title: The prognostic value of multivoxel magnetic resonance spectroscopy determined metabolite levels in white and grey matter brain tissue for adverse outcome in term newborns following perinatal asphyxia.
abstract: OBJECTIVE
  Magnetic resonance spectroscopy can identify brain metabolic changes in perinatal asphyxia by providing ratios of metabolites, such as choline (Cho), creatine (Cr), N-acetyl aspartate (NAA) and lactate (Lact) [Cho/Cr, Lact/NAA, etc.]. The purpose of this study was to quantify the separate white and grey matter metabolites in a slab cranial to the ventricles and relate these to the outcome.
  
  
  METHODS
  A standard 2D-chemical shift imaging protocol was used for measuring a transverse volume of interest located cranial to the ventricles allowing for direct comparison of the metabolites in white and grey matter brain tissue in 24 term asphyxiated newborns aged 3 to 16 days.
  
  
  RESULTS
  Cho, NAA and Lact showed significant differences between four subgroups of asphyxiated infants with more and less favourable outcomes. High levels of Cho and Lact in the grey matter differentiated non-survivors from survivors (P = 0.003 and P = 0.017, respectively).
  
  
  CONCLUSIONS
  In perinatal asphyxia the levels of Cho, NAA and Lact in both white and grey matter brain tissue are affected. The levels of Cho and Lact measured in the grey matter are the most indicative of survival. It is therefore advised to include grey matter brain tissue in the region of interest examined by multivoxel MR spectroscopy.
  
  
  CONCLUSIONS
  Magnetic resonance spectroscopy can identify brain metabolic changes in perinatal asphyxia. Choline and lactate levels in grey matter seem the best indicators of survival. Both grey and white matter should be examined during spectroscopy for perinatal asphyxia.
authors: Department of Pediatrics, Division of Neonatology, University Medical Center Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
authors: Pieter Jan
authors: PJ
authors: van Doormaal
authors: Linda C
authors: LC
authors: Meiners
authors: Hendrik J
authors: HJ
authors: ter Horst
authors: Christa N
authors: CN
authors: van der Veere
authors: Paul E
authors: PE
authors: Sijens
mesh_terms: D001238:Asphyxia Neonatorum / Q000175:diagnosis / Q000378:metabolism* / Q000401:mortality*; D001921:Brain / Q000378:metabolism*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000378:metabolism*; D009426:Netherlands / Q000453:epidemiology; D009474:Neurons / Q000378:metabolism*; D015995:Prevalence; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate