Metabolite alterations in autistic children: a 1H MR spectroscopy study.

PURPOSE: The purpose of this study was to assess the role of proton magnetic resonance spectroscopy (1H MRS) in the detection of changes in cerebral metabolite levels in autistic children. MATERIAL AND METHODS: Study group consisted of 12 children, aged 8-15 years, who were under the care of Pediatric Neurology Department and Pediatric Rehabilitation Department of Medical University of Bialystok. The diagnosis of autism was established by neurologist, psychiatrist and psychologist in every case. All patients matched the clinical criteria of the disease according to International Statistical Classification of Diseases and Related Health Problems (ICD-10). The control group included 16 healthy children aged 7-17. 1H MRS was performed with a single-voxel method (TE-36, TR-1500, NEX-192). The volume of interest (VOI) was located in the frontal lobe regions, separately on each side. RESULTS: We showed lower N-acetylaspartate/creatine (NAA/Cr), γ-aminobutyric acid /creatine (GABA/Cr) and glutamate/creatine (Glx/Cr) in the frontal lobes in the study group comparing with healthy controls. The ratio of myoinositol/creatine (mI/Cr) was increased in autistic children. No differences in choline/creatine (Cho/Cr) ratio in study group and controls were found. There was a correlation between age and NAA/Cr in autistic children (R=0.593 p=0.041). No significant differences in metabolite ratios between right and left hemisphere in ASD and controls were found. CONCLUSIONS: (1)H MRS can provide important information regarding abnormal brain metabolism. Differences in NAA/Cr, GABA/Cr, Glx/Cr and mI/Cr may contribute to the pathogenesis of autism.

Schizencephaly as a cause of spastic cerebral palsy.

PURPOSE: The objective was to investigate the clinical features of schizencephaly in children with spastic cerebral palsy. MATERIAL AND METHODS: The present study included 180 children with cerebral palsy, spastic tetraplegia, diplegia, and hemiplegia. All magnetic resonance (MR) scans were obtained using a 1.5 T MR scanner with the use of a standard circularly polarized head coil. RESULTS: Significant abnormalities relevant to cerebral palsy were evident on MRI in 95%. Periventicular leukomalacia was detected more frequently in children with spastic diplegia than in other patients. Cerebral atrophy was found more often in tetraplegic patients. Porencephalic cysts were detected more often in children with spastic hemiplegia. Congenital brain anomalies were evident in 20 (11.1%) children with spastic cerebral palsy. Twelve patients had schizencephaly with cerebral palsy. Children with spastic diplegia and tetraplegia had bilateral schizencephaly; patients with spastic hemiplegia only had unilateral schizencephaly. Most patients with schizencephaly had epilepsy. CONCLUSIONS: Schizencephaly occurred more often in patients with spastic hemiplegia. Early detection of brain abnormalities in children with cerebral palsy may help in the prognosis and in the introduction of appropriate therapy.

Metabolite Profile in Pyramidal Tracts after Ischemic Brain Stroke Assessed by 1H MRS. A Multicenter Study.

The magnitude of the motor deficit in patients with stroke depends not only on the size and location of the destroyed brain tissue, but also on axonal injury in the descending motor pathways which appears after stroke. After cerebral ischemia, there are no visible abnormalities in conventional MRI in the intact pyramidal tracts despite the process of neuronal destruction by Wallerian degeneration. Conventional MRI is not a sensitive test for Wallerian degeneration in the acute or subacute time period as it shows no changes within the first four weeks. Magnetic resonance spectroscopy (MRS) has been used for better quantification of the extent or severity of fibre damage by evaluating metabolite alterations in normal-appearing corticospinal and corticopontal tracts. This study assessed the role of 1H MRS in the detection of changes in cerebral metabolite levels in pyramidal tracts after cortical/ subcortical infarction and to compare metabolite alterations to clinical outcome (assessed by Barthel index, Scandinavian Stroke Scale). The study included 31 patients who had suffered an ischemic cortical/subcortical stroke involving the motor cortex or the descending fibers. Ratios of NAA/Cr, Cho/Cr, lip/Cr and Lac/Cr from internal capsules and cerebral peduncles were measured and compared with clinical status assessed by Barthel index and Scandinavian Stroke Scale (SSS). The ratio of NAA/Cr was significantly decreased (p<0.001) in the normal-appearing ipsilateral internal capsule in comparison with the control group. Cho/Cr and lac/Cr ratios were increased compared to the control group (p=0.019). Decrease of NAA/Cr ratio correlated with clinical status assessed by Barthel index and there was a correlation between clinical improvement (assessed by SSS) and lac/Cr ratio. Tissue metabolite concentrations distant from the infarcted region correlated with the clinical course and had predictive value. Proton MRS is very useful tool for evaluating major changes in metabolite levels in pyramidal tracts after brain stroke.

Proton magnetic resonance spectroscopy in patients with normal pressure hydrocephalus.

