title: Metabolic assessment of the brain using proton magnetic resonance spectroscopy in a growth-restricted human fetus: case report.
abstract: Proton magnetic resonance spectroscopy (MRS) is a noninvasive method to assess concentrations of different metabolites in tissues, including the brain. We evaluated a fetus with growth restriction using Doppler ultrasound and proton MRS. Doppler assessment revealed absent end diastolic flow in the umbilical artery. Diastolic flow was increased in the middle cerebral artery. Proton MRS of the fetal brain showed lactate and a low N-acetylaspartate/choline index, metabolic markers of starvation/hypoxia. Proton MRS gave us in vivo metabolic information of the brain of a fetus under starvation/hypoxic conditions. It is potentially a new tool for fetal surveillance. To our knowledge, this is the first report of cerebral lactate detection using proton MRS in a growth-restricted human fetus with no associated malformations in the English literature. Further experimental and clinical longitudinal investigations are needed to evaluate its efficacy in the clinical setting.
authors.affiliation: Yale University School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, New Haven, Connecticut 06520, USA.
authors.forename: Humberto
authors.initials: H
authors.lastname: Azpurua
authors.forename: Arturo
authors.initials: A
authors.lastname: Alvarado
authors.forename: Finita
authors.initials: F
authors.lastname: Mayobre
authors.forename: Tamara
authors.initials: T
authors.lastname: Salom
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Copel
authors.forename: Freddy
authors.initials: F
authors.lastname: Guevara-Zuloaga
mesh_terms: D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D001921:Brain / Q000196:embryology* / Q000378:metabolism*; D001923:Brain Chemistry; D002675:Child, Preschool; D002794:Choline / Q000032:analysis; D005260:Female; D005317:Fetal Growth Retardation / Q000503:physiopathology*; D005311:Fetal Hypoxia / Q000175:diagnosis; D005333:Fetus / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D019344:Lactic Acid / Q000032:analysis; D009682:Magnetic Resonance Spectroscopy; D011247:Pregnancy; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging
chemical_list: D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D002794:Choline