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Pediatric Radiology

Published in:

01-01-2010 | Original Article

¹H-MRS for the diagnosis of acute disseminated encephalomyelitis: insight into the acute-disease stage

Authors: Liat Ben Sira, Elka Miller, Moran Artzi, Aviva Fattal-Valevski, Shlomi Constantini, Dafna Ben Bashat

Published in: Pediatric Radiology | Issue 1/2010

Abstract

Background

Acute disseminated encephalomyelitis (ADEM) is a demyelinating disorder of the central nervous system (CNS). Differentiating ADEM from other inflammatory disorders, such as multiple sclerosis, is not always conclusive using conventional MRI.

Objective

To evaluate longitudinal magnetic resonance spectroscopy (MRS) changes that distinguish ADEM from other inflammatory disorders.

Materials and methods

MRI/MRS scans were performed in seven patients with ADEM during the acute and chronic phases of the disease.

Results

Partial recovery was detected between the acute and chronic phases in choline/creatine ratio. Major elevation of lipids and reduction in myo-inositol/creatine ratio was detected in all patients during the acute phase, followed by a reduction in lipids peak and elevation above normal in myo-inositol/creatine ratio during the chronic phase.

Conclusion

Consistent and unique MRS changes in metabolite ratios between the acute and chronic presentations of the disease were found. To the best of our knowledge, these patterns have not been described in other inflammatory disorders and might assist in the early diagnosis of ADEM.

Garg RK (2003) Acute disseminated encephalomyelitis. Postgrad Med J 79:11–17CrossRefPubMed

Krupp LB, Banwell B, Tenembaum S (2007) Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 68:S7–12CrossRefPubMed

Leake JA, Albani S, Kao AS et al (2004) Acute disseminated encephalomyelitis in childhood: epidemiologic, clinical and laboratory features. Pediatr Infect Dis J 23:756–764CrossRefPubMed

Murthy JM (2002) Acute disseminated encephalomyelitis. Neurol India 50:238–243PubMed

Schwarz S, Mohr A, Knauth M et al (2001) Acute disseminated encephalomyelitis: a follow-up study of 40 adult patients. Neurology 56:1313–1318PubMed

Tenembaum S, Chitnis T, Ness J et al (2007) Acute disseminated encephalomyelitis. Neurology 68:S23–36CrossRefPubMed

Gujar SK, Maheshwari S, Bjorkman-Burtscher I et al (2005) Magnetic resonance spectroscopy. J Neuroophthalmol 25:217–226PubMed

Kuker W, Ruff J, Gaertner S et al (2004) Modern MRI tools for the characterization of acute demyelinating lesions: value of chemical shift and diffusion-weighted imaging. Neuroradiology 46:421–426PubMed

Banwell B, Ghezzi A, Bar-Or A et al (2007) Multiple sclerosis in children: clinical diagnosis, therapeutic strategies, and future directions. Lancet Neurol 6:887–902CrossRefPubMed

10.

Mader I, Wolff M, Nagele T et al (2005) MRI and proton MR spectroscopy in acute disseminated encephalomyelitis. Childs Nerv Syst 21:566–572CrossRefPubMed

11.

Bizzi A, Ulug AM, Crawford TO et al (2001) Quantitative proton MR spectroscopic imaging in acute disseminated encephalomyelitis. AJNR 22:1125–1130PubMed

12.

Gabis LV, Panasci DJ, Andriola MR et al (2004) Acute disseminated encephalomyelitis: an MRI/MRS longitudinal study. Pediatr Neurol 30:324–329CrossRefPubMed

13.

Srinivasan R, Sailasuta N, Hurd R et al (2005) Evidence of elevated glutamate in multiple sclerosis using magnetic resonance spectroscopy at 3 T. Brain 128:1016–1025CrossRefPubMed

14.

Poser CM, Brinar VV (2007) Disseminated encephalomyelitis and multiple sclerosis: two different diseases — a critical review. Acta Neurol Scand 116:201–206CrossRefPubMed

15.

Mascalchi M, Cosottini M, Lolli F et al (2002) Proton MR spectroscopy of the cerebellum and pons in patients with degenerative ataxia. Radiology 223:371–378CrossRefPubMed

16.

Galinska B, Szulc A, Tarasow E et al (2009) Duration of untreated psychosis and proton magnetic resonance spectroscopy (1H-MRS) findings in first-episode schizophrenia. Med Sci Monit 15:CR82–88PubMed

17.

Dale RC, Branson JA (2005) Acute disseminated encephalomyelitis or multiple sclerosis: can the initial presentation help in establishing a correct diagnosis? Arch Dis Child 90:636–639CrossRefPubMed

18.

Danielsen ER, Ross B (eds) (1999) Magnetic resonance spectroscopy diagnosis of neurological diseases. CRC, Boca Raton

19.

Fernando KT, McLean MA, Chard DT et al (2004) Elevated white matter myo-inositol in clinically isolated syndromes suggestive of multiple sclerosis. Brain 127:1361–1369CrossRefPubMed

20.

Brex PA, Parker GJ, Leary SM et al (2000) Lesion heterogeneity in multiple sclerosis: a study of the relations between appearances on T1 weighted images, T1 relaxation times, and metabolite concentrations. J Neurol Neurosurg Psychiatry 68:627–632CrossRefPubMed

21.

