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Prognostic value of high-field proton magnetic resonance spectroscopy in patients presenting with clinically isolated syndromes suggestive of multiple sclerosis

  • Diagnostic Neuroradiology
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Abstract

Introduction

The aim of this study was to determine the prognostic value of metabolic alterations in the normal-appearing white matter (NAWM) of patients presenting with clinically isolated syndromes (CIS) suggestive of multiple sclerosis (MS) with special regard to the prediction of conversion to definite MS.

Methods

Using a 3T whole-body MR system, a multisequence conventional MRI protocol and single-voxel proton MR spectroscopy (PRESS, repetition time 2000 ms, echo times 38 ms and 140 ms) of the parietal NAWM were performed in 25 patients presenting with CIS at baseline and in 20 controls. Absolute concentrations of N-acetyl-aspartate (tNAA), myo-inositol (Ins), choline (Cho) and creatine (tCr) as well as metabolite ratios were determined. Follow-up including neurological assessment and conventional MRI was performed 3–4 and 6–7 months after the initial event.

Results

Nine patients converted to definite MS during the follow-up period. Compared to controls, those patients who converted to MS also showed significantly lower tNAA concentrations in the NAWM (−13.4%, P = 0.002) whereas nonconverters (−6.5%, P = 0.052) did not. The Ins concentration was 20.2% higher in the converter group and 1.9% higher in the nonconverter group, but these differences did not reach significance. No significant differences could be observed for tCr and Cho in either patient group.

Conclusion

Axonal damage at baseline in patients presenting with CIS was more prominent in those who subsequently converted to definite MS in the short term follow-up, indicating that tNAA might be a sufficient prognostic marker for patients with a higher risk of conversion to early definite MS.

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Acknowledgements

The authors would like to thank all patients and control subjects who took part in this study. MPW was supported by the European Exchange Program provided by the European Society of Neuroradiology (ESNR).

Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology/Neuroradiology, University of Bonn, Bonn, Germany

    Mike P. Wattjes, Götz G. Lutterbey, Hans H. Schild & Frank Träber

  2. MS Center Amsterdam, Department of Radiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    Mike P. Wattjes

  3. Department of Neurology, University of Bonn, Bonn, Germany

    Michael Harzheim & Stephan Schmidt

  4. Department of Medical Biometrics, Informatics and Epidemiology, University of Bonn, Bonn, Germany

    Manuela Bogdanow

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  1. Mike P. Wattjes
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  2. Michael Harzheim
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Correspondence to Mike P. Wattjes.

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Wattjes, M.P., Harzheim, M., Lutterbey, G.G. et al. Prognostic value of high-field proton magnetic resonance spectroscopy in patients presenting with clinically isolated syndromes suggestive of multiple sclerosis. Neuroradiology 50, 123–129 (2008). https://doi.org/10.1007/s00234-007-0325-y

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  • DOI: https://doi.org/10.1007/s00234-007-0325-y

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