Single-voxel proton MR spectroscopy in toluene abuse

Inhalation of toluene, which is an organic solvent, causes toxic encephalopathy characterized by cognitive impairment, cerebellar and extra-pyramidal symptoms. We studied cranial MR images and single-voxel MR spectroscopy of 22 toluene abusers and age-matched control subjects. The mean age of the abusers and mean duration of abuse were 18,1 years and 47 months, respectively. We got three MR spectra from the centrum semiovale, cerebellum and thalamus by using STEAM sequence with a TE value of 30 ms. N-acetyl aspartate (NAA)/Creatine (Cr), Choline (Cho)/Cr, myo-inositol (mI)/Cr peak integral ratios were calculated. NAA/Cr in the cerebellum and centrum semiovale of the abusers were significantly lower than those of the control subjects. mI/Cr in centrum semiovale and cerebellum were higher in toluene abusers. No significant difference was found in the metabolite ratios of the thalami. The association of NAA/Cr and mI/Cr ratios in cerebellum and centrum semiovale with the duration of abuse was significant. Normal level of NAA in thalamus, which was a neuron rich gray matter structure, might imply that toluene inhalation did not cause direct neuronal injury. Selective reduction of NAA and increased level of mI in white matter supported the theory of that axonopathy and gliosis were the main mechanisms of pathophysiology in chronic toluene encepholopathy. Insignificance of elevation of Cho/Cr ratios demonstrated that toluene inhalation did not cause active demyelination.     

Short echo time multislice proton magnetic resonance spectroscopic imaging in human brain: metabolite distributions and reliability.

Multislice proton magnetic resonance spectroscopic imaging (1H MRSI) at 25 ms echo time was used to measure concentrations of myo-inositol (mI), N-acetylaspartate (NAA), and creatine (Cr) and choline (Cho) in ten normal subjects between 22 and 84 years of age (mean age 44 +/- 18 years). By co-analysis with MRI based tissue segmentation results, metabolite distributions were analyzed for each tissue type and for different brain regions. Measurement reliability was evaluated using intraclass correlation coefficients (ICC). Significant differences in metabolite distributions were found for all metabolites. mI of frontal gray matter was 84% of parietal gray matter and 87% of white matter. NAA of frontal gray matter was 86% of parietal gray matter and 85% of white matter. Cho of frontal gray matter was 125% of parietal gray matter and 59% of white matter and Cho of parietal gray matter was 47% of white matter. Cr of parietal gray matter was 113% of white matter. Reliability was relatively high (ICC from.70 to.93) for all metabolites in white matter and for NAA and Cr in gray matter, though limited (ICC less than.63) for mI and Cho in gray matter. These findings indicate that voxel gray/white matter contributions, regional variations in metabolite concentrations, and reliability limitations must be considered when interpreting 1H MR spectra of the brain.     

Proton MR spectroscopy features of normal appearing white matter in neurofibromatosis type 1

To determine whether differences exist between neurofibromatosis type 1 (NF1) patients with or without focal lesions and healthy normal volunteers in the metabolite ratios of normal appearing white matter, 27 patients with NF1 (with parenchymal lesion, MR positive, n: 17; without parenchymal lesions, MR negative, n: 10) and 20 healthy volunteers underwent MRI and short TE (31 ms) proton MR spectroscopy (MRS). In 17 patients with parenchymal lesions, 61 focal lesions were detected by MRI. MRS was performed from normal appearing frontal and posterior parietal white matter (FWM and PWM) in NF1 and from control groups. NAA/Cr, Cho/Cr and MI/Cr ratios were calculated. Significant increase in Cho/Cr and MI/Cr ratios were found in FWM and PWM in MR negative and positive groups when compared to control group. NAA/Cr ratio in MR positive group was significantly decreased in FWM compared to control group. There were no significant differences between FWM and PWM in all metabolite ratios of MR negative group. MI/Cr ratio in MR positive group was significantly elevated in PWM compared to FWM. Metabolite changes detected by MRS could indicate demyelination and gliosis in normal appearing white matter in all NF1 patients, and additionally neuroaxonal damage in the FWM of NF1 patients with focal lesions. For that reason, in the clinical evaluation and follow-up of these patients MRS features of normal appearing white matter should be considered in addition to focal lesions.     

