title: Elucidating Metabolic Maturation in the Healthy Fetal Brain Using 1H-MR Spectroscopy.
abstract: OBJECTIVE
  (1)H-MRS provides a noninvasive way to study fetal brain maturation at the biochemical level. The purpose of this study was to characterize in vivo metabolic maturation in the healthy fetal brain during the second and third trimester using (1)H-MRS.
  
  
  METHODS
  Healthy pregnant volunteers between 18 and 40 weeks gestational age underwent single voxel (1)H-MRS. MR spectra were retrospectively corrected for motion-induced artifacts and quantified using LCModel. Linear regression was used to examine the relationship between absolute metabolite concentrations and ratios of total NAA, Cr, and Cho to total Cho and total Cr and gestational age.
  
  
  RESULTS
  Two hundred four spectra were acquired from 129 pregnant women at mean gestational age of 30.63 ± 6 weeks. Total Cho remained relatively stable across the gestational age (r(2) = 0.04, P = .01). Both total Cr (r(2) = 0.60, P < .0001) as well as total NAA and total NAA to total Cho (r(2) = 0.58, P < .0001) increased significantly between 18 and 40 weeks, whereas total NAA to total Cr exhibited a slower increase (r(2) = 0.12, P < .0001). Total Cr to total Cho also increased (r(2) = 0.53, P < .0001), whereas total Cho to total Cr decreased (r(2) = 0.52, P < .0001) with gestational age. The cohort was also stratified into those that underwent MRS in the second and third trimesters and analyzed separately.
  
  
  CONCLUSIONS
  We characterized metabolic changes in the normal fetal brain during the second and third trimesters of pregnancy and derived normative metabolic indices. These reference values can be used to study metabolic maturation of the fetal brain in vivo.
authors.affiliation: From the Divisions of Diagnostic Imaging and Radiology (I.E.E., G.V., C.L.) Departments of Pediatrics (I.E.E. A.J.D.P., G.V., C.L.) Radiology (I.E.E., G.V.), The George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: I E
authors.identifier: http://orcid.org/0000-0002-9213-0907
authors.initials: IE
authors.lastname: Evangelou
authors.affiliation: Fetal and Transitional Medicine (A.J.D.P., C.L.), Children's National Medical Center, Washington, DC Departments of Pediatrics (I.E.E. A.J.D.P., G.V., C.L.).
authors.forename: A J
authors.identifier: http://orcid.org/0000-0003-3144-8791
authors.initials: AJ
authors.lastname: du Plessis
authors.affiliation: From the Divisions of Diagnostic Imaging and Radiology (I.E.E., G.V., C.L.) Departments of Pediatrics (I.E.E. A.J.D.P., G.V., C.L.) Radiology (I.E.E., G.V.), The George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: G
authors.identifier: http://orcid.org/0000-0002-1999-336X
authors.initials: G
authors.lastname: Vezina
authors.affiliation: Applied Science Laboratory, GE Healthcare, Berlin, Germany (R.N.).
authors.forename: R
authors.identifier: http://orcid.org/0000-0002-6193-366X
authors.initials: R
authors.lastname: Noeske
authors.affiliation: From the Divisions of Diagnostic Imaging and Radiology (I.E.E., G.V., C.L.) Fetal and Transitional Medicine (A.J.D.P., C.L.), Children's National Medical Center, Washington, DC Departments of Pediatrics (I.E.E. A.J.D.P., G.V., C.L.) climpero@childrensnational.org.
authors.forename: C
authors.identifier: http://orcid.org/0000-0003-1735-0069
authors.initials: C
authors.lastname: Limperopoulos
mesh_terms: D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D001921:Brain / Q000196:embryology* / Q000378:metabolism*; D002794:Choline / Q000032:analysis / Q000378:metabolism; D003401:Creatine / Q000032:analysis / Q000378:metabolism; D005260:Female; D047109:Fetal Development; D005333:Fetus / Q000378:metabolism*; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D066244:Proton Magnetic Resonance Spectroscopy / Q000379:methods*; D012016:Reference Values
chemical_list: D001224:Aspartic Acid; D003401:Creatine; D002794:Choline