Preoperative brain injury in newborns with transposition of the great arteries Steven P Miller, MD, Patrick S McQuillen, MD, Daniel B Vigneron, PhD, David.

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Preoperative brain injury in newborns with transposition of the great arteries Steven P Miller, MD, Patrick S McQuillen, MD, Daniel B Vigneron, PhD, David V Glidden, PhD, A.James Barkovich, MD, Donna M Ferriero, MD, Shannon E.G Hamrick, MD, Anthony Azakie, MD, Tom R Karl, MD The Annals of Thoracic Surgery Volume 77, Issue 5, Pages 1698-1706 (May 2004) DOI: 10.1016/j.athoracsur.2003.10.084

Fig 1 MRSI technique: (A) PRESS in a selected volume, typically 150 to 250 cm3 in the brain with further localization by three-dimensional chemical shift imaging to provide 8 × 8 × 8 arrays of 1 cm3 spectral voxels; (B) assessment of the MR spectra in various anatomic locations in the brain; 1 cm3 spectral voxels were retrospectively centered bilaterally in the (1) thalamus, (2) basal ganglia, and (3) corticospinal tracts; (C) representative spectra from the basal ganglia in a normal term newborn with well-resolved NAA, choline, and creatine (not labeled) peaks. With the lactate-editing MRSI scheme, a separate spectrum is generated for lactate that, if present, would be found within the dashed lines as a doublet centered at 1.33 ppm (as in Fig 2). As demonstrated here, no significant lactate resonances (defined as > 3 standard deviations above noise) were observed in the normal term newborn. (MR = magnetic resonance; MRSI = magnetic resonance spectroscopy imaging; NAA = N-acetylaspartate; PRESS = point-resolved spectroscopy sequence.) The Annals of Thoracic Surgery 2004 77, 1698-1706DOI: (10.1016/j.athoracsur.2003.10.084)

Fig 2 Preoperative MRSI: individual spectra from the left and right striatum are illustrated from the same newborn with preoperative stroke. Ipsilateral to the stroke there is a reduction in NAA/choline with a marked increase in the lactate/choline. At this age, lactate is normally not present. There is also a contralateral decrease in NAA/choline and striking increase in lactate/choline. This indicates that the metabolically abnormal area is far more extensive than the area of abnormality on MRI. (MRI = magnetic resonance imaging; MRSI = magnetic resonance spectroscopic imaging; NAA = N-acetylaspartate.) The Annals of Thoracic Surgery 2004 77, 1698-1706DOI: (10.1016/j.athoracsur.2003.10.084)

Fig 3 Lactate/choline plotted by gestational age at the time of the MR study. Newborns with preoperative brain injury on MRI are represented by the black circles (•) and those with normal preoperative MRI by the gray squares (). The dashed line represents the median lactate/choline value in newborns without congenital heart disease studied once at term. Note the overall decline in lactate/choline values from the preoperative to postoperative studies. (MR = magnetic resonance; MRI = magnetic resonance imaging.) The Annals of Thoracic Surgery 2004 77, 1698-1706DOI: (10.1016/j.athoracsur.2003.10.084)

Fig 4 (Left column) No preoperative brain injury. (Right column) Preoperative brain injury. NAA/choline plotted by gestational age at the time of the MR study in individual newborns in each region of interest. Note that the expected increase in NAA/choline over time is not observed in 3 newborns with normal preoperative MRI and in 2 newborns with preoperative brain injury in most regions. (MR = magnetic resonance; MRI = magnetic resonance imaging; NAA = N-acetylaspartate.) The Annals of Thoracic Surgery 2004 77, 1698-1706DOI: (10.1016/j.athoracsur.2003.10.084)