Magnetic resonance spectroscopy in neonatal hypoxic-ischaemic insults

Abstract 

This article aims to review the major achievements of phosphorus (³¹P) and proton (¹H) magnetic resonance spectroscopy (MRS) in the field of perinatal hypoxic-ischaemic cerebral injury. Methodologies for applying MRS to the routine study of the infant brain are now well developed. Both ³¹P and ¹H MRS reveal gross abnormalities in severe hypoxic-ischaemic injury – in ³¹P studies [phosphocreatine] and [adenosine triphosphate] are low whilst [inorganic phosphate] is high; ¹H MRS reveals high [lactate] and reduced [N-acetylaspartate]. The ³¹P abnormalities are not apparent in early spectra but develop after 12–24 h – a phenomenon termed ”secondary energy failure”. These metabolic changes have now been modelled, and investigations of cerebroprotective therapies are underway. Extensive long-term studies have revealed that both ³¹P and ¹H MRS, performed within a few days of birth, have great prognostic utility.