The Evaluation of Leukoaraiosis Etiopathogenesis with MR-Spectroscopy

Abstract

OBJECTIVE: Leukoaraiosis (LA), is a radiological finding with bilateral, either patchy or diffuse areas of the cerebral white matter.We aimed to determine proton MRS findings of LA and compare to those with chronic ischemic infarcts and control subjects, in order to understand the metabolic changes in LA.

METHODS: We compared 25 patients with LA, 10 patients with chronic ischemic infarct and 9 control subjects without LA. Ratios for n-acetyl aspartate (NAA)/creatine (Cr) and myoinositol (MI)/Cr were obtained from leukoaraiotic area, chronic ischemic infarct and normal white matter. For the cognitive impairment Minimental Status Examination (MMSE) was applied to all individuals.

RESULTS: Between LA and normal white matter, NAA/Cr values were shown no statistically significant difference. MI/Cr value of LA was significantly increased when compared with normal white matter (0.72±0.22 to 0.59±0.15; p<0.0001). NAA/Cr value of chronic ischemic infarct was significantly reduced when compared with both normal white matter (0.68±0.64 to 1.47±0.11; p<0.01) and leukoaraiotic area (0.68±0.64 to 1.70±0.28; p<0.01). MMSE scores of leukoaraiotic patients were significantly decreased when compared with control subjects (p<0.01).

CONCLUSION: Nonsignificant changes in NAA concentrations and high MI values of LA, indicate that gliosis is the major pathological finding. Because of the risk factors that disturbing arterioler structure in LA, altered cerebral blood flow autoregulation seems to contribute to develop gliosis before neuronal or axonal loss.