Baik Hyun-Man, Choe Bo-Young, Son Byung-Chul, Jeun Sin-Soo, Kim Moon-Chan, Lee Kwang-Soo, Kim Bum-Soo, Lee Jae-Mun, Lee Hyoung-Koo, Suh Tae-Suk
Department of Biomedical Engineering, Kangnam St. Mary's Hospital, College of Medicine, Catholic University of Korea, #505 Banpo-Dong, Seocho-Ku, Seoul 137-040, South Korea.
Eur J Radiol. 2003 Sep;47(3):179-87. doi: 10.1016/s0720-048x(02)00211-5.
To investigate whether there are significant changes in regional brain metabolism in patients with Parkinson's disease before and after thalamotomy using proton magnetic resonance spectroscopy (1H MRS). Fifteen patients underwent 15 stereotactic thalamotomies for control of medically refractory parkinsonian tremor. Single-voxel 1H MRS was carried out on a 1.5 T unit using stimulated-echo acquisition mode (STEAM) sequence (TR/TM/TE, 2000/14/20 ms). Spectra were obtained from substantia nigra, thalamus and putamen areas with volumes of interests (7-8 ml) in patients before and after the surgery. Metabolite ratios of NAA/Cho, NAA/Cr and Cho/Cr were calculated from relative peak area measurements. We evaluated alterations of metabolite ratios in brain metabolism in Parkinson's disease patients with clinical outcome following thalamotomy. NAA/Cho ratios showed generally low levels in substantia nigra and thalamus in Parkinson's disease patients with clinical improvement following thalamotomy. In 80% (12/15) patients, decreased NAA/Cho ratios were observed from the selected voxels in substantia nigra after thalamic surgery (P<0.05). The ratios were also significantly decreased in thalamus in 67% (10/15) patients with clinical improvement (P<0.05). Our results suggest that NAA/Cho ratio may be a valuable criterion for evaluation of Parkinson's disease patients with the clinical improvement following surgery. 1H MRS may be a useful utility for the aid in better understanding the pathophysiologic process in Parkinson's disease patients on the basis of the variation of NAA/Cho ratio.
采用质子磁共振波谱（1H MRS）研究帕金森病患者丘脑切开术前、后大脑局部代谢是否存在显著变化。15例患者接受了15次立体定向丘脑切开术以控制药物难治性帕金森震颤。在1.5 T设备上使用刺激回波采集模式（STEAM）序列（TR/TM/TE，2000/14/20 ms）进行单体素1H MRS检查。在手术前后，从黑质、丘脑和壳核区域获取感兴趣体积（7 - 8 ml）的波谱。根据相对峰面积测量计算NAA/Cho、NAA/Cr和Cho/Cr的代谢物比率。我们评估了丘脑切开术后帕金森病患者脑代谢中代谢物比率的变化及其临床结局。丘脑切开术后临床症状改善的帕金森病患者，其黑质和丘脑中NAA/Cho比率总体较低。在80%（12/15）的患者中，丘脑手术后黑质中选定体素的NAA/Cho比率降低（P<0.05）。在67%（10/15）临床症状改善的患者中，丘脑中该比率也显著降低（P<0.05）。我们的结果表明，NAA/Cho比率可能是评估丘脑切开术后临床症状改善的帕金森病患者的一个有价值的指标。基于NAA/Cho比率的变化，1H MRS可能有助于更好地理解帕金森病患者的病理生理过程。
