title: Developmental delay in children: assessment with proton MR spectroscopy.
abstract: OBJECTIVE
  The cause of developmental delay frequently is unknown, and clinicians and families can be frustrated by the lack of neuroimaging correlation especially when considering therapeutic options and long-term prognosis. We sought to determine if proton MR spectroscopy can depict abnormalities in patients with developmental delay who have structurally normal brain MR images.
  
  
  METHODS
  Children with developmental delay who were older than 2 years (mean age, 5.0 years; range, 3.0-10.0 years) and those aged 2 years or younger (mean age, 1.5 years; range, 0.5-2.0 years) and age-matched control subjects for each patient group underwent brain MR imaging and proton MR spectroscopy. A point-resolved spectroscopy sequence (2000/144 [TR/TE]) was used. Voxels (8 cm(3)) were placed in the subcortical white matter of the frontal and parieto-occipital lobes bilaterally. N-acetylaspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios were assessed.
  
  
  RESULTS
  All patients had normal brain MR images. In children with developmental delay who were aged 2 years or younger, no statistically significant differences were detected in the NAA/Cr or Cho/Cr ratios compared with those of the control subjects. In children with developmental delay who were older than 2 years, decreases in the NAA/Cr ratio were observed in frontal (P <.001) and parieto-occipital (P <.017) subcortical white matter, and elevations in the Cho/Cr ratio were detected in the frontal (P <.24) and parieto-occipital (P <.002) subcortical white matter compared with age-matched control subjects.
  
  
  CONCLUSIONS
  In children with developmental delay who are older than 2 years, proton MR spectroscopy depicted abnormalities in the NAA/Cr and Cho/Cr ratios. Proton MR spectroscopy should be performed as part of the neuroimaging evaluation of developmental delay. Further studies will be needed to determine if abnormalities detected with proton MR spectroscopy can be used as a diagnostic tool and neuroimaging marker to assess long-term functional outcome.
authors: Department of Radiology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY 10021, USA.
authors: Christopher G
authors: CG
authors: Filippi
authors: Aziz M
authors: AM
authors: Uluğ
authors: Michael D F
authors: MD
authors: Deck
authors: Robert D
authors: RD
authors: Zimmerman
authors: Linda A
authors: LA
authors: Heier
mesh_terms: D000375:Aging / Q000378:metabolism; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D001921:Brain / Q000378:metabolism / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D005625:Frontal Lobe / Q000378:metabolism; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D009778:Occipital Lobe / Q000378:metabolism; D010296:Parietal Lobe / Q000378:metabolism; D012016:Reference Values; D014018:Tissue Distribution
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline