Normal appearing white matter metabolite pattern and sex differences in multiple sclerosis patients compared to healthy controls

Abstract

Introduction: Proton magnetic resonance spectroscopy (PrMRS) detects changes in brain metabolite levels in vivo. Aim: The aim of the present study was to evaluate the brain metabolites choline ((Cho), creatine (Cr), and N-acetyl aspartate (NAA) in lesion free normal appearing white matter (NAWM) in patients with relapsing-remitting multiple sclerosis (RRMS) versus healthy controls. The second aim was to explore the impact of sex on brain metabolite changes. Materials and methods: Fifty RRMS patients received PrMRS evaluation of their brain NAWM regions. The results were compared with the findings in 28 healthy demographically matched controls. Results: We found elevated levels of Cho, Cr, and NAA in NAWM of MS patients in comparison with healthy controls. The NAA/Cr and Cr/NAA ratios were collated. A statistically significant difference between both groups was found only for NAA/Cr and Cr/NAA ratios. It is due to metabolite changes in the female MS patients. Conclusions: The results of the present study using PrMRS proved metabolic changes in NAWM. Accompanying pathological process should be assumed, preceding plaques of demyelination. The gender impact needs further investigation.