A proton magnetic resonance spectroscopic study in ALS - Correlation with clinical findings
A proton magnetic resonance spectroscopic study in ALS - Correlation with clinical findings
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DOI：
10.1212/wnl.51.4.1104
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发表时间：
1998-10-01
期刊：
影响因子：
9.9
通讯作者：
Leigh, PN
中科院分区：
文献类型：
--
作者：
Ellis, CM;Simmons, A;Leigh, PN
目的：采用体积定位质子磁共振波谱（H-1-MRS）评价ALS患者皮质下白色物质运动区神经元功能障碍。方法：研究16例确诊、可能或可能患有埃尔埃斯科里亚ALS的患者和8例年龄匹配的健康对照者。ALS患者分为肢体起病组（n = 8）和延髓起病组（n = 8）。N-乙酰天冬氨酸（NAA）/肌酸和磷酸肌酸（Cr+PCr），NAA/胆碱（Cho）和Cho/（Cr+PCr）的代谢比的测量与临床评估相关。结果：我们发现，在运动区的代谢峰面积比相比，总ALS组和对照组没有显着差异。然而，NAA/（Cr+PCr）比值与埃尔埃斯科里亚分类（p = 0.03）、ALS严重程度量表（p = 0.01）和医学研究理事会评分（p = 0.06）之间存在相关性。NAA/（Cr+PCr）比值与Ashworth痉挛量表、反射评分或疾病持续时间之间无相关性（p > 0.16）。与肢体型患者相比，球型患者运动区的NAA/（Cr+PCr）比值较低（p = 0.03）。结论：在体内H-1-MRS的皮质下白色物质在运动区是不太可能足够敏感，以检测ALS的早期疾病变化，因为有相当大的重叠代谢峰面积比ALS患者和正常对照组。然而，NAA/（Cr+PCr）代谢峰面积比的变化与疾病严重程度的临床指标相关，该指标可用于监测疾病进展。
Objective: To evaluate neuronal dysfunction in the motor region subcortical white matter in ALS using volumetric localized proton magnetic resonance spectroscopy (H-1-MRS). Methods: Sixteen patients with El Escorial definite, probable, or possible ALS and eight healthy age-matched control subjects were studied. The ALS patients were divided into those with limb onset (n = 8) and those with bulbar onset (n = 8). Measurements of the metabolic ratios N-acetylaspartate (NAA)/creatine and phosphocreatine (Cr+PCr), NAA/choline (Cho), and Cho/(Cr+PCr) were correlated with clinical assessments. Results: We found no differences in the metabolic peak area ratios in the motor region when comparing the total ALS group and the control subjects. However, correlations were found between the NAA/(Cr+PCr) ratio and the El Escorial category (p = 0.03), the ALS severity scale (p = 0.01), and the Medical Research Council score (p = 0.06). No correlations were found between the NAA/(Cr+PCr) ratio and the Ashworth Spasticity Scale, reflex score, or disease duration (p > 0.16). Bulbar-onset patients had a lower NAA/(Cr+PCr) ratio in the motor region compared with limb-onset patients (p = 0.03). Conclusion: In vivo H-1-MRS of the subcortical white matter in the motor region is unlikely to be sensitive enough to detect early disease changes in ALS because there is considerable overlap between the metabolic peak area ratios from patients with ALS and normal control subjects. However, changes in the NAA/(Cr+PCr) metabolic peak area ratios correlate with clinical measures of disease severity, and this measure may be useful in monitoring disease progression.