14800-DvRappard

116 Chapter 7 Figure 5 : Longitudinal WM metabolite concentrations of (A) NAA, (B) concentration ratio Cho/ NAA (a single extreme value of 2.1 outside the range is shown at the top border). C: longitudinal MRI score. D: longitudinal lesion volumes. Control values are indicated with black asterisks, and the black line is the mono-exponential fit visualizing the age-dependency. Green, orange and red symbols correspond to patients with good, moderate, and poor outcome, respectively. Non- eligible patients are indicated with triangles, and eligible patients with circles. After patients are transplanted, symbols are filled. To distinguish overlapping symbols (patients of the same age with similar scores), symbols are outlined and connected with different colors. The treated eligible patient (good outcome) that was described before had her first scan at the age of 14.1 y. DISCUSSION Metabolite concentrations at baseline in relation to outcome MRS is a powerful method to gain insight into brain metabolites, thereby contributing to understanding pathological processes. Reduced concentrations of NAA and Glu are associated with neuroaxonal damage. 9-11 Increased Lac reflects energy failure, 9 probably also macrophage/microglia activation, 21 and oligodendrocyte injury leading to limiting Lac transport into axons. 22 Cho is increased in regions of active demyelination. 9-11,23,24