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Twenty-nine patients with disk herniations, 7 patients with intraspinal tumors, 4 patients with multiple sclerosis and one patient with infection by borrelia have been studied by CT, myelography and/or MR. To gain information on the metabolism of central nervous system disease (CNS), and thus, to improve diagnosis the cerebrospinal fluid (CSF) was studied in all cases using high-resolution 1H NMR spectroscopy at 360 MHz. Seventeen metabolites could be identified in CSF in addition to the usual clinical chemical parameters. As compared to a control group discrimination of tumors from inflammation was possible by means of different metabolites and/or metabolite concentration. The CSF in disk herniations differed in the concentration of acetate from the control group. In CSF of tumors, multiple sclerosis and of infection by borrelia distinct differences in the concentrations of putrescine, citrate, valine, alpha-alanine, acetate, creatinine, glucose, beta-hydroxy-butyric acid, glutamine and creatine have been observed both as compared directly and in comparison to the control group. Thus, high-resolution 1H NMR spectroscopy of CSF gives speedy information on metabolism, since a variety of metabolites, usually examined only in different tests, can be studied in one single step. Thus, high-resolution 1H NMR spectroscopy supports imaging, especially MR, as morphological changes in diseases may be differentiated by means of different metabolite profiles. This assumption needs further confirmation on a prospective study with a larger patient population.

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Sixty-six samples of CSF from 66 patients with a variety of diseases, including tumors, arteriovenous malformations, aneurysms, brain infarctions, and lumbar back pain, were studied with 1H MR spectroscopy at 360 MHz. 1H MR spectroscopy offers a simple means to obtain fast information about different metabolites simultaneously. As compared with the control group, which consisted of 19 CSF samples from the same group of 66 patients, but from individuals who had no abnormal findings on neurologic examination, common clinicochemical tests, or neuroradiologic studies, our preliminary results suggest that tumors and hemorrhages may be differentiated by 1H MR spectroscopy. MR peak intensities relative to lactate peak intensity were used as variables in a statistical analysis to determine the significance of individual resonance intensities in predicting CNS abnormalities. The most important factors for diagnosis were analyzed by means of a multivariate general linear hypothesis and a principal component method. The most important factors for predicting CNS abnormalities in the studied diseases were creatinine, glucose, creatine, citrate, protein content, glutamine, amount of cells, and valine. By using this model for discriminant analysis, we could predict hemorrhages correctly in 88% of cases and tumors in 75% of cases. All samples of controls were determined correctly. In cases of brain infarctions, different signals were observed, which may lead to further characterization of such lesions. 1H MR spectroscopy may offer a simple means for further characterizing CNS lesions. However, this needs confirmation by a prospective study, which would include a larger patient population with different diseases.

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Development of severe ataxia and mild pyramidal signs without mental deterioration, tetraparesis or pseudobulbar palsy during recovery from withdrawal delirium and initial hyponatraemia are unusual clinical features consistent with central pontine myelinolysis. This diagnosis was confirmed by magnetic resonance imaging (MRI) in an alcoholic man. Clinical and electrodiagnostic improvement occurred, whereas the MRI findings remained unchanged in a follow-up study.

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Cerebrospinal fluid (CSF) samples from 84 patients with confirmed or suspected diseases of the central nervous system were studied with hydrogen-1 magnetic resonance (MR) spectroscopy. In 19 of the patients, clinical chemical tests of the CSF indicated normal protein contents and normal quantities of cells; these samples were used as controls. Preliminary results indicate that tumors may be reflected in the MR spectra of CSF; disk herniations could not be distinguished on the basis of the MR spectral characteristics.

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To improve the specificity of MR imaging, 45 patients with different lesions in the CNS were studied with gadolinium-DTPA from June to December 1985. With a dosage of 0.2 ml/kg body weight, no adverse effects were seen. Seventeen of these patients were also studied with dynamic MR imaging, using a spin-echo sequence of TR = 100 msec and TE = 30 msec and a display matrix of 128(2). Four parameters were determined and compared with histologic findings: the time to peak of signal intensity, the ascent to peak of signal intensity, the height of peak of signal intensity, and the percentage of peak of signal intensity at the end of measurement. In this small series, arteriovenous malformations had a short time to peak and a steep ascent to peak as compared with tumors. Gliomas had a slow ascent to peak and usually a longer time to peak as compared with tumors of mesodermal origin. Paragliomas according to Zülch's classification had a steeper ascent to peak than gliomas. Dynamic MR with gadolinium-DTPA may lead to further information about lesions in the CNS, as the ascent to peak parameter seems helpful in discriminating among different lesions.

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MRI and gadolinium-DTPA enhanced dynamic MRI increase the information available for and from diagnosis of vascular malformations since it appears possible to obtain nearly specific information about these lesions. Further investigations are needed with fast imaging, flow imaging, and MR substraction angiography to obtain information similar to that obtained by angiography and CT. The value of X-ray CT for the diagnosis of vascular malformations seems to be inferior to MRI since MRI can delineate vessels and flow better and also allows direct multiplanar imaging.

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Nuclear spin tomography since its beginnings in the seventies has steadily gained in importance as a method of examination in medical diagnostics as it produces a picture. In the field of forensic medicine the NMR technique as used for anatomic-anthropologic issues attempting to identify skulls this is a valuable supplement to an extension of the existing methods of investigation. The results of a measurement of the thickness of soft facial tissue in a live test person is shown as compared to measures obtained by sonography.

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The results of operation in 851 intracranial aneurysms were statistically analysed. The influence of 22 factors on operative outcome is shown. The importance of the time of intervention for the prognosis of patients is of special interest. It is striking that the outcome of an operation within 48 hours only depends on the neurological status, whereas at operation in the stage of recovery further factors such as vasospasm, arteriosclerosis, brain oedema, ischaemia and blood in the subarachnoid space are of great importance. They lead to a more unfavourable outcome.

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In 15 cases dynamic studies of cervical spinal cord and canal in flexion and extension were performed by magnetic resonance imaging (MRI). In addition measurements of the complete spinal cord were made in 5 cases. As compared with extension the cervical spinal canal and spinal cord lengthen 12 mm in average during flexion, whereas the spinal canal lengthens 28 mm in average, which means a difference of about 15 mm. We feel that these results indicate that adverse mechanical tension may occur in the cervical spinal cord during flexion. The impact of these results on surgical treatment for chronic cervical myelopathy is discussed.

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