschisis in gray and white matter tissue types. The blood flow and metabolite changes were evaluated at superior cerebral regions distant from the stroke to allow a measure of diaschisis relatively unconfounded by their expected changes in the infarction region. RESULTS The rCBF SPECT data in stroke patients showed a perfusion defect, with size ranging from 1.23 cc to 10.23 cc, in the region of cortical diaschisis. 1H MRSI showed increased Cr/NAA ratios in regions of white matter diaschisis. There was a tendency for larger rCBF defect size to be associated with greater increases in Cr/NAA values in the same diaschitic cerebral hemisphere, ipsilateral to the infarction. CONCLUSION Diaschisis ipsilateral to stroke in white matter can be characterized by 1H MRSI, and diaschisis ipsilateral to stroke in cortical gray matter regions can be characterized by changes in rCBF. The tendency for greater reductions in cortical rCBF values to be associated with increased Cr/NAA values in the same diaschitic cerebral hemisphere implies that a relationship exists between rCBF reductions in gray matter and abnormal changes in white matter subservient to it.
Collapse
Affiliation(s)
- Wen-Jang Chu
- Division of Nuclear Medicine, Department of Radiology, University of Alabama at Birmingham Medical Center, Birmingham, Ala 35233, USA
| | | | | | | | | | | | | |
Collapse
|
43
|
Garnett MR, Corkill RG, Blamire AM, Rajagopalan B, Manners DN, Young JD, Styles P, Cadoux-Hudson TA. Altered cellular metabolism following traumatic brain injury: a magnetic resonance spectroscopy study. J Neurotrauma 2001; 18:231-40. [PMID: 11284544 DOI: 10.1089/08977150151070838] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Experimental studies have reported early reductions in pH, phosphocreatine, and free intracellular magnesium following traumatic brain injury using phosphorus magnetic resonance spectroscopy. Paradoxically, in clinical studies there is some evidence for an increase in the pH in the subacute stage following traumatic brain injury. We therefore performed phosphorus magnetic resonance spectroscopy on seven patients in the subacute stage (mean 9 days postinjury) following traumatic brain injury to assess cellular metabolism. In areas of normal-appearing white matter, the pH was significantly alkaline (patients 7.09 +/- 0.04 [mean +/- SD], controls 7.01 +/- 0.04, p = 0.008), the phosphocreatine to inorganic phosphate ratio (PCr/Pi) was significantly increased (patients 4.03 +/- 1.18, controls 2.64 +/- 0.71, p = 0.03), the inorganic phosphate to adenosine triphosphate ratio (Pi/ATP) was significantly reduced (patients 0.37 +/- 0.10, controls 0.56 +/- 0.19, p = 0.04), and the PCr/ATP ratio was nonsignificantly increased (patients 1.53 +/- 0.29, controls 1.34 +/- 0.19, p = 0.14) in patients compared to controls. Furthermore, the calculated free intracellular magnesium was significantly increased in the patients compared to the controls (patients 0.33 +/- 0.09 mM, controls 0.22 +/- 0.09 mM, p = 0.03)). Proton spectra, acquired from similar regions showed a significant reduction in N-acetylaspartate (patients 9.64 +/- 2.49 units, controls 12.84 +/- 2.35 units, p = 0.03) and a significant increase in choline compounds (patients 7.96 +/- 1.02, controls 6.67 +/- 1.01 units, p = 0.03). No lactate was visible in any patient or control spectrum. The alterations in metabolism observed in these patients could not be explained by ongoing ischemia but might be secondary to a loss of normal cellular homeostasis or a relative alteration in the cellular population, in particular an increase in the glial cell density, in these regions.
