Proton Magnetic Resonance Spectroscopy of the Brain in Normal Preterm and Term Infants, and Early Changes after Perinatal Hypoxia-Ischemia

Abstract

The aims of this study were 1) to define normal perinatal maturational changes in proton metabolite peak-area ratios in two regions of the neonatal brain, the thalamic and occipitoparietal regions, and 2) to investigate abnormalities of these ratios after perinatal hypoxia-ischemia. Fifty-four infants were studied: 35 normal control infants at 31-42 wk of gestational plus postnatal age, and 19 "asphyxiated" infants suspected of cerebral hypoxic-ischemic injury. Proton spectra were collected at 2.4 tesla from (2 cm)3 voxels using the point-resolved spectroscopy technique with a 270-ms echo time. Lactate was detected in all infants studied. In the normal infants, lactate relative to N-acetylaspartate (NAA), choline and creatine was significantly greater in the occipitoparietal region than in the thalamus, and fell with increasing maturity in both regions, whereas NAA/ choline increased. The 19 asphyxiated infants were studied on a total of 34 occasions during the 1st wk of life (median age 1.8 d), at gestational plus postnatal ages of 27-41 wk. Maximum lactate/NAA was above 95% confidence limits for the control data in one or both regions in 11 of the 19 infants. Minimum NAA/choline was below 95% confidence limits in only one asphyxiated infants, who was later found to have congenital hypothyroidism. SD scores for lactate, relative to NAA, choline, and creatine, were higher in both regions in the asphyxiated infants compared with the normal infants, particularly in the thalamus. Early results of 1-y follow-up examinations indicate that raised lactate/NAA carries a poor long-term prognosis.

Identification of diffuse and focal brain lesions by clinical magnetic resonance spectroscopy

“…1). Alanine is found in spectra of pyogenic abscesses (see Table 1) and meningiomas and propanediol can accumulate with intravenous anti-seizure medications, especially in neonates (1,(8)(9)(10).…”

Neonatal Encephalopathy: Association of Cytokines with MR Spectroscopy and Outcome

“…MRI studies of term newborns with NE show the DGN as the most severely injured area (8,28,29), which corresponds to the spatial distribution of lactate measured by 1 H-MRS (9,30). The measured cytokines were not associated with structural abnormalities detected by MRI.…”

Magnetic Resonance Imaging versus Proton Magnetic Resonance Spectroscopy in Neonatal Hypoxic Ischemic Encephalopathy in Egyptian Population: Pilot study

“…In HIE, cerebral lactate (Lac) rises as a result of anaerobic metabolism, then it is rapidly cleared on resuscitation to be followed by a secondary increase after 12-24 hours because of renewed production of Lac in brain tissue rather than entry via the circulation [22,23]. The Cr was chosen as the metabolite of reference in 1H-MRS as it is not signifi cantly changed after the onset of HIE.…”

“…The signal abnormalities of basal ganglia can be considered as an indicator of the severity of neonatal HIE, while the signal abnormality of thalamus is considered as a relatively specifi c and sensitive indicator of ischemic brain injury caused by hypoxia [21,22]. In the study of Thayyil, et al [6], the MRI of neonates with mild HIE showed normal basal ganglia with variable degrees of cortical signal abnormalities, while patients with most severe HIE showed mixed cortical and basal ganglia signal abnormalities.…”