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NMR Research Unit.
Institute of Neurology, Queen Square, London WC1N 3BG, UK
Correspondence to: Professor D H Miller, NMR Research Unit. Institute of Neurology, Queen Square, London WC1N 3BG, UK. Telephone 0044 171 278 5616.
Received 16 June 1998 and in revised form 4 March 1999;
Accepted 18 March
1999
OBJECTIVE
To determine
non-invasively the relation between the degree of axonal loss and the
extent of demyelination in chronic lesions visible on MRI in patients
with different subgroups of clinically definite multiple sclerosis
using 1H magnetic resonance spectroscopy (1H
MRS) and magnetisation transfer imaging (MT). Conventional MRI is
unable to differentiate between the various pathological processes occurring in the multiple sclerosis lesion. There are, however, newer
MR techniques which show promise in this respect.
METHODS
1H MRS and MT were performed in 18 patients with clinically
definite multiple sclerosis who had a wide range of disability and
disease duration.
RESULTSA significant
correlation was found between a reduction in the concentration of
N-acetyl aspartate (NAA; an in vivo marker of axonal loss or
dysfunction) and a reduction in MT ratio (a probable marker of
demyelination) in patients who had entered the secondary progressive
stage of the disease. Patients with minimal disability after a disease
duration of greater than 10 yearsso called benign multiple
sclerosisshowed a relative preservation of NAA and MT.
CONCLUSIONSBecause a
reduction in MT seems to be a relative marker for demyelination and a
reduction of NAA from chronic lesions is indicative of axonal loss,
this study supports the hypothesis that demyelination and axonal loss
occur in the same chronic multiple sclerosis lesions. In addition, the
degree of axonal loss and demyelination correlates with clinical heterogeneity.
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