Elsevier

The Lancet

Volume 337, Issue 8732, 5 January 1991, Pages 58-59
The Lancet

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Proton magnetic resonance spectroscopy of an acute and chronic lesion in multiple sclerosis

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    MS is a heterogeneous and complex autoimmune disease that is characterized by inflammation, demyelination, and axon degeneration in the CNS. MRS changes that occur during the development of an acute MS plaque include elevation of Cho and a decline in NAA (Arnold et al., 1990, 1992, 1994; Miller et al., 1991; Davie et al., 1994; Husted et al., 1994; Ferguson et al., 1997; Trapp et al., 1998; Narayana, 2005; Gonzalez-Toledo et al., 2006; Tartaglia and Arnold, 2006; De Stefano and Filippi, 2007). These changes reflect the inflammatory process and the resulting neuronal injury.

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    Because of its prominence in the 1H-MR spectrum and its localization within neurons, decreases in NAA are often used as indicators of MS disease and disease progression.101,108,116 The presence of low NAA, measured both as an absolute concentration and as a ratio of NAA/Cr, has been confirmed within lesional white matter, NAWM, and normal-appearing cortical gray matter of adult patients with MS relative to healthy controls.105,109,117–124 Decreases in NAA resonance intensity of up to 50% can be observed in the NAWM of adult patients125 and of up to 80% in white matter regions of T2 hyperintensity.126

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    MRS measures concentrations of neurometabolites, including choline-containing compounds (Cho), markers of cell membrane stability and myelination; N-acetyl aspartate (NAA), a neuronal or axonal marker; and creatine (Cre), a marker of metabolic activity [11-14]. Decreased concentrations of Cho and/or NAA have been correlated with organic brain damage in many different disease states and disorders, and with varying levels of cognitive/behavioral dysfunction among both humans and animals [15-20]. Only three FASD MRS studies have been conducted to date, with varied outcomes [16,21,22].

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