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Localized 1H-MR spectroscopy in moyamoya disease before and after revascularization surgery.

Lim SM, Choi HY, Suh JS, Lee JH, Lim KH, Suh DC, Lee HK, Lim TH, Ra YS - Korean J Radiol (2003 Apr-Jun)

Bottom Line: Decreased NAA/Cr ratios (1.35+/-0.14 in patients vs. 1.55+/-0.24 in controls) and Cho/Cr ratios (0.96+/-0.13 in patients vs. 1.10+/-0.11 in controls) were observed in frontal white matter.In the basal ganglia, there is no abnormal metabolic ratios.Because of its non-invasive nature, (1)H-MRS is potentially useful for the preoperative evaluation of metabolic abnormalities and their postoperative monitoring.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, College of Medicine, Ewha Womans University Hospital, Yangcheon-gu, Seoul, Korea. soomee@mm.ewha.ac.kr

ABSTRACT

Objective: To evaluate, using localized proton magnetic resonance spectroscopy ((1)H-MRS), the cerebral metabolic change apparent after revascularization surgery in patients with moyamoya disease.

Materials and methods: Sixteen children with moyamoya disease and eight age-matched normal controls underwent MR imaging, MR angiography, conventional angiography, and (99m)Tc- ECD SPECT. Frontal white matter and the basal ganglia of both hemispheres were subjected to localized (1)H-MRS, and after revascularization surgery, four patients underwent follow-up (1)H-MRS.

Results: Decreased NAA/Cr ratios (1.35+/-0.14 in patients vs. 1.55+/-0.24 in controls) and Cho/Cr ratios (0.96+/-0.13 in patients vs. 1.10+/-0.11 in controls) were observed in frontal white matter. After revascularization surgery, NAA/Cr and Cho/Cr ratios in this region increased. In the basal ganglia, there is no abnormal metabolic ratios.

Conclusion: Localized (1)H-MRS revealed abnormal metabolic change in both hemispheres of children with moyamoya disease. Because of its non-invasive nature, (1)H-MRS is potentially useful for the preoperative evaluation of metabolic abnormalities and their postoperative monitoring.

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Related in: MedlinePlus

MRI, basal and diamox stress SPECT, cerebral angiography and 1H-MR spectra obtained in patient No. 5.A. T2-weighted axial image shows a voxel location for 1H-MRS and no abnormal signal intensity in the brain.B. Basal SPECT (axial view) discloses normal uptake in both hemispheres.C. Diamox stress SPECT (axial view) reveals decreased uptake in both hemispheres.D. Arterial-phase angiogram of the left common carotid artery (frontal view) shows marked stenosis of the distal internal carotid and anterior and middle cerebral arteries, with tortuous and dilated medial and lateral lenticulostriate vessels (Suzuki stage II).E. Arterial-phase angiogram of the right common carotid artery (frontal view) demonstrates findings similar to those of the left side (Suzuki stage II).F. Representative 1H-MR spectra of frontal white matter (both sides) show lower NAA/Cr [Lt(b): 1.21, Rt(c): 1.34], Cho/Cr [Lt(b): 0.71, Rt (c): 0.77] ratios than in an age-matched control (a).
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Figure 1: MRI, basal and diamox stress SPECT, cerebral angiography and 1H-MR spectra obtained in patient No. 5.A. T2-weighted axial image shows a voxel location for 1H-MRS and no abnormal signal intensity in the brain.B. Basal SPECT (axial view) discloses normal uptake in both hemispheres.C. Diamox stress SPECT (axial view) reveals decreased uptake in both hemispheres.D. Arterial-phase angiogram of the left common carotid artery (frontal view) shows marked stenosis of the distal internal carotid and anterior and middle cerebral arteries, with tortuous and dilated medial and lateral lenticulostriate vessels (Suzuki stage II).E. Arterial-phase angiogram of the right common carotid artery (frontal view) demonstrates findings similar to those of the left side (Suzuki stage II).F. Representative 1H-MR spectra of frontal white matter (both sides) show lower NAA/Cr [Lt(b): 1.21, Rt(c): 1.34], Cho/Cr [Lt(b): 0.71, Rt (c): 0.77] ratios than in an age-matched control (a).

Mentions: Using a 1.5T system (Signa; GE Medical Systems, Milwaukee, U.S.A.) equipped with shielded gradients, localized in-vivo 1H-MRS was performed 1-2 weeks after T2-weighted MRI was used to localize and evaluate any changes in brain parenchymal signal intensity, compared to previous MRI findings. Image-guided STEAM spectra were obtained from frontal white matter at the border zone between anterior and middle cerebral artery territory and the basal ganglia in both hemispheres, avoiding areas of old infarcts or abnormal signal intensities (Figs. 1A, 2A). The spectroscopic acquisition parameters were as follows: TR=3.0 sec/ TE=30 msec, and NS=36 AVG with PROton Brain Exam (PROBE) (GE Medical Systems). Voxel volumes were 7-9 ml, and a 3-pulse CHESS (CHEmical Shift Selective) sequence was used for suppression of the H2O signal.


