title: Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure.
abstract: Acute liver failure (ALF)-related encephalopathy was previously characterized by MR spectroscopy of single voxels containing both grey and white matter brain tissue. Quantitative multivoxel MRS was used here to compare grey and white matter brain tissue concentrations of glutamate/glutamine (Glx) and lactate in ALF and associate the results with other liver function parameters. Five pediatric patients with ALF-related encephalopathy and five controls, examined after successful liver transplantation, were examined by brain MRI/MRS. ALF patients had higher Glx and lactate concentrations in brain white matter than controls (Glx + 125%: P < 0.01; lactate + 33%, P < 0.05) and higher Glx in grey matter (Glx + 125%: P < 0.01). Within the group of ALF patients positive correlations were found between grey or white matter lactate concentration and serum ammonia (P < 0.05), and negative correlations between grey or white matter Glx and venous pH (P < 0.001). This is the first study presenting evidence of high Glx levels in both white and grey matter brain tissue in ALF-related encephalopathy. The elevations in CNS Glx and lactate concentrations appear to relate to hepatic detoxification (ammonia, venous pH), rather than to liver parenchymal integrity (aspartate aminotransferase, alanine aminotransferase) or biliary cholestasis (bilirubin, gamma-glutamyl transpeptidase, alkaline phosphatase).
authors.affiliation: Department of Radiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. p.e.sijens@rad.umcg.nl
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sijens
authors.forename: Heyder
authors.initials: H
authors.lastname: Alkefaji
authors.forename: Roelineke J
authors.initials: RJ
authors.lastname: Lunsing
authors.forename: Francjan J
authors.initials: FJ
authors.lastname: van Spronsen
authors.forename: Linda C
authors.initials: LC
authors.lastname: Meiners
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
authors.forename: Henkjan J
authors.initials: HJ
authors.lastname: Verkade
mesh_terms: D015415:Biomarkers / Q000032:analysis; D001921:Brain; D001927:Brain Diseases / Q000175:diagnosis* / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018698:Glutamic Acid / Q000032:analysis*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000378:metabolism*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011522:Protons; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D011522:Protons; D018698:Glutamic Acid