Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Investigation of stroke in sickle cell disease by1H nuclear magnetic resonance spectroscopy

Summary

Localized proton nuclear magnetic resonance spectroscopy (MRS), obtained with stimulated echo and spin echo sequences, MR imaging (MRI) and MR angiography (MRA) were used to study the brain in 13 children and adolescents with sickle cell disease. Regions of interest (ROI) studied by MRS included regions appearing normal on MRI as well as regions showing complications of sickle cell disease, including focal deep white matter areas of high signal intensity (deep white matter ischemia, DWMI) seen on long TR images, focal atrophic brain areas, and infarcts. The findings in these studies are summarized as follows: Normal-appearing regions on MRI have normal MRS. In ROI including small areas of DWMI, lactate elevation was not detected, but the levels ofN-acetyl-aspartate (NAA) appeared slightly elevated. In areas of DWMI 1–2 cm in size, reduced blood flow could be seen on MRA and lactate elevation could be detected with MRS. When blood flow to a DWMI region was normal, NAA was reduced and there was little lactate elevation, as cell death had already occurred. ROI consisting of atrophic tissue had reduced NAA levels but total creatine levels were not changed. Sometimes lipids, presumably from broken cell membrane, could be detected. In regions of past massive stroke, all metabolites were absent except for small amounts of lactate or lipids.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Ohene-Frempong K (1991) Stroke in sickle cell disease: demographic, clinical, and therapeutic considerations. Semin Hematol 28:213–219

  2. 2.

    Zimmerman RA, Gill F, Goldberg HI, Bilaniuk LT, Hackney DB, Johnson M, Grossman RI, Hecht-Leavitt C (1987) MRI of sickle cell cerebral infarction. Neuroradiology 29:232–237

  3. 3.

    Pavlakis SG, Bello J, Prohovnik I, Sutton M, Ince C, Mohr JP, Piomelli S, Hilal S, De Vivo DC (1988) Brain infarction in sickle cell anemia: magnetic resonance imaging correlates, Ann Neurol 23:125–130

  4. 4.

    Bottomley PA, Drayer BP, Smith LS (1986) Chronic adult cerebral infarction studied by phosphorus NMR spectroscopy. Radiology 160:763–766

  5. 5.

    Hubesch B, Marinier DS, Hetherington HP, Twieg DB, Weiner MW (1989) Clinical MRS studies of the brain. Invest Radiol 24: 1039–1042

  6. 6.

    Fenstermacher MJ, Narayana PA (1990) Serial proton magnetic resonance spectroscopy of ischemic brain injury in humans. Invest Radiol 25:1034–1039

  7. 7.

    Bruhn H, Frahm J, Gyngell ML, Merboldt KD, Hanicke W, Sauter R (1989) Cerebral metabolism in man after acute stroke: new observations using localized proton NMR spectroscopy. Magn Reson Med 9:126–131

  8. 8.

    Berkelbachvan der Sprenkel JW, Luyten PR, Rijen PC van, Tulleken CA, Hollander JA den (1988) Cerebral lactate detected by regional proton resonance spectroscopy in a patient with cerebral infarction. Stroke 19:1556–1560

  9. 9.

    Graham GD, Howseman AM, Rothman DL, et al. (1991) Proton magnetic resonance spectroscopy of metabolites after cerebral infarction in humans. Stroke 22:143

  10. 10.

    Levine SR, Welch KM, Helpern JA, Chopp M, Bruce R, Selwa J, Smith MB (1988) Prolonged deterioration of ischemic brain energy metabolism and acidosis associated with hyperglycemia; human cerebral infarction studied by31P NMR spectroscopy. Ann Neurol 23:416–418

  11. 11.

    Ott D, Ernst T, Hennig J (1990) In vivo1H spectroscopy in cerebral ischemia. Society of Magnetic Resonance in Medicine, 9th Annual Meeting, New York, p 1011

  12. 12.

    Rijen PC van, Luyten PR, Hollander JA den, Tulleken CAF (1989) Prolonged elevation of cerebral lactate detected with1H NMR spectroscopy in patients with focal cerebral ischemia. Society of Magnetic Resonance in Medicine, 8th Annual Meeting, Amsterdam, p 374

  13. 13.

    Duyn IH, Hugg JW, Matson GB, Maudsley AA, Weiner MW (1991)1H and31P spectroscopic imaging of human brain infarction. Society of Magnetic Resonance in Medicine, 10th Annual Meeting, San Francisco, p 225

  14. 14.

    Mathews VP, Barker PB, Blackband SJ, Chatham JC, Bryan RN (1991)1H NMR spectroscopy of acute cerebral infarction. Society of Magnetic Resonance in Medicine, 10th Annual Meeting, San Francisco, p 226

  15. 15.