Brain metabolite concentration ratios in vivo: multisite reproducibility by single-voxel 1H MR spectroscopy

Ten normal subjects were scanned identically at three separate sites (Little Rock, Houston, and New Orleans) to evaluate the reproducibility of brain metabolite ratios in single-voxel (1)H point-resolved spectroscopy sequence (PRESS) magnetic resonance (MR) spectroscopy in vivo. All scans were processed by a single individual at a single site. Coefficients of variation of the measured metabolite ratios generally were in the range found for previous single-voxel, single-site reproducibility studies. No differences were found among the sites for ratios of N-acetylaspartate to creatine (NAA/Cr) or choline to Cr (Cho/Cr) in left thalamus by multivariate ANOVA. Metabolite ratios of Cr or Cho relative to local brain H(2)O did not vary among the sites. However, by multivariate ANOVA, NAA/H(2)O differed between Little Rock and New Orleans, but not between those sites and Houston. Intraclass correlation coefficients suggested reasonable reproducibility between Little Rock and New Orleans, but not between those sites and Houston.     

Assessment of the metabolic profile in Type 2 diabetes mellitus and hypothyroidism through proton MR spectroscopy

The metabolic changes in the brain of patients affected with Type 2 diabetes mellitus (DM) alone, both Type 2 DM and hypothyroidism and hypothyroidism only were investigated using proton magnetic resonance spectroscopy ((1)H MRS). Single-voxel spectroscopy was carried out in right and left frontal lobe white matter, left parietal white matter and left occipital gray matter. Choline (Cho)/creatine (Cr) value was found to be increased in the left occipital gray matter of the subjects affected with Type 2 DM and both Type 2 DM and hypothyroidism as compared to controls. No significant change in the Cho/Cr value in the occipital gray matter was observed in hypothyroid subjects as compared to controls. However, they showed an increased level of Cho/Cr in the frontal white matter. High Cho is associated with altered membrane phospholipid metabolism. The high Cho in frontal white matter in hypothyroids and occipital gray matter in diabetic patients suggests that, though both the diseases are endocrine disorders, they differ from each other in terms of regional brain metabolite changes.     

Magnetic resonance spectroscopy of the brain in neurologically asymptomatic HIV-infected patients

The CNS involvement is frequently found in human immunodeficiency virus (HIV) infection. The purpose of our study was to determine whether proton magnetic resonance spectroscopy (MRS) could detect early brain involvement in neurologically asymptomatic HIV-infected patients with normal MR imagings and to find the correlation between MRS and the immune status. We performed MRS in 30 HIV seropositive neurologically asymptomatic patients with normal MRI and compared the MRS findings with 13 controls. A statistically significant reduction in N-acetylaspartate (NAA)/creatine (Cr) and N-acetylaspartate (NAA)/choline (Cho) in both centrum semiovale (p < 0.005) and thalamic areas (p < 0.05) was found. There is no statistically significant difference as to choline (Cho)/creatine (Cr) and myoinositol (mI)/creatine (Cr) ratios in both regions. The difference of NAA/Cr was more pronounced in the white matter than in the gray matter. As for the immune status, there was a trend towards correlation between CD4 counts and NAA/Cr but devoid of statistical significance. Our results suggest that MRS is more sensitive than conventional MR imaging in detecting CNS involvement in neurologically asymptomatic HIV patients and may, therefore, be used for early detection of brain damage induced by HIV.     

Brain metabolite changes in alcoholism: An in vivo proton magnetic resonance spectroscopy (MRS) study

Image-guided, single voxel, localized proton magnetic resonance (MR) spectroscopy was performed to assess the brain metabolite changes in 10 (n = 10) alcoholic patients in the frontal lobe, cerebellum, and thalamus regions. The spectra obtained were characterized by a reduced N-acetyl-aspartate (NAA) to choline (Cho) (p < .01) and NAA to total creatine (Cr + PCr) (p < .01) ratios relative to age-matched (n = 27) controls. These decreased ratios correspond to depleted concentration of the metabolite levels such as NAA and Cho. Reduction of NAA is consistent with the neuronal loss while reduction in Cho suggests significant changes in the membrane lipids of alcoholics.     

Proton MR spectroscopy of cerebellitis

Single voxel proton MR spectroscopy ((1)H-MRS) of the vermis was obtained in two patients with cerebellitis. In the acute phase (1)H-MRS revealed low N-acetyl-aspartate (NAA)/creatine (Cr) and NAA/choline (Cho) and normal Cho/Cr ratios. Decrease of the concentration of NAA was confirmed by quantitative analysis in one patient. The NAA/Cr and NAA/Cho ratios and NAA concentration were increased in (1)H-MRS examinations obtained 10 and 24 months after the acute episode. (1)H-MRS demonstrates reversible metabolite changes in cerebellitis.     

