Pohl C, Block W, Karitzky J, Träber F, Schmidt S, Grothe C, Lamerichs R, Schild H, Klockgether T
Department of Neurology, University of Bonn, Sigmund-Freud-Str 25, D-53105 Bonn, Germany.
Arch Neurol. 2001 May;58(5):729-35. doi: 10.1001/archneur.58.5.729.
To evaluate proton magnetic resonance spectroscopy for detection and monitoring of upper motoneuron degeneration in patients with amyotrophic lateral sclerosis.
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.
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.
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.
评估质子磁共振波谱在检测和监测肌萎缩侧索硬化症患者上运动神经元变性中的作用。
将70例符合埃尔埃斯科里亚尔标准的肌萎缩侧索硬化症患者与48名健康对照者进行比较。在双侧运动皮层进行单容积质子磁共振波谱分析（回波时间272毫秒；重复时间2000毫秒），以检测N-乙酰天门冬氨酸（NAA）、磷酸肌酸+肌酸（[P]Cr）和含胆碱化合物（Cho），并计算代谢物比率NAA/Cho、NAA/（P）Cr和Cho/（P）Cr。此外，在30例患者和15名对照者中，以未抑制的水信号作为内部参照，获得NAA、（P）Cr和Cho的绝对代谢物浓度。
患者运动皮层中NAA（P<0.001）和（P）Cr（P<0.05）的绝对浓度降低，而Cho浓度保持不变。在所有埃尔埃斯科里亚尔亚组中，NAA/Cho和NAA/（P）Cr比率均降低（P<0.001）。明确的肌萎缩侧索硬化症患者的Cho/（P）Cr比率升高（P<0.05）。代谢物比率变化与临床症状的侧化相对应，并且与疾病持续时间和疾病严重程度呈弱相关。在对16例患者进行平均（±标准差）12.1±8.7个月的随访观察中，NAA/Cho下降了9.1%（P<0.01），Cho/（P）Cr升高了7.0%（P<0.01）。代谢物比率变化与疾病严重程度的进展显著相关。
通过单容积质子磁共振波谱测量NAA浓度和NAA/Cho比率似乎最适合检测运动皮层变性。降低的NAA/Cho比率与临床表现的各个方面相对应，并在随访测量中反映疾病进展。
