Clinical use of H1 MR spectroscopy in assessment of relapsing remitting and secondary progressive multiple sclerosis

BackgroundConventional MRI has a limited ability to provide specific information about axonal pathology in MS, recently, MRI spectroscopy used for assessment of the axonal loss even in normal appearing white matter.ObjectiveTo assess the axonal degeneration in plaques and normal appearing white matter in patients with relapsing remitting MS and secondary progressive MS, and correlate their clinical disability using expanded disability status scale (EDSS) score with H1 MRS abnormalities.Patients and methodsThirty-two MS patients (20 RRMS, 12 SPMS) and 20 controls were subjected to thorough history taking, clinical examination with special attention to: age at first symptoms, disease duration and the EDSS score. MRS was performed in order to map N-acetylaspartate (NAA), choline (Cho) and creatine (Cr).ResultsIn SPMS, the NAA/Cr ratio and absolute concentrations for NAA in MS plaques and NAWM were significantly reduced compared to RRMS and to controls, also, significant relation with this metabolite values and clinical disability using EDSS score.ConclusionIn SPMS patients group there were significant reduction in the levels of NAA in both plaques and NAWM compared to RRMS and control groups, moreover significant correlation of NAA reduction in the plaques of both groups related to clinical disability and disease progression.