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

Abstract

It is well known that multiple sclerosis (MS) pathogenesis continues even during periods of clinical silence. To quantify the metabolic characteristics of this activity we compared the absolute levels of N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) in the normal-appearing white matter (NAWM) between relapsing-remitting (RR) MS patients and controls. Metabolite concentrations were obtained with 3D proton MR spectroscopy at 1.5 T in a 480 cm(3) volume-of-interest (VOI), centered on the corpus callosum of 11 MS patients and 9 matched controls. Gray/white-matter/cerebral-spinal-fluid (CSF) volumes were obtained from MRI segmentation. Patients' average VOI tissue volume (V(T)), 410.8 +/- 24.0 cm(3), and metabolite levels, NAA = 6.33 +/- 0.70, Cr = 4.67 +/- 0.52, Cho = 1.40 +/- 0.17 mM, were different from the controls by -8%, -9%, +22% and +32%. The Cho level was the only single metric differentiating patients from controls at 100% specificity and >90% sensitivity. Diffusely elevated Cho and Cr probably reflect widespread microscopic inflammation, gliosis, or de- and remyelination in the NAWM. Both metabolites are potential prognostic indicators of current disease activity, preceding NAA decline and atrophy.

• Authors: Matilde Inglese, Belinda S Y Li, Henry Rusinek, James S Babb, Robert I Grossman, Oded Gonen
• Journal: Magnetic resonance in medicine (Magn Reson Med) Vol. 50 Issue 1 Pg. 190-5 (Jul 2003) ISSN: 0740-3194 [Print] United States
• PMID: 12815694 (Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
• Copyright: Copyright 2003 Wiley-Liss, Inc.

Chemical References

• Aspartic Acid
• N-acetylaspartate
• Creatine
• Choline

Topics

• Adult
• Aspartic Acid (analogs & derivatives, metabolism)
• Brain (metabolism)
• Choline (metabolism)
• Corpus Callosum (metabolism)
• Creatine (metabolism)
• Diffusion
• Female
• Humans
• Magnetic Resonance Spectroscopy (methods)
• Male
• Middle Aged
• Multiple Sclerosis (diagnosis, metabolism)
• Nerve Fibers, Myelinated (metabolism)
• Recurrence
• Remission, Spontaneous
• Reproducibility of Results
• Sensitivity and Specificity
• Tissue Distribution