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Object: This study demonstrates that 3T SV-MRS data can be used with the currently available automatic brain tumour diagnostic classifiers which were trained on databases of 1.5T spectra. This will allow the existing large databases of 1.5T MRS data to be used for diagnostic classification of 3T spectra, and perhaps also the combination of 1.5T and 3T databases. Materials and methods: Brain tumour classifiers trained with 154 1.5T spectra to discriminate among high grade malignant tumours and common grade II glial tumours were evaluated with a subsequently-acquired set of 155 1.5T and 37 3T spectra. A similarity study between spectra and main brain tumour metabolite ratios for both field strengths (1.5T and 3T) was also performed. Results: Our results showed that classifiers trained with 1.5T samples had similar accuracy for both test datasets (0.87 ± 0.03 for 1.5T and 0.88 ± 0.03 for 3.0T). Moreover, non-significant differences were observed with most metabolite ratios and spectral patterns. Conclusion: These results encourage the use of existing classifiers based on 1.5T datasets for diagnosis with 3T H SV-MRS. The large 1.5T databases compiled throughout many years and the prediction models based on 1.5T acquisitions can therefore continue to be used with data from the new 3T instruments. [ABSTRACT FROM AUTHOR]

1H magnetic resonance spectroscopy (MRS) allows accurate and non-invasive in vivo metabolic study, and is a useful tool for the diagnosis of different forms of dementias. Cognitive impairment pathologies have been almost exclusively studied with MRS by comparison with healthy without a global comparison amongst Alzheimer disease (AD), vascular dementia, mild cognitive impairment (MCI) and major depression patients with cognitive impairment. Whereas decrease of N-acetylaspartate (NAA) and increase myo-Inositol (mI) at different brain locations by 1H MRS are common features of AD, Choline (Cho) alterations have been inconclusive. In our study, 64 patients with cognitive impairment were evaluated by 1H MRS using two echo times (31 and 136 ms). There were statistical differences between dementia (AD and vascular dementia) and non-dementia (MCI and depression) spectra at posterior cingulate gyrus. Cho/Cr, mI/Cr and NAA/Cr have been valuables for the differentiation amongst the different cognitive impairment entities. NAA/mI provides the best area under the ROC curve with the highest sensitivity (82.5%) and specificity (72.7%) in diagnosing AD. NAA/mI and mI/Cr ratios differed amongst the four cognitive impairment degenerative pathologies. Metabolic MRS differences found amongst patients with cognitive impairment entities can be useful to differentiate between AD, vascular dementia, MCI and depression. [ABSTRACT FROM AUTHOR]

Objective: Wallerian degeneration in normal appearing white matter in early relapsing-remitting multiple sclerosis (RRMS), and its correlation with the number of relapses and disease duration. Background Recent pathological studies have demonstrated Wallerian degeneration in normal appearing white matter (NAWM) in multiple sclerosis (MS), in established RRMS, and in chronic MS. However, the presence of Wallerian degeneration early in the disease and its correlation with relapse and with disease duration has not been studied. Methods: We performed proton magnetic resonance spectroscopic imaging in 21 MS patients, and 4 healthy controls, age and gender matched, aged under 45 years, with a maximum of 4 years since first bout, and an EDSS score of less than 3.0. N-acetyl-aspartate (NAA) (an index of axonal integrity) was measured in the NAWM from the pons and the cerebellar peduncles. Results: We observed that the NAA levels were abnormally low in the NAWM in the early RRMS patients (p = 0.04, Student's t-test). The decrease in the NAA concentration correlated with disease duration in the two areas studied (p = 0.03 for pons and p = 0.04 for cerebellar peduncle); and with the number of previous relapses (Pearson's correlation = -0.582, p < 0.002). Conclusion: Wallerian degeneration measured by the NAA concentration at pons and cerebellar peduncles is present early in the disease and correlates with the number of relapses and disease duration. [ABSTRACT FROM AUTHOR]