Degaonkar MN, Khubchandhani M, Dhawan JK et al (2002) Sequential proton MRS study of brain metabolite changes monitored during a complete pathological cycle of demyelination and remyelination in a lysophosphatidyl choline (LPC)-induced experimental demyelinating lesion model. NMR Biomed 15:293–300CrossRefPubMed

22.

Silver NC, Barker RA, MacManus DG et al (1997) Proton magnetic resonance spectroscopy in a pathologically confirmed acute demyelinating lesion. J Neurol 244:204–207CrossRefPubMed

23.

Gruber S, Frey R, Mlynarik V et al (2003) Quantification of metabolic differences in the frontal brain of depressive patients and controls obtained by 1H-MRS at 3 Tesla. Invest Radiol 38:403–408CrossRefPubMed

24.

Coupland NJ, Ogilvie CJ, Hegadoren KM et al (2005) Decreased prefrontal Myo-inositol in major depressive disorder. Biol Psychiatry 57:1526–1534CrossRefPubMed

25.

Frey R, Metzler D, Fischer P et al (1998) Myo-inositol in depressive and healthy subjects determined by frontal 1H-magnetic resonance spectroscopy at 1.5 Tesla. J Psychiatr Res 32:411–420CrossRefPubMed

26.

Hass HG, Nagele T, Seeger U et al (2005) Detection of subclinical and overt hepatic encephalopathy and treatment control after L-ornithine-L-aspartate medication by magnetic resonance spectroscopy ((1)H-MRS). Z Gastroenterol 43:373–378CrossRefPubMed

27.

Cordoba J, Gottstein J, Blei AT (1998) Chronic hyponatremia exacerbates ammonia-induced brain edema in rats after portacaval anastomosis. J Hepatol 29:589–594CrossRefPubMed

28.

Elberling TV, Danielsen ER, Rasmussen AK et al (2003) Reduced myo-inositol and total choline measured with cerebral MRS in acute thyrotoxic Graves’ disease. Neurology 60:142–145PubMed

29.

Wellard RM, Briellmann RS, Prichard JW et al (2003) Myoinositol abnormalities in temporal lobe epilepsy. Epilepsia 44:815–821CrossRefPubMed

30.

Macri MA, Garreffa G, Giove F et al (2004) In vivo quantitative 1H MRS of cerebellum and evaluation of quantitation reproducibility by simulation of different levels of noise and spectral resolution. Magn Reson Imaging 22:1385–1393CrossRefPubMed

31.

Ashwal S, Holshouser B, Tong K et al (2004) Proton spectroscopy detected myoinositol in children with traumatic brain injury. Pediatr Res 56:630–638CrossRefPubMed

32.

Shonk TK, Moats RA, Gifford P et al (1995) Probable Alzheimer disease: diagnosis with proton MR spectroscopy. Radiology 195:65–72PubMed

33.

Brand A, Leibfritz D, Richter-Landsberg C (1999) Oxidative stress-induced metabolic alterations in rat brain astrocytes studied by multinuclear nmrNMR spectroscopy. J Neurosci Res 58(4):576–585CrossRefPubMed

34.

Trip SA, Miller DH (2005) Imaging in multiple sclerosis. J Neurol Neurosurg Psychiatry 76(Suppl 3):iii11–18CrossRefPubMed

35.

Brex PA, Gomez-Anson B, Parker GJ et al (1999) Proton MR spectroscopy in clinically isolated syndromes suggestive of multiple sclerosis. J Neurol Sci 166:16–22CrossRefPubMed

36.

Kapeller P, Brex PA, Chard D et al (2002) Quantitative 1H MRS imaging 14 years after presenting with a clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 8:207–210CrossRefPubMed

37.

Wattjes MP, Harzheim M, Lutterbey GG et al (2008) High field MR imaging and (1)H-MR spectroscopy in clinically isolated syndromes suggestive of multiple sclerosis: Correlation between metabolic alterations and diagnostic MR imaging criteria. J Neurol 255:56–63CrossRefPubMed

38.

Kapeller P, Ropele S, Enzinger C et al (2005) Discrimination of white matter lesions and multiple sclerosis plaques by short echo quantitative 1H-magnetic resonance spectroscopy. J Neurol 252:1229–1234CrossRefPubMed

39.

Rudick RA (2004) Contemporary diagnosis and management of multiple sclerosis. Handbooks in Health Care, Newtown, PA

40.

Zivadinov R, Cox JL (2007) Neuroimaging in multiple sclerosis. Int Rev Neurobiol 79:449–474CrossRefPubMed

Title: 1H-MRS for the diagnosis of acute disseminated encephalomyelitis: insight into the acute-disease stage
Authors: Liat Ben Sira
Elka Miller
Moran Artzi
Aviva Fattal-Valevski
Shlomi Constantini
Dafna Ben Bashat
Publication date: 01-01-2010
Publisher: Springer-Verlag
Published in: Pediatric Radiology / Issue 1/2010
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-009-1372-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

¹H-MRS for the diagnosis of acute disseminated encephalomyelitis: insight into the acute-disease stage

Abstract

Background

Objective

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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