What is the role of echo-planar imaging in the workup of acute stroke?

Updated: Dec 19, 2018
  • Author: Souvik Sen, MD, MPH, MS, FAHA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

Magnetic resonance spectroscopy (MRS) evaluates metabolic activity and the concentration of certain metabolites in specified areas of the brain. Proton and phosphorus spectroscopic studies have been performed.

In proton spectroscopy, depression of N -acetyl aspartate, which is considered to be a marker of neurons, is the most consistent finding in acute stroke. This depression may occur within hours after the onset of stroke and continues through the subacute and chronic phases of the stroke, presumably because of neuron loss.

An increase in the lactate level is another important finding and has been attributed to anaerobic metabolism in ischemic tissue. Initial studies of other metabolites, such as choline and creatine, have demonstrated decreases in their levels in acute stroke.

Phosphorus spectroscopy provides information about energy metabolism and pH, depletion of ATP, decrease of tissue pH, and increase of the ratio of inorganic phosphate to phosphocreatine, which has been reported in human and animal studies.

Long acquisition times, weak signal, and low spatial resolution associated with this technique have limited enthusiasm for its use in the clinical management of cerebral ischemia; however, some studies have suggested that MRS results can have prognostic value in stroke.


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