Gated mesoporous silica nanoparticles can deliver payload upon the application of a predefined stimulus, and therefore are promising drug delivery systems. Despite their important role, relatively low emphasis has been placed on the design of gating systems that actively target carbohydrate tumor cell membrane receptors. We describe herein a new Lewis X (Le x ) antigen-targeted delivery system comprising mesoporous silica nanoparticles (MSNs) loaded with ATTO 430LS dye, functionalized with a Le x derivative (1) and capped with a fucose-specific carbohydrate-binding protein (Aleuria aurantia lectin (AAL)). This design takes advantage of the affinity of AAL for Le x overexpressed receptors in certain cancer cells. In the proximity of the cells, AAL is detached from MSNs to bind Le x , and selectins in the cells bind Le x in the gated MSNs, thereby inducing cargo delivery. Gated MSNs are nontoxic to colon cancer DLD-1 cells, and ATTO 430LS dye delivered correlated with the amount of Le x antigen overexpressed at the DLD-1 cell surface. This is one of the few examples of MSNs using biologically relevant glycans for both capping (via interaction with AAL) and targeting (via interaction with overexpressed Le x at the cell membrane).

Objective: To determine the viability of quadrature coils for detecting prostate cancer using single voxel and multivoxel spectroscopy images., Material and Methods: We used a quadrature coil on a 1.5T MR scanner to evaluate 23 patients with suspected prostate cancer and prostate specific antigen levels greater than 4ng/ml (mean 12±8ng/ml), independently of findings at digital rectal examination. We acquired T2-weighted images and MR spectroscopy images. We also acquired single voxel studies in areas in which the T2-weighted images or the multivoxel images were altered. We used a citrate solution to verify the spectroscopic calibration., Results: Using spectroscopy images and a (Co+Cr)/Cit cutoff of 1.40 in single voxel spectroscopy, we achieved a sensitivity of 92%, specificity of 55%, a negative predictive value of 86%, and a positive predictive value of 69%. Using a cutoff of 0.75 decreased specificity slightly (45%). The (Co+Cr)/Cit ratio calculated for the single volume obtained from the most abnormal area in the T2-weighted images and in the multivoxel spectroscopy slices was not significantly different between cancerous and non-cancerous tissues (ANOVA, p=0.1), although there was a clear trend toward increased coefficients with hyperplasia and neoplastic degeneration., Conclusion: The quadrature coil enables multivoxel and single voxel spectroscopic images of clinically and technically acceptable quality to be obtained. Using single voxel spectroscopy does not improve the diagnostic performance of multivoxel spectroscopy and T2-weighted images., (Copyright © 2009 SERAM. Published by Elsevier Espana. All rights reserved.)

Magnetic resonance spectroscopic imaging (MRSI) is a non-invasive imaging technique that provides metabolic information on brain tumor. This biochemical information can be processed and presented as density maps of several metabolites, among them N-acetylaspartate (marker of neuronal viability), choline (marker of membrane turnover), creatine (related to the energy state of the cells), myo-Inositol (exclusively found in astrocytes), lipids and lactate (observed in necrosis and other pathological processes) which mean relevant information in the context of brain tumors. Thus, this technique is a multiparametrical molecular imaging method that can complete the magnetic resonance imaging (MRI) study enabling the detection of biochemical patterns of different features and aspects of brain tumors. In this article, the role of MRSI as a molecular imaging technique to provide biochemical information on human brain tumors is reviewed. The most frequent questions and situations in the study of human brain tumors in clinical settings will be considered, as well as the distinction of neoplastic lesions from non neoplastic, the tumor type identification, the study of heterogeneity and infiltration of normal appearing white matter and the therapy following with detection of side effects. The great amount of data in MRSI acquisition compared to the single voxel techniques requires the use of automated methods of quantification, but the possibility to obtain self-reference in the non-affected areas allows different strategies for data handling and interpretation, as presented in the literature. The combination of MRSI with other physiological MRI techniques and positron emission tomography is also included in this review.

