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Proton MR Spectroscopy of the Cerebellum and Pons in Patients with Degenerative Ataxia¹

¹ From the Section of Diagnostic Radiology, Department of Clinical Physiopathology (M. Mascalchi, C.T., N.V.) and Section of Neurophysiopathology (F.L.), University of Florence, Viale Morgagni 85, 50134 Florence, Italy; Department of Radiology, University of Pisa, Italy (M.C.); Department of Clinical Neurology, Ospedale Bellaria, University of Bologna, Italy (F.S., R.P., C.A.T.); Department of Neurophysiopathology, Ospedale di Empoli, Italy (M. Macucci); IRCSS Stella Maris, Calambrone, Pisa, Italy (M.T.); and Institute of Genetic Medicine, University of Ferrara, Italy (A.F.). Received April 4, 2001; revision requested May 14; revision received July 23; accepted November 20. Supported by grant No. E444 from Telethon-Italy. Address correspondence to M. Mascalchi.

PURPOSE: To investigate whether proton magnetic resonance (MR) spectroscopy is a useful complement to MR imaging in patients with degenerative ataxia.

MATERIALS AND METHODS: Brain MR imaging and single-voxel proton MR spectroscopy of the right cerebellar hemisphere and pons were performed in 30 patients with sporadic (n = 16) or inherited (n = 14) degenerative ataxia and in 20 healthy control subjects. Several indexes of brainstem and cerebellar atrophy were measured on MR images, as well as the N-acetylaspartate/creatine (NAA/Cr), choline/Cr (Cho/Cr), and myo-inositol/Cr (mI/Cr) ratios in the MR spectra. Differences between patients and subjects were evaluated with the Kruskal-Wallis and Mann-Whitney tests, whereas correlation of clinical, MR imaging, and spectroscopic data was assessed with nonparametric Spearman rank correlation.

RESULTS: Measurements of brainstem and cerebellar atrophy obtained from MR images revealed patients had olivopontocerebellar atrophy (OPCA) (n = 11), spinal atrophy (SA) (n = 8), or corticocerebellar atrophy (CCA) (n = 4). Seven patients did not fulfill the criteria for any group and were considered undefined. In patients with OPCA, the pontine and cerebellar NAA/Cr and Cho/Cr ratios were significantly decreased when compared with those of the control subjects. Pontine and cerebellar NAA/Cr ratios were also significantly reduced in patients with SA and CCA. Five patients with undefined ataxia had a substantial decrease of pontine or cerebellar NAA/Cr ratio when compared with that of the control subjects. In patients with OPCA, the pontine NAA/Cr ratio (but not the atrophy measurements) showed a correlation (P = .04) with disability.

CONCLUSION: MR spectroscopy is a useful complement to MR imaging in patients with degenerative ataxia.

© RSNA, 2002

Index terms: Brain, atrophy, 151.1839, 153.1839 • Brainstem, abnormalities, 158.1839 • Brainstem, MR, 158.12145 • Magnetic resonance (MR), spectroscopy, 158.12145 • Spinal cord, diseases, 341.189

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