Abstract
Publisher Summary Magnetic resonance spectroscopy (MRS) is a research method, involving chemically specific, noninvasive measurement of certain compounds in living tissue. It is possible to study human tissues that are inaccessible except by invasive techniques. In the human brain, phosphate energy stores, intra-cellular pH, lactate concentration, and the neuronal marker N-acetylaspartate (NAA) are examples of MRS-measurable variables and cannot be studied easily by any other technique. In this chapter, the four major resonances in water-suppressed, localized magnetic resonance (MR) spectra of normal human brain at “long” echo times are discussed. Evidence supports the use of NAA as a neuronal marker. It is found exclusively in neurons and their processes in the mature brain. In the human brain spectra, in vivo NAA is reduced in situations associated with neuronal loss. The application of MRS in cerebral disorders is done to quantify neuronal loss or damage. Creatine can be used as an internal standard to normalize resonance intensities of NAA and choline-containing phospholipids (Cho) to correct artifactual variations in signal intensity, because of magnetic field and radiofrequency in homogeneity. Brain lactate is elevated by seizure activity, as demonstrated by the biochemical studies of excised tissue. In vivo animal studies, using proton MRS, has allowed studies on lactate elevation after convulsive seizure. Studies suggest that in situ lactate increase is a marker of the seizure-induced neuronal damage. MRS may be useful for the evaluation of partial epilepsies associated with cortical developmental malformations. Proton MRS has shown NAA signal intensity to be variably normal or abnormal in patients with heterotopias, suggesting that some of the apparently normal neurons are dysfunctional. Magnetic resonance spectroscopy imaging based metabolic abnormalities in patients with cortical developmental malformations are variable and are likely to be associated with complex cellular mechanisms, involving the regulation of NAA, total creatine-phosphocreatine content, Cho, and seizure activity.
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