Objective: Previous studies have found neurochemical abnormalities in thalamic nuclei in patients with schizophrenia. These abnormalities have been associated with information processing deficiencies and symptom formation. There are no metabolic spectroscopy studies in patients with schizophrenia attending to auditory hallucinations. The aim of the present study is to explore metabolic Magnetic Resonance Spectroscopy (MRS) ratio differences in the thalamus between schizophrenic patients with and without auditory hallucinations and control subjects., Methods: MRS studies (MRI 1.5 T unit) were performed in 49 patients with schizophrenia (30 with auditory hallucinations and 19 without auditory hallucinations) and 37 controls. (1)H MRS imaging was used to acquire 2 transverse slices (TR/TE 2700/272 ms, region of interest 110 x 100 x 23 mm). In the quantitative analysis four elements of volume (9.2 x 9.2 x 23 x 4 mm), added into one spectrum representative of each thalamus, were chosen in the slice passing through the main body of the thalamus. The areas of metabolites were integrated with the jMRUI program., Results: The patients with schizophrenia had significantly lower bilateral NAA/Cho ratios when compared with healthy subjects. There was also a lower NAA/Cho ratio in the right thalamus in patients with auditory hallucinations compared to patients without auditory hallucinations and control subjects. Significant correlations were found between metabolic ratios and BPRS, PANSS and PSYRATS scores, age of onset of auditory hallucinations, and age of subjects., Conclusions: Choline and NAA ratio abnormalities determined by thalamic spectroscopy may be related to the pathogenesis of auditory hallucinations in patients with schizophrenia.

Aim: To evaluate the relationship between the total brain T2-hyperintense lesion volume (TBT2LV) and the axonal damage in the normal-appearing white matter of brainstem measured by 1H-MRS in a group of early relapsing-remitting multiple sclerosis patients., Subjects and Methods: 40 relapsing-remitting multiple sclerosis patients and ten sex- and age-matched healthy subjects were prospectively studied for two years. T2-weighted MR and 1H-MRS imaging were acquired at time of recruitment and at year two. The TBT2LV was calculated with a semiautomatic program; N-acetylaspartate (NAA), creatine (Cr) and choline (Cho) resonances areas were integrated with jMRUI program and the ratios were calculated for four volume elements that represented the brainstem., Results: At basal study we obtained an axonal loss (as a decrement of NAA/ Cho ratio) in the group of patients compared with controls (p = 0.017); this axonal loss increased at the second year of the follow-up for patients (NAA/Cho decrease, p = 0.004, and NAA/Cr decrease, p = 0.002) meanwhile control subjects had no significant metabolic changes. Higher lesion load was correlated with a poor clinical outcome, being the correlation between the basal TBT2LV and the Expanded Disability Status Scale at second year (r = 0.299; p = 0.05). Besides, axonal loss was not homogeneous for all multiple sclerosis patients, being stronger in the subgroup of patients with high basal TBT2LV (p = 0.043; ANOVA)., Conclusion: Our data suggest that axonal damage is early in multiple sclerosis and higher in patients high basal TBT2LV, suggesting a possible relationship between these two phenomena.

Introduction: The objective is analyze the complementarity between 1H magnetic resonance spectroscopy (MRS) and magnetic resonance (MR) imaging in the global diagnosis of Alzheimer's disease (AD) or vascular dementia (VD)., Methods: We studied 168 patients with cognitive impairment from AD, VD, mild cognitive impairment (MCI) and major depression. All patients were evaluated by brain MR imaging and MRS using two sample volumes localized at right medial temporal gyrus and posterior parietal gyrus. Metabolites analyzed were N-acetylaspartate (NAA), myo-Inositol (mI), Choline (Cho) and creatine (Cr), as standard references for obtaining the Co/Cr, mI/Cr and NAA/Cr ratios. Imaging and spectroscopy alterations were graded from 0 to 4 and the average of both was used to draw ROC and SROC curves. Area under ROC curve (Az) was used as a measure of discriminative ability., Results: Combination of MR imaging and MRS significantly improved AD diagnosis (Global Az: 0.722 vs. MR imaging Az: 0.624; p: 0.003). However, the combination of MR imaging and MRS did not improve VD diagnosis. SROC curve obtained for the diagnosis of global dementia was Az: 0.6658 with 0.67 sensitivity and 0.65 specificity., Conclusions: Combination of both MR techniques significantly improved AD diagnosis versus MR imaging alone. More studies are needed to enhance VD classification. Metabolic data found by MRS can be useful to differentiate cognitive impairment

