title: Association between baseline peri-infarct magnetic resonance spectroscopy and regional white matter atrophy after stroke.
abstract: BACKGROUND
  Cerebral atrophy after stroke is associated with poor functional outcome. The prediction and prevention of post-stroke brain atrophy could therefore represent a target for neurorestorative therapies. We investigated the associations between peri-infarct metabolite concentrations measured by quantitative MRS and brain volume change in the infarct hemisphere after stroke.
  
  
  METHODS
  Twenty patients with ischemic stroke were enrolled. Patients underwent 3T-MRI within 1 week of onset, and at 1 and 3 months. At the baseline scan, an MRS voxel was placed manually in the peri-infarct area and another in the corresponding contralateral region. Volumetric analysis of T1 images was performed using two automated processing packages. Changes in gray and white matter volume were assessed as percentage change between 1 and 3 months.
  
  
  RESULTS
  Mean concentrations (institutional units) of N-acetylaspartic acid (NAA) (6.1 vs 7.0, p = 0.039), total creatine (Cr+PCr) (5.4 vs 5.8, p = 0.043), and inositol (4.5 vs 5.0, p = 0.014), were significantly lower in the peri-infarct region compared with the contralateral hemisphere. There was a significant correlation between baseline peri-infarct NAA and white matter volume change in the infarct hemisphere between 1 and 3 months, with lower NAA being associated with subsequent white matter atrophy (Spearman's rho = 0.66, p = 0.010). The baseline concentration of Cr+PCr was also significantly correlated with white matter atrophy in the infarct hemisphere (Spearman's rho = 0.59, p = 0.027). Both of these associations were significant after adjustment for the false discovery rate and were validated using the secondary volumetric method.
  
  
  CONCLUSIONS
  MRS may be useful in the prediction of white matter atrophy post-stroke and in the testing of novel neurorestorative therapies.
authors.affiliation: Departments of Medicine and Neurology, Melbourne Brain Centre @ The Royal Melbourne Hospital, 4 Centre, The Royal Melbourne Hospital, Grattan St, Parkville, Victoria, 3050, Australia. nawaf.yassi@mh.org.au.
authors.forename: Nawaf
authors.initials: N
authors.lastname: Yassi
authors.affiliation: Departments of Medicine and Neurology, Melbourne Brain Centre @ The Royal Melbourne Hospital, 4 Centre, The Royal Melbourne Hospital, Grattan St, Parkville, Victoria, 3050, Australia.
authors.forename: Bruce C V
authors.initials: BC
authors.lastname: Campbell
authors.affiliation: Department of Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.
authors.forename: Bradford A
authors.initials: BA
authors.lastname: Moffat
authors.affiliation: Department of Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Steward
authors.affiliation: Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.
authors.forename: Leonid
authors.initials: L
authors.lastname: Churilov
authors.affiliation: Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Parsons
authors.affiliation: Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Donnan
authors.affiliation: Department of Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Desmond
authors.affiliation: Departments of Medicine and Neurology, Melbourne Brain Centre @ The Royal Melbourne Hospital, 4 Centre, The Royal Melbourne Hospital, Grattan St, Parkville, Victoria, 3050, Australia.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Davis
authors.affiliation: Departments of Medicine and Neurology, Melbourne Brain Centre @ The Royal Melbourne Hospital, 4 Centre, The Royal Melbourne Hospital, Grattan St, Parkville, Victoria, 3050, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bivard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000209:etiology; D020520:Brain Infarction / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000175:diagnosis*; D066127:White Matter / Q000473:pathology*
keywords: Brain imaging; Ischemic; Magnetic resonance spectroscopy; Stroke; Stroke recovery