Chateil J F, Quesson B, Brun M, Thiaudière E, Sarlangue J, Delalande C, Billeaud C, Canioni P, Diard F
Service de Radiologie A, Hôpital Pellegrin, Bordeaux, France.
Pediatr Radiol. 1999 Mar;29(3):199-205. doi: 10.1007/s002470050572.
Perinatal hypoxic ischaemic injury is a significant cause of neurodevelopmental impairment. The aim of this study was to evaluate localised proton magnetic resonance spectroscopy (1H-MRS) after birth asphyxia.
Thirty newborn infants suspected of having perinatal asphyxia (Apgar score < 3) were studied. The mean gestational age was 37 weeks, mean age at the MR examination was 18 days and mean weight was 2.9 kg. A 1.5-T unit was used for imaging and spectroscopy. None of the babies had mechanically assisted ventilation. No sedation was used. Axial T1-weighted and T2-weighted images were obtained. 1H-MRS was recorded in a single voxel, localised in white matter, using a STEAM sequence.
Image quality was good in 25 of 30 babies. 1H-MRS was performed in 19 of 30 subjects, with adequate quality in 16. Choline, creatine/phosphocreatine and N-acetylaspartate peaks and peak-area ratios were analysed. Lactate was detected in four infants. The N-acetylaspartate/choline ratio was lower in infants with an impaired neurological outcome, but the difference was not statistically significant.
This study suggests that 1H-MRS may be useful for assessing cerebral metabolism in the neonate. A raised lactate level and decreased N-acetylaspartate/choline ratio may be predictive of a poor outcome. However, in our experience this method is limited by the difficulty in performing the examination during the first hours after birth in critically ill babies, the problems related to use of a monovoxel sequence, the dispersion of the ratios and the lack of determination of the absolute concentration of the metabolites.
围产期缺氧缺血性损伤是神经发育障碍的一个重要原因。本研究的目的是评估出生窒息后局部质子磁共振波谱（1H-MRS）。
研究了30名疑似有围产期窒息（阿氏评分<3）的新生儿。平均胎龄为37周，磁共振检查时的平均年龄为18天，平均体重为2.9千克。使用1.5-T设备进行成像和波谱分析。所有婴儿均未接受机械辅助通气。未使用镇静剂。获取了轴位T1加权和T2加权图像。使用STEAM序列在单个体素中记录白质中的1H-MRS。
30名婴儿中有25名图像质量良好。30名受试者中有19名进行了1H-MRS，其中16名质量合格。分析了胆碱、肌酸/磷酸肌酸和N-乙酰天门冬氨酸峰及峰面积比。在4名婴儿中检测到乳酸。神经功能结局受损的婴儿中N-乙酰天门冬氨酸/胆碱比值较低，但差异无统计学意义。
本研究表明1H-MRS可能有助于评估新生儿的脑代谢。乳酸水平升高和N-乙酰天门冬氨酸/胆碱比值降低可能预示预后不良。然而，根据我们的经验，这种方法受到以下限制：在危重新生儿出生后的最初几个小时内进行检查困难、与使用单体素序列相关的问题、比值的离散性以及代谢物绝对浓度测定的缺乏。
