Abstract
Twenty children older than 2 y infected with human immunodeficiency virus (HIV) were examined by in vivo proton magnetic resonance spectroscopy (1H MRS) to study their cerebral metabolism and to identify metabolic profiles in relation with different stages of the disease. Patients were rated regarding their clinical and immunologic status according to the Centers for Disease Control classification and were divided into two groups: without encephalopathy (E-, n = 15) and with progressive encephalopathy (E+, n = 5). The acquisition was performed in the centrum semiovale using the short echo stimulated echo acquisition mode 20-ms sequence. The MRS profile was abnormal in all HIV-infected children compared with healthy age-matched controls (n = 7), even when magnetic resonance images were normal. A significant increase of the proportion of the lipid signals (ANOVA, p < 0.05) was found in all HIV-infected children. In addition, a significant decrease of the proportion of the N-acetylaspartate signal and a significant increase of the proportion of the myo-inositol signal (ANOVA, p < 0.05) characterized the E+ group. The principal component analysis performed on eight variables on 30 spectra confirms that the spectra of HIV-infected children differ from control spectra. The E+ group and the E- group are clearly separated on the map of subjects on the principal plane. The E- group lies in an intermediate position between the E+ group and the control group. The evolution of metabolic alterations in the brain of HIV-infected children can clearly be monitored by 1H MRS and associated with the occurrence of an encephalopathy.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
Abbreviations
- Cho:
-
choline-containing compounds
- Cr-PCr:
-
creatine/phosphocreatine
- E-:
-
without encephalopathy
- E+:
-
with progressive encephalopathy
- Glx:
-
glutamate-glutamine
- 1H MRS:
-
proton magnetic resonance spectroscopy
- Ins:
-
myo-inositol
- Lip:
-
lipids and/or proteins
- MR:
-
magnetic resonance
- MRI:
-
magnetic resonance imaging
- Mi:
-
metabolite of interest
- NAA:
-
N-acetylaspartate
- PCA:
-
principal component analysis
- S:
-
sum of signals of low molecular weight metabolites
- STEAM:
-
stimulated echo acquisition mode
- Tau:
-
taurine and/or scyllo-inositol
- TE:
-
echo time
- TR:
-
repetition time
References
Mintz M 1994 Clinical comparison of adult and pediatric neuroAIDS. Adv Neuroimmunol 4: 207–221
Lobato MN, Caldwell MB, Ng P, Oxtoby MJ 1995 The pediatric spectrum of disease clinical consortium. Encephalopathy in children with perinatally acquired human immunodeficiency virus infection. J Pediatr 126: 710–715
Burns DK 1992 The neuropathology of pediatric acquired immunodeficiency syndrome. J Child Neurol 7: 332–346
Ross B, Kreis R, Ernst T 1992 Clinical tools for the 90s: magnetic resonance spectroscopy and metabolite imaging. Eur J Radiol 14: 128–140
Vion-Dury J, Meyerhoff DJ, Cozzone PJ, Weiner MW 1994 What might be the impact on neurology of the analysis of brain metabolism by in vivo magnetic resonance spectroscopy? J Neurol 241: 354–371
Chong WK, Sweeney B, Wilkinson ID, Paley M, Hall-Craggs MA, Kendall BE, Shepard JK, Beecham M, Miller RF, Weller IVD, Newman SP, Harrison MJG 1993 Proton spectroscopy of the brain in AIDS infection: correlation with clinical, immunologic and MR imaging findings. Radiology 188: 119–124
Meyerhoff DJ, McKay S, Bachman L, Poole N, Dillon WP, Weiner MW, Fein G 1993 Reduced brain N-acetylaspartate suggests neuronal loss in cognitively impaired human immunodeficiency virus-seropositive individuals. In vivo1H magnetic resonance spectroscopic imaging. Neurology 43: 509–515
Vion-Dury J, Confort-Gouny S, Nicoli F, Dhiver C, Gastaut JA, Gastaut JL, Cozzone PJ 1994 Localized brain proton MRS metabolic patterns in AIDS-related encephalopathies. CR Acad Sci (Paris) 317: 833–840
Chang L, Miller BL, McBride D, Cornford M, Oropilla G, Buchtal S, Chiang F, Aronow H, Ersnt T 1995 Brain lesions in patients with AIDS: 1H MR spectroscopy. Radiology 197: 525–531
Paley M, Cozzone PJ, Alonso J, Vion-Dury J, Confort-Gouny S, Wilkinson ID, Chong WK, Hall-Craggs M, Harrison MJG, Gili J, Rovira A, Cappellades J, Rio J, Ocana I, Nicoli F, Dhiver C, Gastaut JL, Gastaut JA, Wicklow K, Sauter R 1996 A multicenter proton magnetic resonance spectroscopy study of neurological complications of AIDS. AIDS Res Hum Retroviruses 12: 213–222
Salvan AM, Vion-Dury J, Confort-Gouny S, Nicoli F, Lamoureux S, Cozzone PJ 1997 Brain proton MR spectroscopy in HIV-related encephalopathy. Identification of evolving metabolic patterns in relation to dementia and therapy. AIDS Res Hum Retroviruses 13: 1055–1066
Salvan AM, Vion-Dury J, Confort-Gouny S, Nicoli F, Lamoureux S, Cozzone PJ 1997 Cerebral metabolic alterations in HIV-related encephalopathy detected by brain proton MR spectroscopy: comparison between sequences using short and long echo times. Invest Radiol 32: 485–495
Pavlakis SG, Lu D, Frank Y, Bakshi S, Pahwa S, Barnett TA, Porricolo ME, Gould RJ, Nozyce ML, Hyman RA 1995 Magnetic resonance spectroscopy in childhood AIDS encephalopathy. Pediatr Neurol 12: 277–282
Dongfeng L, Pavlakis SG, Frank Y, Bakshi S, Pahwa S, Gould RJ, Sison C, Hsu C, Lesser M, Hoberman M, Barnett T, Hyman RA 1996 Proton MR spectroscopy of the basal ganglia in healthy children and children with AIDS. Radiology 199: 423–428
Vion-Dury J, Nicoli F, Salvan AM, Confort-Gouny S, Lamoureux S, Dhiver C, Gastaut JA, Gastaut JL, Michel G, Cozzone PJ 1996 >Why do clinicians effectively need localized brain proton MRS in HIV related encephalopathies? In: Podo F, Bovée WMMJ, De Certaines JD, Henriksen O, Leach MO, Leibfritz D (eds) Eurospin Annual 1995-1996. Instituto Superiore di Sanita, Roma, Italy, pp 369–385
Van der Knaap MS, Valk J 1995 Magnetic Resonance of Myelin, Myelination, and Myelin Disorders. Springer, Berlin, pp 445–456.
