title: Proton MR spectroscopy after acute central nervous system injury: outcome prediction in neonates, infants, and children.
abstract: OBJECTIVE
  To evaluate the usefulness of proton magnetic resonance (MR) spectroscopy in predicting 6-12-month neurologic outcome in children after central nervous system injuries.
  
  
  METHODS
  Localized single-voxel, 20-msec-echo-time MR spectra (including N-acetylaspartate [NAA], choline [Ch], creatine and phosphocreatine [Cr]) were obtained in the occipital gray matter in 82 patients and 24 control patients. Patient age groups were defined as neonates (< or = 1 month [n = 23]), infants (1-18 months [n = 31]), and children (> or = 18 months [n = 28]). Metabolite ratios and the presence of lactate were determined. Linear discriminant analysis-with admission clinical data, proton MR spectroscopy findings, and MR imaging score (three-point scale based on severity of structural neuroimaging changes)-was performed to help predict outcome in each patient. Findings were then compared with the actual 6-12-month outcome assigned by a pediatric neurologist.
  
  
  RESULTS
  Outcome on the basis of proton MR spectroscopy findings combined with clinical data and MR imaging score was predicted correctly in 91% of neonates and in 100% of infants and children. Outcome on the basis of clinical data and MR imaging score alone was 83% in neonates, 84% in infants, and 93% in children. The presence of lactate was significantly higher in patients with poor outcome than in patients with good-moderate outcomes in all three age groups (neonates, 38% vs 5%; infants, 87% vs 5%; children, 64% vs 10% [chi 2 test, P < .02]). In children with poor outcomes, NAA/Cr ratios were significantly lower in infants (P = .006) and children (P < .001), and NAA/Ch ratios were significantly lower in infants (P = .001) and neonates (P = .05).
  
  
  CONCLUSIONS
  Findings at proton MR spectroscopy helped predict long-term neurologic outcomes in children after central nervous system injury.
authors.affiliation: Department of Radiology, Magnetic Resonance Imaging, Loma Linda University School of Medicine 92354, USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Holshouser
authors.forename: S
authors.initials: S
authors.lastname: Ashwal
authors.forename: G Y
authors.initials: GY
authors.lastname: Luh
authors.forename: S
authors.initials: S
authors.lastname: Shu
authors.forename: S
authors.initials: S
authors.lastname: Kahlon
authors.forename: K L
authors.initials: KL
authors.lastname: Auld
authors.forename: L G
authors.initials: LG
authors.lastname: Tomasi
authors.forename: R M
authors.initials: RM
authors.lastname: Perkin
authors.forename: D B
authors.initials: DB
authors.lastname: Hinshaw
mesh_terms: D000293:Adolescent; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D001921:Brain / Q000378:metabolism; D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D001930:Brain Injuries / Q000175:diagnosis* / Q000378:metabolism; D002648:Child; D002794:Choline / Q000032:analysis; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019344:Lactic Acid / Q000032:analysis; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D010725:Phosphocreatine / Q000032:analysis; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D010725:Phosphocreatine; D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D002794:Choline