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Andescavage N, Limperopoulos C, Evangelou I, Murnick J, du Plessis A. Pregnancy outcomes in two growth restricted fetuses with in utero cerebral lactate. J Neonatal Perinatal Med 2015; 8:269-73. [PMID: 26518409 DOI: 10.3233/npm-15814084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Elevated cerebral lactate is increasingly detected by magnetic resonance spectroscopy in the human fetus diagnosed with various pathologic conditions. However, the significance of detectable cerebral lactate remains uncertain. We present two cases of fetal cerebral lactate with adverse pregnancy outcomes.
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Affiliation(s)
- N Andescavage
- Children's National Medical Center, Division of Neonatology, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC, USA
| | - C Limperopoulos
- George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC, USA.,Children's National Medical Center, Division of Diagnostic Imaging and Radiology, Washington, DC, USA.,Children's National Medical Center, Division of Fetal-Transitional Medicine, Washington, DC, USA
| | - I Evangelou
- George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC, USA.,Children's National Medical Center, Division of Diagnostic Imaging and Radiology, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Department of Radiology, Washington, DC, USA
| | - J Murnick
- Children's National Medical Center, Division of Diagnostic Imaging and Radiology, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Department of Radiology, Washington, DC, USA
| | - A du Plessis
- George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington, DC, USA.,Children's National Medical Center, Division of Fetal-Transitional Medicine, Washington, DC, USA
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Cetin I, Barberis B, Brusati V, Brighina E, Mandia L, Arighi A, Radaelli T, Biondetti P, Bresolin N, Pardi G, Rango M. Lactate detection in the brain of growth-restricted fetuses with magnetic resonance spectroscopy. Am J Obstet Gynecol 2011; 205:350.e1-7. [PMID: 21861968 DOI: 10.1016/j.ajog.2011.06.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 04/29/2011] [Accepted: 06/06/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of the study was to determine the feasibility of detecting fetal brain lactate, a marker of fetal metabolic acidemia, using a noninvasive technique, proton magnetic resonance spectroscopy ((1)H MRS), in intrauterine growth-restricted (IUGR) fetuses. STUDY DESIGN In vivo human fetal brain lactate detection was determined by (1)H MRS in 5 fetuses with IUGR. Oxygenation and acid-base balance data were obtained at birth. RESULTS (1)H MRS analysis showed the presence of a lactate peak in the brain of the most severely affected IUGR fetus, with abnormal umbilical artery Doppler and fetal heart rate tracing. This finding was consistent with the low oxygen content and high lactic acid concentration observed in umbilical blood obtained at delivery. CONCLUSION (1)H MRS allows the noninvasive detection of cerebral lactate in IUGR fetuses. Lactate detected by (1)H MRS may represent a possible marker of in utero cerebral injury or underperfusion.
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Affiliation(s)
- Irene Cetin
- Center for Fetal Research Giorgio Pardi, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Charles-Edwards GD, Jan W, To M, Maxwell D, Keevil SF, Robinson R. Non-invasive detection and quantification of human foetal brain lactate in utero by magnetic resonance spectroscopy. Prenat Diagn 2010; 30:260-6. [PMID: 20120007 DOI: 10.1002/pd.2463] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the feasibility of foetal cerebral lactate detection and quantification by proton magnetic resonance spectroscopy ((1)H-MRS) in pregnancies at increased risk of cerebral hypoxia, using a clinical 1.5 T magnetic resonance imaging (MRI) system. METHOD Localised (1)H-MRS was performed in four patients with pregnancies in their third trimester complicated by intrauterine growth restriction (IUGR). A long echo time (TE) of 288 ms was used to maximise detection and conspicuity of the lactate methyl resonance, together with a short TE MRS acquisition to check for the presence of lipid contamination. Individual peaks in the resulting spectra were measured, corrected for relaxation and referenced to the unsuppressed water signal to provide metabolite concentrations. RESULTS A resonance peak consistent with the presence of lactate was observed in all cases. In one subject, this was confounded by the identification of significant lipid contamination in the short TE MRS acquisition. The range of measured lactate concentrations was 2.0-3.3 mmol/kg and compared well with preterm neonatal MRS studies. CONCLUSION The non-invasive detection and quantification of foetal cerebral lactate by MRS is achievable on a clinical 1.5 T MRI system.
