Elevated white matter myo-inositol in clinically isolated syndromes suggestive of multiple sclerosis
Elevated white matter myo-inositol in clinically isolated syndromes suggestive of multiple sclerosis
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DOI：
10.1093/brain/awh153
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发表时间：
2004-06-01
期刊：
影响因子：
14.5
通讯作者：
Miller, DH
中科院分区：
文献类型：
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作者：
Fernando, KTM;McLean, MA;Miller, DH
已建立的多发性硬化症的正常外观白质(NAWM)已被证明是异常的，使用各种磁共振(MR)技术，包括质子磁共振波谱((1)H-MRS)，尽管这些变化最初出现的阶段不太清楚。使用1.5T扫描仪和单体素(1)H-MRS[TR3000ms，TE 30ms，点分辨光谱(PRESS)定位]，我们测定了96例患者和44名健康对照组的NAWM代谢物浓度，平均为发病后19周(范围12-28周)。使用LC模型自动估算N-乙酰天冬氨酸、总肌酸和磷酸肌酸(Cr)、胆碱类化合物、谷氨酸+谷氨酰胺和肌醇(INS)的绝对浓度。与正常对照组比较，INS浓度显著升高(平均3.31mM，SD0.86vs3.82 mM，SD1.06；P=0.001)。磁共振T2加权像异常的患者亚组(平均3.88 mm，SD1.10；P=0.001)和符合McDonald标准的多发性硬化症患者(平均4.04 mm，SD1.31；P=0.001)也有INS的增加。CIS NAWM组的肌酸值也明显升高(P=0.023)，但其他代谢物在整个CIS组与对照组之间无显著差异。NAWM INS与T2损伤负荷无明显相关性。早期INS的升高可能反映了多发性硬化症NAWM的发病过程。后续研究将调查NAWM INS的增加是否对未来复发和残疾具有预后重要性。
Normal-appearing white matter (NAWM) in established multiple sclerosis has been shown to be abnormal using a variety of magnetic resonance (MR) techniques, including proton MR spectroscopy ((1)H-MRS), although the stage at which these changes first appear is less clear. Using a 1.5 T scanner and single-voxel (1)H-MRS [TR 3000 ms, TE 30 ms, point-resolved spectroscopy (PRESS) localization], we determined NAWM metabolite concentrations in 96 patients a mean of 19 weeks (range 12-28 weeks) after onset of a clinically isolated syndrome (CIS) suggestive of multiple sclerosis and in 44 healthy control subjects. Absolute concentrations of N-acetyl-aspartate, total creatine and phosphocreatine (Cr), choline-containing compounds, glutamate plus glutamine, and myo-inositol (Ins) were estimated automatically using the LCModel. Compared with control subjects, the concentration of Ins was elevated in CIS NAWM (mean 3.31 mM, SD 0.86 versus mean 3.82 mM, SD 1.06; P = 0.001). The increase in Ins was also seen in the patient subgroup with abnormal T2-weighted MRI (mean 3.88 mM, SD 1.10; P = 0.001) and in those who satisfied the McDonald criteria for multiple sclerosis (mean 4.04 mM, SD 1.31; P = 0.001). An increase in Cr was also observed in CIS NAWM (P = 0.023), but other metabolites did not significantly differ between the whole CIS group and control subjects. There was no significant correlation between NAWM Ins and T2 lesion load. The early increase in Ins may reflect a process of pathogenic importance in multiple sclerosis NAWM. Follow-up studies will investigate whether the increase in NAWM Ins is of prognostic importance for future relapses and disability.