Magnetic Resonance Spectroscopy In Evaluation Research Articles

A prospective observational role of magnetic resonance imaging and magnetic resonance spectroscopy in evaluation of choline levels in gall bladder carcinoma in tertiary care hospital in central India

Background Gall bladder carcinoma (GBC) is a challenging malignancy characterized by late-stage diagnosis and poor prognosis. Early detection and accurate staging are crucial for improving patient outcomes. Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) offer non-invasive imaging modalities that may aid in the evaluation of GBC. Choline, a metabolite detected by MRS, has been implicated in tumor growth and may serve as a potential biomarker for GBC. This study aims to investigate the role of MRI and MRS in evaluating choline levels as biomarkers for GBC. Method A prospective observational study will be conducted involving patients with suspected or confirmed GBC referred to the Department of Radiology, AVBRH, Sawangi. Patients meeting inclusion criteria will undergo MRI scans and MRS examinations to assess tumor characteristics and choline levels. Data collected will include MRI images, MRS spectra, histopathological results, and clinical outcomes. Statistical analysis will be performed to examine correlations between MRI findings, choline levels, and histopathological characteristics. Expected Outcome It is anticipated that MRI and MRS will demonstrate utility in evaluating choline levels as imaging biomarkers for GBC. Correlations between choline levels, tumor characteristics, and clinical outcomes are expected to provide valuable insights into the role of choline in GBC pathogenesis and prognosis. If successful, MRI and MRS could serve as non-invasive tools for early detection, staging, and treatment response monitoring in GBC, ultimately leading to improved patient outcomes and management strategies.

31-Phosphorus Magnetic Resonance Spectroscopy in Evaluation of Glioma and Metastases in 3T MRI.

Background: 31-Phosphorus magnetic resonance spectroscopy (31-P MRS) has excellent potential for clinical neurological practice because of its noninvasive in-vivo assessment of cellular energy metabolism and the indirect evaluation of the phospholipid composition of the cell membrane, intracellular pH, and intracellular Mg2+ concentration. Purpose: The aim of this study was to evaluate the metabolic characteristics of glioma and metastases using 31-P MRS and assess utility to differentiate both. Study Type: Prospective study. Population: Fifteen consecutive patients with brain tumor. Field Strength/Sequence: Three-tesla magnetic resonance imaging/three-dimensional MRS imaging sequence. Statistical Tests: Unpaired sample t -test, and one-way analysis of variance with Tukey's post-hoc test. Results: Significantly decreased values of phosphomonoesters/inorganic phosphate (PME/Pi) in the tumor group (1.22 ± 0.72) compared with controls (2.28 ± 1.44) with a p -value of 0.041 were observed. There is a significant decrease in phosphocreatine (PCr)/Pi values (energy demand) in the tumor group (2.76 ± 0.73) compared with controls (4.13 ± 1.75) with a p -value of 0.050. Significant increase in Pi/adenosine triphosphate (ATP) was noted in tumor group (0.28 ± 0.09) compared with controls (0.22 ± 0.08) with p -value 0.049. Among tumor group, PME/PCr values were significantly decreased in gliomas (0.35 ± 0.17) than metastasis (0.58 ± 0.23) compared with controls with a p -value of 0.047. A significant decrease in PME/ATP was noted in gliomas (0.25 ± 0.12) than metastasis (0.41 ± 0.14) compared with controls with a p -value of 0.034. The tumor group exhibits alkaline pH (7.12 ± 0.10) compared with the normal parenchyma (7.04 ± 0.06) with a significant p -value of 0.025. Glioma and metastasis could not be differentiated with pH. However, the perilesional edema of glioma shows alkaline pH (7.09 ± 0.06) and metastasis shows acidic pH (7.02 ± 0.05) with a significant p -value of 0.030. Conclusion: Our study provides new insight into the cellular constituents and pH of gliomas and metastases and results were significant in differentiation between these two. However, due to the additional high expense, it is available as a research tool in very few institutions in India.

Application of Magnetic Resonance Imaging in the Evaluation of Nutritional Status: A Literature Review with Focus on Dialysis Patients.

