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14 - MRS in musculoskeletal disease

Published online by Cambridge University Press:  04 August 2010

Peter B. Barker ,
Alberto Bizzi ,
Nicola De Stefano ,
Rao Gullapalli  and
Doris D. M. Lin
Peter B. Barker
Affiliation:
The Johns Hopkins University School of Medicine
Alberto Bizzi
Affiliation:
Istituto Neurologico Carlo Besta, Milan
Nicola De Stefano
Affiliation:
Università degli Studi, Siena
Rao Gullapalli
Affiliation:
University of Maryland, Baltimore
Doris D. M. Lin
Affiliation:
The Johns Hopkins University School of Medicine
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Summary

Key points

  • 31P-MRS allows the detection of phosphate-containing metabolites that are central to energy metabolism, and therefore is particularly suitable for studying muscle physiology and its disorders in vivo.

  • Time-resolved signals from inorganic phosphates, phosphocreatine, phosphodiesters/monoesters, and intermediates of ATP reflect physiologic changes in muscles during rest, exercise, and recovery.

  • Quantitative analysis of metabolites allows estimates of cytosolic ADP based on a number of assumptions, and the recovery of ADP has been used as a measure of in vivo mitochondrial function.

  • In pathologic states including metabolic (mitochondrial or glycolytic pathway) dysfunction, hereditary and acquired myopathies, 31P-MRS shows biochemical alterations (reduced PCr, increased Pi, slow ADP recovery) that tend to overlap between pathologies.

  • Glycogenolytic disorders (such as McArdle's disease) may show paradoxical alkalosis during exercise.

  • Muscle 31P-MRS is valuable in monitoring therapeutic response in a number of neuromuscular disorders.

  • 1H-MRS currently has a limited role in the clinical evaluation of musculoskeletal disease, but has been used as a research tool to assess intramyocellular lipid, which has been implicated in skeletal muscle insulin resistance and type 2 diabetes mellitus.

Introduction

Magnetic resonance spectroscopy (MRS) of skeletal muscle has been studied over several decades. In particular, muscle MRS has been utilized to study carbohydrate metabolism (by 13-carbon (13C) MRS), lipid metabolism (by proton (1H) MRS) and, more widely, energy metabolism (by 31-phosphorus (31P) MRS).

Information

Type
Chapter
Information
Clinical MR Spectroscopy
Techniques and Applications
 , pp. 243 - 255
Publisher: Cambridge University Press
Print publication year: 2009

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