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Abstract
Background: Magnetic resonance spectroscopy (MRS) is an imaging diagnostic method that allows non-invasive measurement of metabolites in tissues. MRS may demonstrate metabolic changes in normal appearing MRI examinations. Long term impairment of cognitive function can occur in patients with type I diabetes mellitus (DM). Objective: In this study, we used MRS to investigate the impact of DM on brain neuro-chemical profile. Patients & Methods: MR spectroscopic analysis was performed on 12 children diagnosed with type I DM and 12 age-matched volunteer healthy subjects. The duration of the disease, number of diabetic keto-acidosis episodes (DKA), number of hypoglycemic events and the level of hemoglobin A1C (HbA1C) in the patients were noted. Voxels were placed in the right posterior parietal white matter, the occipital gray matter and the right basal ganglia. Single-voxel MRS with intermediate TE (144 ms) was performed in all 3 regions of interest plus short TE (34.5 ms) done only in the right posterior parietal white matter. N-acetylaspartate (NAA)/Creatinine (Cr) and Choline (Cho)/Cr ratios were recorded and compared between diabetic children and control subjects. The ratios collected from the diabetic group were correlated with the clinical data obtained. The presence of a significant lactate peak was also recorded. Results: Type 1 diabetic subjects had lower NAA/Cr ratio in the white matter than control subjects. Longer duration of DM and increased number of DKA episodes predicted lower NAA/Cr ratio. The study also revealed slightly higher Cho/Cr ratios in the gray matter and basal ganglia in diabetic patients. No other significant differences in the metabolite ratios between the diabetic and control groups. Significant lactate peaks were detected in some diabetic patients performing the exam post recovery from DKA. Conclusion: The decrease in NAA indicates reduced neuronal density or neuronal dysfunction as a consequence of long term poorly controlled type 1 DM. The explanation for the increase in Cho may be demyelination/gliosis or increased membrane turnover. The presence of lactate peaks suggest anaerobic metabolism during DKA