Collapse
Affiliation(s)
- M R Garnett
- Department of Biochemistry, University of Oxford, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Wild JM, Wardlaw JM, Marshall I, Warlow CP. N-acetylaspartate distribution in proton spectroscopic images of ischemic stroke: relationship to infarct appearance on T2-weighted magnetic resonance imaging. Stroke 2000; 31:3008-14. [PMID: 11108764 DOI: 10.1161/01.str.31.12.3008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE It is generally considered that tissue that appears abnormal on T2 MRI is already infarcted and that any penumbra lies outside the T2-visible lesion. We investigated the distribution of infarcted tissue using proton spectroscopic MRI. METHODS In patients with symptoms of acute hemispheric ischemic stroke, imaged within a maximum of 3 days of stroke, we explored the distribution of N:-acetylaspartate (NAA), a marker of intact neurons, within and around the abnormal (hyperintense) areas on T2-weighted MR images, using proton spectroscopic MRI. RESULTS In 11 patients, imaged 24 to 72 hours after stroke onset, there was little evidence of damaged neurons (reduced NAA) beyond the margins of hyperintensity on the T2 image. However, within the abnormal T2 area, there were statistically significant differences in the amount of NAA (ie, the proportion of intact neurons) between areas that were obviously abnormal on T2 (very hyperintense) and those that were only slightly abnormal (slightly hyperintense). CONCLUSIONS The extent and degree of hyperintensity of the T2-visible lesion directly reflect the amount of neuronal damage; lack of a T2-visible lesion would suggest predominantly intact neurons at the time of imaging. We hypothesize that once tissue damage has reached a critical (probably irreversible) level, the T2 image quickly becomes abnormal without any significant time lag between the pathological staging of the infarct and its visualization on T2. Further testing in a larger study with information on blood flow levels would be required to confirm this.
Collapse
Affiliation(s)
- J M Wild
- Department of Medical Physics, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | | | | | | |
Collapse
|
45
|
Lim MK, Suh CH, Kim HJ, Cho YK, Choi SH, Kang JH, Park W, Lee JH. Systemic lupus erythematosus: brain MR imaging and single-voxel hydrogen 1 MR spectroscopy. Radiology 2000; 217:43-9. [PMID: 11012421 DOI: 10.1148/radiology.217.1.r00oc1543] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the usefulness of magnetic resonance (MR) imaging and hydrogen 1 MR spectroscopy in the detection of brain involvement in patients with systemic lupus erythematosus (SLE) with or without neuropsychiatric symptoms. MATERIALS AND METHODS Twenty-six patients who had SLE with (n = 17) or without (n = 9) neuropsychiatric symptoms were examined at MR imaging and (1)H MR spectroscopy. The voxel was placed in the basal ganglia and peritrigonal white matter. Eight healthy volunteers were included. RESULTS Five of nine patients with major neuropsychiatric symptoms and one of eight patients with minor neuropsychiatric symptoms had abnormal MR imaging findings. (1)H MR spectroscopy showed a significantly decreased N:-acetylaspartate-creatine (Cr) ratio in the basal ganglia and an increased choline-Cr ratio in the peritrigonal white matter in patients with major symptoms compared with those with minor symptoms, those without symptoms, and healthy control subjects. Among patients with major symptoms, there was no difference in metabolite ratios between those with and those without abnormal MR imaging findings. Among patients with normal MR imaging findings, abnormal spectral changes were observed only in those with major neuropsychiatric symptoms. In patients without neuropsychiatric symptoms, results of (1)H MR spectroscopy and MR imaging were normal. CONCLUSION In patients with SLE, (1)H MR spectroscopic findings seem to reflect the cerebral metabolic disturbance related to the severity of the neuropsychiatric symptoms and are not related to the presence of abnormal MR imaging findings.
