Does MR spectroscopy of normal-appearing cervical spinal cord in patients with multiple sclerosis have diagnostic value in assessing disease progression? A prospective comparative analysis.

AIM: To clarify the role of magnetic resonance spectroscopy (MRS) in examining the normal-appearing cervical spinal cord of patients with multiple sclerosis (MS) to detect metabolite abnormalities in this disease and to assess its progression.

MATERIAL AND METHODS: Thirty-six patients with MS and 30 healthy controls were enrolled. Each patient was submitted to MRS performed using a 1.5 T magnetic resonance imaging (MRI) scanner. The spectra of total N-acetyl-aspartate (tNAA), choline (Cho), creatine (Cr), and myoinositol (M-Ins), as well as the metabolite ratios of tNAA/Cr, tNAA/Cho, Cho/Cr, and M-Ins/Cr of the two groups were measured and compared. The correlations between the metabolite concentrations, disease duration, and clinical disability (expanded disability status scale, EDSS) were further explored.

RESULTS: Significantly lower tNAA and higher M-Ins were observed in MS patients than in health controls. The tNAA/Cr and tNAA/Cho ratios were significantly lower in MS patients than in healthy controls. In MS patients, the EDSS was correlated with the tNAA/Cr ratio. The spinal cord cross-sectional area was significantly smaller in MS patients than in healthy controls.

CONCLUSION: Reduced tNAA and increased M-Ins are important, sensitive indices for differentiating between MS patients and healthy controls. In MS patients, before lesions appear, MRS of the spinal cord may provide crucial information for assessing disease progression.