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Henrik Kahr Mathiesen, MD, PhD; Agnete Jonsson, MSc; Thomas Tscherning, MD; Lars G. Hanson, MSc, PhD; Jente Andresen, MSc; Morten Blinkenberg, MD, PhD; Olaf B. Paulson, MD, DMSc; Per Soelberg Sorensen, MD, DMSc

Arch Neurol. 2006;63:533-536.

Background  Whole-brain N-acetyl aspartate (NAA), a measure of neuronal function, can be assessed by multislice echo-planar spectroscopic imaging.

Objective  To test the hypothesis that the global brain NAA/creatine (Cr) ratio is a better predictor of cognitive dysfunction in multiple sclerosis than conventional magnetic resonance imaging measures.

Design  Survey.

Setting  Research-oriented hospitals.

Patients  Twenty patients, 16 women and 4 men (mean age, 36 years), with early relapsing-remitting multiple sclerosis (mean Expanded Disability Status Scale score, 2.5).

Main Outcome Measures  Correlation between the global NAA/Cr ratio and a cognitive dysfunction factor comprising 16 measures from an extensive neuropsychological test battery that best distinguished patients with multiple sclerosis from healthy control subjects.

Results  A significant partial correlation between the global NAA/Cr ratio and the cognitive dysfunction factor was found (partial r = 0.62, P = .01), and 9 cognitively impaired patients had significantly lower global NAA/Cr ratios than 11 unimpaired patients (P = .04). No significant correlations were found between the cognitive dysfunction factor and conventional magnetic resonance imaging measures (ie, brain parenchymal fraction and lesion volume).

Conclusions  Multislice echo-planar spectroscopic imaging provides global metabolic measures that distinguish between cognitively impaired and unimpaired patients with multiple sclerosis and correlate with a global cognitive measure. Standardization of the technique is needed, and larger-scale studies that include healthy controls are suggested.

Author Affiliations: Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Hvidovre (Drs Mathiesen, Hanson, and Paulson); Danish Multiple Sclerosis Research Centre (Ms Jonsson and Drs Tscherning, Blinkenberg, and Sorensen) and Neurobiology Research Unit (Dr Paulson), Department of Neurology, Copenhagen University Hospital, Rigshospitalet; and Department of Pediatrics, Copenhagen University Hospital, Glostrup (Ms Andresen); Denmark.