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Wedegärtner U, Kooijman H, Andreas T, Beindorff N, Hecher K, Adam G. T2 and T2* measurements of fetal brain oxygenation during hypoxia with MRI at 3T: correlation with fetal arterial blood oxygen saturation. Eur Radiol 2009; 20:121-7. [DOI: 10.1007/s00330-009-1513-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 04/23/2009] [Accepted: 05/23/2009] [Indexed: 11/28/2022]
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Brighina E, Bresolin N, Pardi G, Rango M. Human fetal brain chemistry as detected by proton magnetic resonance spectroscopy. Pediatr Neurol 2009; 40:327-42. [PMID: 19380068 DOI: 10.1016/j.pediatrneurol.2008.11.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 11/03/2008] [Accepted: 11/19/2008] [Indexed: 11/25/2022]
Abstract
Magnetic resonance spectroscopy represents an invaluable tool for the in vivo study of brain development at the chemistry level. Whereas magnetic resonance spectroscopy has received wide attention in pediatric and adult settings, only a few studies were performed on the human fetal brain. They revealed changes occurring throughout gestation in the levels of the main metabolites detected by proton magnetic resonance spectroscopy (N-acetylaspartate, choline, myo-inositol, creatine, and glutamate), providing a reference for the normal metabolic brain development. Throughout the third trimester of gestation, N-acetylaspartate gradually increases, whereas choline undergoes a slow reduction during the process of myelination. Less clear are the modifications in creatine, myo-inositol, and glutamate levels. Under conditions of fetal distress, the meaning of lactate detection is unclear, and further studies are needed. Another field for investigation involves the possibility of early detection of glutamate levels in fetuses at risk for hypoxic-ischemic encephalopathy, because the role of glutamate excitotoxicity in this context is well-established. Because metabolic modifications may precede functional or morphologic changes in the central nervous system, magnetic resonance spectroscopy may likely serve as a powerful, noninvasive tool for the early diagnosis and prognosis of different pathologic conditions.
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Affiliation(s)
- Erika Brighina
- Foundation Instituto di Ricerca e Cura a Carattere Scientifico Policlinico, Mangiagalli and Regina Elena, University of Milan, Milan, Italy
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Schubert GA, Poli S, Schilling L, Heiland S, Thomé C. Hypothermia Reduces Cytotoxic Edema and Metabolic Alterations during the Acute Phase of Massive SAH: A Diffusion-Weighted Imaging and Spectroscopy Study in Rats. J Neurotrauma 2008; 25:841-52. [DOI: 10.1089/neu.2007.0443] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Gerrit Alexander Schubert
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sven Poli
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lothar Schilling
- Department of Neurosurgical Research, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sabine Heiland
- Department of Neuroradiological Research, University of Heidelberg, Mannheim, Germany
| | - Claudius Thomé
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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Van Os S, Klaessens J, Hopman J, Liem D, Van de Bor M. Brain Cell Function during Hypoxemia in Near-Term Lambs: A Near-Infrared Spectroscopy Study. Neonatology 2005; 88:79-86. [PMID: 15795506 DOI: 10.1159/000084702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Accepted: 12/27/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sufficient O2 supply to the brain is necessary for adequate cerebral energy metabolism, function and growth. OBJECTIVES To elucidate the relation between changes in cerebral arterial O2 content and cerebral O2 supply and changes in the oxygenation state of cerebral hemoglobin, and to determine whether concentration changes in oxyhemoglobin (DeltacO2Hb), deoxyhemoglobin (DeltacHHb), and cerebral arterial oxygenation (DeltacHbD; the difference between DeltacO2Hb and DeltacHHb), and cerebral blood volume (DeltaCBV) can be used to assess the decline in brain cell function during hypoxemia in lambs born near term. METHODS 17 preterm lambs were delivered at a mean gestational age of 133 days. Decreases in cerebral arterial oxygen content were induced by a stepwise reduction in inspired oxygen concentration. Mean values of all continuous variables were calculated over the last 180 s of each hypoxemic level. Cerebral arterial blood gases were analyzed at the end of each level to calculate cerebral arterial O2 content and cerebral O2 supply. RESULTS Changes in cerebral arterial O2 content and cerebral O2 supply were positively linearly related with DeltacO2Hb and DeltacHbD, and negatively with DeltacHHb and the concentration changes in total hemoglobin. Electrocortical brain activity remained stable until the cO2Hb and cHbD decreased to >3.0 +/- 0.9 and >8.1 +/- 1.9 (mean +/- SD) micromol/100 g, respectively, and cHHb and CBV increased to >4.3 +/- 1.7 and 1.37 +/- 0.48 ml/100 g, respectively, as compared to baseline. CONCLUSIONS Changes in cerebral arterial O2 content and cerebral O2 supply are adequately reflected by changes in the oxygenation state of cerebral hemoglobin. Concentration changes in DeltacO2Hb, DeltacHHb, DeltacHbD and DeltaCBV can be used to assess the decline in brain cell function during hypoxemia in lambs born near term.
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Affiliation(s)
- Sandra Van Os
- Division of Neonatology, Department of Pediatrics, University Medical Center Nijmegen, Nijmegen, The Netherlands
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Kok RD, de Vries MM, Heerschap A, van den Berg PP. Absence of harmful effects of magnetic resonance exposure at 1.5 T in utero during the third trimester of pregnancy: a follow-up study. Magn Reson Imaging 2004; 22:851-4. [PMID: 15234454 DOI: 10.1016/j.mri.2004.01.047] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2003] [Accepted: 01/27/2004] [Indexed: 10/26/2022]
Abstract
In this study the possible adverse effects of in utero exposure to magnetic resonance (MR) conditions at 1.5 Tesla were examined. Thirty-five children between 1 and 3 years of age, and nine children between 8 and 9 years of age, that were exposed to MR during the third trimester of pregnancy, were checked for possible adverse effects in a follow-up study. Data on pregnancy and birth, the results of a neurological examination at 3 months, their medical documentary with emphasis on eye and ear functioning, and a questionnaire answered by their mothers were collected and evaluated. In five children abnormal test results were observed, that had no relation to the MR exposure. No harmful effects of prenatal MR exposure in the third trimester of pregnancy were detected in this study.
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Affiliation(s)
- René D Kok
- Department of Obstetrics and Gynecology, University Medical Center, Nijmegen, The Netherlands.
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Robinson JN, Cleary-Goldman J, Arias-Mendoza F, Cruz-Lobo J, Tempany C, Mulkern RV, Feinberg BB, Brown TR. Detection of Fetal Lactate With Two-Dimensional-Localized Proton Magnetic Resonance Spectroscopy. Obstet Gynecol 2004; 104:1208-10. [PMID: 15516455 DOI: 10.1097/01.aog.0000142697.09330.77] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antenatal surveillance is inefficient for accurately detecting fetal compromise. A noninvasive technique for assessing fetal metabolic status would be useful for clinical management. CASE Fetal magnetic resonance spectroscopy was performed at 20 weeks in a pregnancy complicated by severe intrauterine growth restriction to determine if lactate, a metabolite associated with fetal hypoxia, was present. Two-dimensional, single-slice proton magnetic resonance spectroscopy was carried out at 1.5 T using a volume-selective, double-spin echo technique. Lactate was detected in fetal back muscle. Fetal death occurred the next day. CONCLUSIONS Although this initial report is purely experimental, further development of this technique may prove to be a valuable noninvasive tool in the management of suspected fetal hypoxia.
