Quantitative 1H MRS imaging 14 years after presenting with a clinicallyisolated syndrome suggestive of multiple sclerosis

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Abstract

Clinically isolated syndromes (CIS) are events suggestive for emerging multiple sclerosis (MS). A majority of patients develop MS within monthsor years whilst others remain clinically isolated. The goal of this study was to investigate whether biochemical metabolites detectable by 1Hmagnetic resonance spectroscopy (MRS) may serve to distinguish between these two groups. We investigated 41 patients 14 years afterpresentation with a CIS and 21 controls with combined quantitative short echo 1H MRS and magnetic resonance imaging (MRI) and assesseddisability according to the Expanded Disability Status Scale (EDSS). At follow-up, 32 had developed MS, and 9 still had CIS. Compared withcontrols, MS patients demonstrated significantly higher concentrations of myo-inositol (Ins) in normal appearing white matter (NAWM) andlesions. Lesions also demonstrated a reduced N-acetyl-aspartate (NAA) level and an increase in choline-containing compounds (Cho). TheNAWM Ins concentration was correlated with EDSS (r = 0.48, p = 0.005). MS normal appearing cortical grey matter (CGM) exhibited adecreased NAA. Patients who remained CIS did not differ significantly from controls in any MRS measure. Metabolite changes in normalappearing white and grey matter in MS indicate diffuse involvement of the entire MS brain, which was not seen in the persisting CISpatients. Elevated Ins in MS NAWM appeared functionally relevant. It may indicate glial cell proliferation or gliosis.

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