Metabolite concentrations and relaxation in perinatal cerebral hypoxic-ischemic injury

Regional cerebral metabolite concentrations, principally of choline-containing compounds (Cho), total creatine (Cr), N-acetylaspartate (Naa), and lactate (Lac), can be quantified by in vivo proton magnetic resonance spectroscopy. In order to estimate a metabolite concentration, it is often necessary to measure the transverse relaxation time (T2). Metabolite T2s depend on cytosolic viscosity: as [adenosine triphosphate] falls leading to Na+/K+ pump failure, cytosolic water increases and T2s lengthen. In central grey-matter in human infants, Naa may be almost exclusively neuronal: Naa T2 may index neuronal edema and energy generation. In this preliminary report, metabolite concentrations and T2s have been measured in central grey matter in human infants suspected of perinatal hypoxic-ischemic cerebral injury. In infants who developed serious cerebral injury or died, [Cho] and [Naa] were low (the latter suggesting neuronal loss), [Lac] and all metabolite T2s were increased: the Naa T2 increase possibly reflected neuronal edema following failure of energy generation in a fraction of remaining neurons.