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(Stroke. 1999;30:1577-1582.)
© 1999 American Heart Association, Inc.

Original Contributions

Measurement of Initial N-Acetyl Aspartate Concentration by Magnetic Resonance Spectroscopy and Initial Infarct Volume by MRI Predicts Outcome in Patients With Middle Cerebral Artery Territory Infarction

Anthony C. Pereira, MB, BChir; Dawn E. Saunders, MD; Victoria L. Doyle, PhD; J. Martin Bland, PhD; Franklyn A. Howe, DPhil; John R. Griffiths, DPhil Martin M. Brown, MD

From the Division of Clinical Neuroscience (A.C.P.), CRC Biomedical Magnetic Resonance Research Group (V.L.D., F.A.H., J.R.G.), and Department of Public Health Medicine (J.M.B.), St George's Hospital Medical School; Department of Radiology (D.E.S.), King's College Hospital; and Institute of Neurology, University College (M.M.B.), London, UK.

Correspondence to Dr Anthony C. Pereira, c/o Prof Martin Brown, Institute of Neurology, Queen Square, London, WC1N 3BG, England. E-mail m.brown{at}ion.ucl.ac.uk

Background and Purpose—¹H MR spectroscopy can be used to study biochemical changes occurring in the brain in stroke. We used it to examine the relationship between metabolite concentration (N-acetyl aspartate [NAA], lactate, cholines and creatines), size of infarct, clinical deficit, and 3-month clinical outcome in patients with middle cerebral artery (MCA) territory infarction.

Methods—Thirty-one patients with acute MCA territory infarction were recruited within 72 hours of the onset of symptoms. Single-voxel short echo time stimulated echo acquistion mode spectroscopy was used to obtain metabolite data from the infarct core. Metabolite concentrations were determined with use of variable projection time domain-fitting analysis. Infarct size was determined with T2-weighted images. Patient outcome groups at 3 months were "independent," "dependent," or "dead."

Results—All patients (100%; 95% CI 75% to 100%) who had an infarct >70 mL did poorly. Eighteen of 20 patients (90%; 95% CI 68% to 99%) with a core NAA concentration <7 mmol/L did poorly at 3 months, whereas 7 of 11 patients (64%; 95% CI 31% to 89%) with an initial NAA concentration >7 mmol/L did well. Combining these results showed that all patients who had an initial infarct volume >70 mL did poorly, irrespective of the NAA concentration. Of those patients with infarcts <70 mL, those who had a core NAA concentration >7 mmol/L did well (88%; 95% CI 47% to 100%), whereas those with a lower NAA concentration did poorly (80%; 95% CI 44% to 97%). There was no association between other metabolite concentrations and outcome.

Conclusions—Infarct volume and NAA concentration can together predict clinical outcome in MCA infarction in humans.

Key Words: human • outcome • spectroscopy, nuclear magnetic resonance • stroke

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