Serial proton MR spectroscopy of gray and white matter in relapsing-remitting MS

Author(s): Kirov II, Tal A, Babb JS, Herbert J, Gonen O


Objective:To characterize and follow the diffuse gray and white matter (GM/WM) metabolic abnormalities in early relapsing-remitting multiple sclerosis using proton magnetic resonance spectroscopic imaging ((1)H-MRSI).

Methods:Eighteen recently diagnosed, mildly disabled patients (mean baseline time from diagnosis 32 months, mean Expanded Disability Status Scale [EDSS] score 1.3), all on immunomodulatory medication, were scanned semiannually for 3 years with T1-weighted and T2-weighted MRI and 3D (1)H-MRSI at 3 T. Ten sex- and age-matched controls were followed annually. Global absolute concentrations of N-acetylaspartate (NAA), choline (Cho), creatine (Cr), and myo-inositol (mI) were obtained for all GM and WM in the 360 cm(3) (1)H-MRSI volume of interest.

Results:Patients' average WM Cr, Cho, and mI concentrations (over all time points), 5.3 ± 0.4, 1.6 ± 0.1, and 5.1 ± 0.7 mM, were 8%, 12%, and 11% higher than controls' (p ≤ 0.01), while their WM NAA, 7.4 ± 0.7 mM, was 6% lower (p = 0.07). There were increases with time of patients' WM Cr: 0.1 mM/year, Cho: 0.02 mM/year, and NAA: 0.1 mM/year (all p < 0.05). None of the patients' metabolic concentrations correlated with their EDSS score, relapse rate, GM/WM/CSF fractions, or lesion volume.

Conclusions:Diffuse WM glial abnormalities were larger in magnitude than the axonal abnormalities and increased over time independently of conventional clinical or imaging metrics and despite immunomodulatory treatment. In contrast, the axonal abnormalities showed partial recovery, suggesting that patients' lower WM NAA levels represented a dysfunction, which may abate with treatment. Absence of detectable diffuse changes in GM suggests that injury there is minimal, focal, or heterogeneous between cortex and deep GM nuclei.

Similar Articles

Neuroplasticity and functional recovery in multiple sclerosis

Author(s): Tomassini V, Matthews PM, Thompson AJ, Fuglø D, Geurts JJ, et al.

Cerebral activation patterns during working memory performance in multiple sclerosis using FMRI

Author(s): Chiaravalloti N, Hillary F, Ricker J, Christodoulou C, Kalnin A, et al.

Default network activity is a sensitive and specific biomarker of memory in multiple sclerosis

Author(s): Sumowski JF, Wylie GR, Leavitt VM, Chiaravalloti ND, Deluca J

Cortical motor reorganization after a single clinical attack of multiple sclerosis

Author(s): Pantano P, Iannetti GD, Caramia F, Mainero C, Di Legge S, et al.

An investigation of working memory rehearsal in multiple sclerosis using fMRI

Author(s): Hillary FG, Chiaravalloti N, Ricker JH, Steffener J, Bly BM, et al.

Magnetic resonance spectroscopy of memory and frontal brain region in early multiple sclerosis

Author(s): Staffen W, Zauner H, Mair A, Kutzelnigg A, Kapeller P, et al.

MR Spectroscopy INdicates Diffuse Multiple Sclerosis Activity During Remission

Author(s): Kirov II, Patil V, Babb JS, Rusenek H, Herbert J, et al.

Proton magnetic resonance spectroscopy in multiple sclerosis

Author(s): Sajja BR, Wolinsky JS, Narayana PA

Guidelines for using proton MR spectroscopy in multicenter clinical MS studies

Author(s): De Stefano N, Filippi M, Miller D, Pouwels PJ, Rovira a, et al.

Magnetic resonance spectroscopy markers of disease progression in multiple sclerosis

Author(s): Llufriu S, Kornak J, Ratiney H, Oh J, Brenneman D, et al.

The motor cortex shows adaptive functional changes to brain injury from multiple sclerosis

Author(s): Lee M, Reddy H, Johansen-Berg H, Pendlebury S, Jenkinson M, et al.

fMRI evidence of brain reorganization during attention and memory tasks in multiple sclerosis

Author(s): Mainero C, Caramia F, Pozzilli C, Pisani A, Pestalozza I, et al.

Evidence for adaptive functional changes in the cerebral cortex with axonal injury from multiple sclerosis

Author(s): Reddy H, Narayanan S, Arnoutelis R, Jenkinson M, Antel J, et al.

Reduced information processing speed as primummovens for cognitive decline in MS

Author(s): Van Schependom J, D’hooghe MB, Cleynhens K, D’hooge M, Haelewyck M-C, et al.

Relating axonal injury to functional recovery in MS

Author(s): Reddy H, Narayanan S, Matthews PM, Hoge RD, Pike GB, et al.

Diffusely elevated cerebral choline and creatine in relapsing-remitting multiple sclerosis

Author(s): Inglese M, Li BSY, Rusinek H, Babb JS, Grossman RI, et al.

Incorporating prior knowledge into image registration

Author(s): Ashburner J, Neelin P, Collins DL, Evans A, Friston K

Fully automatic segmentation of the brain from T1-weighted MRI using Bridge Burner algorithm

Author(s): Mikheev A, Nevsky G, Govindan S, Grossman R, Rusinek H

MR spectroscopy indicates diffuse multiple sclerosis activity during remission

Author(s): Kirov II, Patil V, Babb JS, Rusinek H, Herbert J, et al.