Collapse
Affiliation(s)
- M K Lim
- Department of Radiology, and Internal Medicine, Inha University College of Medicine, 7-206 3rd St, Shinheung-Dong, Choong-Gu, Incheon 400-103, Korea.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Robertson NJ, Cox IJ, Cowan FM, Counsell SJ, Azzopardi D, Edwards AD. Cerebral intracellular lactic alkalosis persisting months after neonatal encephalopathy measured by magnetic resonance spectroscopy. Pediatr Res 1999; 46:287-96. [PMID: 10473043 DOI: 10.1203/00006450-199909000-00007] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We have found that cerebral lactate can be detected later than 1 month of age after neonatal encephalopathy (NE) in infants with severe neurodevelopmental impairment at 1 y. Our hypothesis was that persisting lactate after NE is associated with alkalosis and a decreased cell phosphorylation potential. Forty-three infants with NE underwent proton and phosphorus-31 magnetic resonance spectroscopy at 0.2-56 wk postnatal age. Seventy-seven examinations were obtained: 25 aged <2 wk, 16 aged > or = 2 to < or = 4 wk, 25 aged > 4 to < or = 30 wk, and 11 aged > 30 wk. Neurodevelopmental outcome was assessed at 1 y of age: 17 infants had a normal outcome and 26 infants had an abnormal outcome. Using univariate linear regression, we determined that increased lactate/creatine plus phosphocreatine (Cr) was associated with an alkaline intracellular pH (pHi) (p < 0.001) and increased inorganic phosphate/phosphocreatine (Pi/PCr) (p < 0.001). This relationship was significant, irrespective of outcome group or age at time of study. Between outcome groups, there were significant differences for lactate/Cr measured at < 2 wk (p = 0.005) and > 4 to < or = 30 wk (p = 0.01); Pi/PCr measured at < 2 wk (p < 0.001); pHi measured at < 2 wk (p < 0.001), > or = 2 to < or = 4 wk (p = 0.02) and > 4 to < or = 30 wk (p = 0.03); and for N-acetylaspartate/Cr measured at > or = 2 to < or = 4 wk (p = 0.03) and > 4 to < or = 30 wk (p = 0.01). Possible mechanisms leading to this persisting cerebral lactic alkalosis are a prolonged change in redox state within neuronal cells, the presence of phagocytic cells, the proliferation of glial cells, or altered buffering mechanisms. These findings may have implications for therapeutic intervention.
Collapse
Affiliation(s)
- N J Robertson
- Department of Paediatrics, Imperial College School of Medicine, London, United Kingdom
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
Until recently, there was no efficacious treatment for acute cerebral ischemia. As a result, the role of neuroimaging and the radiologist was peripheral in the diagnosis and management of this disease. The demonstration of efficacy using thrombolysis has redefined this role, with the success of intervention becoming increasingly dependent on timely imaging and accurate interpretation. The potential benefits of intervention have only begun to be realized. In this State-of-the-Art review of imaging of acute stroke, the role of imaging in the current and future management of stroke is presented. The role of computed tomography is emphasized in that it is currently the most utilized technique, and its value has been demonstrated in prospective clinical trials. Magnetic resonance techniques are equally emphasized in that they have the potential to provide a single modality evaluation of tissue viability and vessel patency in an increasingly rapid evaluation.
Collapse
Affiliation(s)
- N J Beauchamp
- Morgan H. Russell Department of Radiology, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
| | | | | | | |
Collapse
|
48
|
Abstract
Proton magnetic resonance spectroscopy (1H MRS) permits the acquisition of the signal arising from several brain metabolites. At long echo-time (TE) 1H MRS can detect N-acetyl-aspartate containing compounds, choline containing compounds, creatine + phosphocreatine and lactate. At short TE, lipids, tryglicerides, alanine, glutamate, glutamine, GABA, scyllo-inositol, glucose, myo-inositol, carnosine and histydine are visible. 1H MRS can be performed with single-voxel, multivoxel, single slice and multislice techniques. With single voxel 1H MRS it is possible to measure metabolites relaxation time, which allows the measurement of metabolite concentrations. This technique can be useful in the study of focal lesions in the central nervous system (CNS) such as epilepsy (pre-surgical identification of epileptic focus), brain tumors (evaluation of recurrence and radiation necrosis), stroke, multiple sclerosis, etc. Single slice and multislice 1H MRS imaging (1H MRSI) can be performed only at long TE and permits the mapping of the brain metabolites distribution which makes them particularly useful in studying diffuse diseases and heterogeneous lesions of the CNS. 1H MRS can also be useful in the evaluation of 'ischemic penumbra' of stroke; developmental (myelin and neuronal dysgenesis); head trauma (evaluation of cerebral damage not visible with MRI); degenerative disorders (identification of microscopic pathology not visible with MRI); and metabolic diseases (metabolic disturbances with specific metabolic patterns).