    Petroff OAC, Graham GD, Blamire AM, Al-Rayess M, Kim J, Fayad F, Brass LM, Rothman DL, Shulman RG, Prichard JW (1991)1H spectroscopic imaging of strokes in man: histopathology correlates of spectral changes. Society of Magnetic Resonance in Medicine, 10th Annual Meeting, San Francisco, p 227

  16. 16.

    Birken DL, Odendorf WH (1989) N-acetyl-L-aspartic acid: a literature review of a compound prominent in1H NMR spectroscopic studies of brain. Neurosci Biobehav Rev 13:23–31

  17. 17.

    Edelman RR, Mattle HP, Atkinson DJ, Hoogewoud HM (1990) MR angiography. AJR 154:937–946

  18. 18.

    Frahm J, Bruhn H, Gyngell ML, Merboldt KD, Haenicke W, Sauter R (1989) Localized high resolution proton NMR spectroscopy using stimulated echoes: initial applications to human brain in vivo. Magn Reson Med 9:79–93

  19. 19.

    Ordidge RJ, Bendall MR, Gorden RE, Connelly A (1985) Volume selection for in vivo biological spectroscopy. In: Govil G, Khetrapal CL, Saran A (eds) Magnetic resonance in biology and medicine. Tata McGraw Hill, New Delhi, p 387

  20. 20.

    Moonen CTW, Kienlin M von, Zijl PCM van, Cohen J, Gillen J, Daly P, Wolf G (1989) Comparison of single-shot localization methods (STEAM and PRESS) for in vivo proton NMR spectroscopy. NMR Biomed 2:201–208

  21. 21.

    Klose U (1990) In vivo proton spectroscopy in presence of eddy currents. Magn Reson Med 14:26–30

  22. 22.

    Frahm J, Bruhn H, Gyngell ML, Merboldt KD, Haenicke W, Sauter R (1989) Localized proton NMR spectroscopy in different regions of the human brain in vivo. Magn Reson Med 11: 47–63

  23. 23.

    Frahm J, Michaelis T, Merboldt K-D, Hanicke W, Gyngell ML, Bruhn H (1991) On the N-acetyl methyl resonance in localized 1H NMR spectra of human brain in vivo. NMR Biomed 4:201–204

  24. 24.

    Frahm J, Bruhn H, Michaelis KD, Merboldt KD, Gyngell ML, Hanicke W (1990) Regional differences of metabolites in human brain in vivo as detected by proton NMR spectroscopy using 1–8 ml volume of interest. Societa of Magnetic Resonance in Medicine, 9th Annual Meeting, New York, p 1006

  25. 25.

    Petroff OA, Spencer DD, Alger JR, Pritchard JW (1989) High field proton magnetic resonance spectroscopy of human cerebrum obtained during surgery for epilepsy. Neurology 39:1197–2202

  26. 26.

    Petroff OAC, Yu RK, Ogino T (1986) High-resolution proton magnetic resonance analysis of human cerebrospinal fluid. J Neurochem 47:1270

  27. 27.

    Commodari F, Arnold DL, Sabctury BC, Shoubrige EA (1991)1H NMR characterization of normal human cerebrospinal fluid and the detection of methylmalonic acid in a vitamin B12 deficient patient. NMR Biomed 4:192–200

  28. 28.

    Stockman JA, Nigro MA, Miskin MM, Oski FA (1972) Occlusion of large cerebral vessels in sickle cell anemia. N Engl J Med 287:846

  29. 29.

    Merkel KHH, Ginsberg PL, Parker JC, Post MJD (1978) Cerebrovascular disease in sickle cell anemia: a clinical pathological correlation. Stroke 9:45

  30. 30.

    Knaap MS van der, Grond J van der, Rijen PR van, Luyten PR, Valk J (1989) Age-dependent changes in localized proton and phosphorus spectra of the brain in healthy children from birth till sixteen years. Society of Magnetic Resonance in Medicine, 8th Annual Meeting, Amsterdam, p 376

  31. 31.

    Huppi P, Posse S, Lazeyras F, Bossi E, Herschkowitz N (1991) Age-dependent changes in 1H-MR spectroscopy in human brain. American Society for Neurochemistry 22nd. Annual Meeting, Charleston, South Carolina, p206

Download references

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wang, Z., Bogdan, A.R., Zimmerman, R.A. et al. Investigation of stroke in sickle cell disease by1H nuclear magnetic resonance spectroscopy. Neuroradiology 35, 57–65 (1992). https://doi.org/10.1007/BF00588281

Download citation

Key words

  • Stroke
  • Cerebrovascular accident
  • Sickle cell disease
  • Magnetic resonance imaging
  • Magnetic resonance angiography
  • Magnetic resonance spectroscopy