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Relapsing-Remitting Multiple Sclerosis: Metabolic Abnormality in Nonenhancing Lesions and Normal-appearing White Matter at MR Imaging: Initial Experience¹

¹ From the Department of Radiology, New York University School of Medicine, 650 First Ave, New York, NY 10016. Received November 25, 2003; revision requested February 6, 2004; revision received February 19; accepted May 11. Supported by National Institutes of Health grants NS37739, NS29029, and EB01015. Address correspondence to O.G. (e-mail: oded.gonen@med.nyu.edu).

View larger version (101K): [in a new window]   Figure 1. A, Transverse T2-weighted (2500/90) MR image in a 26-year-old woman with MS. B, Transverse T1-weighted (450/14) MR image. C, Coronal T1-weighted (450/14) MR image. MR spectroscopic volume of interest has been superimposed on the images. Spectra from hypo- (arrows 1 and 4) and isointense (arrows 2 and 5) lesions, as well as two normal-appearing white-matter regions (arrows 3 and 6), are shown below the images on common intensity and chemical shift (in parts per million) scales. D-F, Corresponding sections from a matched control subject. Numbered arrows indicate equivalent regions to A-C for metabolite levels and spectra comparisons.

View larger version (27K): [in a new window]   Figure 2. Box plots display the 25%-75% values (boxes) ± 95% values (whiskers), median values (horizontal lines within boxes), and outliers (*) of NAA, Cr, and Cho absolute level distribution within normal white matter in control subjects (NWM) and normal-appearing white matter (NAWM), isointense lesions (ISO), and hypointense lesions (HYPO) in patients with relapsing-remitting MS. Note lower-median NAA in hypointense lesions and higher Cr and Cho levels in normal-appearing white matter and isointense lesions.

View larger version (37K): [in a new window]   Figure 3. NAA level versus average signal intensity of tissue, expressed as percentage of average intensity (AI) of normal-appearing white matter (NAWM). The least squares regression line indicates a significant linear relationship: NAA level (expressed in millimoles per liter) = (0.034 + 0.093) · AI; that is, average 0.09 mmol/L increment of NAA level per 1% increment of average intensity. NWM = normal white matter in control subjects.