title: Multiple regional 1H-MR spectroscopy in multiple system atrophy: NAA/Cr reduction in pontine base as a valuable diagnostic marker.
abstract: OBJECTIVE
  We performed (1)H-MR spectroscopy ((1)H-MRS) on multiple brain regions to determine the metabolite pattern and diagnostic utility of (1)H-MRS in multiple system atrophy (MSA).
  
  
  METHODS
  Examining single voxels at 3.0 T, we studied metabolic findings of the putamen, pontine base, and cerebral white matter in 24 MSA patients (predominant cerebellar ataxia (MSA-C), n = 13), parkinsonism (MSA-P), n = 11), in 11 age and duration matched Parkinson's disease patients (PD) and in 18 age matched control subjects.
  
  
  RESULTS
  The N-acetylaspartate to creatine ratio (NAA/Cr) in MSA patients showed a significant reduction in the pontine base (p<0.0001) and putamen (p = 0.02) compared with controls. NAA/Cr in cerebral white matter also tended to decline in long standing cases. NAA/Cr reduction in the pontine base was prominent in both MSA-P (p<0.0001) and MSA-C (p<0.0001), and putaminal NAA/Cr reduction was significant in MSA-P (p = 0.009). It was also significant in patients who were in an early phase of their disease, and in those who showed no ataxic symptoms or parkinsonism, or did not show any MRI abnormality of the "hot cross bun" sign or hyperintense putaminal rims. NAA/Cr in MSA-P patients was significantly reduced in the pontine base (p = 0.001) and putamen (p = 0.002) compared with PD patients. The combined (1)H-MRS in the putamen and pontine base served to distinguish patients with MSA-P from PD more clearly.
  
  
  CONCLUSIONS
  (1)H-MRS showed widespread neuronal and axonal involvement in MSA. The NAA/Cr reduction in the pontine base proved highly informative in the early diagnosis of MSA prior to MRI changes and even before any clinical manifestation of symptoms.
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Watanabe
authors.forename: H
authors.initials: H
authors.lastname: Fukatsu
authors.forename: M
authors.initials: M
authors.lastname: Katsuno
authors.forename: M
authors.initials: M
authors.lastname: Sugiura
authors.forename: K
authors.initials: K
authors.lastname: Hamada
authors.forename: Y
authors.initials: Y
authors.lastname: Okada
authors.forename: M
authors.initials: M
authors.lastname: Hirayama
authors.forename: T
authors.initials: T
authors.lastname: Ishigaki
authors.forename: G
authors.initials: G
authors.lastname: Sobue
mesh_terms: D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism*; D001933:Brain Stem / Q000473:pathology / Q000502:physiology; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000473:pathology / Q000502:physiology; D003401:Creatine / Q000378:metabolism*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006859:Hydrogen; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis*; D010300:Parkinson Disease / Q000503:physiopathology; D011699:Putamen / Q000473:pathology / Q000502:physiology; D012016:Reference Values
chemical_list: D001224:Aspartic Acid; D006859:Hydrogen; C000179:N-acetylaspartate; D003401:Creatine