Magnetic resonance imaging (MRI) is indispensable in clinical medicine for the morphological and tomographic evaluation of many parenchymal organs. With varied imaging methods, diverse biological information, such as the perfusion volume and measurements of metabolic products, can be obtained. In addition to conventional MRI for morphological assessment, diffusion-weighted MRI/diffusion tensor imaging is used to evaluate white matter structures in the brain; arterial spin labeling is used for cerebral blood flow evaluation; magnetic resonance elastography for fatty liver and cirrhosis evaluation; magnetic resonance spectroscopy for evaluation of metabolites in specific regions of the brain; and blood oxygenation level-dependent imaging for neurological exploration of eating behavior, obesity, and food perception. This range of applications will continue to expand in the future. Nutritional science is a multidisciplinary and all-inclusive field of research; therefore, there are many different applications of MRI. We present a literature review of MRI techniques that can be used to evaluate the nutritional status, particularly in patients on dialysis. We used MEDLINE as the information source, conducted a keyword search in PubMed, and found that, as a nutritional evaluation method, MRI has been used frequently to comprehensively and quantitatively evaluate muscle mass for the determination of body composition.

Assessment of chemotherapy-induced cognitive impairment: A prospective study of the biochemical and metabolic effects of platinum/taxane-based chemotherapy in gynecologic cancer patients.

e24051 Background: Chemotherapy-induced cognitive impairment (CICI) is a common side effect of cancer therapy, affecting up to 75% of cancer patients. Oxidative stress is thought to play a key role in CICI and patients who have been treated with chemotherapy have demonstrated biochemical brain changes on magnetic resonance spectroscopy (MRS). Methods: Following institutional review board approval, chemotherapy-naïve gynecologic cancer patients scheduled to receive intravenous platinum/taxane-based chemotherapy were identified. The primary objective of this study was identification of chemotherapy-induced cognitive function changes using the Montreal Cognitive Assessment (MoCA) tool. This exploratory analysis evaluates correlations between changes in MoCA scores, oxidative analytes TNF-a, protein carbonyls (PC), and 4-hydroxynonenal (HNE) protein adducts, and MRS metabolic signals. Testing was performed at baseline and three weeks post-treatment. Simple linear regression was performed to evaluate the correlation between changes in MoCA scores and oxidative metabolites. Results: Fourteen patients were enrolled. Six patients had complete pre/post oxidative stress data, and four patients had complete pre/post MRS data. Five of six had decreased PC values (mean net change -15.17%, SD 0.15), half had increased HNE levels (mean net change +16.38%, SD 0.38), and four of six had decreased TNF-a values (mean net change -15.10%, SD 0.27) (Table). MoCA scores were positively correlated with serum PC levels ( r = 0.86, p = 0.03) and not significantly correlated with TNF-a or HNE levels. Of those with complete pre/post MRS data, all patients had a decrease in glycerophosphocholine + phosphocholine/creatinine ratio signals. MoCA raw score prior to and after completion of chemotherapy. A higher score indicates improved test performance. Positive percentage of oxidative stress markers (PC, HNE, TNF-a) indicates increased post-therapy levels compared to pre-therapy. Conclusions: In this study, we evaluated candidate oxidative stress serum markers and changes in MRS metabolite signals for CICI. Serum PC levels correlate with cognitive screening scores. For patients undergoing brain imaging, MRS evaluation for individual choline components, glycerophosphocholine and phosphocholine, may serve as an additional marker of oxidative damage. This pilot study highlights the potential value of serum PC levels and dedicated brain imaging for signs of oxidative stress, including MRS, to guide future CICI identification studies. Clinical trial information: NCT03324945. [Table: see text]

Magnetic Resonance Spectroscopy in Evaluation of Focal Brain Lesions- A Cross-sectional Prospective Study

Introduction: The characterisation of intracranial mass lesions only with the help of conventional magnetic resonance imaging alone may be inconclusive. Magnetic Resonance Spectroscopy (MRS) is a non invasive technique which is superior to Magnetic Resonance Imaging (MRI) in the characterisation of brain lesions. Magnetic resonance spectroscopy is comparatively fast, non-invasive method that gives biochemical analysis of the normal brain parenchyma and of the pathological processes. Magnetic resonance spectroscopy has the advantage of providing characterisation of tissues based on their molecular composition. It gives information about neuronal vitality, cell proliferation, degradation and energy metabolism. Aim: To describe the spectrum of magnetic resonance spectroscopy in focal brain lesions and to detect the metabolic and biochemical changes in various focal brain lesions. Also, to distinguish neoplastic from non-neoplastic lesions. Materials and Methods: This prospective study was carried out at Department of Radiodiagnosis, Sri Manakula Vinaynagar Medical College and Hospital, Puducherry, India for a period of 18 months from November 2017 to April 2019. A total of 40 MRI brain with clinically suspected brain lesions were included in the study. Magnetic resonance spectroscopy studies were performed in all patients with focal brain lesions. On the basis of spectral and distribution patterns of the pathologic spectra seen in MR spectroscopy, a qualitative analysis was done. The metabolic area ratios Choline/Creatinine (Cho/Cr)/Cr, NAA/Cho and NAA/Cr were evaluated (NAA- N-acetyl, Cho- choline, Cr- creatine). Data was collected using prescribed proforma and analysed using Statistical Package for the Social Sciences (SPSS) 22 version software. Results: Out of the 40 patients evaluated 11 cases were high grade gliomas, seven cases were Neurocysticercosis, five low grade glioma, five meningioma, four metastasis, four tubercular abscesses, two tuberculoma and two lymphoma. Increased Cho/ Cr ratio was noted in neoplastic lesions when compared to non neoplastic lesions. Conclusion: The MRS in addition to appropriate conventional MRI sequences provides useful supplementary information and has a potential to validate treatment strategies. Neoplastic lesions show elevated choline and Cho Cr ratio with reduction in N-acetyl aspartate (NAA), whereas non neoplastic lesions show decreased Cho/Cr ratio. Hence, MRS could be a problem solving tool in differentiating neoplastic from non neoplastic lesions.

Role of Magnetic Resonance Spectroscopy in Evaluation of Cerebral Metabolic Status Before and After Carotid Endarterectomy/Thromboendarterectomy and Carotid Artery Stenting in Patients with Asymptomatic Critical Internal Carotid Artery Stenosis.

BackgroundThe relative efficacy of carotid endarterectomy (CEA)/thromboendarterectomy (TEA) and carotid artery stenting (CAS) already has been compared in randomized controlled trials and a meta-analysis, but only limited data exist describing the status of cerebral metabolism before and after these interventions.The aim of the present study was to compare metabolic changes before and after treatment of carotid stenosis and assess their potential clinical implications.Material/MethodsPatients with asymptomatic unilateral critical internal CAS were imaged with proton 3T magnetic resonance spectroscopy (H-MRS) because the technique is more sensitive than regular magnetic resonance imaging for detection of the early signs of ischemic events. Abnormal metabolite ratios detected with H-MRS may precede actual morphological changes associated with hypoperfusion as well as reperfusion changes. Ipsilateral and contralateral middle cerebral artery vascular territories were both evaluated before and after vascular intervention. H-MRS was performed within 24 h before and after surgery. Correlations in the metabolic data from H-MRS for N-acetylaspartic acid (NAA)+N-acetylaspartylglutamate, creatinine (Cr)+phosphocreatinine, and phosphocholine+glycerophosphocholine (Cho) were sought.ResultsH-MRS voxels from 11 subjects were analyzed. Values for dCho/CrI, dCho/CrC and Cho/Naal (P<0.001) were significantly higher ipsilaterally than contralaterally. Ratios for dNaa/ChoC and Cho/NaaC were significantly higher on the non-operated side (P<0.001).ConclusionsH-MRS may be helpful for assessment of patients with CAS, particularly because unlike other modalities, it reveals postoperative changes in metabolic brain status. Initial results indicate the important role of perioperative neuroprotective treatment.

NIMG-12. 18F-FLUORETHYLTYROSINE POSITRON EMISSION TOMOGRAPHY VERSUS MAGNETIC RESONANCE SPECTROSCOPY IN PREOPERATIVE DETECTION OF NEWLY DIAGNOSED GLIOMAS BY USING MACHINE LEARNING

