Abstract
To test the hypothesis that cerebral metabolic disturbances could be demonstrated in vivo in neonates with subcortical (SCL) and periventricular cystic leucomalacia (PVL) 7 infants (gestational age 29.1 to 40.4 weeks. 4 preterm--PT, 3 fullterm--FT, birth weight 1050 to 4050 g) with cystic leucomalacia (CL), as diagnosed by cerebral ultrasonography, were examined using 1H-MRS.
Methods: 1H-MRS was performed at a postmenstrual age of 42.1±2.5 wks (40-47 wks), 5.8±4.7 wks (2 days - 12 wks) after cerebral ischemia. In a 1.5 T magnetic field, MR spectra were obtained in a 225 mm field of view, a volume of interest (VOI) of 7×5×2 cm. Pulse sequences included adiabatic pulses for water suppression, followed by 90°-180°-180° pulses. One FT neonate died, the 6 survivors were seen for neurodevelopmental follow-up at 3, 6 and 9 months.
Results: In the 3 FT with SCL N-acetyl-aspartate/choline (NAA/Cho) ratios of the VOI were 0.49, 0.69, and 0.74 respectively (normal FT neonates >0.85), whereas in the 4 PVL-infants these ratios were 1.01±0.17 (range 0.86-1.24). Lactate resonances at 1.33 ppm, which cannot be demonstrated in normal FT, were found in 2 neonates with SCL (lactate/NAA ratio: 1.07, and 1.59). Lactate was present up to 12 wks after cerebral ischemia in one PVL-infant (lactate/NAA: 0.29). Three others had resonances at 1.3 ppm that could not be discriminated from fat. All 3 SCL-neonates had a poor outcome: one died, 2 showed spastic quadriplegia and cerebral visual impairment. Of the 4 PVL-infants, one appeared to be normal at 9 months of age, two had a suspect neuromotor development on follow-up, and the fourth developed spastic diplegia.
Conclusion: using 1H-MRS, cerebral metabolic abnormalities were demonstrated in vivo in infants with CL. Lowest NAA/Cho ratios, reflecting severe loss of neurones, were found in the infants with SCL, who had a very poor outcome.
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Groenendaal, F., Eken, P., Van Der Grond, J. et al. 81 IN VIVO PROTON MAGNETIC RESONANCE SPECTROSCOPY (1H-MRS) IN CYSTIC LEUCOMALACIA OF INFANCY. Pediatr Res 36, 16 (1994). https://doi.org/10.1203/00006450-199407000-00081
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DOI: https://doi.org/10.1203/00006450-199407000-00081