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Proton magnetic resonance spectroscopy in children with acute central nervous system injury
K L Auld1, S Ashwal, B A Holshouser
1Department of Pediatrics, Loma Linda University School of Medicine, CA 92354, USA.
Insights
Proton magnetic resonance spectroscopy (1H-MRS) in children with acute brain injuries shows specific metabolite ratios can predict outcomes. Combining 1H-MRS data with clinical factors achieved 100% accurate outcome prediction.
Area of Science:
- Neuroimaging
- Biochemistry
- Pediatric Neurology
Background:
- Acute central nervous system (CNS) injuries in infants and children require accurate outcome prediction for optimal management.
- Proton magnetic resonance spectroscopy (1H-MRS) offers a non-invasive method to assess brain metabolites.
- Metabolite ratios may serve as biomarkers for neurological damage and recovery potential.
Observation:
- Single voxel 1H-MRS was performed on 30 pediatric patients with acute CNS injuries.
- Metabolite ratios, including N-acetylaspartate/creatine (NA/Cr) and N-acetylaspartate/choline (NA/Ch), were analyzed.
- Lactate presence was also assessed in occipital gray and parietal white matter.
Findings:
- Patients with poor outcomes exhibited significantly lower NA/Cr and NA/Ch ratios compared to those with good/moderate outcomes.
- Lactate was detected in 80% of patients with bad outcomes, but in none of the good/moderate outcome group.
- A combination of clinical variables and 1H-MRS data achieved 100% accuracy in predicting patient outcomes.
Implications:
- 1H-MRS metabolite ratios provide valuable prognostic information in pediatric acute CNS injuries.
- Integrating 1H-MRS findings with clinical assessments can significantly enhance outcome prediction accuracy.
- This approach may aid in tailoring treatment strategies and improving patient management in pediatric neurocritical care.
Abstract:
Single voxel proton magnetic resonance spectroscopy (1H-MRS) was used in 30 infants and children with acute central nervous system injuries to determine the value of changes in specific metabolite ratios in predicting outcome. The mean age of all patients was 38 +/- 52 months and the mean time of study after insult was 7 +/- 5 days. 1H-MRS was determined in the occipital gray and parietal white matter (8 cm3 volume, STEAM sequence with TE = 20 ms, TR = 3,000 ms). Data were expressed as ratios of different metabolite peak areas including N-acetylaspartate (NA), choline-containing compounds (Ch), creatine and phosphocreatine (Cr), and lactate (Lac). Statistically significant differences were observed when patients with good/moderate (G/M) outcomes (n = 17; mean age: 46 months) were compared to patients with bad outcomes (n = 10; mean age: 26 months). NA/Cr and NA/Ch were significantly lower in the bad outcome group (NA/Cr = 1.15 +/- 0.38; NA/Ch = 1.18 +/- 0.52) compared to the G/M group (NA/Cr = 1.41 +/- 0.28, P < .05; NA/Ch = 1.98 +/- 0.81, P < .01). Lactate was present in 80% of bad outcome patients and in none of the G/M group (P < .0001). Using a linear discriminant analysis and combining 4 clinical variables (Glasgow Coma Scale score, initial pH and glucose, number of days unconscious at time of 1H-MRS) allows classification of 94% of patients into their correct outcome group. Use of spectroscopy variables (NA/Cr, NA/Ch, Ch/Cr, presence of lactate) alone correctly classified 81% of patients. The combination of clinical and 1H-MRS variables correctly classified 100% of patients. Our findings suggest that 1H-MRS adds information which, in combination with clinical examination, may be useful in outcome assessment in children with serious acute central nervous system injury.