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Diffuse central neuronal involvement in Fabry disease

A proton MRS imaging study

From the Neuroimaging Branch (Drs. Tedeschi, Bonavita, and Virta) and Developmental and Metabolic Neurology Branch (Drs. Banerjee and Schiffmann), NINDS, National Institutes of Health, Bethesda, MD.

Address correspondence and reprint requests to Dr. Gioacchino Tedeschi, Institute of Neurological Sciences, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.

BACKGROUND: The in vivo determination of parenchymal involvement is important to evaluate disease burden. Proton MRS imaging (¹H-MRSI) permits simultaneous measurement of N-acetylaspartate (NA), a putative neuron-specific molecule, choline-containing compounds, creatine-phosphocreatine, and lactate from four 15-mm slices divided into 0.84-mL single-volume elements.

OBJECTIVE: To assess the cortical and subcortical neuropathology in Fabry disease (FD).

METHODS: Regions of interest (ROIs) were selected from several cortical and subcortical locations in nine FD patients. Mean ROI metabolite ratios were compared with control values.

RESULTS: FD patients showed a widespread pattern of cortical and subcortical NA reduction. Seven patients showed discrete MRI abnormalities consisting of white matter hyperintensities or basal ganglia infarcts.

CONCLUSION: We found diffuse neuronal involvement in FD extending beyond the areas of MRI-visible cerebrovascular abnormalities. ¹H-MRSI may become useful in therapeutic trials.

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