Abstract BACKGROUND Advanced imaging techniques entered the field of neurooncology. In this analysis we compare the diagnostic potential of 18F-fluorethyltyrosine (FET) positron emission tomography (PET) and magnetic resonance spectroscopy (MRS) in their potential to preoperatively predict certain glioma subtypes. AIMS Goal of this analysis ist the evaluation of FET PET and MRS regarding the preoperative prediction of glioma subtypes. METHODS We analyzed 33 patients with histopathologically confirmed newly diagnosed glioma. The patients received FET PET and MRS during one single preoperative diagnostic session. According to the molecular portfolio patients were subdivided in IDH wildtype glioblastoma patients (GBM), IDH wildtype WHO grade II/III glioma patients (Astro_IDHwt), IDH mutant WHO grade II/III glioma patients without 1p/19q codeletion (Astro_IDHmut) and with 1p/19q codeletion (ODG). Mean and maximum tumor-to-brain ratio (TBRmean and TBRmax), N-acetylaspartate, choline and creatine peaks were correlated with postoperative tumor diagnosis. To gain generalizable implications we subdivided the study cohort into a development and validation subcohort. A support vector machine model was fitted to the development subcohort and evaluated on the validation subcohort. Receiver operating characteristic curve served to assess model performance. RESULTS GBM patients had highest TBRmax and TBRmean values (mean: 3.5 and 3.8) and the ODG patients showed the second highest TBRmax and TBRmean values (mean: 2.6 and 3). The distribution of MRS markers exhibited to clear trend. The performance of glioma subtyping was comparatively low for the TBR values (AUC: 0.68) and even lower for the MRS markers (AUC: 0.60). These results are in line with preliminary investigations performed by our institute for the comparison of 11C-methionine PET with MRS in preoperative glioma subtyping. CONCLUSIONS FET PET and MRS bear limited potential in glioma subgrouping. However, FET PET appears to be slightly superior. Investigation in a larger cohort is required to draw definite conclusions.

Glycine by MR spectroscopy is an imaging biomarker of glioma aggressiveness.

High-grade gliomas likely remodel the metabolic machinery to meet the increased demands for amino acids and nucleotides during rapid cell proliferation. Glycine, a non-essential amino acid and intermediate of nucleotide biosynthesis, may increase with proliferation. Non-invasive measurement of glycine by magnetic resonance spectroscopy (MRS) was evaluated as an imaging biomarker for assessment of tumor aggressiveness. We measured glycine, 2-hydroxyglutarate (2HG), and other tumor-related metabolites in 35 glioma patients using an MRS sequence tailored for co-detection of glycine and 2HG in gadolinium-enhancing and non-enhancing tumor regions on 3T MRI. Glycine and 2HG concentrations as measured by MRS were correlated with tumor cell proliferation (MIB-1 labeling index), expression of mitochondrial serine hydroxymethyltransferase (SHMT2), and glycine decarboxylase (GLDC) enzymes, and patient overall survival. Elevated glycine was strongly associated with presence of gadolinium enhancement, indicating more rapidly proliferative disease. Glycine concentration was positively correlated with MIB-1, and levels higher than 2.5 mM showed significant association with shorter patient survival, irrespective of isocitrate dehydrogenase status. Concentration of 2HG did not correlate with MIB-1 index. A high glycine/2HG concentration ratio, >2.5, was strongly associated with shorter survival (P < 0.0001). GLDC and SHMT2 expression were detectable in all tumors with glycine concentration, demonstrating an inverse correlation with GLDC. The data suggest that aggressive gliomas reprogram glycine-mediated one-carbon metabolism to meet the biosynthetic demands for rapid cell proliferation. MRS evaluation of glycine provides a non-invasive metabolic imaging biomarker that is predictive of tumor progression and clinical outcome. 1. Glycine and 2-hydroxyglutarate in glioma patients are precisely co-detected using MRS at 3T.2. Tumors with elevated glycine proliferate and progress rapidly.3. A high glycine/2HG ratio is predictive of shortened patient survival.

Role of Magnetic Resonance Spectroscopy in the Evaluation of Ring Enhancing Lesions of the Brain

Introduction: The ring enhancing lesions of the brain are a challenging group of lesions with the variable possibilities of diagnosis under conventional Magnetic Resonance Imaging (MRI). Employing advanced techniques such as Magnetic Resonance Spectroscopy (MRS) could increase the success rates of the diagnosis. Aim: To assess the role of MRS in evaluating varying ring enhancing lesions of the brain. Materials and Methods: This prospective observational study involved 50 patients aged between 3-82 years who were detected with ring enhancing lesions of the brain on contrast MR studies. The patients underwent MRS evaluation. Categorical data was represented as frequency (%). The metabolite peaks of choline, lipid, lactate, N-Acetyl Aspartate (NAA), succinate and amino acids were recorded. The choline/creatine ratio was calculated and associated with the type of lesion the patients exhibited. Results: Among the 50 patients screened, the most prevalent pathologies were tuberculoma (36%) and neurocysticercosis (22%). While the patients diagnosed with tuberculoma presented with higher peak level of lipids and choline/creatine ratio of &gt;1-2. Increased lactate, succinate, choline peak concomitant with no or insignificant lipid peak, were noted in the cases of neurocysticercosis. Primary brain tumour showed high choline peaks and elevated choline/creatine ratio (&gt;2). Metastasis showed increased choline peak. Cerebral abscess showed increased amino acids and lactate peak. Conclusion: The diagnosis of varying ring enhancing lesions of the brain was accurately investigated by MRS. This accuracy enables delineating a treatment plan void of any dilemma.

Multi‑organ assessment via a 9.4‑Tesla MRS evaluation of metabolites during the embryonic development of cleft palate induced by dexamethasone.

The aim of the present study was to determine the association between maternal metabolism and development of the fetal palate, and to suggest a potential non-invasive prenatal diagnostic method for fetal cleft palate (CP). Dexamethasone (DXM) was used to create a CP mouse model. A 9.4-Tesla (T) magnetic resonance spectroscopy (MRS) imager was used to measure an array of metabolites in the maternal serum, placental tissue, amniotic fluid and fetal palates. Multivariate statistical analysis was performed using SIMCA-P 14.1 software. Following DXM treatment, variations were detected in multiple metabolites in the female mice and their fetuses based on 9.4T MRS. It was indicated that in the experimental group during CP formation, leucine, valine, creatine, acetate and citrate levels in the palatal tissue were lower, whereas lactate, alanine, proline/inositol and glutamate-containing metabolite levels were higher, compared with the levels in the control group. In placental tissue and amniotic fluid, succinate and choline levels were lower in the experimental group. The relative concentrations of cholesterol and lipids in palatal tissues from mice treated with DXM were higher compared with the concentrations in tissues from mice in the control group, with the exception of (CH2)n lipids. In the placental tissue, the alteration in cholesterol level exhibited the opposite trend. Lipid levels for the different lipid forms varied and most of them were unsaturated lipids.

Phosphorus (P) magnetic resonance spectroscopy for evaluation of brain tissue metabolism and measuring non-invasive pH. A study involving 23 volunteers. Part I

Evaluation of brain metabolism is an important part in examination of brain lesions. Phosphorus magnetic resonance spectroscopy opens up great opportunities for studying the energy metabolism and allows noninvasive examination of metabolic processes occurring both in healthy and in pathologic brain tissue by obtaining a spectrum of phosphorus-containing metabolites involved in the turnover of cell membrane phospholipids. The technique presented in this paper was used to conduct 31P MR spectroscopy and to estimate the ratio between the peaks of the main metabolites and intracellular pH of the healthy brain tissue of 23 volunteers in the age group under 30 years old in clinical settings. Based on the recorded stable phosphorus spectra of metabolites of the healthy brain tissue, the value of intracellular pH (6.963±0.044) and the ratio of the main PME/PDE peaks (1.17±0.20) were calculated. The database was created to subsequently analyze the metabolic changes in brain tissue spectra in norm and in pathology, as well as the intracellular pH variations that have diagnostic and prognostic value.

Role of magnetic resonance spectroscopy in evaluation of intracranial malignancies

Role of magnetic resonance spectroscopy in evaluation of intracranial malignancies

Role of magnetic resonance spectroscopy in evaluation of breast masses

Background Early detection followed by appropriate treatment is currently the most effective strategy to reduce breast cancer mortality. New techniques must provide more precise evaluation of the indeterminate lesions. Magnetic resonance spectroscopy (MRS) is one of the available new techniques on MRI. It represents a noninvasive and nonionizing method of characterizing a user-selected volume of tissue based on the metabolic (chemical) content. Aim The aim was to assess the role of in-vivo proton MRS in diagnosis, characterization, and differentiation between benign and malignant breast masses. Patients and methods In this study, 40 female patients were examined by MRI using the multiphase dynamic sequence and proton MRS using magnets of intensity field 1.5 Tesla systems. Single-voxel technique after adequate shimming was used. Results Thirty (62.5%) cases were malignant (based on the presence of high choline peak in the spectrum) and 18 (37.5%) cases were benign (no choline peak). MRS has increased the specificity of dynamic MRI for diagnosis of probable lesion from 76.5 to 94.1%. False-positive results were found in one case, and false-negative results were found in two cases. Conclusion In-vivo proton MRS is a powerful method for characterizing indeterminate breast lesions based on the presence of a high choline peak in the spectrum.

