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Early cerebral proton MRS and neurodevelopmental outcome in infants with cystic leukomalacia
F Groenendaal1, J van der Grond, P Eken
1Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Insights
Proton magnetic resonance spectroscopy (1H-MRS) can predict neurodevelopmental outcomes in infants with cystic leukomalacia (CL). A lower N-acetylaspartate (NAA) to choline (Cho) ratio indicates a poorer outcome, aiding in prognosis.
Area of Science:
- Biomedical Imaging
- Neuroscience
- Pediatric Neurology
Background:
- Cystic leukomalacia (CL) is a severe form of white matter injury in premature infants.
- Predicting neurodevelopmental outcomes in infants with CL is crucial for early intervention.
- Proton magnetic resonance spectroscopy (1H-MRS) offers a non-invasive method to assess brain metabolites.
Purpose of the Study:
- To investigate the predictive value of 1H-MRS in determining neurodevelopmental outcomes for infants diagnosed with CL.
- To correlate specific metabolite ratios measured by 1H-MRS with the severity of CL and subsequent developmental quotients (DQ).
Main Methods:
- Nineteen infants with varying grades of CL underwent 1H-MRS of the basal ganglia and periventricular white matter.
- Metabolite ratios, including N-acetylaspartate (NAA) to choline (Cho) and lactate (Lac) to NAA, were calculated.
- Neurodevelopmental outcomes were assessed at follow-up, with a focus on DQ at or after 1 year of age.
Main Results:
- Significant differences in NAA:Cho ratios were observed across CL grades (P < 0.01), with lower ratios in more severe CL.
- NAA:Cho ratios positively correlated with DQ at 1 year (P < 0.05), indicating better development with higher ratios.
- Lactate (Lac) was detected in 13 infants; Lac:NAA ratios negatively correlated with NAA:Cho ratios but not with DQ.
Conclusions:
- A reduced NAA:Cho ratio measured by 1H-MRS is a significant predictor of poor neurodevelopmental outcomes in infants with CL.
- While NAA:Cho ratios are valuable, some infants with seemingly normal ratios still experienced adverse outcomes, suggesting other factors may be involved.
- Partial volume effects in 1H-MRS imaging may contribute to discrepancies between metabolite ratios and observed neurodevelopmental trajectories.
Abstract:
The present study tested the hypothesis that proton magnetic resonance spectroscopy (1H-MRS) predicted neurodevelopmental outcome in infants with cystic leukomalacia (CL). Nineteen infants with CL (grade 2, N = 7; grade 3, N = 7; grade 4, N = 5), graded according to the authors' classification, were examined at corrected ages of mean 1.5 +/- 2.1 SD weeks. 1H-MRS of the basal ganglia and the periventricular white matter was performed. Two infants died, 16 had an adverse neurodevelopmental outcome and one was normal at follow-up. N-acetylaspartate (NAA):choline (Cho) ratios were mean 1.12 +/- 0.19 (SD) (grade 2), mean 0.95 +/- 0.11 (SD) (grade 3), and mean 0.71 +/- 0.13 (SD) (grade 4). These differences are significant (P < 0.01, ANOVA). NAA:Cho ratios showed a positive correlation with developmental quotient (DQ) at the age of > or = 1 year (P < 0.05). In 13 infants lactate (Lac) was found. Lac:NAA ratios showed a negative correlation with NAA:Cho ratios, but not with DQ. We conclude that a low NAA:Cho ratio predicted a poor outcome, whereas some infants developed unfavourably despite a normal NAA:Cho ratio. We speculate that partial volume effects might explain this observation.