The Diagnostic Value Of¹H Magnetic Resonance Spectroscopy Of The Brain In Peripheral Vestibular Vertigo

ObjectiveTo investigate the contents and changes of common metabolites within bilateralvestibular cerebellum and brainstem in patients with peripheral vestibular vertigo from thelevel of molecular imaging studies by using proton magnetic resonance spectroscopy(¹H-MRS). The aim is to evaluate the value of the qualitative diagnosis of the disease toprovide basic data of magnetic resonance spectroscopy and new research tools for thestudy of peripheral vestibular vertigo.Materials and Methods1. The choice of subjectsCooperation with the Health Division of the Provincial Hospital in ShandongProvince,22cases of patients with peripheral vestibular vertigo who had been diagnosedby clinical checking or by brainstem auditory evoked （8males,14females, mean age31.14±6.364years, range22-39years old） were selected in the study from December2011to January2013. At the same time,17healthy adults（7males,10females, mean age29.29±6.018years, range24-50years old） without vertigo were randomly selected as acontrol group from college students, people who are health check. Age （t=0.918, P=0.365）, gender （t=-0.299, P=0.767） between groups were not different statistically.2. Apparatus and equipment1.5T superconducting magnetic resonance scanner （Siemens Sonota） was used.Sequences include the conventional sequences and¹H-MRS sequence.All the subjects were carried out axial T2-weighted imaging（TR:4500ms, TE:96ms）,T1-weighted imaging（TR:450ms, TE:8.6ms）, mobile attenuated inversion recoverysequence T2FLAIR（TR:9100ms, TE:106ms）, sagittal and coronal T2-weighted scan （TR: 1980ms, TE:86ms）, axial FOV::180mm×200mm, thickness4.0mm,1.0mm spacing,scan line parallel to the joint line before and after, targeted at the level of thecerebellopontine feet.Sagittal and coronal scanning lines are parallel and perpendicular tothe interhemispheric pool.When the conventional series scan for the brain were completed, the transversal,sagittal and coronal images were used for positioning proton magnetic resonancespectroscopy.¹H-MRS is a three-dimensional chemical shift imaging technology （CSI）sequence. The parameters are as follows: FOV120×120mm, spectral region of interest is:R/L:80mm, A/P:80mm, S/I:60mm, each voxel area was10mm×10mm×10mm, TR:1100ms, TE145ms, water suppression frequency of45Hz, bandwidth of1100Hz,acquisition:4times. The Region of interest was located in the brainstem andcerebellopontine feet level. When placing the ROI, avoid cerebrospinal fluid, skull platebarrier’s role in the interest areas as much as possible. Meanwhile, add the8groups ofsaturated zone around the region of interest, making sure that the skull, baffle fat,cerebrospinal fluid did not affect the signal acquisition. Before the scan, close all coilsoutside except the four-channel head coil; Should also inform patients keeping quiteexactly during the scanning ahead of time. After scanning, the original spectral data wastransferred to the Spectrum tab of workstations. Post-processing software automaticallyprocesses and get MRS curves, and the area under the peak of various substances and thelist of ratio between substances we want to get，such as NAA, Cho, Cr, Cr2and so on.Subsequently, if not satisfied, we can manually adjust the MRS curves, to make thematerial content values more precise.3. Statistical AnalysisSPSS17.0statistical analysis software package was used. All the measurement datasare indicated with s. Single-sample Levene test were used to test data normality andhomogeneity of variance. Paired T test analysis was used to analyze the content differencesof the materials between bilateral bilateral cerebellar hemispheres within one group.Independent samples T Test was used to analyze the content of the materials differences inbrainstem and ipsilateral cerebellar hemisphere between the two groups. Taking the P<0.05as a difference, P <0.01for the significant difference.Results1. Content differences of NAA、Cr、Cho、Cr2、NAA/Cr、Cho/Cr and Cr2/Cr betweenbilateral cerebellar hemisphere within the control group was not statistically significant（P>0.05）; 2. Content differences of NAA、Cr、Cho、Cr2、NAA/Cr、Cho/Cr and Cr2/Cr betweenbilateral cerebellar hemisphere within the peripheral vestibular vertigo group was notstatistically significant （P>0.05）;3. Content differences of NAA、Cr、Cho、Cr2、NAA/Cr、Cho/Cr and Cr2/Cr in thebrainstem between vertigo group and the healthy control group was not statisticallysignificant （P>0.05）;4. Content differences of Cho、Cr2、NAA/Cr、Cho/Cr、Cr2/Cr in the right side ofcerebellar hemisphere between vertigo group and the healthy control group was notstatistically significant （P>0.05）; Content differences of NAA（t=-2.345，p=0.024）and Cr（t=-2.503,p=0.017） in the right side of the cerebellar hemisphere between vertigo groupand the healthy control group was statistically significant;5.Content differences of Cho、Cr2、NAA/Cr、Cho/Cr、Cr2/Cr in the left side ofcerebellar hemisphere between vertigo group and the healthy control group was notstatistically significant （P>0.05）; Content differences of NAA（t=-2.345，p=0.024）and Cr（t=-2.503,p=0.017） in the left side of the c between vertigo group and the healthycontrol group was statistically significant.ConclusionIn this study, magnetic resonance spectroscopy (¹H-MRS) data analysis suggest that,content of NAA and Cr in bilateral cerebellar hemisphere were different significantly inpatients with peripheral vestibular vertigo. It indicates that the content of NAA and Cr inthe vestibular cerebellum is closely related with peripheral vestibular vertigodisease.However, the content differences of NAA、Cr、Cho、Cr2、NAA/Cr、Cho/Cr andCr2/Cr in the brainstem between vertigo group and the healthy control group was notstatistically significant （P>0.05）. Currently, there is no specific means of diagnosis ofperipheral vestibular vertigo check. The method of¹H-MRS has a high diagnostic value ofclinical auxiliary and academic research value of the peripheral vestibular vertigo disease.