Localized 1H-MR spectroscopy in moyamoya disease before and after revascularization surgery.

Lim SM, Choi HY, Suh JS, Lee JH, Lim KH, Suh DC, Lee HK, Lim TH, Ra YS - Korean J Radiol (2003 Apr-Jun)

MRI, basal and diamox stress SPECT, cerebral angiography and 1H-MR spectra obtained in patient No. 5.A. T2-weighted axial image shows a voxel location for 1H-MRS and no abnormal signal intensity in the brain.B. Basal SPECT (axial view) discloses normal uptake in both hemispheres.C. Diamox stress SPECT (axial view) reveals decreased uptake in both hemispheres.D. Arterial-phase angiogram of the left common carotid artery (frontal view) shows marked stenosis of the distal internal carotid and anterior and middle cerebral arteries, with tortuous and dilated medial and lateral lenticulostriate vessels (Suzuki stage II).E. Arterial-phase angiogram of the right common carotid artery (frontal view) demonstrates findings similar to those of the left side (Suzuki stage II).F. Representative 1H-MR spectra of frontal white matter (both sides) show lower NAA/Cr [Lt(b): 1.21, Rt(c): 1.34], Cho/Cr [Lt(b): 0.71, Rt (c): 0.77] ratios than in an age-matched control (a).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698073&req=5

Figure 1: MRI, basal and diamox stress SPECT, cerebral angiography and 1H-MR spectra obtained in patient No. 5.A. T2-weighted axial image shows a voxel location for 1H-MRS and no abnormal signal intensity in the brain.B. Basal SPECT (axial view) discloses normal uptake in both hemispheres.C. Diamox stress SPECT (axial view) reveals decreased uptake in both hemispheres.D. Arterial-phase angiogram of the left common carotid artery (frontal view) shows marked stenosis of the distal internal carotid and anterior and middle cerebral arteries, with tortuous and dilated medial and lateral lenticulostriate vessels (Suzuki stage II).E. Arterial-phase angiogram of the right common carotid artery (frontal view) demonstrates findings similar to those of the left side (Suzuki stage II).F. Representative 1H-MR spectra of frontal white matter (both sides) show lower NAA/Cr [Lt(b): 1.21, Rt(c): 1.34], Cho/Cr [Lt(b): 0.71, Rt (c): 0.77] ratios than in an age-matched control (a).
Mentions: Using a 1.5T system (Signa; GE Medical Systems, Milwaukee, U.S.A.) equipped with shielded gradients, localized in-vivo 1H-MRS was performed 1-2 weeks after T2-weighted MRI was used to localize and evaluate any changes in brain parenchymal signal intensity, compared to previous MRI findings. Image-guided STEAM spectra were obtained from frontal white matter at the border zone between anterior and middle cerebral artery territory and the basal ganglia in both hemispheres, avoiding areas of old infarcts or abnormal signal intensities (Figs. 1A, 2A). The spectroscopic acquisition parameters were as follows: TR=3.0 sec/ TE=30 msec, and NS=36 AVG with PROton Brain Exam (PROBE) (GE Medical Systems). Voxel volumes were 7-9 ml, and a 3-pulse CHESS (CHEmical Shift Selective) sequence was used for suppression of the H2O signal.

Bottom Line: Decreased NAA/Cr ratios (1.35+/-0.14 in patients vs. 1.55+/-0.24 in controls) and Cho/Cr ratios (0.96+/-0.13 in patients vs. 1.10+/-0.11 in controls) were observed in frontal white matter.In the basal ganglia, there is no abnormal metabolic ratios.Because of its non-invasive nature, (1)H-MRS is potentially useful for the preoperative evaluation of metabolic abnormalities and their postoperative monitoring.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, College of Medicine, Ewha Womans University Hospital, Yangcheon-gu, Seoul, Korea. soomee@mm.ewha.ac.kr

ABSTRACT

Objective: To evaluate, using localized proton magnetic resonance spectroscopy ((1)H-MRS), the cerebral metabolic change apparent after revascularization surgery in patients with moyamoya disease.

Materials and methods: Sixteen children with moyamoya disease and eight age-matched normal controls underwent MR imaging, MR angiography, conventional angiography, and (99m)Tc- ECD SPECT. Frontal white matter and the basal ganglia of both hemispheres were subjected to localized (1)H-MRS, and after revascularization surgery, four patients underwent follow-up (1)H-MRS.

Results: Decreased NAA/Cr ratios (1.35+/-0.14 in patients vs. 1.55+/-0.24 in controls) and Cho/Cr ratios (0.96+/-0.13 in patients vs. 1.10+/-0.11 in controls) were observed in frontal white matter. After revascularization surgery, NAA/Cr and Cho/Cr ratios in this region increased. In the basal ganglia, there is no abnormal metabolic ratios.

Conclusion: Localized (1)H-MRS revealed abnormal metabolic change in both hemispheres of children with moyamoya disease. Because of its non-invasive nature, (1)H-MRS is potentially useful for the preoperative evaluation of metabolic abnormalities and their postoperative monitoring.

Show MeSH
Related in: MedlinePlus