Diffusely elevated cerebral choline and creatine in relapsing-remitting multiple sclerosis.
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.
Inglese
Matilde
M
Department of Radiology, New York University School of Medicine, New York, New York 10016, USA.
Li
Belinda S Y
BS
Rusinek
Henry
H
Babb
James S
JS
Grossman
Robert I
RI
Gonen
Oded
O
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
D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline