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Articles

¹H-MRS Differentiates White Matter Hyperintensities in Subcortical Arteriosclerotic Encephalopathy From Those in Normal Elderly

Presented in part at the American Academy of Neurology meeting, May 1992 (Neurology. 1992;42:397); the XVth World Congress Neurology, Vancouver, Canada, 1993; and the 3rd Scientific Meeting of the Society of Magnetic Resonance, Nice, France, 1995.

William M. Brooks, PhD; Mary H. Wesley, RN; Piyadasa W. Kodituwakku, PhD; Philip J. Garry, PhD; Gary A. Rosenberg, MD

From the The Center for Non-Invasive Diagnosis (W.M.B.), and Departments of Cell Biology (W.M.B.), Neurology (M.H.W., G.A.R.), Psychiatry (P.W.K.), and Pathology (P.J.G.), University of New Mexico School of Medicine, and Neurology Services (G.A.R.), Veterans Affairs Medical Center, Albuquerque, NM.

Correspondence and reprint requests to William Brooks, PhD, Center for Non-Invasive Diagnosis, University of New Mexico, 1201 Yale NE, Albuquerque, NM 87131. E-mail brooks{at}lizard.unm.edu

Background and Purpose White matter hyperintensities in MRI of the brain are often seen in normal elderly subjects. Radiologically, these hyperintense regions are similar to those in symptomatic patients with subcortical arteriosclerotic encephalopathy (SAE). Our aim was to discriminate white matter hyperintensities (WMH) on MRI in patients with SAE from similar appearing changes in normal elderly.

Methods Three groups of elderly patients were studied: symptomatic patients with WMH of SAE (n=5); asymptomatic subjects with diffuse, confluent WMH (n=4); and elderly control subjects (n=5). Proton density images revealed WMH in the occipital lobes. Proton magnetic resonance spectroscopy (¹H-MRS) was used to acquire spectra in these hyperintensities. Metabolite concentrations were calculated from peak areas of N-acetylaspartate (NAA), creatine (Cre), and choline (Cho).

Results The NAA/Cre and NAA/Cho ratios were reduced in the SAE group compared with the two asymptomatic groups (P<.05). NAA was decreased and Cho elevated in SAE compared with control subjects (P<.05). The average volumes of WMH in the SAE group (65.5 cm³) and in asymptomatic control subjects (59.4 cm³) were similar, and greater than those of the normal control group (4.0 cm³).

Conclusions Proton MRS discriminates WMH in SAE patients from those in asymptomatic elderly, suggesting differing causes of the hyperintensities.

Key Words: leukoencephalopathy • Binswanger's disease • aging • spectroscopy, nuclear magnetic resonance • subcortical arteriosclerotic encephalopathy

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