Contributions
Abstract: P1077
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
Background: Tailoring treatment for patients with multiple sclerosis (MS) is hampered by the lack of predictors of the individual course of the disease. MR-spectroscopy has given insights into the pathobiochemistry of MS but methodical challenges such as field inhomogeneity and unfavourable signal to noise ratio (SNR) have limited its use as a surrogate marker or predictor for treatment response. Here, we introduce a novel approach to reduce methodical limitations to improve the sensitivity and specificity of MR-spectroscopy for assessment of disease-related regional brain damage. The new approach increases spatial resolution in 3D-MRSI via reducing the voxel size, enabling adaptation of the detection volume of spectroscopic measurement to the anatomy of the target.
Hypothesis: We hypothesized that our method can detect significant changes of N-acetylaspartate (NAA) -a marker of neuronal integrity- in a small number of patients within a very short period of time and that these changes predict subsequent clinical progression.
Methods: We included 11 patients with early MS (age 32.9 ± 6.8 years, disease duration, 17.5 ± 15.0 months) and 10 healthy controls (age 32.6 ± 9.0 years). Spectroscopy datasets are acquired using PRESS-based 3D-MRSI. For postprocessing, 5 voxels within the VOI of the 3D spectroscopy dataset are selected. The 5 spectra are first spectroscopically aligned in order to correct for spatial inhomogeneity and added afterwards. The resulting single spectrum is fitted. The fit results now represent only the metabolic information of the selected detection volume. The SNR loss resulting from the reduced voxel size is compensated via the improved linewidth and the addition of 5 voxels. Since partial volume effects are now reduced, the diagnostic value of the metabolic information acquired improves. Concentrations of NAA in normal-appearing white matter (NAWM) were measured at baseline and after 6 months. The EDSS was obtained semi-annually over 3 years.
Results: Longitudinal assessment of NAA revealed a significant decline in the splenium of the corpus callosum (p = 0.017) and the periventricular NAWM (0.005) within 6 months. High declines of NAA within 6 months correlated with higher sustained EDSS progression in the following 2.5 years (r=0.53, p=0.04).
Conclusion: NAA in defined regions of NAWM might have predictive power on disability evolution in MS when measured with the new 3D-MRSI method established here.
Disclosure:
Dr. M. Wahl (M.W.) has received speaker honoraria and/or travel compensation from Genzyme GmbH, TEVA Pharma GmbH and Novartis GmbH
Prof. Dr. med. E. Hattingen has nothing to disclose
Prof. Dr. U. Ziemann (U.Z.) has received speaker honoraria and/or travel compensation from Biogen Idec GmbH, Bayer Vital GmbH, Bristol Myers Squibb GmbH, CorTec GmbH, Medtronic GmbH, and grants from Biogen Idec GmbH, Servier, and Janssen Pharmaceuticals NV, outside of the submitted work.
Dr. rer. nat. U. Pilatus (U.P.) has nothing to disclose
Dr. J.L. Rinnenthal (J.L.) has nothing to disclose
Abstract: P1077
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
Background: Tailoring treatment for patients with multiple sclerosis (MS) is hampered by the lack of predictors of the individual course of the disease. MR-spectroscopy has given insights into the pathobiochemistry of MS but methodical challenges such as field inhomogeneity and unfavourable signal to noise ratio (SNR) have limited its use as a surrogate marker or predictor for treatment response. Here, we introduce a novel approach to reduce methodical limitations to improve the sensitivity and specificity of MR-spectroscopy for assessment of disease-related regional brain damage. The new approach increases spatial resolution in 3D-MRSI via reducing the voxel size, enabling adaptation of the detection volume of spectroscopic measurement to the anatomy of the target.
Hypothesis: We hypothesized that our method can detect significant changes of N-acetylaspartate (NAA) -a marker of neuronal integrity- in a small number of patients within a very short period of time and that these changes predict subsequent clinical progression.
Methods: We included 11 patients with early MS (age 32.9 ± 6.8 years, disease duration, 17.5 ± 15.0 months) and 10 healthy controls (age 32.6 ± 9.0 years). Spectroscopy datasets are acquired using PRESS-based 3D-MRSI. For postprocessing, 5 voxels within the VOI of the 3D spectroscopy dataset are selected. The 5 spectra are first spectroscopically aligned in order to correct for spatial inhomogeneity and added afterwards. The resulting single spectrum is fitted. The fit results now represent only the metabolic information of the selected detection volume. The SNR loss resulting from the reduced voxel size is compensated via the improved linewidth and the addition of 5 voxels. Since partial volume effects are now reduced, the diagnostic value of the metabolic information acquired improves. Concentrations of NAA in normal-appearing white matter (NAWM) were measured at baseline and after 6 months. The EDSS was obtained semi-annually over 3 years.
Results: Longitudinal assessment of NAA revealed a significant decline in the splenium of the corpus callosum (p = 0.017) and the periventricular NAWM (0.005) within 6 months. High declines of NAA within 6 months correlated with higher sustained EDSS progression in the following 2.5 years (r=0.53, p=0.04).
Conclusion: NAA in defined regions of NAWM might have predictive power on disability evolution in MS when measured with the new 3D-MRSI method established here.
Disclosure:
Dr. M. Wahl (M.W.) has received speaker honoraria and/or travel compensation from Genzyme GmbH, TEVA Pharma GmbH and Novartis GmbH
Prof. Dr. med. E. Hattingen has nothing to disclose
Prof. Dr. U. Ziemann (U.Z.) has received speaker honoraria and/or travel compensation from Biogen Idec GmbH, Bayer Vital GmbH, Bristol Myers Squibb GmbH, CorTec GmbH, Medtronic GmbH, and grants from Biogen Idec GmbH, Servier, and Janssen Pharmaceuticals NV, outside of the submitted work.
Dr. rer. nat. U. Pilatus (U.P.) has nothing to disclose
Dr. J.L. Rinnenthal (J.L.) has nothing to disclose