Besides high-resolution and ultra-high-field (7-tesla) magnetic resonance imaging (MRI),1 proton MR spectroscopy holds much promise for the diagnosis of multiple sclerosis (MS).2,3 1H-MR spectroscopy enables us to investigate the metabolic changes in the normal-appearing white matter (NAWM) of MS patients.2,3 It is widely accepted that the axonal damage occurs already during the first demyelinating episode in patients with clinically isolated syndromes (CIS) as well as in patients diagnosed as definite MS.1,4 Both the significantly decreased N-acetylaspartate (NAA) concentration and a reduced total NAA/total creatine ratio in the NAWN were observed in patients presenting with CIS as well as in patients with a very short disease duration of relapsing-remitting MS (RRMS).2 Furthermore, the significant declined level of NAA in the NAWN was recognized exclusively in patients with CIS who developed MS later.5 Therefore, the metabolic alterations in the NAWM of patients with CIS are of particular interest because these changes have prognostic relevance for the clinical outcome and are also expected to be helpful to exclude other differential diagnoses including neuromyelitis optica and transverse myelitis.
[References]
1: Reich DS, Lucchinetti CF, Calabresi PA. Multiple Sclerosis. N Engl J Med. 2018;378:169-180.
2: Wattjes MP, Harzheim M, Lutterbey GG, et al. Axonal damage but no increased glial cell activity in the normal-appearing white matter of patients with clinically isolated syndromes suggestive of multiple sclerosis using high-field magnetic resonance spectroscopy. AJNR Am J Neuroradiol. 2007;28:1517-22.
3: Sajja BR, Wolinsky JS, Narayana PA. Proton magnetic resonance spectroscopy in multiple sclerosis. Neuroimaging Clin N Am. 2009;19:45-58.
4: De Stefano N, Narayanan S, Francis GS, et al. Evidence of axonal damage in the early stages of multiple sclerosis and its relevance to disability. Arch Neurol 2001;58:65-70.
5: Wattjes MP, Harzheim M, Lutterbey GG, et al. Prognostic value of high-field proton magnetic resonance spectroscopy in patients presenting with clinically isolated syndromes suggestive of multiple sclerosis. Neuroradiology. 2008;50:123-129.
Multiple sclerosis is masked for a variety of diseases. It is advisable to take into account a complex of predictors and symptoms, along with magnetic resonance imaging (in the Attachment).
Hello,
From a research perspective, other emerging imaging techniques include phosphorus magnetic resonance spectroscopy which we recently applied in an exploratory study. A correlation between disability (EDSS scores) and ATP metabolites (b ATP) was found.
Kauv P, Ayache SS, Créange A, Chalah MA, Lefaucheur JP, Hodel J, Brugières P. Adenosine Triphosphate Metabolism Measured by Phosphorus Magnetic Resonance Spectroscopy: A Potential Biomarker for Multiple Sclerosis Severity. Eur Neurol. 2017;77(5-6):316-321. doi: 10.1159/000475496. Epub 2017 May 4.
Sincerely yours,
In vivo (before at postmortem), the only finding shown to set MS specifically apart are its vein "centered", i.e. imparted, DAWSON's FINGERS.
They alone characterize MS unmistakably ... as long as the dependence of the spinal cord lesions's development on the spinal cord moorings to its sheats (www.ms-info.net) are not made evident in vivo.
MRI alone shows this. So there is not other tool for unmistakably identifying MS.
Why CLINICAL imaging toll ? and why not [morphological] pathology imaging tool, John Joseph McIntyre?
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