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Neuroradiology

, Volume 43, Issue 7, pp 525–531 | Cite as

In vivo proton MR spectroscopy of chorea-ballismus in diabetes mellitus

  • P. H. Lai
  • P. C. Chen
  • M. H. Chang
  • H. B. Pan
  • C. F. Yang
  • M. T. Wu
  • J. Y. Li
  • C. Chen
  • H. L. Liang
  • W. L. Chen
DIAGNOSTIC NEURORADIOLOGY

Abstract

The most common cause of chorea-ballismus (CB) is a vascular lesion; it is also associated with nonketotic hyperglycaemia in diabetes mellitus (DM) and may be the first manifestation of this disorder. We describe the CT, MRI and proton MR spectroscopy (1H-MRS) of CB in eight patients. Six had hemichorea-hemiballismus (HC-HB) and two bilateral CB. Single-voxel (SV) 1H-MRS was performed using point-resolved spectroscopy (PRESS). Voxels were positioned in the basal ganglia of the patients and control subjects. PRESS was also used to obtain spectroscopic imaging (1H-MRSI) of the slice of interest in two patients. CT showed a slightly dense striatum in all the patients with CB, and T1-weighted images revealed high signal. The CB correlated well with the neuroimaging findings. SV 1H-MRS showed the mean ( ± SD) N-acetylaspartate (NAA)/ creatine (Cr) ratio to be 1.45 ± 0.19 in HC-HB and 1.82 ± 0.06 on the opposite normal side (P = 0.01). The choline (Cho)/Cr ratio was 1.3 ± 0.12 in HC-HB and 1.11 ± 0.13 on the opposite normal side (P = 0.005). A lactate peak was seen in seven patients. The NAA/Cr ratio was 1.44 ± 0.15 in bilateral CB and 1.74 ± 0.16 in the controls (P = 0.017); the Cho/Cr ratios were 1.36 ± 0.1 and 1.19 ± 0.07 (P = 0.015). The low NAA/Cr suggests neuronal loss or damage and the high Cho/Cr probably indicates gliosis. The presence of lactate may suggest mild ischaemia due to acute vascular events during hyperglycaemia and underlying chronic focal cerebrovascular diseases in DM.

Keywords Chorea Diabetes mellitus Magnetic resonance spectroscopy 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • P. H. Lai
    • 1
  • P. C. Chen
    • 2
  • M. H. Chang
    • 3
  • H. B. Pan
    • 1
  • C. F. Yang
    • 1
  • M. T. Wu
    • 1
  • J. Y. Li
    • 3
  • C. Chen
    • 1
  • H. L. Liang
    • 1
  • W. L. Chen
    • 1
  1. 1.Department of Radiology, Veterans General Hospital-Kaohsiung, National Yang-Ming College, 386 Ta-Chung First Rd, Kaohsiung, Taiwan 813 e-mail: phlai@ksts.seed.net.tw Tel.: + 8 86-7-3 42 21 21 Fax: + 8 86-7-3 46 83 01TW
  2. 2.Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan 813TW
  3. 3.Department of Neurology, Veterans General Hospital-Kaohsiung, National Yang-Ming College, 386 Ta-Chung first Rd, Kaohsiung, Taiwan 813TW

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