Brain metabolite alterations demonstrated by proton magnetic resonance spectroscopy in diabetic patients with retinopathy

Due to the homology between retinal and cerebral microvasculatures, retinopathy is a putative indicator of cerebrovascular dysfunction. This study aimed to detect metabolite changes of brain tissue in type 2 diabetes mellitus (T2DM) patients with diabetic retinopathy (DR) using proton magnetic resonance spectroscopy (¹H-MRS). Twenty-nine T2DM patients with DR (DR group), thirty T2DM patients without DR (DM group) and thirty normal controls (NC group) were involved in this study. Single-voxel ¹H-MRS (TR: 2000 ms, TE: 30 ms) was performed at 3.0 T MRI/MRS imager in cerebral left frontal white matter, left lenticular nucleus, and left optic radiation. Our data showed that NAA/Cr ratios of the DR group were significantly lower than those of the DM group in the frontal white matter and optic radiation. In the lenticular nucleus, MI/Cr ratios were significantly higher in the DM group than those in the NC group, while MI/Cr ratios were significantly lower in the DR group than those in the DM group. In the frontal white matter, NAA/Cho ratios were found to be decreased in the DR group as compared to the NC group. Additionally, our finding indicated that NAA/Cr ratios were negatively associated with DR severity in both the frontal white matter and optic radiation. A decrease in NAA indicated neuronal loss and the likely explanation for a decrease in MI was glial loss. In conclusion, we inferred that cerebral neurons and glia cells were damaged in patients with DR. Our data support that DR is associated with brain tissue damage.     

Spectroscopic imaging of radiation-induced effects in the white matter of glioma patients

External radiation therapy of brain tumors may cause adverse effects on normal brain tissue, resulting in severe neuropsychological and cognitive impairment. We investigated the late delayed radiation effects in the white matter (WM) using (1)H magnetic resonance spectroscopic imaging ((1)HMRSI). Nine glioma patients with local radiation-induced signal abnormalities in the T(2)-weighted MR images were studied with nine age- and sex-matched controls. The metabolite ratios in the radiation-induced hyper intensity area (RIHA) and in the normal appearing white matter (NAWM) of the patients were compared with respective WM areas of the controls. In RIHA, choline/creatine (Cho/Cr) was 17% decreased (1.22 +/- 0.13 vs 1.47 +/- 0.16, p = 0.0027, significant (s), unpaired Student's t test with Bonferroni correction) in the patients compared to the controls, while there was no difference in N-acetyl aspartate/Cr (NAA/Cr) (2.49 +/- 0.57 vs 2.98 +/- 0.32, p = 0.039) or NAA/Cho (2. 03 +/- 0.40 vs 2.04 +/- 0.17, p = 0.95). In NAWM, Cho/Cr was 24% decreased (1.21 +/- 0.15 vs 1.59 +/- 0.13, p < 0.0001, s) and NAA/Cho was 20% increased (2.49 +/- 0.49 vs 1.98 +/- 0.15, p = 0. 0082, s) in the patients compared to the controls, while there was no difference in NAA/Cr (2.99 +/- 0.46 vs 3.16 +/- 0.32, p = 0.38). NAA(RIHA)/NAA(NAWM) was 25% decreased (0.75 +/- 0.20 vs 1.00 +/- 0. 12, p = 0.0043, s) and Cr(RIHA)/Cr(NAWM) was 16% decreased (0.89 +/- 0.15 vs 1.06 +/- 0.10, p = 0.013, s) in the patients compared to the controls, while there was no difference in Cho(RIHA)/Cho(NAWM) (0.92 +/- 0.23 vs 0.98 +/- 0.10, p = 0.47). (1)HMRSI reveals widespread chemical changes in the WM after radiation therapy. In RIHA, there is loss of NAA, Cho, and Cr implying axonal and membrane damage and in NAWM, there is loss of Cho, reflecting membrane damage.     

