title: Localised proton MR spectroscopy of brain metabolism changes in vegetative patients.
abstract: We examined 14 vegetative brain-injured patients with proton magnetic resonance single-volume spectroscopy (1H MRS) at 1.5 T to establish whether there were changes in relative concentrations of N-acetyl aspartate (NAA), choline (Cho) and creatine (CR) metabolites from those found in healthy brains. Spectra were obtained from two different (2 x 2 x 2 cm) volumes of interest in the left and in the right frontal cortex, normal on MRI. All spectra revealed abnormalities compared with normal spectra obtained from age-matched control subjects. Values outside the normal range for at least one of the metabolite ratios were observed in all patients. Cho/Cr was markedly higher and NAA/Cho and NAA/Cr were markedly lower than in the control subjects. At different times six patients regained awareness and the ability to obey commands, and four were re-examined; changes in metabolite ratios were observed, which were different in individual patients. The NAA/Cho ratio reaches statistical significance in discriminating between the patients with a poor outcome (death or prolonged vegetative state) and those who regained awareness; the dividing line appears to be at a value of about 1.6.
authors.affiliation: Servizio di Neuroradiologia, Ospedale Bellaria, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Ricci
authors.forename: G
authors.initials: G
authors.lastname: Barbarella
authors.forename: P
authors.initials: P
authors.lastname: Musi
authors.forename: P
authors.initials: P
authors.lastname: Boldrini
authors.forename: C
authors.initials: C
authors.lastname: Trevisan
authors.forename: N
authors.initials: N
authors.lastname: Basaglia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D001921:Brain / Q000378:metabolism*; D001930:Brain Injuries / Q000150:complications; D002648:Child; D002675:Child, Preschool; D002794:Choline / Q000032:analysis; D003401:Creatine / Q000032:analysis; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D018458:Persistent Vegetative State / Q000209:etiology / Q000378:metabolism*; D011379:Prognosis; D013997:Time Factors
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline