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1H and31P magnetic resonance spectroscopic imaging of white matter signal hyperintensity areas in elderly subjects

  • Diagnostic Neuroradiology
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Abstract

White matter signal hyperintensities (WMSH) are commonly seen on MRI of elderly subjects. The purpose of this study was to characterize metabolic changes in the white matter of elderly subjects with extensive WMSH. We used water-suppressed proton (1H) magnetic resonance spectroscopic imaging (MRSI) to compare six subjects with extensive WMSH with eight age-matched elderly subjects with minimal or absent WMSH, and phosphorus (31P) MRSI to compare nine subjects with extensive WMSH and seven age-matched elderly subjects without extensive WMSH. Relative to region-matched tissue in elderly controls, extensive WMSH were associated with increased signal from choline-containing metabolites, no significant change of signal fromN-acetylaspartate, and a trend to a decreased phosphomonoester (PME) resonance. These findings suggest that WMSH may be associated with an alteration of brain myelin phospholipids in the absence of axonal damage. There were no differences in energy phosphates, consistent with lack of ongoing brain ischemia. Within the group with extensive WMSH, PME resonance measures were significantly lower in WMSH than in contralateral normal-appearing white matter. These results provide information on pathophysiology of WMSH and a basis for comparison with WMSH in Alzheimer's disease, vascular dementia, multiple sclerosis, and other diseases.

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References

  1. Bowen BC, Barker WW, Loewenstein DA, Sheldon J, Duara R (1990) MR signal abnormalities in memory disorder and dementia. AJNR 11:283–290

    Google Scholar 

  2. Bradley WG, Waluch V, Brant-Zawadski M, Tadley RA, Wycoff RR (1984) Patchy, periventricular white matter lesions in the elderly: a common observation during NMR imaging. Noninvasive Med Imag 1:35–41

    Google Scholar 

  3. Braffman B, Zimmerman R, Trojanowski J, Gonatas N, Hickey W, Schlaepfer W (1988) Brain MR: pathologic correlation with gross and histopathology. 2. Hyperintense white-matter foci in the elderly. AJR 151:559–566

    Google Scholar 

  4. Brant-Zawadski M, Fein G, Van Dyke C, Kierman R, Davenport L, Groot J de (1985) Magnetic resonance imaging of the aging brain: patchy white matter lesions in dementia. AJNR 6:675–682

    Google Scholar 

  5. Drayer BP (1988) Imaging of the aging brain, part I. Normal findings. Radiology 166:785–796

    Google Scholar 

  6. Sullivan P, Pary R, Telang F, Rifai AH, Zubenko GS (1990) Risk factors for white matter changes detected by magnetic resonance imaging in the elderly. Stroke 21:1424–1428

    Google Scholar 

  7. Symon L, Pasztor E, Dorsch NWC, Branston NM (1973) Physiological responses of local areas of the cerebral circulation in experimental primates determined by the method of hydrogen clearance. Stroke 4:632–642

    Google Scholar 

  8. Awad IA, Johnson PC, Spetzler RF, Hodak JA (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. II. Postmortem pathological correlations. Stroke 17:1090–1097

    Google Scholar 

  9. Fazekas F, Kleinert R, Offenbacher H, Payer F, Schmidt R, Kleinert G, Radner H, Lechner H (1991) The morphologic correlate of incidental punctate white matter hyperintensities on MR images. AJNR 12:915–921

    Google Scholar 

  10. Grafton ST, Sumi SM, Stimac GK, Alvord EC Jr, Shaw C-M, Nochlin D (1991) Comparison of postmortem magnetic resonance imaging and neuropathologic findings in the cerebral white matter. Arch Neurol 48:293–298

    Google Scholar 

  11. Janota I, Mirsen TR, Hachinski VC, Lee DH, Merskey H (1990) Neuropathologic correlates of leuko-araiosis. Arch Neurol 46:1124–1128. Erratum published in Arch Neurol 47:281

    Google Scholar 

  12. Kirkpatrick JB, Hayman LA (1987) White-matter lesions in MR imaging of clinically healthy brain of elderly subjects: possible pathology basis. Radiology 162:509–511

    Google Scholar 

  13. Marshall VG, Bradley WG, Marshall CE, Bhoopat T, Rhodes R (1988) Deep white matter infaction: correlation of MR imaging and histopathologic findings. Radiology 167:517–522

    Google Scholar 

  14. Munoz DG, Hastak SM, Harper B, Lee D, Hachinski VC (1993) Pathologic correlates of increased signals of the centrum ovale on magnetic resonance imaging. Arch Neurol 50:492–497

    Google Scholar 

  15. Sze G, De Armond SJ, Brant-Zawadski M, Davis RL, Norman D, Newton TH (1986) Foci of MRI signal (pseudolesions) anterior to the frontal horns: histologic correlations of a normal findings. AJNR 7:381–387

    Google Scholar 

  16. Brun A, Englund EA (1986) White matter disorder in dementia of the alzheimer type: a pathoanatomical study. Ann Neurol 19:253–262