Objective: To analyze the diagnostic accuracy of proton magnetic resonance spectroscopy (1H MRS) in patients with cognitive impairment and to establish the usefulness of complementary information provided by conventional magnetic resonance imaging (MRI)., Material and Methods: 64 patients with cognitive impairment, including Alzheimer's disease (AD) (n=31), vascular dementia (n=6), mild cognitive impairment (MCI) (n=9), and major depression (n=18), were studied. All patients underwent cerebral MRI and single-volume 1H MRS using two echo times (TE, 31 and 136 ms) in the posterior cingulate gyrus and right temporal lobe. The metabolites analyzed were N-acetylaspartate (NAA), myo-Inositol (mI), choline (Ch), and creatine (Cr), and the ratios of Ch/Cr, mI/Cr, NAA/mI and NAA/Cr were calculated. In order to differentiate among the different types of cognitive impairment, the alterations in imaging and spectroscopy findings were graded from 0 to 4, as was the mean combination of the two, and then ROC curves were obtained., Results: Statistically significant differences were found between the spectra of patients with dementia (AD and vascular dementia) and those without dementia (MCI and depression) in the posterior cingulate gyrus. The NAA/mI ratio yielded the best area under the ROC curve, with the best sensitivity (82.5%) and specificity (72.7%) in the diagnosis of AD. The NAA/mI and mI/Cr quotients differentiated between the four degenerative pathologies causing the cognitive impairment. The combination of MRI and 1H MRS significantly improved the accuracy of the diagnosis of AD., Conclusions: The metabolic differences found among patients with cognitive impairment using 1H MRS can be useful for differentiating AD, vascular dementia, MCI, and depression. The combination of spectroscopy and MRI findings is useful in the diagnosis of AD.

Introduction: Multiple sclerosis (MS) is a chronic demyelinating disorder of the central nervous system, characterized by the presence of inflammatory lesions., Objective: To analyze the biochemical profile of the demyelinating lesions of the initial forms of MS (remitting relapsing) by analyzing the proton magnetic resonance spectra (1H MRS) to characterize the process of demyelination and relate it to the metabolites and clinical variables analyzed., Patients and Methods: We analyzed the largest demyelinating lesions in eight patients with remitting relapsing MS (RRMS) using the technique of single volume 1H MRS (VOI) with short echo time. The spectra of the white matter of two healthy control were used as reference., Results: NAA/Cr and NAA/Cho value ratios decrease and mI/Cr one increase in all spectra lesions as compared to healthy controls. In four of the eight patients, the Cho/Cr was higher than in the controls. Qualitative and quantitative differences in the resonances of macromolecules were observed, related to the biochemistry of the process of demyelination. These differences in NAA/Cr, Cho/Cr, mI/Cr and macromolecules probably represent different stages in the evolution of the plaques., Conclusions: MRS is a non invasive technique able to observe biochemical variations related to the evolution process of demyelination. Activity of the lesion is shown by the increment of resonances around 0.9 1.3 ppm. An increase in mI seems to occur at an early stage of demyelination and later the NAA is reduced. The initial forms of MS show metabolic alterations in the plaques which are similar to the most advanced forms of MS.

Introduction: 1H MRS allows the study of metabolite concentration changes in intracranial tumours, relating them, more or less successfully, to the histological type and grade of the tumour., Objective: To analyse the patterns which are useful for classifying the grades of cerebral gliomas by means of various ratios obtained using 1H MRS with two echo times (ET), with and without water suppression, paying special attention to the macromolecules., Patients and Methods: We studied 8 gliomas (1 grade II, 2 grade III and 5 grade IV) with single volume 1H MRS at ET 31 ms (8/8) and 136 ms (7/8). The intensities of the metabolites, including macromolecules (MMA, 0.9 ppm; MMB, 1.3 ppm), were normalised to water signal intensity for ET 31, to Cr at ET 31 and 136 ms and NAA/Cho for both ET and the ratio MMA/MMB at ET 31., Results: There were significant differences between the three grades on the ratios MMA/MMB (p= 0.000) with descent of the MMA/MMB coefficient as the grade increases, and NNA/Cho at ET 136 (p= 0.018). We found an inverse relationship between the quantity in mI and the increase in grade. No macromolecules were found at ET 136 in any of the tumours of grade II or III., Conclusions: The spectra of gliomas with ET 31 showed macromolecules around 0.9 and 1.3 ppm with different relative ratios for each tumour grade. The ET 136 spectra informs about the content of NNA and Cho. Apart from the increase in MMB (0.9 ppm), with short ET the higher grades showed lower content of mI. The study of gliomas using 1H MRS with ET 31 and 136 ms contributes to the diagnosis of the grade of tumour.