Institute for Women's Health, University College London, London, UK.
Women and Children, University College London NHS Foundation Trust, London, UK.
Arch Dis Child Fetal Neonatal Ed. 2019 Jul;104(4):F424-F432. doi: 10.1136/archdischild-2018-315478. Epub 2018 Oct 15.
Brain proton (H) magnetic resonance spectroscopy (MRS) lactate/N-acetylaspartate (Lac/NAA) peak area ratio is used for prognostication in neonatal encephalopathy (NE). At 3 Tesla in NE babies, the objectives were to assess: (1) sensitivity and specificity of basal ganglia and thalamus (BGT) H MRS Lac/NAA for the prediction of Bayley III outcomes at 2 years using optimised metabolite fitting (Tarquin) with threonine and total NAA; (2) prediction of motor outcome with diffusion-weighted MRI; (3) BGT Lac/NAA correlation with the National Institute of Child Health and Human Development (NICHD) MRI score.
55 (16 inborn, 39 outborn) infants at 39w+5 d (35w+5d-42w+0d) with NE admitted between February 2012 and August 2014 to University College London Hospitals for therapeutic hypothermia underwent MRI and H MRS at 3T on day 2-14 (median day 5). MRIs were scored. Bayley III was assessed at 24 (22-26) months.
16 babies died (1 inborn, 15 outborn); 20, 19 and 21 babies had poor motor, cognitive and language outcomes. Using a threshold of 0.39, sensitivity and specificity of BGT Lac/NAA for 2-year motor outcome was 100% and 97%, cognition 90% and 97% and language 81% and 97%, respectively. Sensitivity and specificity for motor outcome of mean diffusivity (threshold 0.001 mm/s) up to day 9 was 72% and 100% and fractional anisotropy (threshold 0.198) was 39% and 94%, respectively. Lac/NAA correlated with BGT injury on NICHD scores (2A, 2B, 3).
BGT Lac/NAA on H MRS at 3T within 14 days accurately predicts 2-year motor, cognitive and language outcome and may be a marker directing decisions for therapies after cooling.
脑质子（H）磁共振波谱（MRS）乳酸/乙酰天门冬氨酸（Lac/NAA）峰面积比用于新生儿脑病（NE）的预后评估。在 NE 婴儿中，在 3 Tesla 下，目的是评估：（1）使用优化的代谢物拟合（Tarquin），包括苏氨酸和总 NAA，基底节和丘脑（BGT）H MRS Lac/NAA 对 2 年 Bayley III 结果的预测的灵敏度和特异性；（2）扩散加权 MRI 对运动结果的预测；（3）BGT Lac/NAA 与国家儿童健康与人类发展研究所（NICHD）MRI 评分的相关性。
2012 年 2 月至 2014 年 8 月，在伦敦大学学院医院接受治疗性低温治疗的 55 名（16 名宫内，39 名宫外）39w+5 d（35w+5d-42w+0d）NE 婴儿在第 2-14 天（中位数第 5 天）进行 3T MRI 和 H MRS 检查。对 MRI 进行评分。在 24 个月（22-26 个月）时进行 Bayley III 评估。
16 名婴儿死亡（1 名宫内，15 名宫外）；20、19 和 21 名婴儿的运动、认知和语言能力较差。使用 0.39 的阈值，BGT Lac/NAA 对 2 年运动结果的灵敏度和特异性分别为 100%和 97%，认知为 90%和 97%，语言为 81%和 97%。第 9 天及以前平均弥散度（阈值 0.001mm/s）的运动结果的灵敏度和特异性分别为 72%和 100%，各向异性分数（阈值 0.198）分别为 39%和 94%。Lac/NAA 与 NICHD 评分的 BGT 损伤相关（2A、2B、3）。
3T 内 14 天内的 BGT Lac/NAA 在 H MRS 上准确预测 2 年的运动、认知和语言结局，可能是指导冷却后治疗决策的标志物。
