title: 1H MR spectroscopic characteristics of kernicterus: a possible metabolic signature.
abstract: OBJECTIVE
  MR examination of infants with kernicterus shows abnormal changes in signal intensity in various parts of the brain, including the globus pallidus and subthalamic regions. The purpose of this study was to retrospectively analyze proton ((1)H) MR spectroscopic data to see if the MR spectroscopic profiles of infants with hyperbilirubinemia and symptoms of kernicterus provide new insights into the pathophysiology of bilirubin neurotoxicity.
  
  
  METHODS
  Six patients aged 3 days to 3 weeks, with hyperbilirubinemia and symptoms of kernicterus underwent MR imaging and MR spectroscopy with a single-voxel point-resolved spectroscopic sequence. The voxel of interest was centered in the basal ganglia with CSF excluded. Quantitative analysis was done by using LCModel. Between-subject comparisons were based on metabolite ratios relative to creatine.
  
  
  RESULTS
  Ratios of taurine, glutamate and glutamine, and myoinositol relative to creatine were significantly elevated (P < .001), whereas the ratio of choline to creatine was significantly decreased (P < .001) compared with normal values published for this age group. Lactate levels were not significantly elevated.
  
  
  CONCLUSIONS
  Kernicterus has a characteristic signature that is detectable on (1)H-MR spectroscopy. Our results are generally in agreement with what is known about bilirubin pathology, and the finding of increased glutamate and glutamine and decreased choline ratios indicates a possible link between hepatic encephalopathy and kernicterus. This observation may help in elucidating the pathophysiology of bilirubin neurotoxicity.
authors.affiliation: Imaging Research Centre, Brain Body Institute, St Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Wendy K
authors.initials: WK
authors.lastname: Oakden
authors.forename: Aideen M
authors.initials: AM
authors.lastname: Moore
authors.forename: Susan
authors.initials: S
authors.lastname: Blaser
authors.forename: Michael D
authors.initials: MD
authors.lastname: Noseworthy
mesh_terms: D005260:Female; D006801:Humans; D006859:Hydrogen; D007223:Infant; D007231:Infant, Newborn; D007647:Kernicterus / Q000175:diagnosis / Q000378:metabolism*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D012189:Retrospective Studies
chemical_list: D006859:Hydrogen