Centers for Disease Control and Prevention 1994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR 43: 1–10
Frahm J, Bruhn H, Gyngell ML, Merboldt KD, Hänicke W, Sauter R 1989 Localized high-resolution proton NMR spectroscopy using stimulated echoes: initial application to human brain in vivo. Magn Reson Med 9: 79–93
Yongbi NM, Payne GS, Collins DJ, Leach MO 1995 Quantification of signal selection efficiency, extra volume suppression and contamination for ISI, STEAM and PRESS localized 1H NMR spectroscopy using an EEC localization test object. Phys Med Biol 40: 1293–1303
Michaelis T, Merboldt KD, Hänicke W, Gyngell ML, Bruhn H, Frahm J 1991 On the identification of cerebral metabolites in localized 1H NMR spectra of human brain in vivo. NMR Biomed 4: 90–98
Alger JR, Symko SC, Bizzi A, Posse S, DesPres DJ, Amstrong MR 1993 Absolute quantitation of short TE brain H1-MR spectra and spectroscopic imaging data. J Comput Assist Tomogr 17: 191–199
Confort-Gouny S, Vion-Dury J, Nicoli F, Dano P, Donnet A, Grazziani N, Gastaut JL, Grisoli F, Cozzone PJ 1993 A multiparametric data analysis showing the potential of localized proton MR spectroscopy of the brain in the metabolic characterization of neurological diseases. J Neurol Sci 118: 123–133
Cleveland S, McGill R 1983 Graphical perception and graphical methods for analyzing scientific data. Science 229: 828–833
Chabrol B, Salvan AM, Confort-Gouny S, Vion-Dury J, Cozzone PJ 1995 Localized proton magnetic resonance spectroscopy differentiates the inborn metabolic encephalopathies in children. CR Acad Sci (Paris) 318: 985–92
Gelbard HA, James HJ, Sharer LR, Perry SW, Saito Y, Kazee AM, Blumberg BM, Epstein LG 1995 Apoptotic neurons in brains from paediatric patients with HIV-1 encephalitis and progressive encephalopathy. Neuropathol Appl Neurobiol 21: 208–217
Brand A, Richter-Landsberg C, Leibfritz D 1993 Multinuclear NMR studies on the energy metabolism of glial and neuronal cells. Dev Neurosci 15: 289–298
Kauppinen RA 1993 1H Nuclear magnetic resonance spectroscopy identifies neural cell types: a promising step for neuroimaging? Trends Neurosci 16: 384–386
Moats RA, Ernst T, Shonk TK, Ross BD 1994 Abnormal cerebral metabolite concentrations in patients with probable Alzheimer disease. Magn Reson Med 32: 110–115
Laubenberger J, Häussinger D, Bayer S, Thielemann S, Schneider B, Mundinger A, Hennig J, Langer M 1996 HIV-related metabolic abnormalities in the brain: depiction with proton MR spectroscopy with short echo times. Radiology 199: 805–810
Tornatore C, Chandra R, Berger JR, Major EO 1994 HIV-1 infection of subcortical astrocytes in the pediatric central nervous system. Neurology 44: 481–487
Author information
Authors and Affiliations
Additional information
Supported by CNRS (UMR 6612), AP-HM (Assistance Publique Hôpitaux de Marseille), the Programme Hospitalier de Recherche Clinique (Ministère de la Santé), the Agence Nationale contre le SIDA (ANRS), and Sidaction (Ensemble Contre le SIDA).
Rights and permissions
About this article
Cite this article
Salvan, AM., Lamoureux, S., Michel, G. et al. Localized Proton Magnetic Resonance Spectroscopy of the Brain in Children Infected with Human Immunodeficiency Virus with and without Encephalopathy. Pediatr Res 44, 755–762 (1998). https://doi.org/10.1203/00006450-199811000-00019
Received:
Accepted:
Issue date:
DOI: https://doi.org/10.1203/00006450-199811000-00019
This article is cited by
-
Case control study: magnetic resonance spectroscopy of brain in HIV infected patients
BMC Neurology (2016)
-
Neuropsychological Function and Cerebral Metabolites in HIV-infected Youth
Journal of Neuroimmune Pharmacology (2012)
-
The Role of Medical Imaging in Defining CNS Abnormalities Associated with HIV-Infection and Opportunistic Infections
Neurotherapeutics (2011)