Serial Precision of Metabolite Peak Area Ratios and Water Referenced Metabolite Peak Areas in Proton MR Spectroscopy of the Human Brain

The precision of cerebral proton magnetic resonance spectroscopy (MRS) measurements is critical both in the clinical setting and for research purposes. Marshall et al. have recently concluded that “disappointing in vivo repeatability…is likely to limit” the ability of MRS to detect modest changes. We present here a comprehensive study of the precision of short- and long-term metabolite peak area ratios and water referenced metabolite peak areas for long echo time point resolved spectroscopy (PRESS) spectra (repetition time (TR) = 2000 ms, echo time (TE) = 136 ms) acquired from the occipital lobes of normal volunteers and a phantom using a conventional whole body 1.5 T MR system and conventional acquisition and analysis protocols. Short-term in vitro precision determined by five repeat scans on five occasions was excellent as measured by a mean coefficient of variation (NAA/Cho = 1.3%, NAA/Cr + PCr = 1.0%, Cho/Cr + PCr = 1.6%, NAA/H₂O = 0.5%, Cho/H₂O = 1.2%, Cr + PCr/H₂O = 0.8%). Long term in vitro precision using 100 spectra acquired over 2 years was also very good (NAA/Cho = 2.7%, NAA/Cr + PCr = 1.4%, Cho/Cr + PCr = 2.2%, NAA/H₂O = 1.5%, Cho/H₂O = 2.4%, Cr + PCr/H₂O = 1.5%). Short-term in vivo precision determined by five repeat scans in a single scanning session on eight subjects was also excellent (NAA/Cho = 5.2%, NAA/Cr + PCr = 3.0%, Cho/Cr + PCr = 6.6%, NAA/H₂O = 1.4%, Cho/H₂O = 4.9%, Cr + PCr/H₂O = 2.7%) and only worsened slightly for long-term in vivo precision determined by five repeat scans on eight subjects over 3 months (NAA/Cho = 5.2%, NAA/Cr + PCr = 4.8%, Cho/Cr + PCr = 7.7%, NAA/H₂O = 2.5%, Cho/H₂O = 6.4%, Cr + PCr/H₂O = 3.8%). We attribute the excellent precision reported here to the use of highly automated techniques for voxel shimming, water suppression and peak area measurements. These results allow us to repudiate Marshall’s assertion regarding disappointing repeatability of in vivo MRS.     

Magnetic resonance spectroscopy study of proton metabolite level changes in sensorimotor cortex after upper limb replantation-revascularization

We aimed to investigate the changes in proton metabolite levels at the motor and somatosensory cortex by magnetic resonance spectroscopy (MRS) after upper extremity replantation or revascularization. Nine patients who referred to our clinic suffering from major total (two) and subtotal (seven) amputation of the upper extremity were enrolled in this study. Mean time value between the injury and operation was 5.1 h. Mean follow-up period or mean time between the injury and MRS analysis was 26.2 months (ranging from 7 to 41 months). Voxels (TR: 2000; TE: 136 ms) were placed onto locations in the bilateral precentral and postcentral cortex area of the cerebral hemispheres that represent the upper extremity. Contralateral sides of the brain hemisphere that represent the injured extremity were accounted as control groups. Metabolite ratios [NAA (N-acetyl aspartate)/Cr (creatine) and Cho (choline)/Cr] of the motor and somatosensory cortex were calculated. The NAA/Cr and Cho/Cr metabolite ratios between the two groups were found to be insignificant, and these results may indicate that there is no remarkable somatosensorial cortex disruption or demyelination in these patients. Fifty-six percent of patients were found as functional according to Chen's scale.     

Noninvasive evaluation of cerebral glioma grade by using multivoxel 3D proton MR spectroscopy

Objective

To determine whether metabolite ratios in multivoxel 3D proton MR spectroscopy (¹H MRS) is different between low-grade and high-grade gliomas and may be useful for glioma grading.

Materials and Methods

Thirty-nine patients (23 male and 16 female; 22-75 years old; mean age, 44.92±12.65 years) suspected of having gliomas underwent 3D ¹H MRS examinations. Metabolite ratios [choline (Cho)/creatine (Cr), N-acetylaspartate (NAA)/Cr and Cho/NAA] were measured. Tumor grade was determined by using the histopathologic grading. Receiver operating characteristic analysis of metabolite ratios was performed, and optimum thresholds for tumor grading were determined. The resulting sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for identifying high-grade gliomas were calculated.

Results

Diagnostic-quality 3D ¹H MRS with readily quantifiable Cho, Cr and NAA peaks was obtained in 94.87% of the cases. The Cho/Cr and Cho/NAA ratios were significantly higher in high-grade than in low-grade glioma (P<.001), whereas the NAA/Cr ratios were significantly lower in high-grade than in low-grade glioma (P<.001). Receiver operating characteristic analysis demonstrated a threshold value of 2.04 for Cho/Cr ratio to provide sensitivity, specificity, PPV and NPV of 84.00%, 83.33%, 91.30% and 71.43%, respectively. Threshold value of 2.20 for Cho/NAA ratio resulted in sensitivity, specificity, PPV and NPV of 88.00%, 66.67%, 84.62% and 72.73%, respectively. Overall diagnostic accuracy was not statistically significantly different between Cho/Cr and Cho/NAA ratios (χ²=0.093, P=.76).

