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Proton Magnetic Resonance Spectroscopy of the Motor Cortex in 70 Patients With Amyotrophic Lateral Sclerosis
Christoph Pohl, MD;
Wolfgang Block, PhD;
Jochen Karitzky, MD;
Frank Träber, PhD;
Stephan Schmidt, MD;
Christoph Grothe, MD;
Rolf Lamerichs, PhD;
Hans Schild, MD;
Thomas Klockgether, MD
Arch Neurol. 2001;58:729-735.
Objective To evaluate proton magnetic resonance spectroscopy for detection and
monitoring of upper motoneuron degeneration in patients with amyotrophic lateral
sclerosis.
Methods Seventy patients with amyotrophic lateral sclerosis according to the
El Escorial criteria were compared with 48 healthy control subjects. Single-volume
proton magnetic resonance spectroscopy (echo time, 272 milliseconds; repetition
time, 2000 milliseconds) was performed in both motor cortices for detection
of N-acetylaspartate (NAA), phosphocreatine + creatine
([P]Cr), and choline-containing compounds (Cho) to calculate the metabolite
ratios NAA/Cho, NAA/(P)Cr, and Cho/(P)Cr. In addition, absolute metabolite
concentrations of NAA, (P)Cr, and Cho were obtained in 30 patients and 15
controls with the unsuppressed water signal used as an internal reference.
Results Absolute concentrations of NAA (P<.001)
and (P)Cr (P<.05) were reduced in motor cortices
of patients, whereas Cho concentrations remained unchanged. The NAA/Cho and
NAA/(P)Cr ratios were reduced in all El Escorial subgroups (P<.001). The Cho/(P)Cr ratio was elevated in patients with definite
amyotrophic lateral sclerosis (P<.05). Metabolite
ratio changes corresponded to the lateralization of clinical symptoms and
were weakly correlated with disease duration and disease severity. In follow-up
observations of 16 patients during a mean (±SD) of 12.1 ± 8.7
months, NAA/Cho dropped by 9.1% (P<.01), and Cho/(P)Cr
increased by 7.0% (P<.01). Changes of metabolite
ratios were significantly correlated with progression of disease severity.
Conclusions Measurement of NAA concentrations and NAA/Cho ratios appear to be most
suitable for detection of motor cortex degeneration by single-volume proton
magnetic resonance spectroscopy. Reduced NAA/Cho ratios correspond to aspects
of the clinical presentation and reflect disease progression in follow-up
measurements.
From the Departments of Neurology (Drs Pohl, Schmidt, Grothe, and Klockgether)
and Radiology (Drs Block, Träber, and Schild), University of Bonn, Bonn,
Germany; Department of Neurology, University of Ulm, Ulm, Germany (Dr Karitzky);
and Philips Medical Systems, Best, the Netherlands (Dr Lamerichs).
Corresponding author and reprints: Christoph Pohl, MD, Department
of Neurology, University of Bonn, Sigmund-Freud-Str 25, D-53105 Bonn, Germany
(e-mail: c.pohl{at}uni-bonn.de).
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