Metabolic Assessment of the Brain Using Proton Magnetic Resonance Spectroscopy in a Growth-Restricted Human Fetus: Case Report

Abstract

Proton magnetic resonance spectroscopy (MRS) is a noninvasive method to assess concentrations of different metabolites in tissues, including the brain. We evaluated a fetus with growth restriction using Doppler ultrasound and proton MRS. Doppler assessment revealed absent end diastolic flow in the umbilical artery. Diastolic flow was increased in the middle cerebral artery. Proton MRS of the fetal brain showed lactate and a low N-acetylaspartate/choline index, metabolic markers of starvation/hypoxia. Proton MRS gave us in vivo metabolic information of the brain of a fetus under starvation/hypoxic conditions. It is potentially a new tool for fetal surveillance. To our knowledge, this is the first report of cerebral lactate detection using proton MRS in a growth-restricted human fetus with no associated malformations in the English literature. Further experimental and clinical longitudinal investigations are needed to evaluate its efficacy in the clinical setting.

In Utero Exposure to Ischemic-Hypoxic Conditions and Attention-Deficit/Hyperactivity Disorder

“…In particular, it has long been known that hypoxic injury during fetal development leads to significant structural and functional brain injuries in the offspring. [26][27][28][29][30][31][32][33] Selective vulnerability of striatal neurons has been described in children born after a pregnancy complicated by asphyxia. 54 Lower concentrations of N-acetylaspartate and creatine levels have also been found in the central nervous system tissue of fetuses affected by hypoxic conditions indicating neuronal loss or damage.…”

“…Emerging evidence suggests that ischemic-hypoxic conditions (IHCs) in pregnancy resulting from acute and chronic perinatal events have adverse consequences on fetal brain development that are not apparent at birth. [19][20][21][22][23][24][25][26][27] Although previous studies noted that in utero exposure to IHC is associated with fetal brain injury, [26][27][28][29][30][31][32][33][34][35] the role of IHCs in the development of ADHD is unexplored. Thus, we hypothesize that IHC is an independent risk factor for childhood ADHD.…”

Proton Magnetic Resonance Spectroscopy Assessment of Fetal Brain Metabolism in Late-Onset ‘Small for Gestational Age' versus ‘Intrauterine Growth Restriction' Fetuses

“…A preliminary study on a small number of term SGA fetuses reported that brain metabolic differences were detectable in the frontal lobe [25]. In addition, several spectroscopic studies have shown that fetuses diagnosed with early and severe IUGR presented specific metabolic changes, such as increased brain lactate [35,36] and lower NAA/Cr and NAA/Cho levels when compared to matched controls [15]. Interestingly, similar findings have been reported for congenital heart disease (CHD), a condition associated with poor brain blood supply.…”

Lactate detection in the brain of growth-restricted fetuses with magnetic resonance spectroscopy

“…9 Our finding is in agreement with 2 previous studies that reported the presence of lactate by fetal brain MRS in IUGR fetuses. 17,26 Both studies, however, lack data about oxygenation and acid-base balance at delivery.…”

“…However, several authors have recently suggested that the potential evidence of cerebral lactate is an indicator of altered fetal cerebral metabolism in pathological conditions. [15][16][17] In this study, we sought to measure fetal cerebral lactate using 1 H MRS to evaluate whether it could represent a marker of brain damage in IUGR fetuses.…”