The effects of transcranial direct current stimulation on metabolite changes at the anterior cingulate cortex in neuropathic pain: a pilot study.

BackgroundNeuropathic pain (NP) in individuals with spinal cord injury (SCI) is both common and highly refractory to treatment. Primary motor cortex stimulation can relieve pain by interrupting the transmission of noxious information of descending pain modulatory systems including the anterior cingulate cortex (ACC). Previous research has shown that transcranial direct current stimulation (tDCS) can produce pain relief in individuals with NP. However, the underlying mechanisms for these effects are not yet understood. Research findings suggest the possibility that changes in brain metabolite concentrations produced by tDCS might explain some of these effects. For example, previous research has shown that SCI-related NP is associated with elevated levels of glutamine combined glutamate (Glx) per creatine (Glx/Cr). In addition, decreased N-acetylaspartate (NAA) has been observed in the ACC in individuals with chronic pain.MethodsWe used magnetic resonance spectroscopy (MRS) to study changes in NAA and Glx levels in the ACC after tDCS treatment. Ten patients with SCI with NP were given five daily anodal tDCS sessions, and an MRS evaluation was performed before and after treatment.ResultsThe results showed treatment-related reductions in pain, and increases in both Glx/Cr and NAA/Cr in the ACC. The observed increase in NAA/Cr is consistent with the possibility that tDCS improves the descending pain modulation system by increasing the neuronal activity in the ACC.ConclusionThe findings suggest the possibility that tDCS’s beneficial effects on neuropathic pain may be due, at least in part, to the changes it produces in Glx/Cr and NAA/Cr levels in the ACC. Additional research with larger samples sizes and a control group to evaluate this possibility is warranted.

Comparison of Single Voxel and Multi Voxel Magnetic Resonance Spectroscopy in Evaluation of Brain Tumors

Comparison of Single Voxel and Multi Voxel Magnetic Resonance Spectroscopy in Evaluation of Brain Tumors

Magnetic Resonance Spectroscopy in Evaluation of Multiple Sclerosis

MS is a diffuse immune-mediated inflammatory disease that evolves over time; it’s characterized by the presence of CNS lesions disseminated in space and time. Plaques of inflammatory demyelination within the CNS are the pathologic hallmark of MS. 1H-MRS is a noninvasive imaging technique that’s promising as diagnostic technique for MS as well as a good marked for immune-modularity therapy response and as a predictor for clinical disability in MS. Aim of the Study: To highlight the value of MR spectroscopy in evaluation & monitoring patients with multiple sclerosis and how MR spectroscopy can add valuable information to conventional MR.

Magnetic resonance spectroscopy in evaluation of cerebral chemical changes in fibromyalgia patients

Fibromyalgia (FM) is a clinical syndrome defined by the presence of chronic widespread musculoskeletal pain and the presence of at least 11 of 18 body tender points and these features are often accompanied by other symptoms such as fatigue, poor sleep quality, loss of memory, and mood disturbance. The aim of this work was to investigate the role of magnetic resonance spectroscopy (MRS) to detect the differences in cerebral chemical changes between FM patients and control participants. Thirty patients with primary FM (27 females and three males) were selected from the outpatient clinic of the Department of Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University Hospitals. Patients with primary FM fulfill the American College of Rheumatology criteria for diagnosis of FM. Ten persons were needed as healthy control participants with the same age and sex as the included patients. 1H-MRS unit was used to assess N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), and their ratios from both hippocampi. Our results showed the following: there was a significant difference in the level of l-hippocampal (NAA) and right hippocampus Cho and the levels of hippocampal glutamate/glutamine (Glx) in the patient group compared with the control group. There is a highly significant difference between the level of Rt and Lt hippocampal Glx in the same patient, highly significant difference in the level of Rt and Lt hippocampal NAA/Cr, NAA/ Cho, and left hippocampal Cho/Cr ratios between cases and controls, and there was a negative correlation between the number of tender points and the level of Lt hippocampal Cr. Moreover, there was a significant difference between the number of tender points and the level of Rt hippocampal NAA and Lt hippocampal Ch/Cr ratios, highly significant difference between the level of Rt hippocampal NAA/Cho, NAA/Cr, and Lt NAA/Cr and number of tender points, and a highly significant difference between the level of Rt hippocampal NAA/Cho, Rt NAA/Cr, Lt NAA/Cr, and number of tender points (P < 0.001). There was a highly significant difference between the level of Rt hippocampal NAA/Cho, Lt hippocampal NAA/Cr, and visual analogue scale, and there was a significant difference between the level of Rt hippocampal NAA/Cho, Lt hippocampal NAA/Cr, and fibromyalgia impact questionnaire. These findings outline the possible nature of FM as a systemic disorder that is mainly expressed through sensorineural dysfunction and abnormal neuroendocrine stress responses.

