CEREBRAL METABOLITE PATTERNS IN DIALYSIS PATIENTS - EVALUATION WITH H-1 MR SPECTROSCOPY

PURPOSE: To analyze metabolic changes in the brain of patients undergoing dialysis. MATERIALS AND METHODS: Sixteen patients undergoing hemodialysis, 10 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and 42 healthy volunteers underwent magnetic resonance (MR) spectroscopy and MR imaging. Spectra were obtained from one occipital gray matter voxel and one parietal white matter voxel. Changes in N-acetylaspartate (NAA), choline (Cho), myo-inositol and glycine (Myo), and creatine (Cr) were analyzed and the results presented as ratios, with Cr as the reference. RESULTS: Three abnormalities were observed in the spectra of the hemodialysis patients: (a) significant elevation of the Cho/Cr ratio in gray matter, (b) significant elevation of the Myo/Cr ratio in gray matter, and (c) significant reduction of the NAA/Cr ratio in gray and white matter. The strongest metabolic alterations were found in cortical gray matter. In CAPD patients, only gray matter Cho/Cr ratio was significantly elevated. An increased frequency of focal white matter lesions was observed on MR images in the dialysis patients. CONCLUSION: Proton MR spectroscopy is useful for in vivo monitoring of metabolic alterations in the brain due to chronic dialysis.