Objective: To evaluate the prognostic value of the cortical N-acetyl aspartate to creatine ratio (NAA/Cr) in early relapsing-remitting multiple sclerosis (RRMS). Methods: Sixteen patients with newly diagnosed RRMS were studied by serial MRI and MR spectroscopic imaging (MRSI) once every 6 months for 24 months. Clinical examinations, including the expanded disability status scale (EDSS), were performed at baseline, month 24, and at year 7. Results: Baseline cortical NAA/Cr correlated inversely with EDSS at month 24 (r = -0.61, P <0.05), and patients with EDSS >= 4 had a lower baseline cortical NAA/Cr compared to those with EDSS less than 4 (P <0.05). Baseline cortical NAA/Cr also correlated inversely with EDSS at the 7-year follow-up (r = -0.56, P <0.05), and patients with EDSS >= 4 had a lower baseline cortical NAA/Cr compared to those with EDSS less than 4 (P <0.05). Baseline brain parenchymal fraction (BPF) correlated inversely with EDSS at month 24 (r = -0.61, P <0.05), but not with EDSS at year 7. Discussion: Cortical NAA/Cr in early RRMS correlated with clinical disability after 2 and 7 years and may be used as a predictor of long-term disease outcome.
Neurological Research, 2014, Vol 36, Issue 8, p. 701-708
Adult; Aspartic Acid; Cerebral Cortex; Creatine; Disability Evaluation; Disease Progression; Female; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Multiple Sclerosis; Prognosis; Young Adult; Primates Mammalia Vertebrata Chordata Animalia (Animals, Chordates, Humans, Mammals, Primates, Vertebrates) - Hominidae  human common adult female, male; creatine 57-00-1; N-acetyl aspartate 997-55-7; 06504, Radiation biology - Radiation and isotope techniques; 10064, Biochemistry studies - Proteins, peptides and amino acids; 20504, Nervous system - Physiology and biochemistry; 20506, Nervous system - Pathology; 34508, Immunology - Immunopathology, tissue immunology; Clinical Immunology; Neurology; Radiology; relapsing-remitting multiple sclerosis Multiple Sclerosis, Relapsing-Remitting (MeSH) nervous system disease, immune system disease; clinical disability; Human Medicine, Medical Sciences; Medical Sciences; brain nervous system; clinical examination clinical techniques, diagnostic techniques; magnetic resonance imaging imaging and microscopy techniques, diagnostic techniques, clinical techniques; magnetic resonance spectroscopy laboratory techniques, spectrum analysis techniques; CLINICAL; NEUROSCIENCES; APPEARING WHITE-MATTER; MAGNETIC-RESONANCE-SPECTROSCOPY; AXONAL DAMAGE; GRAY-MATTER; METABOLITE CHANGES; GREY-MATTER; BRAIN; LESIONS; IMPAIRMENT; RELEVANCE; MRSI; MRI; Cortical NAA; Cortical choline; Multiple sclerosis; Journal Article; Research Support, Non-U.S. Gov't