Metabolic changes of prefrontal cerebral lobe,white matter and cerebellum in patients with post-stroke depression A proton magnetic resonance spectroscopy study

摘要

BACKGROUND: Proton magnetic resonance spectroscopy (1H-MRS) non-invasively detects changes in chemical substances in the brain,which reflects the pathological metabolism. OBJECTIVE: To investigate changes in N-acetyl-aspartate (NAA),choline (Cho),creatine (Cr),and myoinositol (MI) in the gray and white matter of cerebral prefrontal lobe and cerebellum of patients with differential degrees of post-stroke depression (PSD) using 1H-MRS. DESIGN: A case control study. SETTING: The First Affiliated Hospital of the Dalian Medical University. PARTICIPANTS: A total of 38 patients with stroke (28 male and 10 female patients,aged 40 to 79 years) were selected from the Department of Neurology,1st Affiliated Hospital,Dalian Medical University,from February to October in 2004. All subjects met the DSM-IV criteria for cerebrovascular disease and depression. The degree of depression was defined according to Hamilton criteria. 38 patients with PSD were divided into two groups according to the time after ischemia,20 patients in the acute group with less than 10 days after ischemic attack (mild: 16 patients,moderate/severe: 4 patients) and 18 patients in the chronic group with more than 11 days after ischemic attack (mild: 15 patients,moderate/severe: 3 patients). Seventeen healthy volunteers with matching age from 41 to 80 years were examined as a control group. The study was approved by the Medical Ethics Committee of the University Medical Center Utrecht,and each participant signed an informed consent form. METHODS: Spectra were acquired by multi-voxel point-resolved spectroscopy (PRESS) sequence with GE signa1.5T MR/i,localized in prefrontal cerebral lobe and cerebellum. Values of NAA,Cho,MI,and Cr ere compared between different graded PSD patients and control subjects with one-way analysis of variance in software SPSS11.5. MAIN OUTCOME MEASURES: Metabolite concentration in different brain regions of interest. Difference in metabolites between distinctly graded PSD patients and control subjects. Exclusion of age-effects on metabolites. RESULTS: Metabolite concentrations of different brain regions: A significant rise in the Cho/Cr ratio was detected in the acute and chronic group compared to the control group. The ratio change was more significant in the acute group (P 0.05). Comparison of metabolite levels among differently graded PSD patients and control subjects: a significant increase in the Cho/Cr ratio was detected in the left frontal white matter compared to the control group (P 0.05),and similarly,there was no significant correlation between age and absolute or relative values in the control group (P > 0.05). CONCLUSION: Abnormalities of frontal lobe in PSD were located in the white matter. There was early abnormality of metabolic substance in PSD.