Conclusion

Metabolite ratios of low-grade gliomas were significantly different from high-grade gliomas. Cho/Cr and Cho/NAA ratios could have the superior diagnostic performance in predicting the glioma grade.     

Absolute Quantification Using Turbo Spectroscopic Imaging in Multiple Sclerosis Patients

One of the drawbacks of scanning patients using multiple-voxel spectroscopic imaging is the long acquisition time. This is especially true when one is interested in obtaining absolute metabolite concentrations which requires acquisition of unsuppressed water spectra in addition to the suppressed spectra. In our experiment, turbo spectroscopic imaging (TSI) method with acquisition of three echoes per excitation was applied to reduce scanning time without lowering the spatial resolution. In 15 relapsing-remitting multiple sclerosis patients (mean age 37.07 years, mean disease duration 7.67 years), an MRSI scan at the level of centrum semiovale was obtained. The scan time was approximately 7 min including the unsuppressed spectra. Tissue water was used as an internal concentration reference to obtain absolute metabolite concentrations of N-acetyl-aspartate (NAA), creatine (Cr), and choline (Cho). The peak areas were corrected for differences in transversal and longitudinal relaxation times and a water concentration of 55.5 M was assumed. A three-dimensional high-resolution T ₁ scan was acquired and used to segment tissue in gray matter (GM), white matter (WM), and cerebrospinal fluid using FSL’S FAST segmentation method (a software library of the automated segmentation tool by the Center of Functional MRI of the Brain, Oxford, UK). Finally, a regression analysis was employed to address the metabolite concentrations and ratios in GM and WM, respectively. Our study shows that the metabolite concentrations (NAA, Cho, Cr) and metabolite ratios (NAA/Cr and Cho/Cr) in GM and WM obtained using the methods discussed earlier are comparable to the results found in other studies of similar patient groups. It also shows that TSI method can be used to obtain the absolute metabolite ratios in a reasonable scan time.     

Metabolite ratios to assumed stable creatine level may confound the quantification of proton brain MR spectroscopy

In localized brain proton MR spectroscopy ((1)H-MRS), metabolites' levels are often expressed as ratios, rather than as absolute concentrations. Frequently, their denominator is the creatine [Cr], which level is explicitly assumed to be stable in normal as well as in many pathologic states. The rationale is that ratios self-correct for imager and localization method differences, gain instabilities, regional susceptibility variations and partial volume effects. The implicit assumption is that these benefits are worth their cost(w)-(w) propagation of the individual variation of each of the ratio's components. To test this hypothesis, absolute levels of N-acetylaspartate [NAA], choline [Cho] and [Cr] were quantified in various regions of the brains of 8 volunteers, using 3-dimensional (3D) (1)H-MRS at 1.5 T. The results show that in over 50% of approximately 2000 voxels examined, [NAA]/[Cr] and [Cho]/[Cr] exhibited higher coefficients of variations (CV) than [NAA] and [Cho] individually. Furthermore, in approximately 33% of these voxels, the ratios' CVs exceeded even the combined constituents' CVs. Consequently, basing metabolite quantification on ratios and assuming stable [Cr] introduces more variability into (1)H-MRS than it prevents. Therefore, its cost exceeds the benefit.     

Molality as a unit of measure for expressing 1H MRS brain metabolite concentrations in vivo

Absolute concentrations of cerebral metabolite in in vivo 1H magnetic resonance spectroscopy studies (1H-MRS) are widely reported in molar units as moles per liter of tissue, or in molal units as moles per kilogram of tissue. Such measurements require external referencing or assumptions as to local water content. To reduce the scan time, avoid assumptions that may be invalid under specific pathologies, and provide a universally accessible referencing procedure, we suggest that metabolite concentrations from 1H-MRS measurements in vivo be reported in molal units as moles per kilogram of tissue water. Using internal water referencing, a two-compartment water model, a simulated brain spectrum for peak identification, and a spectroscopic bi-exponential spin-spin relaxation segmentation technique, we measured the absolute concentrations for the four common 1H brain metabolites: choline (Cho), myo-inositol (mIno), phosphocreatine + creatine (Cr), and N-acetyl-aspartate (NAA), in the hippocampal region (n = 26) and along the Sylvian fissure (n = 61) of 35 healthy adults. A stimulated echo localization method (20 ms echo time, 10 ms mixing time, 4 s repetition time) yielded metabolite concentrations, uncorrected for metabolite relaxation or contributions from macromolecule resonances, that were expectantly higher than with molar literature values. Along the Sylvian fissure the average concentrations (coefficient of variation (CV)) in mmoles/kg of tissue water were 17.6 (12%) for NAA, 14.2 (9%) for Cr, 3.6 (13%) for Cho, and 13.2 (15%) for mIno. Respective values for the hippocampal region were 15.7 (20%), 14.7 (16%), 4.6 (19%), and 17.7 (26%). The concentrations of the two regions were significantly different (p 相似文献   