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Affiliation(s)
- Julian N Robinson
- Department of Obstetrics and Gynecology, Columbia Presbyterian Medical Center, New York, New York, USA.
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Van Cappellen Van Walsum AM, Rijpkema M, Heerschap A, Oeseburg B, Nijhuis JG, Jongsma HW. Cerebral (31)P magnetic resonance spectroscopy and systemic acid-base balance during hypoxia in fetal sheep. Pediatr Res 2003; 54:747-52. [PMID: 12904591 DOI: 10.1203/01.pdr.0000088013.00581.bd] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to investigate cerebral energy metabolism and acid-base homeostasis during impaired oxygen supply in fetal sheep. Systemic acid-base balance was correlated with the sequence in changes of cerebral phosphorus metabolite ratios and intracellular pH. Phosphorus magnetic resonance spectra were obtained from the brain of six fetal sheep simultaneously with repeated measurements of fetal arterial oxygen saturation and acid-base balance. Fetal hypoxia was induced by gradually reducing the oxygen supply to the anesthetized pregnant ewe to establish an intended arterial pH of 7.00 or lower. The ratio of phosphocreatine to inorganic phosphate decreased from 1.08 +/- 0.10 (SD) during the control period to 0.77 +/- 0.29 at an arterial pH between 7.20 and 7.25. The inorganic phosphate level became significantly increased at an arterial pH between 7.10 and 7.15 compared with control values. With ongoing arterial acidosis, cerebral intracellular pH decreased linearly with the arterial pH. At an arterial pH of 7.00, cerebral intracellular pH was decreased from 7.18 +/- 0.03 to 6.71 +/- 0.28, and phosphocreatine and nucleoside triphosphates levels were decreased significantly. In fetal sheep brain, cerebral oxidative phosphorylation (ratio of phosphocreatine to inorganic phosphate) is already affected at a mild arterial acidosis. At an arterial pH of 7.00 or lower, nucleoside triphosphates disappeared, which almost inevitably was followed by death in fetal sheep.
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Hunter CJ, Blood AB, Power GG. Cerebral metabolism during cord occlusion and hypoxia in the fetal sheep: a novel method of continuous measurement based on heat production. J Physiol 2003; 552:241-51. [PMID: 12878759 PMCID: PMC2343310 DOI: 10.1113/jphysiol.2003.048082] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study was undertaken to validate a new method of measuring cerebral metabolic rate in the fetal sheep based on heat production in a local region of the brain. Heat production was compared to oxygen use in 20 near-term fetuses during basal conditions, moderate hypoxia and cord occlusion. Thermocouples were placed to measure core and brain temperature and a composite probe placed in the parietal cortex to measure changes in cortical blood flow (CBF) using laser Doppler flowmetry and tissue PO2 using fluorescent decay. Catheters were inserted in a brachiocephalic artery and sagittal sinus for blood sampling. With moderate hypoxia, induced by administering 10-12 % oxygen to the ewes, fetal arterial PO2 declined from 23 +/- 1 to 11 +/- 1 Torr and brain tissue PO2 fell from 7.6+/- 0.7 to a nadir of 0.8 +/- 0.4 Torr, while CBF increased to 139 +/- 5 % of baseline. Cortical heat production, calculated as the product of CBF, the temperature gain from artery to brain tissue, and the specific heat of blood, decreased by 45 +/- 11 % in parallel to similar declines in oxygen uptake. With severe asphyxia induced by complete cord occlusion for 10 min, fetal arterial PO2 declined from 23 +/- 1 to 9 +/- 2 Torr and brain tissue PO2 fell from 7.0 +/- 0.7 to essentially 0 Torr while CBF decreased 40 +/- 5 %. Cortical heat production decreased by 78 +/- 6 % while oxygen use declined by 90 +/- 3 %. Glucose uptake increased significantly relative to oxygen use and lactate concentration increased in sagittal sinus blood. We conclude that local measurements of heat production in the brain provide a useful index of overall metabolic rate, closely reflecting oxygen use in moderate hypoxia and indicating a significant contribution from anaerobic metabolism during severe asphyxia.
