Fetal Medicine Institute, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
Department of Pediatrics (Neonatology), Baylor College of Medicine, Houston, TX, USA.
Pediatr Radiol. 2019 Jun;49(7):941-950. doi: 10.1007/s00247-019-04383-8. Epub 2019 Mar 28.
Hypoxic-ischemic encephalopathy (HIE) remains a significant cause of mortality and neurodevelopmental impairment despite treatment with therapeutic hypothermia. Magnetic resonance H-spectroscopy measures concentrations of cerebral metabolites to detect derangements in aerobic metabolism.
We assessed MR spectroscopy in neonates with HIE within 18-24 h of initiating therapeutic hypothermia and at 5-6 days post therapeutic hypothermia.
Eleven neonates with HIE underwent MR spectroscopy of the basal ganglia and white matter. We compared metabolite concentrations during therapeutic hypothermia and post-therapeutic hypothermia and between moderate and severe HIE.
During therapeutic hypothermia, neonates with severe HIE had decreased basal ganglia N-acetylaspartate (NAA; 0.62±0.08 vs. 0.72±0.05; P=0.02), NAA + N-acetylaspartylglutamate (NAAG; 0.66±0.11 vs. 0.77±0.06; P=0.05), glycerophosphorylcholine + phosphatidylcholine (GPC+PCh; 0.28±0.05 vs. 0.38±0.06; P=0.02) and decreased white matter GPC+PCh (0.35±0.13 vs. 0.48±0.04; P=0.02) compared to neonates with moderate HIE. For all subjects, basal ganglia NAA decreased (-0.08±0.07; P=0.01), whereas white matter GPC+PCh increased (0.03±0.04; P=0.04) from therapeutic hypothermia MRI to post-therapeutic-hypothermia MRI. All metabolite values are expressed in mmol/L.
Decreased NAA and GPC+PCh were associated with greater HIE severity and could distinguish neonates who might benefit most from targeted additional neuroprotective therapies.
尽管采用了治疗性低温疗法，缺氧缺血性脑病（HIE）仍然是导致死亡和神经发育障碍的重要原因。磁共振 H 谱测量脑代谢物浓度，以检测有氧代谢的紊乱。
我们评估了在开始治疗性低温后 18-24 小时内和治疗性低温后 5-6 天内患有 HIE 的新生儿的磁共振光谱。
11 名患有 HIE 的新生儿接受了基底节和白质的磁共振光谱检查。我们比较了治疗性低温期间和治疗性低温后的代谢物浓度，以及中度和重度 HIE 之间的代谢物浓度。
在治疗性低温期间，重度 HIE 新生儿的基底节 N-乙酰天冬氨酸（NAA；0.62±0.08 与 0.72±0.05；P=0.02）、NAA+N-乙酰天冬氨酸谷氨酸（NAAG；0.66±0.11 与 0.77±0.06；P=0.05）、甘油磷酸胆碱+磷脂酰胆碱（GPC+PCh；0.28±0.05 与 0.38±0.06；P=0.02）和白质 GPC+PCh（0.35±0.13 与 0.48±0.04；P=0.02）降低。与中度 HIE 新生儿相比，所有受试者的基底节 NAA 减少（-0.08±0.07；P=0.01），而白质 GPC+PCh 增加（0.03±0.04；P=0.04），从治疗性低温 MRI 到治疗性低温后 MRI。所有代谢物值均以 mmol/L 表示。
NAA 和 GPC+PCh 的减少与 HIE 严重程度有关，可区分最有可能从靶向神经保护治疗中获益最大的新生儿。
