1H MRSI comparison of white matter and lesions in primary progressive and relapsing-remitting MS.
OBJECTIVE
To compare brain metabolite levels in patients with primary progressive (PP) and relapsing remitting (RR) MS and controls.


OBJECTIVE
(1) creatine (Cr), a putative marker of gliosis, is elevated and N-acetylaspartate (NAA), a putative marker of axonal density and functional integrity, is reduced in PPMS lesions and normal appearing white matter (NAWM) compared to control white matter; (2) The pattern of metabolite change in PPMS is different than in RRMS.


METHODS
MRI and proton magnetic resonance spectroscopic imaging (1H MRSI) were collected from 15 PPMS patients, 13 RRMS patients, and 20 controls.


RESULTS
Cr was increased in PPMS NAWM compared to controls (P=0.035), and compared to RRMS NAWM (P=0.038). Cr was increased in focal MRI lesions from PPMS compared to lesions from RRMS (P=0.044) and compared to control white matter (P=0.041). NAA was similarly reduced in PPMS and RRMS NAWM compared to control. NAA was similarly reduced in PPMS and RRMS lesions, compared to control white matter.


CONCLUSIONS
Creatine is higher in PPMS than RRMS NAWM and focal lesions. This observation is consistent with the notion that progressive disability in PPMS reflects increased gliosis and axonal loss whereas disability in RRMS reflects the cumulative effects of acute inflammatory lesions and axonal loss.
Suhy
J
J
Department of Radiology, University of California at San Francisco, USA.
Rooney
W D
WD
Goodkin
D E
DE
Capizzano
A A
AA
Soher
B J
BJ
Maudsley
A A
AA
Waubant
E
E
Andersson
P B
PB
Weiner
M W
MW
D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001921:Brain / Q000378:metabolism / Q000473:pathology*; D003401:Creatine / Q000378:metabolism; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis* / Q000378:metabolism; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis* / Q000378:metabolism; D011522:Protons; D012016:Reference Values
D011522:Protons; D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine