C. Pohl et al., Proton magnetic resonance spectroscopy of the motor cortex in 70 patients with amyotrophic lateral sclerosis, ARCH NEUROL, 58(5), 2001, pp. 729-735
Objective: To evaluate proton magnetic resonance spectroscopy for detection
and monitoring of upper motoneuron degeneration in patients with amyotroph
ic lateral sclerosis.
Methods: Seventy patients with amyotrophic lateral sclerosis according to t
he El Escorial criteria were compared with 48 healthy control subjects. Sin
gle-volume proton magnetic resonance spectroscopy (echo time, 272 milliseco
nds; repetition time, 2000 milliseconds) was performed in both motor cortic
es for detection of N-acetylaspartate (NAA), phosphocreatine+creatine ([PIC
r), and choline-containing compounds (Cho) to calculate the metabolite rati
os NAA/Cho, NAA/(P)Cr, and Cho/ (P)Cr. In addition, absolute metabolite con
centrations of NAA, (P) Cr, and Cho were obtained in 30 patients and 15 con
trols with the unsuppressed water signal used as an internal reference.
Results: Absolute concentrations of NAA (P<.001) and (P)Cr (P<.05) were red
uced in motor cortices of patients, whereas Cho concentrations remained unc
hanged. The NAA/Cho and NAA/(P)Cr ratios were reduced in all El Escorial su
bgroups (P<.001). The Cho/(P)Cr ratio was elevated in patients with definit
e amyotrophic lateral sclerosis (P<.05). Metabolite ratio changes correspon
ded to the lateralization of clinical symptoms and were weakly correlated w
ith disease duration and disease severity. In follow-up observations of 16
patients during a mean (+/-SD) of 12.1+/-8.7 months, NAA/Cho dropped by 9.1
% (P<.01), and Cho/(P)Cr increased by 7.0% (P<.01). Changes of metabolite r
atios were significantly correlated with progression of disease severity.
Conclusions: Measurement of NAA concentrations and NAA/Cho ratios appear to
be most suitable for detection of motor cortex degeneration by single-volu
me proton magnetic resonance spectroscopy. Reduced NAA/Cho ratios correspon
d to aspects of the clinical presentation and reflect disease progression i
n follow-up measurements.