The objective of this prospective study was the application of proton magnetic resonance spectroscopy (1HMRS) in patients with normal pressure hydrocephalus (NPH) to determine the metabolite profile in the white matter next to left lateral ventricle and to assess the relationship of this profile with Evan's index. The study included 26 patients with NPH. Diagnosis of NPH was confirmed by clinical symptoms such as gait disturbance, dementia or urinary incontinence and CT study with ventricular enlargement. Ratios of NAA/Cr, Cho/Cr, Lac/Cr and mI/Cr from deep white matter were measured and compared with Evan's index and diameter of the IIIrd ventricle. Patients with hydrocephalus showed decreased ratios of N-acetylaspartate (NAA)/Cr (creatine), and increased ratios of Lac(lactate)/Cr in the white matter near the left frontal horn of the lateral ventricle compared with a well-matched control group. There was no correlation between NAA/Cr, Ch/Cr, Lac/Cr, mI (myo-Inositol)/Cr and Evan's index. A significant correlation was found between Lac/Cr and third ventricle diameter. A positive correlation was noted between Cho/Cr and dementia in patients with NPH. Our preliminary results of 1 H MRS support the idea that NPH is associated with white matter ischemia. Proton MRS is a very useful tool for evaluating major changes in metabolic levels in deep white matter in NPH patients.

The effect of risperidone on metabolite measures in the frontal lobe, temporal lobe, and thalamus in schizophrenic patients. A proton magnetic resonance spectroscopy (1H MRS).

OBJECTIVE: The aim of the study was the evaluation of risperidone effect on metabolite measures in the frontal lobe, temporal lobe and thalamus in schizophrenic patients on the basis of proton magnetic resonance spectroscopy ( (1)H MRS). METHODS: A group of 14 patients with the diagnosis of schizophrenia, according to DSM-IV, were examined in the study. The patients were examined twice, once after a period of at least 7 days without neuroleptics and for the second time at least 4 weeks after stable risperidone doses. RESULTS: The significant differences in the metabolite levels before and after the treatment were observed only in thalamus: an increase in myoinositol (mI) and N-acetylaspartate (NAA) levels. Positive symptoms before the treatment correlated positively with NAA level in the frontal lobes and negatively in the temporal lobes. Negative symptoms before the treatment correlated positively with Glx (a common signal for GABA, glutamine and glutamate) level in the temporal lobes. CONCLUSION: Our results seem to confirm the influence of risperidone on the brain metabolism, specifically in the region of thalamus.

Assessment of fetal distress based on magnetic resonance examinations: preliminary report.

RATIONALE AND OBJECTIVES: Hypoxia is the main cause of injuries and intrauterine death of the fetus. Therefore, the main aim of monitoring and assessment of the fetus should be diagnosis of fetal distress before irreversible changes occur. Besides the fetal condition assessment methods used so far, in recent years in obstetrics new non-invasive imaging methods were introduced such as magnetic resonance (MR). This method enables morphologic evaluation of brain and brain tissue metabolism using magnetic resonance spectroscopy (MRS). MATERIALS AND METHODS: Twenty pregnant women with pregnancy-induced hypertension (11 cases, including 3 with coexisting diabetes mellitus and 2 with intrauterine growth retardation), chronic hypertension (2 cases), gestational diabetes mellitus (6 cases), and suspected intrauterine fetal growth retardation (IUGR) participated in the study. Cardiotocography (CTG) and Doppler ultrasound examination of the blood flow in the umbilical artery and in the middle cerebral artery were performed. RESULTS: In case of abnormal CTG and Doppler study records that indicated fetal hypoxia, MR studies showed the existence of ischemic focus in 5 patients and abnormal spectral images in 6 patients. CONCLUSION: The results of the preliminary study suggests that the use of MR in prenatal diagnosis may revolutionize the early detection of fetal injury in fetal distress. It is a valuable component of the diagnostic process, supplementing other examinations. The use of MR to assess fetal condition gives additional information and helps to make decisions about therapeutic actions.

Cerebral MR spectroscopy in neurologically asymptomatic HIV-infected patients.

PURPOSE: To detect early metabolic changes in the brain of neurologically asymptomatic HIV-infected patients with normal MR imaging and to find the correlation between 1H MR results and immune status. MATERIAL AND METHODS: Twenty neurologically asymptomatic HIV seropositive patients underwent MR imaging and single-voxel 1H MR spectroscopy (MRS) using a PRESS sequence. For all patients, the signals from N-acetyl-aspartate (NAA), choline-containing compounds (Cho), creatine-phosphocreatine (Cr) and myoinositol (mI) were compared with 32 healthy volunteers as metabolite ratios and metabolite areas to non-suppressed water area ratios. RESULTS: In HIV patients, the NAA/Cho ratio was significantly lower ( p < 0.01), but there were no changes in NAA/Cr ratio. A statistically significant reduction in NAA/H2O and Cr/H2O (both p < 0.05) was observed. For the immune status there was a statistically significant correlation (r=0.47, p<0.05) between CD4 counts and NAA/H2O ratio. A significant increase in Cho/Cr ( p<0.001) and mI/Cr ( p<0.01) ratios in HIV patients was found, but Cho/H2O and mI/H2O concentrations were non-significantly increased. CONCLUSION: These results indicate that neuronal loss and gliosis in HIV-infected patients may be associated with impairment of energy metabolism. The spectral changes found suggest that 1H MRS can be used for early detection of brain damage induced by HIV.

