ab22502

Magnetic resonance imaging and proton magnetic resonance spectroscopy in neuro-Behçet's disease

K.-S. Park¹, H.-J. Ko¹, C.-H. Yoon¹, S.-H. Park¹, C.-S. Cho¹, H.-Y. Kim¹, B.-Y. Choe², W.-U. Kim¹

¹Department of Internal Medicine and ²Department of Biomedical Engineering, School of Medicine, The Catholic University of Korea, Seoul, Korea

ABSTRACT
Objective
Neuro-Behçet's disease (NBD) is one of the most serious complications of Behçet's disease (BD). Proton magnetic resonance spectroscopy (1H MRS) has been proved to be useful in detecting neuro-metabolic abnormalities in various diseases affecting the brain. In this study, we attempted to characterize the magnetic resonance imaging (MRI) findings in Korean patients with NBD and then examined the usefulness of 1H MRS in evaluating the MRI-negative brain area of NBD patients.

Methods
We performed brain MRI in 18 BD patients with neurologic symptoms and signs. Seven NBD patients without thalamic lesions and 8 healthy controls underwent brain 1H MRS, in which an 8 ml voxel was placed in the left thalamus and the N-acetylaspartate (NAA)/creatine (Cr) ratio was measured.

Results
Fourteen of 18 BD patients were diagnosed as having NBD and 12 NBD patients (86%) had brain lesions on MRI. Most lesions were of high signal intensity on T2-weighted images and located in the midbrain, pons, basal ganglia, and white matter. On 1H MRS, the thalamic area without gross abnormalities on MRI showed a significantly lower NAA/Cr ratio in NBD patients compared to healthy controls (1.07 ± 0.08 versus 1.54 ± 0.27, P < 0.01). In 2 NBD patients, the NAA/Cr ratios, monitored serially, were normalized along with clinical improvement 6 months after treatment with prednisolone and immune suppressive agents.

Conclusion
MRI is a very sensitive diagnostic method for NBD, and 1H MRS may be useful for the early detection and follow-up of MRI-negative NBD.

Key words
Neuro-Behçet's disease, magnetic resonance imaging, magnetic resonance spectroscopy.

This study was supported by a grant from the Center for Functional and Metabolic Imaging Technology, Ministry of Health & Welfare, Republic of Korea (02-PJ3-PG6-EV07-0002).
Please address correspondence and reprint requests to: Dr. Wan-Uk Kim, Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, 93 Chi-Dong, Suwon 442-060, South Korea.
E-mail: wan725@catholic.ac.kr