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Among them MRI and MRS are the main tools for diagnosis and work up of MD, and this review will focus mainly on them. The MRI findings of MD are very heterogeneous, as they depend on the metabolic brain defects, age of the patient, stage and severity of the disease. No correlation has been found between genetic defects and neuroimaging picture; however, some relationships between MR findings and clinical phenotypes may be identified. Different combinations of MRI signal abnormalities are often encountered but the most common findings may be summarized into three main MR patterns: (i) non-specific; (ii) specific; (iii) leukodystrophic-like. Regarding the functional MR techniques, only proton MRS plays an important role in demonstrating an oxidative metabolism impairment in the brain since it can show the accumulation of lactate, present as a doublet peak at 1.33 ppm. Assessment of lactate should be always performed on brain tissue and on the ventricular cerebral spinal fluid. As for MRI, metabolic MRS abnormalities can be of different types, and two distinct patterns can be recognized: non-specific and specific. The specific metabolic profiles, although not frequent to find, are highly pathognomonic of MD. The un-specific metabolic profiles add value to structural images in allowing to define the lesion load and to monitor the response to therapy trials.<\/jats:p>","DOI":"10.1007\/s10540-007-9046-z","type":"journal-article","created":{"date-parts":[[2007,5,17]],"date-time":"2007-05-17T23:51:43Z","timestamp":1179445903000},"page":"69-85","update-policy":"http:\/\/dx.doi.org\/10.1042\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Brain Magnetic Resonance in the Diagnostic Evaluation of Mitochondrial Encephalopathies"],"prefix":"10.1042","volume":"27","author":[{"given":"Maria Cristina","family":"Bianchi","sequence":"first","affiliation":[{"name":"Department of Neuroradiology, Santa Chiara Hospital, Pisa, Italy"},{"name":"Laboratory of Magnetic Resonance, IRCCS Stella Maris, Viale del Tirreno 331, Calambrone 56018 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppina","family":"Sgandurra","sequence":"additional","affiliation":[{"name":"Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy"},{"name":"Department of Child Neurology and Psychiatry, University of Pisa, Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michela","family":"Tosetti","sequence":"additional","affiliation":[{"name":"Laboratory of Magnetic Resonance, IRCCS Stella Maris, Viale del Tirreno 331, Calambrone 56018 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Battini","sequence":"additional","affiliation":[{"name":"Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Cioni","sequence":"additional","affiliation":[{"name":"Department of Child Neurology and Psychiatry, University of Pisa, Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"288","published-online":{"date-parts":[[2007,6,13]]},"reference":[{"key":"9046_CR1","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s00234-003-1138-2","volume":"46","author":"K Abe","year":"2004","unstructured":"Abe K, Yoshimura H, Tanaka, H et al (2004) Comparison of conventional and diffusion-weighted MRI and proton MR spectroscopy in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like events. 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