    Google Scholar 

  17. Englund E, Brun A, Persson B (1987) Correlations between histopathologic white matter changes and proton MR relaxation times in dementia. Alzheimer Dis Assoc Disord 1:156–170

    Google Scholar 

  18. Wallin A, Blennow K, Uhlemann C, Langstrom G, Gottfries CG (1989) White matter low attenuation on computed tomography in Alzheimer's disease and vascular dementia: diagnostic and pathogenetic aspects. Acta Neurol Scand 80:518–523

    Google Scholar 

  19. Kozachuk WE, DeCarli C, Schapiro MB, Wagner EE, Rapoport SI, Horwitz B (1990) White matter hyperintensities in dementia of Alzheimer's type and in healthy subjects without cerebrovascular risk factors. A magnetic resonance imaging study. Arch Neurol 47:1306–1310

    Google Scholar 

  20. McDonald WM, Krishnan KR, Doraiswamy PM, Figiel GS, Husain MM, Boyko OB, Heyman A (1991) Magnetic resonance findings in patients with early-onset Alzheimer's disease. Biol Psychiatry 29:799–810

    Google Scholar 

  21. Scheltens P, Barkhof F, Valk J, Algra PR, Hoop RG van der, Nauta J, Wolters EC (1992) White matter lesions on magnetic resonance imaging in clinically diagnosed Alzheimer's disease. Evidence for heterogeneity. Brain 115: 735–748

    Google Scholar 

  22. Schmidt R (1992) Comparison of magnetic resonance imaging in Alzheimer's disease, vascular dementia and normal aging. Eur Neurol 32:164–169

    Google Scholar 

  23. McArthur JC, Kumar AJ, Johnson DW, Selnes OA, Becker JT, Herman C, Cohen BA, Saah A (1990) Incidental white matter hyperintensities on magnetic resonance imaging in HIV-1 infection. Multicenter AIDS cohort study. J Acquir Immune Defic Syndr 3:252–259

    Google Scholar 

  24. Olsen WL, Longo FM, Mills CM, Norman D (1988) White matter disease in AIDS: findings at MR imaging. Radiology 169:445–448

    Google Scholar 

  25. Coffey CE, Figiel GS, Saunders WB, Weiner RD (1989) White matter hyperintensity on magnetic resonance imaging: clinical and neuroanatomic correlates in the depressed elderly. J Neuropsychiat Clin Neurosci 1:135–144

    Google Scholar 

  26. Hunt AL, Orrison WW, Yeo RA, Haaland KY, Rhyne RL, Garry PJ, Rosenberg GA (1989) Clinical significance of MRI white matter lesions in the elderly. Neurology 39:1470–1474

    Google Scholar 

  27. Leys D, Soetaert G, Petit H, Fauquette A, Pruvo JP, Steinling M (1990) Periventricular and white matter magnetic resonance imaging hyperintensities do not differ between Alzheimer's disease and normal aging. Arch Neurol 47:524–527

    Google Scholar 

  28. Nadler JV, Cooper JR (1971)N-Acetyl-1-aspartic acid content of human neural tumours and bovine peripheral nervous tissues. J Neurochem 19:313–319

    Google Scholar 

  29. Urenjak J, Williams SR, Gadian DG, Noble M (1992) Specific expression ofN-acetylaspartate in neurons, oligodendrocyte-type-2 astrocyte progenitors, and immature oligodendrocytes in-vitro. J Neurochem 59:55–61

    Google Scholar 

  30. Birken L, Oldendorf WH (1989)N-Acetyl-L-aspartatic acid: a literature review of a compound prominent in1H-NMR spectroscopic studies of the brain. Neurosci Behav Rev 13:23–31

    Google Scholar 

  31. Tallan HH (1957) Studies on the distribution ofN-acetyl-L-aspartic acid in brain. J Biol Chem 224:41–45

    Google Scholar 

  32. Sappey-Marinier D, Calabrese G, Hetherington HP, Fisher SN, Deicken R, Van Dyke C, Fein G, Weiner MW (1992) Proton magnetic resonance spectroscopy of human brain: applications to normal white matter, chronic infarction, and MRI white matter signal hyperintensities. Magn Reson Med 26: 313–327

    Google Scholar 

  33. Sappey-Marinier D, Deicken RF, Fein G, Calabrese G, Hubesch B, Van Dyke C, Dillon WP, Davenport L, Meyerhoff DJ, Weiner MW (1992) Alterations in brain phosphorus metabolite concentrations associated with areas of high signal intensity in white matter at MR imaging. Radiology 183:247–256

    Google Scholar 

  34. Maudsley AA, Hilal SK, Perman WH, Simon HE (1983) Spatially resolved high resolution spectroscopy by “four dimensional” NMR. J Magn Reson 51: 147–152

    Google Scholar 

  35. Brown TR, Kincaid BM, Ugurbil K (1982) NMR chemical shift imaging in three dimensions. Proc Nat Acad Sci USA 79:3523–3526