In vivo quantification of the metabolites in normal brain and brain tumors by proton MR spectroscopy using water as an internal standard

Metabolite concentrations in normal adult brains and in gliomas were quantitatively analyzed by in vivo proton magnetic resonance spectroscopy (MRS) using the fully relaxed water signal as an internal standard. Between January 1998 and October 2001, 28 healthy volunteers and 18 patients with gliomas were examined by in vivo proton MRS. Single voxel spectra were acquired using the point-resolved spectroscopic pulse sequence with a 1.5-T scanner (TR/TE/Ave = 3000 ms/30 ms/64). The calculated concentrations of N-acetyl-aspartate (NAA), creatine (Cre), choline (Cho), and water (H2O) in the normal hemispheric white matter were 23.59 +/- 2.62 mM (mean +/- SD), 13.06 +/- 1.8 mM, 4.28 +/- 0.8 mM, and 47280.96 +/- 5414.85 mM, respectively. The metabolite concentrations were not necessarily uniform in different parts of the brain. The concentrations of NAA and Cre decreased in all gliomas (p < 0.001). The NAA/Cho and NAA/H2O ratios can distinguish the normal brain from gliomas, and low-grade astrocytoma from high-grade group (p < 0.001). The concentration of taurine (Tau) in medulloblastomas was 29.64 +/- 5.76 mM. This is the first quantitative analysis of Tau in medulloblastoma in vivo and confirms earlier in vitro findings.     

Straightforward relative quantitation and age-related human standards of N-acetylaspartate at the centrum semiovale level by CSI (1)H-MRS

1H-MRS was aimed to monitor metabolite concentrations in homogeneous interaxial slices of cerebral matter at the centrum semiovale level in healthy volunteers. NAA (N-acetylaspartate + N-acetylglutamate), Cr (creatine + phosphocreatine), and Cho (choline + acetylcholine) were evaluated by resonance integrations. Using Cr as an internal standard, NAA/Cr ratio was considered as a relative measure of concentration. CSI sequence explored volunteer's interaxial slices of white and gray matter by means of 8 x 8 matrices of (1)H-NMR spectra. NAA/Cr integral ratios were averaged over the whole spectral matrix to obtain the Index of NAA at Centrum Semiovale (INACS) of each individual. Indexes of the sixty-eight healthy volunteers, divided into three groups by age, showed good intraindividual reproducibility, and were virtually unaffected by small shifts or bendings of the interaxial slice analyzed. The INACSs were used to estimate Age-Sectorial INACS Ranges (ASIR), the intervals that, on the basis of a normal statistical distribution, should comprise 95% of the age-matched healthy population. Individual INACSs, compared to accurately defined ASIRs taken as standards, could early detect subtle, diffuse neuronal or axonal damage within centrum semiovale interaxial slices. Periodic inspection of INACS could also allow monitoring of progressive neuronal or axonal degeneration.     

Central pontine myelinolysis after liver transplantation: MR diffusion, spectroscopy and perfusion findings

Magnetic resonance spectroscopy (MRS) and perfusion of central pontine myelinolysis (CPM) have been rarely reported. One case of CPM that developed after liver transplantation was analyzed with serial diffusion-weighted imaging (DWI), MRS and MR perfusion. During the acute phase, a pontine lesion showed an obvious high-signal intensity on DWI with decreased apparent diffusion coefficient value, decreased N-acetylaspartate (NAA)/creatine (Cr) ratio, increased choline (Cho)/Cr ratio and increased perfusion on the cerebral blood volume map. In a later phase, the lesion showed isosignal intensity on DWI, further decreased NAA/Cr ratio, increased Cho/Cr ratio and decreased perfusion. The increase in lesion perfusion during the acute phase may reflect a higher metabolic activity due to an increase in cell number and activity.