MR proton spectroscopy in patients with CNS involvement in Bourneville's disease.

BACKGROUND: Despite much previous research, the origin of intracranial lesions in tuberous sclerosis is still unknown. We present MR and proton magnetic resonance (1H-MRS) studies of two patients with tuberous sclerosis. MATERIAL AND METHODS: The study material consisted of MR and 1H-MRS examinations from 2 patients (4-5 years old) with tuberous sclerosis. MR images (FSE, FAST, FLAIR) were obtained with a 1.5 T unit. Localized 1H-MRS studies (PRESS 35, TE 35 ms, TR 1500 ms, NEX 192) on cortical (n=3) and subependymal (n=1) lesions were also performed. RESULTS: Decreased N-acatyloaspartate/creatine (NAA/Cr) and increased myoinositol/creatine (mI/Cr) ratios were observed in the spectra obtained from the subcortical and subependymal tubers. CONCLUSIONS: Our observations confirm the hypothesis that disturbances of migration, adhesion and differentiation of germ neuronal cells may underlay the pathogenesis of tuberous sclerosis.

[Magnetic resonance proton spectroscopy in neurooncology--preliminary report]. / Spektroskopia protonowa rezonansu magnetycznego w neuroonkologii--doswiadczenia wstepne.

UNLABELLED: MR proton spectroscopy (1H MRS) has been widely applied in characterisation and differentiation of brain tumors, staging, recurrence of pathologic process, post radiotherapy changes and other lesions mimicking neoplasm like abscesses. Despite of many studies performed over last 3 years in many countries spectroscopic pattern (phenotype) of brain tumors is still not well estimated and the role of each metabolite as an indicator of histopathologic grade and type of the tumor is still unknown. MATERIALS AND METHODS: In vivo 1H MR spectroscopy was prospectively performed in 36 patients with intracranial tumors (low grade gliomas, high grade gliomas, meningiomas and abscesses). Examinations was performed with 1.5 T system, using voxels of 8 cc. RESULTS: In high grade gliomas level of NAA was decreased, and consequently low ratios of NAA to other metabolites were obtained; lactate and choline peaks were markedly increased. In patients with meningiomas signal of NAA was reduced, while in abscesses group peaks of acetate and succinate were observed. Authors analysed ratios of metabolites in above-mentioned tumors. The method is especially useful in differential diagnosis in neoplastic and nonneoplastic cases. CONCLUSIONS: Our study confirms diagnostic value of 1H MRS in doubtful cases of intracranial tumors.

[New imaging diagnostics of liver echinococcosis]. / Przydatnosc nowoczesnych technik obrazowania w diagnostyce bablowicy watroby.

Cystic and alveolar echinococcosis, parasitic diseases, caused in humans by the larval stage of tapeworm Echinococcus granulosus and E. multilocularis are rare diseases in Poland. We have diagnosed 71 patients with cystic echinococcosis and 10 patients with alveolar echinococcosis during last 12 years. Echinococcosis still create significant diagnostic difficulties, particularly alveolar one. Progress and actually available radiological imaging techniques, which can be applied in the cystic and alveolar echinococcosis diagnostics, are presented. Ultrasound appearance, CT, MRI images are described. Own experience with Proton Magnetic Resonans Spectroscopy in two patients with recurrent alveolar echinococcosis are presented.

[Prognostic value of early CT examination for evaluating duration and complications in acute pancreatitis]. / Wartosc prognostyczna wczesnego badania CT w ocenie przebiegu i rozwoju powiklan w ostrym zapaleniu trzustki.

In 47 patients with acute pancreatitis abdominal CT scans at admission (< 72 hrs) and control CT scans (2-4 week) were performed. We evaluated degree of pancreatic swelling on the ground of pancreatic size index (anterio-posterior size of head x anterio-posterior size of body), extent of peripancreatic inflammatory changes and presence of local complications. We demonstrated a high frequency of pancreatic abscess in patients with peripancreatic inflammatory changes in initiàl CT scans and in patients with high degree of pancreatic swelling (wt > 10 cm2). Early CT had a sensitivity of 80 percent and specificity of 100 percent for abscess development when these two prognostic factors were considered. It show that early CT has a significant value in establishing prognosis in patients with acute pancreatitis.