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Table 1 Magnetic resonance spectroscopy in our patient at relapse (28 days post insult) and at follow-up (217 days post insult) compared to normal control values

From: Cerebral proton magnetic resonance spectroscopy demonstrates reversibility of N-acetylaspartate/creatine in gray matter after delayed encephalopathy due to carbon monoxide intoxication: a case report

 

NAA/Cr

Cho/Cr

mI/Cr

Lac/Cr

WM relapse

−49% (−6.9 SD)

ns***

+21% (+2.6 SD)

+698% (+12.4SD)

WM follow-up

−17% (−2.3 SD)

+22% (+2.3 SD)

+38% (+4.6 SD)

ns

GM relapse

−37% (−4.4 SD)

ns

ns

+141% (+3.5 SD)

GM follow-up

ns

ns

ns

ns

CSO * relapse

−59% (−7.7 SD)

+73% (+7.8 SD)

+77% (+9.4 SD)

+918% (+16.3 SD)

CSO * follow-up

−29% (−3.8 SD)

+40% (+4.2 SD)

+55% (+6.8 SD)

ns**

  1. WM, occipito-parietal white matter; GM, mid-occipital gray matter; CSO, centrum semiovale; NAA, N-acetylaspartate; Cr, total creatine; Cho total choline; mI myo-inositol; Lac, lactate; ns, not significant; SD, standard deviation. The metabolite ratios were calculated and compared to results in healthy subjects. The values reported are listed as deviations in percent from normal along with the corresponding SDs. The values were obtained using LCModel, and only values with Cramer-Rao lower bound (CRLB) less than 20 percent were considered. When CRLB was larger than 20 percent or the ratios were less than ±2 SD from normal, ‘ns’ was noted. The GM and WM ratios were compared to values from the same volumes of interest in a group of 17 normal controls used in the clinic for adult MRS patients.
  2. *Exact control values were not available for CSO. The results provided for CSO were calculated as the best approximation using the WM control values. Metabolite ratios in CSO and WM differ probably less than 10 percent, but by the same factor for the two MRS examinations before and after recovery, so the dramatic recovery overshadows this approximation; **in CSO at follow-up Lac/Cr is assigned the value, ‘ns’, because CRLB was 21 percent, if included the Lac/Cr ratio is 172 percent increased corresponding to 3 SD consistent with the visual detection of Lac in Figure 1; ***the Cho/Cr in WM at relapse is elevated based on a visual inspection, but the analytical evaluation based on the LCModel fit resulted in only 11 percent (+1.1 SD) elevated Cho/Cr: not significant. An inspection of the LCModel fit reveals that a shoulder of the left-hand side of Cho is not well accounted for by the fit. The LCModel fit accounts for glycerophosphocholine and phosphocholine. In this case yet another Cho-containing compound with a slightly different chemical shift may have been present at relapse causing the poorer fit of total choline. A similar shoulder was seen in the WM of CSO at relapse.