Prognostic value of 1H-MRS in perinatal CNS insults

Shu, Stanford; Ashwal, Stephen; Holshouser, Barbara A.; Nystrom, Gerald A.; Hinshaw, David B.

doi:10.1016/s0887-8994(97)00140-9

Cited by 76 publications

(39 citation statements)

References 39 publications

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“…102,103 In another report, abnormalities of NAA/creatine, NAA/ choline, and choline/creatine ratios in the occipital gray/parietal white matter regions were predictive of adverse outcome at a mean age of 15 months in infants with HIE. 104 Positive predictive values for abnormal neurodevelopmental outcome based on these metabolites were 0.64, 0.68, and 0.75 for values Ͼ2 SD from those of controls.…”

Section: Gray-scale Us Doppler Us and Studies Comparing Us With Ct mentioning

confidence: 94%

Practice parameter: Neuroimaging of the neonate: [RETIRED]

Ment

Bada²,

Barnes³

et al. 2002

Neurology

392

100

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Article abstract-Objective: The authors reviewed available evidence on neonatal neuroimaging strategies for evaluating both very low birth weight preterm infants and encephalopathic term neonates. Imaging for the preterm neonate: Routine screening cranial ultrasonography (US) should be performed on all infants of Ͻ30 weeks' gestation once between 7 and 14 days of age and should be optimally repeated between 36 and 40 weeks' postmenstrual age. This strategy detects lesions such as intraventricular hemorrhage, which influences clinical care, and those such as periventricular leukomalacia and low-pressure ventriculomegaly, which provide information about long-term neurodevelopmental outcome. There is insufficient evidence for routine MRI of all very low birth weight preterm infants with abnormal results of cranial US. Imaging for the term infant: Noncontrast CT should be performed to detect hemorrhagic lesions in the encephalopathic term infant with a history of birth trauma, low hematocrit, or coagulopathy. If CT findings are inconclusive, MRI should be performed between days 2 and 8 to assess the location and extent of injury. The pattern of injury identified with conventional MRI may provide diagnostic and prognostic information for term infants with evidence of encephalopathy. In particular, basal ganglia and thalamic lesions detected by conventional MRI are associated with poor neurodevelopmental outcome. Diffusion-weighted imaging may allow earlier detection of these cerebral injuries. Recommendations: US plays an established role in the management of preterm neonates of Ͻ30 weeks' gestation. US also provides valuable prognostic information when the infant reaches 40 weeks' postmenstrual age. For encephalopathic term infants, early CT should be used to exclude hemorrhage; MRI should be performed later in the first postnatal week to establish the pattern of injury and predict neurologic outcome.

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Section: Gray-scale Us Doppler Us and Studies Comparing Us With Ct mentioning

confidence: 94%

Practice parameter: Neuroimaging of the neonate: [RETIRED]

Ment

Bada²,

Barnes³

et al. 2002

Neurology

392

100

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“…OGM Cr and Ins, reduced NAA/Cho in BG) (17,18) and (2) opioid-treated infants had evidence of reduced brain injury as determined by higher NAA/Cr (OGM) ratios and no evidence of Lac (OGM) than non-opioid-treated neonates. Together these findings suggest that TDPs may increase the amount of neonatal pain and stress augmenting neonatal brain injury associated with hypoxia-ischemia and that opioids used to treat pain do not have a harmful effect and may be neuroprotective.…”

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confidence: 98%

Relationship Between Opioid Therapy, Tissue-Damaging Procedures, and Brain Metabolites as Measured by Proton MRS in Asphyxiated Term Neonates

