title: 1H-magnetic resonance spectroscopy in diffuse and focal cervical cord lesions in multiple sclerosis.
abstract: OBJECTIVE
  To investigate differences between focal and diffuse cervical lesions in multiple sclerosis (MS) by proton magnetic resonance spectroscopy ((1)H-MRS) at 1.5 T in comparison to quantitative MR imaging of the upper cervical cord area and T2 relaxometry at baseline and follow-up.
  
  
  METHODS
  Including 22 MS patients with persistent spinal cord symptoms by either diffuse or focal lesions and 17 controls, we acquired MRS, the mean cord area and the water T2 relaxation time and disability at baseline and follow-up. Cross-sectional analyses included group-level comparisons and correlation studies. Follow-up studies covered assessment of reproducibility and progression of the baseline results.
  
  
  RESULTS
  Compared with focal lesions, diffuse lesions were attended by more cord atrophy, longer T2, elevated levels of creatine (Cre) and reduced N-acetyl aspartate (NAA)/Cre (focal/diffuse: 83 ± 9/73 ± 15 mm(2), 121 ± 21/104 ± 13 ms, 3.6 ± 1.1/5.1 ± 2.4 mM, 2.4 ± 1.1/2.0 ± 0.9). NAA/Cre at baseline was associated significantly with cord atrophy and with clinical progression during follow-up. Baseline MRS results were not significantly correlated to the clinical disability parameters. The reproducibility of MRS was 0.17-0.30. Longitudinal changes of the MRS results were not statistically significant.
  
  
  CONCLUSIONS
  MRS indicated differences in demyelination and gliosis between diffuse and focal cervical lesions in MS. Although longitudinal spectral and clinical changes were sparse, NAA/Cre turned out to be the most sensitive spectral parameter.
authors.affiliation: Department of Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr-University of Bochum, Gudrunstr. 56, 44791, Bochum, Germany, B.Bellenberg@klinikum-bochum.de.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bellenberg
authors.forename: Martin
authors.initials: M
authors.lastname: Busch
authors.forename: Nadine
authors.initials: N
authors.lastname: Trampe
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
authors.forename: Andrew
authors.initials: A
authors.lastname: Chan
authors.forename: Carsten
authors.initials: C
authors.lastname: Lukas
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D002574:Cervical Vertebrae; D003401:Creatine / Q000378:metabolism; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000378:metabolism / Q000473:pathology*; D015203:Reproducibility of Results; D013116:Spinal Cord / Q000473:pathology*; D055815:Young Adult
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine