Abstract
Proton nuclear magnetic resonance spectroscopy (MRS) delivers information about cell content and metabolism in a noninvasive manner. The diagnostic strength of MRS lies in its evaluation of pathologies in combination with conventional magnetic resonance imaging (MRI). MRS in children has been most widely used to evaluate brain conditions like tumors, infections, metabolic diseases or learning disabilities and especially in neonates with hypoxic-ischemic encephalopathy. This article reviews some basic theoretical considerations, routine procedures, protocols and pitfalls and will illustrate the range of spectrum alterations occurring in some non-tumorous pediatric brain pathologies.
Similar content being viewed by others
References
Govindaraju V, Young K, Maudsley AA (2000) Proton NMR chemical shifts and coupling constants for brain metabolites. NMR Biomed 13:129–153
Inglese M, Spindler M, Babb JS et al (2006) Field, coil, and echo-time influence on sensitivity and reproducibility of brain proton MR spectroscopy. AJNR Am J Neuroradiol 27:684–688
Jissendi Tchofo P, Baleriaux D (2009) Brain (1)H-MR spectroscopy in clinical neuroimaging at 3T. J Neuroradiol 36:24–40
Frahm J, Michaelis T, Merboldt KD et al (1991) On the N-acetyl methyl resonance in localized 1H NMR spectra of human brain in vivo. NMR Biomed 4:201–204
Ross B, Michaelis T (1994) Clinical applications of magnetic resonance spectroscopy. Magn Reson Q 10:191–247
Holshouser BA, Ashwal S, Shu S et al (2000) Proton MR spectroscopy in children with acute brain injury: comparison of short and long echo time acquisitions. J Magn Reson Imaging 11:9–19
Lange T, Dydak U, Roberts TP et al (2006) Pitfalls in lactate measurements at 3T. AJNR Am J Neuroradiol 27:895–901
Duyn JH, Gillen J, Sobering G et al (1993) Multisection proton MR spectroscopic imaging of the brain. Radiology 188:277–282
Ordidge RJ (1987) Random noise selective excitation pulses. Magn Reson Med 5:93–98
Sijens PE, Oudkerk M, van Dijk P et al (1998) 1H MR spectroscopy monitoring of changes in choline peak area and line shape after Gd-contrast administration. Magn Reson Imaging 16:1273–1280
Gunn AJ, Bennet L (2008) Timing of injury in the fetus and neonate. Curr Opin Obstet Gynecol 20:175–181
Ittoop A, Zacharia TT (2012) Imaging of neonatal brain emergencies: multisequence MRI analysis of pathologic spectrum including diffusion and MR spectroscopy. Emerg Radiol 19:149–157
Rutherford M, Counsell S, Allsop J et al (2004) Diffusion-weighted magnetic resonance imaging in term perinatal brain injury: a comparison with site of lesion and time from birth. Pediatrics 114:1004–1014
Okereafor A, Allsop J, Counsell SJ et al (2008) Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics 121:906–914
Rutherford M, Ramenghi LA, Edwards AD et al (2010) Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic-ischaemic encephalopathy: a nested substudy of a randomised controlled trial. Lancet Neurol 9:39–45
Martinez-Biarge M, Diez-Sebastian J, Kapellou O et al (2011) Predicting motor outcome and death in term hypoxic-ischemic encephalopathy. Neurology 76:2055–2061
Ancora G, Testa C, Grandi S et al (2013) Prognostic value of brain proton MR spectroscopy and diffusion tensor imaging in newborns with hypoxic-ischemic encephalopathy treated by brain cooling. Neuroradiology 55:1017–1025
Pu Y, Li QF, Zeng CM et al (2000) Increased detectability of alpha brain glutamate/glutamine in neonatal hypoxic-ischemic encephalopathy. AJNR Am J Neuroradiol 21:203–212
Leth H, Toft PB, Pryds O et al (1995) Brain lactate in preterm and growth-retarded neonates. Acta Paediatr 84:495–499
Tomiyasu M, Aida N, Endo M et al (2013) Neonatal brain metabolite concentrations: an in vivo magnetic resonance spectroscopy study with a clinical MR system at 3 Tesla. PLoS One 8:e82746
Graham SH, Meyerhoff DJ, Bayne L et al (1994) Magnetic resonance spectroscopy of N-acetylaspartate in hypoxic-ischemic encephalopathy. Ann Neurol 35:490–494
Malik GK, Pandey M, Kumar R et al (2002) MR imaging and in vivo proton spectroscopy of the brain in neonates with hypoxic ischemic encephalopathy. Eur J Radiol 43:6–13
Khong PL, Tse C, Wong IY et al (2004) Diffusion-weighted imaging and proton magnetic resonance spectroscopy in perinatal hypoxic-ischemic encephalopathy: association with neuromotor outcome at 18 months of age. J Child Neurol 19:872–881
Ashwal S, Holshouser B, Tong K et al (2004) Proton MR spectroscopy detected glutamate/glutamine is increased in children with traumatic brain injury. J Neurotrauma 21:1539–1552
Miller SP, Newton N, Ferriero DM et al (2002) Predictors of 30-month outcome after perinatal depression: role of proton MRS and socioeconomic factors. Pediatr Res 52:71–77
Degraeuwe P, Jaspers GJ, Robertson NJ et al (2013) Magnetic resonance spectroscopy as a prognostic marker in neonatal hypoxic-ischemic encephalopathy: a study protocol for an individual patient data meta-analysis. Syst Rev 2:96
Panigrahy A, Bluml S (2007) Advances in magnetic resonance neuroimaging techniques in the evaluation of neonatal encephalopathy. Top Magn Reson Imaging 18:3–29
Bednarek N, Mathur A, Inder T et al (2012) Impact of therapeutic hypothermia on MRI diffusion changes in neonatal encephalopathy. Neurology 78:1420–1427
Rollins N, Booth T, Morriss MC et al (2014) Predictive value of neonatal MRI showing no or minor degrees of brain injury after hypothermia. Pediatr Neurol 50:447–451
Chan KW, Chow AM, Chan KC et al (2010) Magnetic resonance spectroscopy of the brain under mild hypothermia indicates changes in neuroprotection-related metabolites. Neurosci Lett 475:150–155
Thakur NH, Spencer AJ, Kilbride HW et al (2013) Findings and patterns on MRI and MR spectroscopy in neonates after therapeutic hypothermia for hypoxic ischemic encephalopathy treatment. South Med J 106:350–355
Corbo ET, Bartnik-Olson BL, Machado S et al (2012) The effect of whole-body cooling on brain metabolism following perinatal hypoxic-ischemic injury. Pediatr Res 71:85–92
Hanrahan JD, Sargentoni J, Azzopardi D et al (1996) Cerebral metabolism within 18 hours of birth asphyxia: a proton magnetic resonance spectroscopy study. Pediatr Res 39:584–590
Barkovich AJ, Westmark KD, Bedi HS et al (2001) Proton spectroscopy and diffusion imaging on the first day of life after perinatal asphyxia: preliminary report. AJNR Am J Neuroradiol 22:1786–1794
Bitsch A, Bruhn H, Vougioukas V et al (1999) Inflammatory CNS demyelination: histopathologic correlation with in vivo quantitative proton MR spectroscopy. AJNR Am J Neuroradiol 20:1619–1627
Bizzi A, Ulug AM, Crawford TO et al (2001) Quantitative proton MR spectroscopic imaging in acute disseminated encephalomyelitis. AJNR Am J Neuroradiol 22:1125–1130
Gabis LV, Panasci DJ, Andriola MR et al (2004) Acute disseminated encephalomyelitis: an MRI/MRS longitudinal study. Pediatr Neurol 30:324–329
Ben Sira L, Miller E, Artzi M et al (2010) 1H-MRS for the diagnosis of acute disseminated encephalomyelitis: insight into the acute-disease stage. Pediatr Radiol 40:106–113
Zimmerman RA, Wang ZJ (1997) The value of proton MR spectroscopy in pediatric metabolic brain disease. AJNR Am J Neuroradiol 18:1872–1879
Wang ZJ, Zimmerman RA (1998) Proton MR spectroscopy of pediatric brain metabolic disorders. Neuroimaging Clin N Am 8:781–807
Confort-Gouny S, Vion-Dury J, Chabrol B et al (1995) Localised proton magnetic resonance spectroscopy in X-linked adrenoleukodystrophy. Neuroradiology 37:568–575
Boddaert N, Romano S, Funalot B et al (2008) 1H MRS spectroscopy evidence of cerebellar high lactate in mitochondrial respiratory chain deficiency. Mol Genet Metab 93:85–88
Sijens PE, Smit GP, Rodiger LA et al (2008) MR spectroscopy of the brain in Leigh syndrome. Brain Dev 30:579–583
Detre JA, Wang ZY, Bogdan AR et al (1991) Regional variation in brain lactate in Leigh syndrome by localized 1H magnetic resonance spectroscopy. Ann Neurol 29:218–221
Rubio-Gozalbo ME, Heerschap A, Trijbels JM et al (1999) Proton MR spectroscopy in a child with pyruvate dehydrogenase complex deficiency. Magn Reson Imaging 17:939–944
Wittsack HJ, Kugel H, Roth B et al (1996) Quantitative measurements with localized 1H MR spectroscopy in children with Canavan’s disease. J Magn Reson Imaging 6:889–893
Schneider JF, Boltshauser E, Neuhaus TJ et al (2001) MRI and proton spectroscopy in Lowe syndrome. Neuropediatrics 32:45–48
Martin E, Capone A, Schneider J et al (2001) Absence of N-acetylaspartate in the human brain: impact on neurospectroscopy? Ann Neurol 49:518–521
Dezortova M, Jiru F, Petrasek J et al (2008) 1H MR spectroscopy as a diagnostic tool for cerebral creatine deficiency. MAGMA 21:327–332
Bianchi MC, Tosetti M, Battini R et al (2007) Treatment monitoring of brain creatine deficiency syndromes: a 1H- and 31P-MR spectroscopy study. AJNR Am J Neuroradiol 28:548–554
Steinfeld R, Grapp M, Kraetzner R et al (2009) Folate receptor alpha defect causes cerebral folate transport deficiency: a treatable neurodegenerative disorder associated with disturbed myelin metabolism. Am J Hum Genet 85:354–363
Dill P, Schneider J, Weber P et al (2011) Pyridoxal phosphate-responsive seizures in a patient with cerebral folate deficiency (CFD) and congenital deafness with labyrinthine aplasia, microtia and microdontia (LAMM). Mol Genet Metab 104:362–368
Schwahn BC, Chen Z, Laryea MD et al (2003) Homocysteine-betaine interactions in a murine model of 5,10-methylenetetrahydrofolate reductase deficiency. FASEB J 17:512–514
Bizzi A, Bugiani M, Salomons GS et al (2002) X-linked creatine deficiency syndrome: a novel mutation in creatine transporter gene SLC6A8. Ann Neurol 52:227–231
Jan W, Zimmerman RA, Wang ZJ et al (2003) MR diffusion imaging and MR spectroscopy of maple syrup urine disease during acute metabolic decompensation. Neuroradiology 45:393–399
Felber SR, Sperl W, Chemelli A et al (1993) Maple syrup urine disease: metabolic decompensation monitored by proton magnetic resonance imaging and spectroscopy. Ann Neurol 33:396–401
Chang KH, Tsou JC, Chen ST et al (2010) Temporal features of magnetic resonance imaging and spectroscopy in non-ketotic hyperglycemic chorea-ballism patients. Eur J Neurol 17:589–593
Eichler F, Mahmood A, Loes D et al (2007) Magnetic resonance imaging detection of lesion progression in adult patients with X-linked adrenoleukodystrophy. Arch Neurol 64:659–664
Eichler FS, Barker PB, Cox C et al (2002) Proton MR spectroscopic imaging predicts lesion progression on MRI in X-linked adrenoleukodystrophy. Neurology 58:901–907
Conflicts of interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schneider, J.F. MR spectroscopy in children: protocols and pitfalls in non-tumorous brain pathology. Pediatr Radiol 46, 963–982 (2016). https://doi.org/10.1007/s00247-014-3270-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-014-3270-z