Collapse
Affiliation(s)
- S Bonavita
- Institute of Neurological Sciences, Second University of Naples, Italy
| | | | | |
Collapse
|
49
|
Malisza KL, Kozlowski P, Ning G, Bascaramurty S, Tuor UI. Metabolite changes in neonatal rat brain during and after cerebral hypoxia-ischemia: a magnetic resonance spectroscopic imaging study. NMR IN BIOMEDICINE 1999; 12:31-38. [PMID: 10195327 DOI: 10.1002/(sici)1099-1492(199902)12:1<31::aid-nbm544>3.0.co;2-m] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Cerebral metabolite concentrations were measured in infant rats using proton magnetic resonance spectroscopic imaging. Measurements were made prior to, during and after exposure of rats (6- and 7-day-old) to unilateral cerebral hypoxia-ischemia (right carotid artery occlusion +2h 8% oxygen). Data clustered according to age and outcome-6-day-old animals with no infarct and 7-day-old animals with infarct. In 6-day-old animals, cerebral lactate concentration increased during hypoxia-ischemia, particularly ipsilateral to the occlusion, and returned to normal soon after the end of hypoxia. There were no major changes in N-acetyl-aspartate levels (NAA) in this group and no regions of hyperintensity on T2 or DW weighted images at 24 h. In the 7-day-old animals, lactate increased during hypoxia-ischemia and remained elevated in the first hour after reperfusion. Furthermore, lactate remained at 258+/-117% and 233+/-56% of pre-hypoxic levels, 24 and 48 h post-hypoxia, respectively. NAA concentrations ipsilateral to the occlusion decreased to 55+/-14% during hypoxia, recovered early post-hypoxia and again decreased to 61+/-25% and 41+/-28% at 24 and 48 h post-hypoxia-ischemia, respectively. The infarct volumes measured by diffusion weighted and T2 weighted MRI at 48 h post-hypoxia were 152+/-40 mm3 and 172+/-35 mm3, respectively. Thus, irreversible damage correlated well with measured in vivo lactate and NAA changes. Those animals in which NAA was unaltered and lactate recovered soon after hypoxia did not show long-term damage (6-day-old animals), whereas those animals in which NAA decreased and lactate remained elevated went on to infarction (7-day-old animals).
Collapse
Affiliation(s)
- K L Malisza
- Institute for Biodiagnostics, NRCC, Winnipeg, Manitoba, Canada
| | | | | | | | | |
Collapse
|
50
|
Nakano M, Ueda H, Li JY, Matsumoto M, Yanagihara T. Measurement of regional N-acetylaspartate after transient global ischemia in gerbils with and without ischemic tolerance: an index of neuronal survival. Ann Neurol 1998; 44:334-40. [PMID: 9749599 DOI: 10.1002/ana.410440308] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated the correlation between N-acetylaspartate (NAA) level and neuronal density in the hippocampal CA1 region of the brain after occlusion of both common carotid arteries for 5 minutes and reperfusion for 3 hours to 4 weeks in gerbils with and without ischemic preconditioning (tolerance). Animals were divided into four groups--the sham operated group, the nonpreconditioning (non-p) group, the single-preconditioning (single-p) group with 2-minute ischemia once 2 days before 5-minute ischemia, and the double-preconditioning (double-p) group with 2-minute ischemia twice 2 days before 5-minute ischemia (n = 6 for each group). The CA1 region was dissected out from freeze-dried sections for high-performance liquid chromatographic assay of NAA, and adjacent sections were stained with cresyl violet for measurement of the neuronal density. Both NAA (pmol/microg dry weight) and the neuronal density (cells/mm) decreased in the non-p group after 3 days (NAA = 24.0 +/- 3.0; neuronal density = 65 +/- 38 cells/mm) and 7 days (NAA = 17.9 +/- 2.5; neuronal density = 20 +/- 15 cells/mm) and in the single-p group after 7 days (26.4 +/- 3.0, 106 +/- 30) compared with the control group (NAA = 32.9 +/- 3.0; neuronal density = 203 +/- 9 cells/mm). There was no decrease in the double-p group. The NAA level and the neuronal density showed a good linear correlation. The regional NAA level may be used as an index of neuronal viability.
Collapse
Affiliation(s)
- M Nakano
- Department of Neurology, Osaka University Medical School, Japan
| | | | | | | | | |
Collapse
|