Does MRS Lactate Peak Correlate with Lactate in the CSF and Blood?

Abstract

Purpose Cerebrospinal fluid (CSF) or brain parenchyma lactate detection is important for the diagnosis of some diseases with aerobic cellular metabolism compromise. Our purpose is to correlate intraventricular magnetic resonance spectroscopy (MRS) lactate detection and quantification to CSF and blood lactate concentration.

Methods Twenty-one patients (13 females; mean age 5 years) suspected of having mitochondrial disorders underwent proton MRS with point-resolved spectroscopy (TE = 144 ms). The volume of interest was positioned in the lateral ventricles, and LCModel was used for the MRS lactate peak detection and quantification. CSF and venous blood samples were obtained for lactate quantification immediately after MRS. Comparisons between MRS, CSF, and blood lactate detection and quantification were performed. p < 0.05 was considered significant.

Results In our series, CSF lactate levels were high in 11 patients (52%) and blood serum lactate levels were high in 3 patients (14%). MRS was able to detect a lactate peak in all patients. A positive correlation between MRS lactate quantification and CSF lactate was observed (Pearson correlation coefficient = 0.750; p < 0.0001). Blood lactate did not correlate with lactate levels in the lateral ventricle measured by MRS or direct determinations of CSF lactate concentration. When noting the lactate quantification obtained by MRS, only 8 patients (as opposed to 14) presented higher values than the established normality threshold of 1.7 mmol/L. Considering CSF puncture concentration as the gold standard, we obtained 64% of sensitivity and 90% of specificity for MRS quantification.

Conclusion If MRS shows increased lactate levels in the ventricles, CSF puncture is not needed for lactate increase confirmation.

Keywords

magnetic resonance spectroscopy - lactate peak - CSF lactate concentration - blood lactate concentration - mitochondrial disorders

• References

• 1 Benoist JF, Alberti C, Leclercq S , et al. Cerebrospinal fluid lactate and pyruvate concentrations and their ratio in children: age-related reference intervals. Clin Chem 2003; 49 (3) 487-494
• 2 Zhang W-M, Natowicz MR. Cerebrospinal fluid lactate and pyruvate concentrations and their ratio. Clin Biochem 2013; 46 (7–8) 694-697
• 3 Engelhardt B, Sorokin L. The blood-brain and the blood-cerebrospinal fluid barriers: function and dysfunction. Semin Immunopathol 2009; 31 (4) 497-511
• 4 Provencher SW. Estimation of metabolite concentrations from localized in vivo proton NMR spectra. Magn Reson Med 1993; 30 (6) 672-679
• 5 Inao S, Marmarou A, Clarke GD, Andersen BJ, Fatouros PP, Young HF. Production and clearance of lactate from brain tissue, cerebrospinal fluid, and serum following experimental brain injury. J Neurosurg 1988; 69 (5) 736-744
• 6 Chi CS, Lee HF, Tsai CR, Chen WS, Tung JN, Hung HC. Lactate peak on brain MRS in children with syndromic mitochondrial diseases. J Chin Med Assoc 2011; 74 (7) 305-309
• 7 Boddaert N, Romano S, Funalot B , et al. 1H MRS spectroscopy evidence of cerebellar high lactate in mitochondrial respiratory chain deficiency. Mol Genet Metab 2008; 93 (1) 85-88
• 8 Feng F, You H, Gao J , et al. Evaluation of mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes with magnetic resonance imaging and proton magnetic resonance spectroscopy. Chin Med Sci J 2006; 21 (4) 234-238
• 9 Dinopoulos A, Cecil KM, Schapiro MB , et al. Brain MRI and proton MRS findings in infants and children with respiratory chain defects. Neuropediatrics 2005; 36 (5) 290-301
• 10 Cross JH, Gadian DG, Connelly A, Leonard JV. Proton magnetic resonance spectroscopy studies in lactic acidosis and mitochondrial disorders. J Inherit Metab Dis 1993; 16 (4) 800-811
• 11 Lee S-K, Kim J, Kim HD, Lee JS, Lee YM. Initial experiences with proton MR spectroscopy in treatment monitoring of mitochondrial encephalopathy. Yonsei Med J 2010; 51 (5) 672-675
• 12 Lin DD, Crawford TO, Barker PB. Proton MR spectroscopy in the diagnostic evaluation of suspected mitochondrial disease. AJNR Am J Neuroradiol 2003; 24 (1) 33-41
• 13 Ibrahim MA, Emerson JF, Cotman CW. Magnetic resonance imaging relaxation times and gadolinium-DTPA relaxivity values in human cerebrospinal fluid. Invest Radiol 1998; 33 (3) 153-162
• 14 Sack M, Ende G, Weber-Fahr W. T2-CSF pitfalls using water as an internal reference for metabolite quantification. Proc Intl Soc Magn Reson Med Sci Meet Exhib 2011; 2011: 19
• 15 Ernst T, Kreis R, Ross BD. Absolute quantitation of water and metabolites in the human brain. I. Compartments and water. J Magn Reson B 1993; 102: 1-8
• 16 Braun KPJ, Gooskens RHJM, Vandertop WP, Tulleken CA, van der Grond J. 1H magnetic resonance spectroscopy in human hydrocephalus. J Magn Reson Imaging 2003; 17 (3) 291-299
• 17 Isobe T, Matsumura A, Anno I , et al. Lactate quantification by proton magnetic resonance spectroscopy using a clinical MRI machine: a basic study. Australas Radiol 2007; 51 (4) 330-333
• 18 Bianchi MC, Tosetti M, Battini R , et al. Proton MR spectroscopy of mitochondrial diseases: analysis of brain metabolic abnormalities and their possible diagnostic relevance. AJNR Am J Neuroradiol 2003; 24 (10) 1958-1966
• 19 Kingsley PB. Scalar coupling and zero-quantum coherence relaxation in STEAM: implications for spectral editing of lactate. Magn Reson Med 1994; 31 (3) 315-319
• 20 Yablonskiy DA, Neil JJ, Raichle ME, Ackerman JJH. Homonuclear J coupling effects in volume localized NMR spectroscopy: pitfalls and solutions. Magn Reson Med 1998; 39 (2) 169-178