Mesial Prefrontal Cortex Degeneration in Amyotrophic Lateral Sclerosis: A High-Field Proton MR Spectroscopy Study

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Figure.
Sagittal (A) and coronal (B) gradient-weighted MR images demonstrate voxel placement in the mesial prefrontal cortex. Representative spectra (C, gray lines) and LCModel fit (C, dark lines) with peaks identified for mIns and NAA are shown for a control subject (left) and patient with ALS (right); note the increased mIns and decreased NAA in the patient with ALS compared with the control subject.

Table 1:

Spectroscopy results for all patients

Metabolite	Controls	Patients	Difference in Patients vs Controls (%)	P Value
Metabolite	(n=15)	(n=24)	Difference in Patients vs Controls (%)	P Value
NAA/mIns	1.95 ± 0.27	1.62 ± 0.31	−17	.002
NAA (mmol/L)	9.82 ± 1.76	8.92 ± 1.29	−9	.08
mIns (mmol/L)	5.06 ± 0.76	5.63 ± 0.96	+11	.06

Table 2:

Spectroscopy results

Metabolite	Controls (n = 15)	ALS-All (n = 24)	El Escorial Criteria			ALS-FTD (n = 2)
Metabolite	Controls (n = 15)	ALS-All (n = 24)	Possible (n = 5)	Probable (n = 15)	Definite (n = 4)	ALS-FTD (n = 2)
NAA/mIns	1.95 ± 0.27	1.62 ± 0.31	1.65 ± 0.23	1.63 ± 0.37	1.53 ± 0.10	1.10 ± 0.19
NAA (mmol/L)	9.82 ± 1.76	8.92 ± 1.29	9.22 ± 0.65	8.77 ± 1.36	9.14 ± 1.80	7.02 ± 2.02
mIns (mmol/L)	5.06 ± 0.76	5.63 ± 0.96	5.67 ± 0.89	5.06 ± 0.75	5.99 ± 1.14	6.34 ± 0.71

Note:—Spectroscopy quantities are mean ± SD. Patients are categorized according to disease stage by El Escorial Criteria or presence of dementia (ALS-FTD).