Defective brain energy metabolism shown by in vivo 31P MR spectroscopy in 28 patients with mitochondrial cytopathies

We studied brain energy metabolism by phosphorus magnetic resonance spectroscopy (31P MRS) in 28 patients with mitochondrial cytopathies, and 20 normal control subjects. Fourteen patients had myopathy alone, six had only mild brain symptoms, and eight showed different degrees of brain involvement. Brain 31P MRS showed a low phosphocreatine content in all patients, accompanied by a high inorganic phosphate in 14 of 28 patients. The average value of the Pi concentration in the patient group was significantly (p = 0.009) different from the control group. The cytosolic pH was normal. From these data were derived a high concentration of ADP (calculated from the creatine kinase equilibrium), a high percent value of V/Vmax for ATP biosynthesis, and a low phosphorylation potential, all features showing a derangement of brain energy metabolism, in all patients with mitochondrial cytopathies. 31P MRS proved to be sensitive enough to disclose a deficit of mitochondrial functionality not only in the affected patients, but also in those without clinically evident brain symptoms.

Energy metabolism in muscle paresis and recovery studied by 31P-MR spectroscopy: a case report

We report a 31P Magnetic Resonance Spectroscopy (31P-MRS) study on the changes of energy metabolism in human leg anterior and lateral compartment muscles with paresis due to compression from a herniated lumbar disc at the L4-L5 level and recovery to normality. A low phosphocreatine to inorganic phosphate ratio due to both decreased phosphocreatine and increased inorganic phosphate contents and a normal intracellular pH were the features of muscles with paresis. Changes of 31P-MRS parameters were followed during 18 weeks of treatment with physical therapy until complete recovery. Results show that 31P-MRS is a useful clinical tool for detecting even small biochemical changes that may occur in muscles and for checking the effects of therapy.

Brain energy metabolism studied by 31P-MR spectroscopy in a case of migraine with prolonged aura

The brain and skeletal muscle oxidative metabolism of a patient with prolonged aura was studied by phosphorus magnetic resonance spectroscopy. We found that the phosphocreatine to ATP ratio in brain was reduced, while the inorganic phosphate to phosphocreatine ratio and the calculated ADP concentration were increased. The phosphorylation potential and percentage of maximal rate of ATP synthesis were also altered. Intracellular pH and inorganic phosphate concentration were normal. In muscle we found a low post-exercise recovery of phosphocreatine. These data indicate an impairment of energy oxidative metabolism both in brain and muscle.

31P-NMR spectroscopy of skeletal muscle in Becker dystrophy and DMD/BMD carriers. Altered rate of phosphate transport

Muscle energy metabolism was studied by phosphorus nuclear magnetic resonance spectroscopy (31P-NMR) in 6 patients with Becker dystrophy, and in 24 female DMD/BMD carriers (n = 18) and non-carriers (n = 6). At rest all patients showed a high Pi/PCr ratio due to low PCr and high Pi contents, and a high intracellular IpH. 31P-NMR of carriers and non-carriers did not differ from controls. In patients and carriers in-magnet exercise revealed a reduced ability to perform work and Pi/PCr ratios higher than controls for comparable relative levels of steady-state work. Post-exercise Pi recovery was found abnormal in patients and in carriers. The 31P-NMR abnormalities found in the working muscle of both BMD patients and female DMD/BMD carriers indicate a defect of phosphate metabolism that, be it primary or secondary, reflects a deficit of energy metabolism.

Abnormal brain and muscle energy metabolism shown by 31P magnetic resonance spectroscopy in patients affected by migraine with aura

We studied brain and muscle energy metabolism by phosphorus 31 magnetic resonance spectroscopy (31P-MRS) in 12 patients affected by migraine with aura (classic migraine) in interictal periods. Brain 31P-MRS disclosed a low phosphocreatine content in all patients, accompanied by high adenosine diphosphate concentration, a high percentage of V/Vmax (adenosine triphosphate), and a low phosphorylation potential--features showing an unstable state of metabolism in classic migraine. Abnormal muscle mitochondrial function, in the absence of clinical signs of muscle impairment, was present in nine of the 12 patients examined.

Muscle energy metabolism in female DMD/BMD carriers: a 31P-MR spectroscopy study

31P nuclear magnetic resonance spectroscopy (31P-MRS) was used to investigate the energy metabolism of the gastrocnemius muscle in 16 DMD/BMD female carriers. No significant difference was found with the controls in the resting muscle, while all carriers showed a decreased ability to perform work, and a higher Pi/PCr ratio for comparable relative levels of steady-state work. The rate of postexercise recovery of PCr/Pi ratio was lower in all carriers. The decreased rate of PCr/Pi recovery appears to be mainly due to a decreased rate of Pi recovery. Our findings show abnormal muscle energy metabolism in DMD/BMD female carriers.

Compartment syndrome of the scapula. Definition on clinical, neurophysiological and magnetic resonance data

Compartment syndromes of the scapula and pelvic girdle have received scant attention in the literature. In 1938, Comolli first described a clinical sign which he considered specific to fracture of the scapula. We report data on two patients, one presenting with prolonged pressure on the posterior surface of the scapula and the other with symptoms associated with scapular fracture. In one of these patients we were able to measure pressures around the scapula, perform neurophysiological assessment of nerve function and produce magnetic resonance images of the area. In the other case, surgical exploration revealed an established ischaemic contracture of the infraspinatus muscle within its compartment. These findings suggest that the muscles around the scapula are vulnerable to the development of compartment syndrome.

The rate of phosphate transport during recovery from muscular exercise depends on cytosolic [H+]. A 31P-MR spectroscopy study in humans

31-Phosphorus magnetic resonance spectroscopy was used to study in vivo the effect of cytosolic [H+] on the kinetics of initial post-exercise recovery of inorganic phosphate (Pi) in human gastrocnemius muscle. Linear correlations were found between the rate of initial phosphate recovery and: a) the minimum value of cytosolic pH reached during recovery, and b) the minimum percentage of divalent anion present. These linear relationships are consistent with the current knowledge of Pi transport, and represent new invariant parameters for the study of muscle pathologies that may involve Pi and/or H+ transport.

Kinetics of post-exercise phosphate transport in human skeletal muscle: an in vivo 31P-MR spectroscopy study

31-Phosphorus magnetic resonance spectroscopy was used to investigate in vivo the kinetics of inorganic phosphate transport and intracellular pH after exercise in human skeletal muscle. Intracellular pH further decreased from the value reached at the end of work showing a minimum between 25 and 45 sec and then increased back to the resting value. Inorganic phosphate showed an initial fast rate of recovery corresponding to the decreasing phase of pH, and a second phase in which a slow rate of recovery corresponded to increasing pH. The biphasic patterns of both phosphate and pH recoveries are in agreement with and support in vitro evidence that Pi transport into mitochondria is modulated by pH.