Magnetic resonance spectroscopy in neonatal hypoxic-ischaemic insults

This article aims to review the major achievements of phosphorus (P-31) and proton (H-1) 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 P-31 and H-1 MRS reveal gross abnormalities in severe hypoxic-ischaemic injury - in P-31 studies [phosphocreatine] and [adenosine triphosphate] are low whilst [inorganic phosphate] is high; H-1 MRS reveals high [lactate] and reduced [N-acetylaspartate]. The P-31 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 P-31 and H-1 MRS, performed within a few days of birth, have great prognostic utility.