Measurement of initial N-acetyl aspartate concentration by magnetic resonance spectroscopy and initial infarct volume by MRI predicts outcome in patients with middle cerebral artery territory infarction

被引:53
作者
Pereira, AC
Saunders, DE
Doyle, VL
Bland, JM
Howe, FA
Griffiths, JR
Brown, MM
机构
[1] CRC, Biomed Magnet Resonance Res Grp, Div Clin Neurosci, London, England
[2] St George Hosp, Sch Med, Dept Publ Hlth Med, London, England
[3] Kings Coll Hosp London, Dept Radiol, London, England
[4] UCL, Inst Neurol, London, England
关键词
human; outcome; spectroscopy; nuclear magnetic resonance; stroke;
D O I
10.1161/01.STR.30.8.1577
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-H-1 MR spectroscopy can be used to study biochemical changes occurring in the brain in stroke. We used it to examine the relationship between metabolite concentration (N-acetyl aspartate [NAA], lactate, cholines and creatines), size of infarct, clinical deficit, and 3-month clinical outcome in patients with middle cerebral artery (MCA) territory infarction. Methods-Thirty-one patients with acute MCA territory infarction were recruited within 72 hours of the onset of symptoms. Single-voxel short echo time stimulated echo acquistion mode spectroscopy was used to obtain metabolite data from the infarct core. Metabolite concentrations were determined with use of variable projection time domain-fitting analysis. Infarct size was determined with T2-weighted images. Patient outcome groups at 3 months were "independent," "dependent," or "dead." Results-All patients (100%; 95% CI 75% to 100%) who had an infarct >70 mt did poorly. Eighteen of 20 patients (90%; 95% CI 68% to 99%) with a core NAA concentration <7 mmol/L did poorly at 3 months, whereas 7 of 11 patients (64%; 95% CI 31% to 89%) with an initial NAA concentration >7 mmol/L did well. Combining these results showed that all patients who had an initial infarct volume >70 mt did poorly, irrespective of the NAA concentration. Of those patients with infarcts <70 mL, those who had a core NAA concentration >7 mmo/L did well (88%; 95% CI 47% to 100%), whereas those with a lower NAA concentration did poorly (80%; 95% CI 44% to 97%). There was no association between other metabolite concentrations and outcome. Conclusions-Infarct volume and NAA concentration can together predict clinical outcome in MCA infarction in humans.
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页码:1577 / 1582
页数:6
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