title: Diffusely elevated cerebral choline and creatine in relapsing-remitting multiple sclerosis.
abstract: It is well known that multiple sclerosis (MS) pathogenesis continues even during periods of clinical silence. To quantify the metabolic characteristics of this activity we compared the absolute levels of N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) in the normal-appearing white matter (NAWM) between relapsing-remitting (RR) MS patients and controls. Metabolite concentrations were obtained with 3D proton MR spectroscopy at 1.5 T in a 480 cm(3) volume-of-interest (VOI), centered on the corpus callosum of 11 MS patients and 9 matched controls. Gray/white-matter/cerebral-spinal-fluid (CSF) volumes were obtained from MRI segmentation. Patients' average VOI tissue volume (V(T)), 410.8 +/- 24.0 cm(3), and metabolite levels, NAA = 6.33 +/- 0.70, Cr = 4.67 +/- 0.52, Cho = 1.40 +/- 0.17 mM, were different from the controls by -8%, -9%, +22% and +32%. The Cho level was the only single metric differentiating patients from controls at 100% specificity and >90% sensitivity. Diffusely elevated Cho and Cr probably reflect widespread microscopic inflammation, gliosis, or de- and remyelination in the NAWM. Both metabolites are potential prognostic indicators of current disease activity, preceding NAA decline and atrophy.
authors.affiliation: Department of Radiology, New York University School of Medicine, New York, New York 10016, USA.
authors.forename: Matilde
authors.initials: M
authors.lastname: Inglese
authors.forename: Belinda S Y
authors.initials: BS
authors.lastname: Li
authors.forename: Henry
authors.initials: H
authors.lastname: Rusinek
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.forename: Robert I
authors.initials: RI
authors.lastname: Grossman
authors.forename: Oded
authors.initials: O
authors.lastname: Gonen
mesh_terms: D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism*; D001921:Brain / Q000378:metabolism; D002794:Choline / Q000378:metabolism*; D003337:Corpus Callosum / Q000378:metabolism*; D003401:Creatine / Q000378:metabolism*; D004058:Diffusion; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000378:metabolism*; D009413:Nerve Fibers, Myelinated / Q000378:metabolism; D012008:Recurrence; D012075:Remission, Spontaneous; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014018:Tissue Distribution
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline