title: Spectroscopic assessment of alterations in macromolecule and small-molecule metabolites in human brain after stroke.
abstract: OBJECTIVE
  We sought to measure the temporal evolution and spatial distribution of lesion macromolecules and small molecules (lactate, N-acetyl compounds, creatine, and choline) in stroke patients by using short echo time in vivo proton MR spectroscopy.
  
  
  METHODS
  Single-voxel spectra with TE=22 ms were obtained with and without inversion recovery suppression of small-molecule resonances from 30 examinations of 24 patients 3 to 214 days after stroke. Subtraction of the suppressed from the unsuppressed spectra yielded metabolite spectra without overlap from macromolecules. Two-dimensional spectroscopic images were acquired with macromolecule and small-molecule suppression from 5 additional patients.
  
  
  RESULTS
  Macromolecule signals were elevated in lesions relative to normal brain and tended to increase in the subacute period, even as lactate peaks declined. Regions of increased lactate, increased macromolecule signal at 1.3 ppm, and decreased N-acetyl compounds were closely correlated in the 2D spectroscopic images.
  
  
  CONCLUSIONS
  Short echo time spectra can be acquired in vivo in a manner that improves signal-to-noise ratio over long echo experiments and resolves overlapping macromolecule and small-molecule signals. The prominent macromolecule signals seen in the subacute period in association with persistently elevated lactate may represent mobile lipids in macrophages or other cells.
authors.affiliation: Department of Neurology, University of New Mexico School of Medicine and Albuquerque VA Hospital, Albuquerque, NM, USA. graham@unm.edu
authors.forename: G D
authors.initials: GD
authors.lastname: Graham
authors.forename: J H
authors.initials: JH
authors.lastname: Hwang
authors.forename: D L
authors.initials: DL
authors.lastname: Rothman
authors.forename: J W
authors.initials: JW
authors.lastname: Prichard
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000378:metabolism*; D002794:Choline / Q000032:analysis / Q000378:metabolism; D003401:Creatine / Q000032:analysis / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000032:analysis / Q000378:metabolism; D046911:Macromolecular Substances; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000378:metabolism*; D013382:Subtraction Technique; D013995:Time
chemical_list: D046911:Macromolecular Substances; D019344:Lactic Acid; D003401:Creatine; D002794:Choline