Magnetic resonance spectroscopy.

MRS is a noninvasive technique that does not use ionizing radiation and can be used to measure relative metabolite concentrations in human tissues and organs in vivo. Phosphorus MRS can be used to study energy metabolites and intracellular pH. The first neonatal applications were described in 1983 in a study of cerebral metabolism. Since then, the value of cerebral MRS as research tool and an investigative technique has been confirmed, and its prognostic power in asphyxiated infants has been established. Techniques of spatial localization and quantitation have been developed, but studies of other organs and the use of other nuclei remain at a very preliminary stage. Considering the huge potential of MRS and the proliferation of high field magnets primarily designed for imaging, there has been a disappointing lack of progress in the development of clinical and research applications of spectroscopy. The logistic differences of studying sick infants in strong magnetic fields make MRS a time-consuming and labor-intensive investigation, which will inevitably limit its widespread routine use. Research studies are hampered by the diversity of spectroscopic and signal processing techniques, which make comparisons of data from different groups impossible. Some techniques for the assessment of cerebral hemodynamics such as doppler ultrasound and near infrared spectroscopy have the advantage of being available at the cotside, but MRS is unique in providing quantitative information about a wide range of intracellular metabolites. The altricial development of MRS as a clinical investigative tool in neonatology can be ascribed partly to practical difficulties, but these should not detract from the exciting possibilities opened up by a technique that gives a noninvasive insight into intracellular chemistry. The metabolic information from MRS is an invaluable addition to the information provided by other techniques and will certainly play an important role in unraveling the sequence of events between an hypoxic-ischemic insult and cell death. A better understanding of these mechanisms is a prerequisite to the development of rational therapeutic maneuvers following asphyxial insults.