Page 51 - GTM-2-3

Global Translational Medicine Deep learning by NMR-biochemical

parameters and demand large data and uniform thresholds to establish the diagnostic accuracy of hybrid MRI
of substantial hepatosteatosis limits. approaches.
6.7. Monitoring hepatocellular carcinoma and liver 6.11. Migraine pathophysiology and identification
cirrhosis development of neuromarkers in migraine
1 H‑MRI+MRS predicted the probability by high Cho, lipid The 1 H-MRS studies suggested many inter-ictal
(Lip) contents, and Cho/Lip ratio on LCModel software to abnormalities in migraine patients with persistent
assess the magnitude of hepatocellular carcinoma (HCC) altered mitochondrial energy loss, neuronal excitability
with secondary chronic hepatitis B and cirrhosis [108] . The indicated by high excitatory glutamate, high inhibitory
author suggests that H-MRS-visible hepatic metabolite GABA neurotransmitter peaks, low NAA levels due
1
levels may monitor both HCC and liver cirrhosis to mitochondrial dysfunction, and abnormal energy
development, but more validation studies are needed. metabolism toward excitatory stimulation or migraine
attack triggers [113] . MRS can be a valuable non-invasive
6.8. Low back pain method to determine migraine attacks, correlate severity,
In vivo MRS in low back pain subjects showed: (i) low and monitor medication efficacy.
NAA concentration in the right primary motor cortex, left
anterior insula, left somatosensory cortex (SSC), anterior 6.12. Adrenoleukodystrophy
cingulate cortex (ACC), and dorsolateral prefrontal cortex Status epilepticus or childhood cALD shows abrupt
(DLPFC) regions; (ii) low glutamate in ACC; (iii) low MI in pathogenic ABCD1 mutation or transiently altered mental
ACC and thalamus; (iv) high choline in the right SSC; and status neurodegeneration in autism with fever, diarrhea,
(v) high glucose in the DLPFC locations [109] . Biochemical seizures, coma, gross motor loss, fine motor loss, and
alteration in low back pain-brain MRS profile correlates poor speech skills. Serial brain MRI/MRS showed elevated
with possible therapy response and the physiochemical lactate peak and CSF protein levels associated with
functions of brain metabolites and pain receptors. The diffused progressive cortex swelling, laminar necrosis,
author notices concerns about the few subjects selected, and restricted diffusion indicative of mitochondrial,
confounding factors, medication effects, and unclear lysosomal, and peroxisomal disorders. Moreover, MRS
biochemical basis of pain-specific metabolite changes. showed elevated very-long-chain fatty acids, lactate peaks,
and high CSF proteins. The acute decline in neurologic
6.9. Juvenile myoclonic epilepsy functions with elevated CSF proteins and lactate and acute
1 H-MRS showed distinct low NAA and NAA/Cr ratio, a rise decline in neurologic NAA/Cr functions by MRS indicates
in Glx/Cr ratio in the insula and striatum to indicate juvenile MRI non-visible white matter abnormalities to predict
myoclonic epilepsy (JME) as multi-region, thalamo-frontal disease progression [114] .
network epilepsy (not idiopathic general epilepsy) [110] . The
frontal cortex and thalamo-cortical pathways indicated low 6.13. Hypoxic-ischemic encephalopathy
NAA and low NAA/Cr ratio in the frontal region of JME Proton MRI with MRS showed elevated Lac/NAA ratio
related to memory and visual attention Stroop test; low in posterior white matter areas and deep gray nuclei of
NAA/Cr ratio in thalamic linguistic and memory regional putamen and thalamus areas as prognostic indicators
Wisconsin card sorting test. Unaltered Glx, Glx/tCr ratio, for brain hypoxic-ischemic injury underlying neonatal
Cho compounds, and Cho/tCr ratio in frontal and thalamic hypoxic-ischemic encephalopathy (HIE) [115] . Proton
1
regions were associated with epileptic cortical functions, MRS ( H-MRS) showed high NAA/tCr in basal ganglia/
neuropsychological cognitive tests as visuospatial executive thalamus(BG/T), high NAA/Cho in basal ganglia/
functions, linguistic, memory, and visual attention [111] . The thalamus (BG/T), and high Myo‑inositol/choline in the
MRS may show subclinical cognitive changes. The author cerebral cortex as a prognostic marker of therapeutic
suggests the need for validation studies. hypothermia (TH) with adverse outcomes of white
matter and gray matter NAA in prediction for all HIE
6.10. Primary focal CNS lymphoma lesions subjects. The author suggests the need for prospective

A hybrid approach of MRS with SPECT and PET multi-center studies by standardized protocol and
distinguished the CNS lymphoma from the human analysis methods [116] .
immunodeficiency virus (HIV) [112] . MR perfusion,
MRI APC ratio, and regional cerebral blood volume 6.14. Traumatic brain injury
characteristics distinguish lymphoma from HIV-infected The single-voxel H-MRS showed an altered ratio of NAA/
1
patients. The author suggests more clinical investigations Cr+phosphocreatine (PCr), NAA+N-acetylaspartylglutamate

Volume 2 Issue 3 (2023) 19 https://doi.org/10.36922/gtm.337