et al. 2007

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ABSTRACT:To examine the effects of opioid and tissue-damaging procedures (TDPs) [i.e. procedures performed in the neonatal intensive care unit (NICU) known to result in pain, stress, and tissue damage] on brain metabolites, we reviewed the medical records of 28 asphyxiated term neonates (eight opioid-treated, 20 non-opioid treated) who had undergone magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (MRS) within the first month of life as well as eight newborns with no clinical findings of asphyxial injury. We found that lower creatine (Cr), myoinositol (Ins), and N-acetylaspartate (NAA)/choline (Cho) (p Յ 0.03) and higher Cho/Cr and glutamate/glutamine (Glx) Cr (p Յ 0.02) correlated with increased TDP incidence in the first 2 d of life (DOL). We also found that occipital gray matter (OGM) NAA/Cr was decreased (p ϭ 0.03) and lactate (Lac) was present in a significantly higher amount (40%; p ϭ 0.03) in non-opioid-treated neonates compared with opioid-treated neonates. Compared with controls, untreated neonates showed larger changes in more metabolites in basal ganglia (BG), thalami (TH), and OGM with greater significance than treated neonates. Our data suggest that TDPs affect spectral metabolites and that opioids do not cause harm in asphyxiated term neonates exposed to repetitive TDPs in the first 2-4 DOL and may provide a degree of neuroprotection. (Pediatr Res 61: 614-621, 2007) P erinatal asphyxia is a common cause of neonatal encephalopathy and frequently results in epilepsy, cerebral palsy, and other long-term neurodevelopmental disorders (1). A cascade of biochemical events take place after asphyxia resulting in changes in brain metabolites that can be monitored noninvasively using proton magnetic resonance spectroscopy (MRS). Noninvasive in vivo measurements of NAA, total Cr [Cr and phosphocreatine (PCr)], Cho-containing compounds, Ins, Glx, and Lac are possible (2). NAA, an amino acid found exclusively in the nervous system, serves primarily as a neuronal marker. Cr, measured as Cr plus PCr with proton MRS, is a bioenergetic marker and reflects the energy potential available to neurons and other cells. The Cho peak includes contributions mostly from phosphocholine and its products glycerophosphocholine and phosphatidylcholine, which are intermediates in phospholipid metabolism thought to be released during membrane disruption. Ins is a glial marker and an important osmolyte. Glutamate and immediately formed glutamine are the major neurotransmitters for brain excitatory function and are often reported in combination because high spin-coupling makes it difficult to measure them separately. The measurement of Glx provides information about neuronal and glial metabolism and interaction (2,3). Lac and its redox partner pyruvate are the terminal metabolites in glycolysis.We recently reported that asphyxiated term neonates treated with opioids for pain during the first week of life had significantly less brain injury as assessed by MRI scores as well as better long-term neurologic outc...

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“…[1][2][3][4][5][6][7][8][9][10][11][12] Elevated brain metabolite ratios, lactate/Nacetylaspartate (NAA) and lactate/choline, have been associated with poor neurodevelopmental status in neonates with hypoxic-ischemic encephalopathy. 1,10,12,13 The increase in brain lactate level is thought to be a result of anaerobic rather than oxidative energy metabolism during cellular hypoxia.…”

mentioning

confidence: 99%

Brain Metabolite Levels Assessed by Lactate-Edited MR Spectroscopy in Premature Neonates with and without Pentobarbital Sedation

Wang¹,

Vigneron²,

Miller³

et al. 2008

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Pentobarbital is known to affect cerebral metabolism; pentobarbital sedation is, however, frequently used for MR imaging and MR spectroscopy, especially in children. Accurate assessment of the brain metabolite levels is important, particularly in neonates with suspected brain injury. We investigated whether pentobarbital sedation has any effect on the ratios of spectral metabolites lactate, N-acetylaspartate, or choline in a group of premature neonates.

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Prognostic value of 1H-MRS in perinatal CNS insults

Cited by 76 publications

References 39 publications

Practice parameter: Neuroimaging of the neonate: [RETIRED]

Practice parameter: Neuroimaging of the neonate: [RETIRED]

Relationship Between Opioid Therapy, Tissue-Damaging Procedures, and Brain Metabolites as Measured by Proton MRS in Asphyxiated Term Neonates

Brain Metabolite Levels Assessed by Lactate-Edited MR Spectroscopy in Premature Neonates with and without Pentobarbital Sedation

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