Deficient Purposeful Use of Forepaws in Female Mice Modelling Rett Syndrome.

Rett syndrome (RTT) is a rare neurodevelopmental disorder, characterized by severe behavioural and physiological symptoms. Mutations in the methyl CpG binding protein 2 gene (MECP2) cause more than 95% of classic cases. Motor abnormalities represent a significant part of the spectrum of RTT symptoms. In the present study we investigated motor coordination and fine motor skill domains in MeCP2-308 female mice, a validated RTT model. This was complemented by the in vivo magnetic resonance spectroscopy (MRS) analysis of metabolic profile in behaviourally relevant brain areas. MeCP2-308 heterozygous female mice (Het, 10-12 months of age) were impaired in tasks validated for the assessment of purposeful and coordinated forepaw use (Morag test and Capellini handling task). A fine-grain analysis of spontaneous behaviour in the home-cage also revealed an abnormal handling pattern when interacting with the nesting material, reduced motivation to explore the environment, and increased time devoted to feeding in Het mice. The brain MRS evaluation highlighted decreased levels of bioenergetic metabolites in the striatal area in Het mice compared to controls. Present results confirm behavioural and brain alterations previously reported in MeCP2-308 males and identify novel endpoints on which the efficacy of innovative therapeutic strategies for RTT may be tested.

Hemiplegia post-stroke consequences on bone microarchitecture: 3D micro-tomography and magnetic resonance spectroscopy evaluation. Pilot, prospective, single-center study

Hemiplegia post-stroke consequences on bone microarchitecture: 3D micro-tomography and magnetic resonance spectroscopy evaluation. Pilot, prospective, single-center study

Early response to chemotherapy as an indicator for the management of germinoma-like tumors of the pineal and/or suprasellar regions

Recent advances in diagnostic imaging and experience with germinomas may allow for the differentiation of central nervous system germinomas from other tumors based on clinical information, without histological verification. We retrospectively analyzed clinically diagnosed germinoma-like tumors of the pineal and/or suprasellar regions. This was done to evaluate the efficacy of our strategy of defining germinoma-compatible tumors based on good responses to initial chemotherapy. The responses to chemotherapy and survival of 34 consecutive patients with germinoma-like tumors who underwent initial treatment from July 2001 to October 2010 were analyzed. The minimum apparent diffusion coefficient (minADC) value and proton magnetic resonance spectroscopy (MRS) were evaluated in recent patients. Twelve patients with histologically verified germinomas and 18 with germinoma-compatible tumors showed early logarithmic decreases in tumor volume in response to initial chemotherapy, typical low minADC values and typical MRS characteristics, including increased choline/creatine ratios, decreased N-acetylasparate/creatine ratios, and large lipid peaks. These patients had good progression-free survival. The other four patients, with histologically verified non-germinomas, showed no response to chemotherapy, and one patient with a pineoblastoma showed a similar minADC value and MRS characteristics to those of patients with germinomas. The response to initial chemotherapy can be used to distinguish germinoma-compatible tumors from non-germinoma in patients with germinoma-like tumors of the pineal and/or suprasellar regions. The evaluation of minADC and proton MRS are useful for distinguishing germinomas from other tumors. However, a subset of non-germinomas may show similar characteristics to germinomas. The benefit of bypassing unnecessary surgical intervention can be achieved, at least in Asian populations with a high incidence of germinomas.