alexa 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.
Physicaltherapy & Rehabilitation

Physicaltherapy & Rehabilitation

International Journal of Physical Medicine & Rehabilitation

Author(s): Pereira AC, Saunders DE, Doyle VL, Bland JM, Howe FA,

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Abstract BACKGROUND AND PURPOSE: (1)H 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.
This article was published in Stroke and referenced in International Journal of Physical Medicine & Rehabilitation

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