title: MR spectroscopic evidence for thalamic and hippocampal, but not cortical, damage in multiple sclerosis.
abstract: Gray matter (GM) damage is an important pathophysiological feature in Multiple Sclerosis (MS), and may be related to clinical, including cognitive, deficits. Quantitative single-voxel (1)H-Magnetic Resonance Spectroscopy (TR/TE 6000/20 ms) was performed in 33 MS patients (11 per disease subtype; mean age 48 years, 16 females) and 10 healthy controls (mean age 43 years, 7 females). No overall spectroscopic changes were found in MS cortex. In MS thalamus, a 9% decrease of N-acetyl aspartate (NAA; P=0.005) and a 31% increase of myo-inositol (Ins; P=0.002) were found. A 21% Ins increase was observed (P=0.02) in MS hippocampus. Reduced NAA and increased Ins concentrations are thought to reflect neuro-axonal damage or loss and gliosis, respectively. Significant correlations between Ins concentrations and total-brain T(2) lesion load were found for MS thalamus (r=0.65, P<0.001) and hippocampus (r=0.57, P=0.001). MS thalamic and hippocampal Ins concentrations also correlated with each other (r=0.68; P<0.001). Cortical Gln correlated with thalamic NAA (r=-0.38; P=0.03) in MS. Thalamic and hippocampal Ins increases were most prominent in secondary-progressive (SP) patients (37% and 34%, respectively), whereas the largest thalamic NAA decrease (14%) was found in primary-progressive (PP) patients. In conclusion, thalamic and hippocampal GM pathology are important features of (progressive) MS.
authors.affiliation: MS Research Center, Dept. of Radiology, VU University Medical Center, Amsterdam, The Netherlands. j.geurts@vumc.nl
authors.forename: Jeroen J G
authors.initials: JJ
authors.lastname: Geurts
authors.forename: Ilona E W
authors.initials: IE
authors.lastname: Reuling
authors.forename: Hugo
authors.initials: H
authors.lastname: Vrenken
authors.forename: Bernard M J
authors.initials: BM
authors.lastname: Uitdehaag
authors.forename: Chris H
authors.initials: CH
authors.lastname: Polman
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Castelijns
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.forename: Petra J W
authors.initials: PJ
authors.lastname: Pouwels
mesh_terms: D000328:Adult; D000368:Aged; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D002540:Cerebral Cortex / Q000737:chemistry* / Q000473:pathology; D005260:Female; D006624:Hippocampus / Q000737:chemistry* / Q000473:pathology; D006801:Humans; D007294:Inositol / Q000032:analysis; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D013788:Thalamus / Q000737:chemistry* / Q000473:pathology
chemical_list: D001224:Aspartic Acid; D007294:Inositol; C000179:N-acetylaspartate