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Affiliation(s)
- Christian J Hunter
- Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
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Peebles DM, Dixon JC, Thornton JS, Cady EB, Priest A, Miller SL, Blanco CE, Mulder TL, Ordidge RJ, Rodeck CH. Magnetic resonance proton spectroscopy and diffusion weighted imaging of chick embryo brain in ovo. BRAIN RESEARCH. DEVELOPMENTAL BRAIN RESEARCH 2003; 141:101-7. [PMID: 12644253 DOI: 10.1016/s0165-3806(03)00002-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Metabolic compensatory mechanisms may partly account for the decreased vulnerability to hypoxia observed in the developing brain. We used proton magnetic resonance spectroscopy and diffusion-weighted imaging to measure the cerebral concentrations of lactate and other metabolites, as well as the apparent diffusion coefficient (ADC) of tissue water, before, during and after hypoxia in anaesthetised chick embryos in ovo. Reducing the inspired oxygen concentration to 8% for 40 min caused a significant rise in both mean (+/-S.D.) lactate:creatine and alanine:creatine ratios from 0.58 (0.41) to 1.56 (0.56) and 0.14 (0.14) to 0.29 (0.17), respectively. Under similar hypoxic conditions, ADC did not change from a mean baseline value of 0.95 (0.09), but did fall to 0.40 (0.12) x 10(9) mm(2) s(-1) with further stepwise reductions in oxygenation. Moderate hypoxia increases lactate concentration in the developing chick brain without compromising cellular energy metabolism.
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Affiliation(s)
- Donald M Peebles
- Department of Obstetrics and Gynaecology, University College London, 86-96 Chenies Mews, London WC1E 6HX, UK.
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Fan G, Wu Z, Chen L, Guo Q, Ye B, Mao J. Hypoxia-ischemic encephalopathy in full-term neonate: correlation proton MR spectroscopy with MR imaging. Eur J Radiol 2003; 45:91-8. [PMID: 12536086 DOI: 10.1016/s0720-048x(02)00021-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To evaluate 1H Magnetic Resonance Spectroscopy (1HMRS) in the diagnosis of hypoxia-ischemic encephalopathy (HIE) of full-term neonates correlated with Magnetic Resonance Imaging (MRI). MATERIALS AND METHODS Thirty-eight cases of full-term neonates diagnosed as HIE clinically were selected to perform MRI and 1HMRS examination. The ages ranged from 7 to 17 days, with median age of 8.2 days. In which, 26 cases were followed up and/or MRI reexamined at 6 months of age or later. Eight healthy neonates, with no evidence of birth asphyxia, also underwent 1HMRS for comparison. SE sequences were used for routine MR examination; point resolved spectroscopy sequence was required for 1HMRS. The metabolites in the spectra includes: N-acetylaspartate (NAA), choline compounds (CHO), creatine compounds (CR), myo-inositol (MI), lactate (LAC), glutamate and glutamine (Glu-Gln). RESULTS The peaks of NAA were fall in two cases; the peaks of LAC, which were elevated, appeared as typical double-peaks appearance in 26 cases; the peaks of Glu-Gln, which were also elevated, appeared as zigzag appearance in nine cases. The peaks of CR were decreased in 11 cases, while those of MI were increased in seven cases. Mild type of lesions was present on MRI in 12 cases whose LAC/CR ratio lower than 0.5; mild and moderate types of lesions were present in 15 cases whose LAC/CR ratio between 0.5 and 1.5. Whereas, nine cases of severe lesions and two cases of moderate lesions were present on MRI in 11 cases whose LAC/CR ratio greater than 1.5. Twenty-six of 38 cases were followed up and/or MRI reexamined after 6 months, in which, sequelae were present in 12 cases. Among them, eight cases of sequelae in nine cases whose LAC/CR ratio greater than 1.5 were present (account for 88.89%). CONCLUSION 1HMRS plays an important role to diagnose and predict outcome of HIE.
