Comprehensive evaluation of corticospinal tract metabolites in amyotrophic lateral sclerosis using whole-brain 1H MR spectroscopy.
Comprehensive evaluation of corticospinal tract metabolites in amyotrophic lateral sclerosis using whole-brain 1H MR spectroscopy.
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DOI：
10.1371/journal.pone.0035607
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Sheriff S
中科院分区：
文献类型：
--
作者：
Govind V;Sharma KR;Maudsley AA;Arheart KL;Saigal G;Sheriff S
观察了肌萎缩侧索硬化症(ALS)患者大脑皮质脊髓束(CST)包括初级运动皮质的N-乙酰天冬氨酸(NAA)、总胆碱(CHO)和总肌酸(CRE)的质子磁共振波谱(MRS)分布变化。这项研究包括38名散发性ALS患者和70名年龄匹配的对照组。所有受试者均接受了3T全脑MR成像和光谱成像扫描，并进行了包括百分比、最大用力肺活量(FVC)和上运动神经元功能(UMN)在内的临床神经学评估。在整个CST和沿CST长度的5个节段(中央前回(PCG)、半卵圆中心(CS)、放射冠(CR)、内囊后肢(PLIC)和大脑脚(CP)水平)评价各代谢物的差异及其比率分布。主要表现为全颅CST的NAA显著降低，Cho和Cho/NAA显著升高，其中Cho/NAA在各组间差异最大。整个颅内CST的Cho/NAA与右指敲击率显著相关。10个双侧颈总动脉节段中，4个节段NAA显著降低，5个节段Cho升高，Cho/NAA均升高。在CS中，仅在ALS的Cho/NAA存在显著的左右CST不对称。在CHO/NAA与临床评估的显著相关性中，包括左PCG与FVC和右指敲击率，左CR与FVC和右指敲击率，以及左PLIC与FVC和右脚敲击率。这些结果表明，在ALS患者中，代谢物沿整个颅内CST的长度发生了显著的、两侧不对称的改变，各节段的MRS指标与疾病严重程度和UMN功能的衡量标准相关。
Changes in the distribution of the proton magnetic resonance spectroscopy (MRS) observed metabolites N-acetyl aspartate (NAA), total-choline (Cho), and total-creatine (Cre) in the entire intracranial corticospinal tract (CST) including the primary motor cortex were evaluated in patients with amyotrophic lateral sclerosis (ALS). The study included 38 sporadic definite-ALS subjects and 70 age-matched control subjects. All received whole-brain MR imaging and spectroscopic imaging scans at 3T and clinical neurological assessments including percentage maximum forced vital capacity (FVC) and upper motor neuron (UMN) function. Differences in each individual metabolite and its ratio distributions were evaluated in the entire intracranial CST and in five segments along the length of the CST (at the levels of precentral gyrus (PCG), centrum semiovale (CS), corona radiata (CR), posterior limb of internal capsule (PLIC) and cerebral peduncle (CP)). Major findings included significantly decreased NAA and increased Cho and Cho/NAA in the entire intracranial CST, with the largest differences for Cho/NAA in all the groups. Significant correlations between Cho/NAA in the entire intracranial CST and the right finger tap rate were noted. Of the ten bilateral CST segments, significantly decreased NAA in 4 segments, increased Cho in 5 segments and increased Cho/NAA in all the segments were found. Significant left versus right CST asymmetries were found only in ALS for Cho/NAA in the CS. Among the significant correlations found between Cho/NAA and the clinical assessments included the left-PCG versus FVC and right finger tap rate, left -CR versus FVC and right finger tap rate, and left PLIC versus FVC and right foot tap rate. These results demonstrate that a significant and bilaterally asymmetric alteration of metabolites occurs along the length of the entire intracranial CST in ALS, and the MRS metrics in the segments correlate with measures of disease severity and UMN function.
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