Published Online
on July 10, 2008

A more recent version of this article appeared on September 1, 2008

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Submitted on October 12, 2007
Revised on January 4, 2008
Accepted on January 30, 2008

Choline and Creatine Are Not Reliable Denominators for Calculating Metabolite Ratios in Acute Ischemic Stroke

Susana Muñoz Maniega PhD^*; Vera Cvoro MD; Paul A. Armitage PhD; Ian Marshall PhD; Mark E. Bastin DPhil; and Joanna M. Wardlaw MD

From Clinical Neurosciences (S.M.M., V.C., P.A.A., J.M.W.), and Medical Physics (I.M., M.E.B.), University of Edinburgh, Western General Hospital, Edinburgh, UK.

^* To whom correspondence should be addressed. E-mail: s.m.maniega{at}ed.ac.uk.

Background and Purpose—Choline and creatine are commonly used as denominators for other metabolites in ischemic stroke spectroscopy, assuming that they do not change. We investigated their concentration variation over time after stroke.

Methods—Choline and creatine concentrations were measured by proton MR spectroscopic imaging in 51 patients at 5 times up to 3 months after stroke.

Results—Choline and creatine levels changed significantly in the ischemic region. Choline was significantly reduced during the first 2 weeks after stroke onset (P=0.034). Creatine was significantly reduced during the whole period of the study (P=0.011).

Conclusion—Choline and creatine concentrations are not reliable denominators for metabolite ratios in acute stroke because their levels vary significantly in ischemic brain regions.

Key words: acute ischemic stroke • MR spectroscopy • metabolic ratios

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