Low Choline Concentrations in Normal-Appearing White Matter of Patients with Multiple Sclerosis and Normal MR Imaging Brain Scans

Low Choline Concentrations in Normal-Appearing White Matter of Patients with Multiple Sclerosis ORIGINAL RESEARCH and Normal MR Imaging Brain Scans M.C. Gustafsson BACKGROUND AND PURPOSE: Spectroscopic studies ( H-MR spectroscopy) of normal-appearing white matter (NAWM) in patients with multiple sclerosis (MS) with MR imaging brain lesions have already O. Dahlqvist been performed, but our intention was to investigate NAWM in MS patients who lack brain lesions to J. Jaworski elucidate whether the same pathologic changes could be identified. P. Lundberg MATERIALS AND METHODS: We checked 350 medical files of patients with MS who are registered in A.-M.E. Landtblom our institution. Fourteen patients (11 women and 3 men; mean age, 48.6 years; handicap score, Expanded Disability Status Scale [EDSS] 2.9; range, 1–6.5) with clinically definite MS and a normal MR imaging of the brain were included. H-MR spectroscopy was performed in 4 voxels (size approxi- mately 17
17
17 mm ) using absolute quantification of metabolite concentrations. Fourteen healthy control subjects (11 women and 3 men; mean age, 43.3 years) were analyzed in the same way. RESULTS: Significant differences in absolute metabolite concentrations were observed, with the patients with MS showing a lower total concentration of N-acetyl compounds (tNA), including N- acetylaspartate and N-acetyl aspartylglutamate (13.5 mmol/L versus 14.6 mmol/L; P  .002) compared with the healthy control subjects. Unexpectedly, patients with MS presented significantly lower choline-containing compounds (Cho) compared with healthy control subjects (2.2 mmol/L versus 2.4 mmol/L; P  .001). The EDSS showed a positive correlation to...