¹H‐magnetic resonance spectroscopy—determined cerebral lactate and poor neurological outcomes in children with central nervous system disease

Abstract

By using proton magnetic resonance spectroscopy ((1)H-MRS), cerebral lactate has been shown to be elevated in a wide variety of pediatric and adult neurological diseases. In this study we compared 36 newborns, infants, and children with elevated lactate peaks on (1)H-MRS with 61 patients without an identifiable lactate signal. (1)H-MRS was acquired from the occipital gray and parietal white matter (8 cm3 volume, STEAM sequence with echo time = 20 msec, repetition time = 3.0 seconds) and data were expressed as ratios of different metabolite peak areas (N-acetylaspartate [NA]/creatine [Cr], NA/choline [Ch], and Ch/Cr) and the presence of a characteristic lactate doublet peak at 1.3 ppm. Outcomes (Pediatric Cerebral Performance Category Scale score; PCPCS) were assigned 6 to 12 months after injury. Patients with lactate peaks were more likely to have suffered a cardiac arrest, were more often hyperglycemic, and had lower Glasgow Coma Scale scores on admission. They were also more likely to have abnormal metabolite ratios when compared with age-matched controls or with patients without detectable lactate. Of prognostic importance, patients with increased lactate were more likely to be severely disabled (39% vs 10%), survive in a persistent vegetative state (13% vs 2%), or have died (39% vs 7%). In contrast, patients with similar conditions without increased lactate were more likely to have had a good outcome (23% vs 3%) or recovered to a mild (38% vs 6%) or moderate disability (20% vs 0%). Our data suggest that (1)H-MRS is useful in the prediction of long-term outcomes in children with neurological disorders. Patients with elevated cerebral lactate are more likely to die acutely or are at greater risk for serious long-term disability.

Brain lactate by magnetic resonance spectroscopy during fulminant hepatic failure in the dog

“…In one study, elevated levels of brain lactate correlated significantly (P Ͻ .001) with serious long-term disability and death in a group of 36 pediatric patients with acute central nervous system injuries. 2 Mildly elevated concentrations of brain lactate were associated with reversible encephalopathy in a 14-year-old boy with Reye' s syndrome 35 and a patient with acute decompensation of maple syrup urine disease. 7 A proposed explanation for brain lactate production and brain death during FHF induced by D-galactosamine is outlined in Fig.…”

“…Proton spectra of brain lactate at 1.5 T have been reported in a case of Reye' s syndrome 35 and in a variety of other diseases with neurological manifestations. [1][2][3][4][5][6][7] Unfortunately, unambiguous separation of the glutamine/flutamate complex (2.2-2.5 ppm) is not possible at 1.5 T. It was for this reason that the current study was performed at 9.4 T.…”

The effect of whole-body cooling on brain metabolism following perinatal hypoxic–ischemic injury

“…Because previous MRS studies in HII neonates have shown that reduced NAA/ Cr ratios correlate with impaired long-term developmental outcomes (13,16), future studies may find that MRS findings in hypothermia-treated neonates have a similar value in determining long-term neurological outcomes.…”

“…A reference spectrum with eight acquisitions and no water suppression was acquired to use for eddy current correction. The OGM was chosen because it is located in a watershed cortical region and our previous studies show that this region is sensitive to global insults (13,22). Quantitative metabolite levels (in institutional units) and ratios were obtained for NAA (2.02 ppm), Cr (Cr + phosphocreatine; 3.0 ppm), Cho (3.2 ppm), myo-inositol (3.56 ppm), glutamate/glutamine (2.05 -2.5), and Lac (1.33 ppm) using LCmodel (35).…”

“…MRS measures brain metabolites, including N-acetylaspartate (NAA; neuronal integrity and mitochondrial function), creatine (Cr) and phosphocreatine (brain energy metabolism and energy status), choline (Cho; membrane metabolism, integrity, and turnover), myo-inositol (astrocyte proliferation and brain osmotic balance), and glutamate/glutamine (glutamatergic neurotransmitter system). The indicators of HII include increased lactate (Lac) and decreased NAA levels in the BG and TH; these show significant correlation to poor outcomes and are detected using MRS (11)(12)(13)(14)(15)(16).…”