    Google Scholar 

  36. Maudsley AA, Twieg DB, Sappey-Marinier D, Hubesch B, Hugg JW, Matson GB, Weiner MW (1990) Spin echo31P spectroscopic imaging in the human brain. Magn Reson Med 14:415–422

    Google Scholar 

  37. Hugg JW, Matson GB, Twieg DB, Maudsley AA, Sappey-Marinier D, Weiner MW (1992) Phosphorus-31 MR spectroscopic imaging (MRSI) of normal and pathological human brains. Magn Reson Imag 10:227–243

    Google Scholar 

  38. Duijn JH, Matson GB, Maudsley AA, Weiner MW (1992) 3D phase encoding1H spectroscopic imaging of human brain. Magn Reson Imag 10:315–319

    Google Scholar 

  39. Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. J Psychiatric Res 12:189–198

    Google Scholar 

  40. The Neurobehavioral Cognitive Status Examination (NCSE). Northern California Neurobehavioral Group Fairfax, Calif

  41. Kiernan RJ, Mueller J, Langston JW, Van Dyke C (1987) The Neurobehavorial Cognitive Status Examination: a brief but differential approach to cognitive assessment. Ann Inter Med 107: 481–488

    Google Scholar 

  42. Maudsley AA, Lin E, Weiner MW (1991) Spectroscopic imaging display and analysis. Magn Reson Imag 10: 471–485

    Google Scholar 

  43. Miller BL (1991) A review of chemical issues in1H NMR spectroscopy:N-acetyl-L-aspartate, creatine and choline. NMR Biomed 4:47–52

    Google Scholar 

  44. Nitsch RM, Pittas AG, Blusztajn JK, Slack BE, Growdon JH, Wurtman RJ (1991) Alterations of phospholipid metabolites in postmortem brain from patients with Alzheimer's disease. Ann NY Acad Sci 640:110–113

    Google Scholar 

  45. Nitsch RM, Blusztajn JK, Pittas AG, Slack BE, Growdon JH, Wurtman RJ (1992) Evidence for membrane defect in Alzheimer's disease brain. Proc Natl Acad Sci 89:1671–1675

    Google Scholar 

  46. Barany M, Chang YC, Arus C, Rustan T, Frey WH (1985) Increased glycerol-3-phosphorylcholine in post-mortem Alzheimer's brain. Lancet I:517

    Google Scholar 

  47. Ordidge RJ, Connelly A, Lohman JAB (1986) Image-selected in vivo spectroscopy (ISIS). A new technique for spatially selective NMR spectroscopy. J Magn Reson 66:283–294

    Google Scholar 

  48. Hugg JW, Duijn JH, Matson GB, Maudsley AA, Tsuruda JS, Gelinas DF, Weiner MW (1992) Elevated lactate and alkalosis in chronic human brain infarction observed by1H and31P MR spectroscopic imaging. J Cereb Blood Flow Metab 12:734–744

    Google Scholar 

  49. Leys D, Pruvo JP, Parent M, Vermersch P, Soetaert G, Steinling M, Delacourte A, Defossez A, Rapoport A, Clarisse J (1991) Could Wallerian degeneration contribute to “leukoaraiosis” in subjects free of any vascular disorder? J Neurol Neurosurg Psychiatry 54:46–50

    Google Scholar 

  50. Husted CA, Goodin DS, Hugg JW et al. (1994) Biochemical alterations in multiple sclerosis lesions and normal-appearing white matter detected by in vivo31P and1H spectroscopic imaging. Ann Neurol 36 (2):157–165

    Google Scholar 

  51. Duijn JH, Matson GB, Maudsley AA, Hugg JW, Weiner MW (1992) Human brain infarction: proton MR spectroscopy. Radiology 183:711–718

    Google Scholar 

  52. Meyerhoff DJ, MacKay S, Bachman L, Poole N, Dillon WP, Weiner MW, Fein G (1993) Reduced brainN-acetylaspartate suggests neuronal loss in cognitively impaired human immunodeficiency virus-seropositive individuals: in vivo1H magnetic resonance spectroscopic imaging. Neurology 43:509–515

    Google Scholar 

  53. Reference deleted

  54. Yamauchi H, Fukuyama H, Harada K, Yamaguchi S, Miyoshi T, Doi T, Kimura J, Iwasaki Y, Asato R, Yonekura Y (1990) White matter hyperintensities may correspond to areas of increased blood volume: correlative MR and PET observations. J Comput Assist Tomogr 14:905–908

    Google Scholar 

  55. Lawry TJ, Karczmar GS, Weiner MW, Matson GB (1989) Computer simulation of MRS localization techniques: an analysis of ISIS. Magn Reson Med 9: 299–314

    Google Scholar 

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Constans, J.M., Meyerhoff, D.J., Norman, D. et al. 1H and31P magnetic resonance spectroscopic imaging of white matter signal hyperintensity areas in elderly subjects. Neuroradiology 37, 615–623 (1995). https://doi.org/10.1007/BF00593373

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