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Affiliation(s)
- Guoguang Fan
- Department of Radiology, #2 Hospital/China Medical University, No 36 Sanhao St, Heping dist, Shenyang, Liaoning 110004, People's Republic of China.
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Kok RD, van den Bergh AJ, Heerschap A, Nijland R, van den Berg PP. Metabolic information from the human fetal brain obtained with proton magnetic resonance spectroscopy. Am J Obstet Gynecol 2001; 185:1011-5. [PMID: 11717623 DOI: 10.1067/mob.2001.117677] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study the feasibility of proton magnetic resonance spectroscopy for the examination of human fetal brain metabolism. STUDY DESIGN Proton magnetic resonance spectroscopy was performed from a selected volume of brain tissue of 21 single normal fetuses of 36 to 41 weeks' gestational age. Absolute brain metabolite tissue levels were estimated by using the brain water content as an internal reference. RESULTS Proton magnetic resonance spectra showed resonances for four dominating brain metabolites. Inositol, choline, creatine, and N-acetylaspartate could be detected with average tissue levels of 7.42 mmol/L, 3.31 mmol/L, 4.16 mmol/L, and 5.03 mmol/L, respectively. The resonance for N-acetylaspartate could not always be resolved from contaminating lipid signals. CONCLUSION Proton magnetic resonance spectroscopy of the human fetal brain is feasible and can provide useful information about the fetal condition. The metabolite tissue levels for the fetal brain obtained in this study were in the range observed for neonates of similar gestational age.
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Affiliation(s)
- R D Kok
- Department of Obstetrics and Gynecology, University Medical Center Nijmegen, The Netherlands
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Demougeot C, Garnier P, Mossiat C, Bertrand N, Giroud M, Beley A, Marie C. N-Acetylaspartate, a marker of both cellular dysfunction and neuronal loss: its relevance to studies of acute brain injury. J Neurochem 2001; 77:408-15. [PMID: 11299303 DOI: 10.1046/j.1471-4159.2001.00285.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To evaluate the contribution of cellular dysfunction and neuronal loss to brain N-acetylaspartate (NAA) depletion, NAA was measured in brain tissue by HPLC and UV detection in rats subjected to cerebral injury, associated or not with cell death. When lesion was induced by intracarotid injection of microspheres, the fall in NAA was related to the degree of embolization and to the severity of brain oedema. When striatal lesion was induced by local injection of malonate, the larger the lesion volume, the higher the NAA depletion. However, reduction of brain oedema and striatal lesion by treatment with the lipophilic iron chelator dipyridyl (20 mg/kg, 1 h before and every 8 h after embolization) and the inducible nitric oxide synthase inhibitor aminoguanidine (100 mg/kg given 1 h before malonate and then every 9 h), respectively, failed to ameliorate the fall in NAA. Moreover, after systemic administration of 3-nitropropionic acid, a marked reversible fall in NAA striatal content was observed despite the lack of tissue necrosis. Overall results show that cellular dysfunction can cause higher reductions in NAA level than neuronal loss, thus making of NAA quantification a potential tool for visualizing the penumbra area in stroke patients.
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Affiliation(s)
- C Demougeot
- Unité de Biochimie-Pharmacologie-Toxicologie, Laboratoire de Pharmacodynamie, Faculté de Pharmacie, Dijon, France Service de Neurologie, Centre Hospitalier Universitaire, Dijon, France
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Abstract
Lactate has been measured to evaluate fetal metabolic acidosis for some decades. However, not until the past few years have reliable lactate meters become available for bedside obstetric practice. The new technology, which requires only 5 microl blood, has reduced the sampling failure rate of fetal scalp blood to almost nil. A growing body of evidence has also shown lactate to be good at predicting neonatal outcome.
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Affiliation(s)
- L Nordström
- Department of Obstetrics and Gynaecology, Karolinska Institute, Söder Hospital, Stockholm, Sweden.
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