PROTON MR SPECTROSCOPY OF BRAIN ABNORMALITIES IN NEONATES BORN TO HIV-POSITIVE MOTHERS

PURPOSE: To examine the sensitivity of proton MR spectroscopy for dete cting early central nervous system abnormalities in neonates born to h uman immunodeficiency virus (HIV)-positive mothers. METHODS: Asleep, u nsedated, and continuously monitored by electrocardiography, 10 newbor ns, 5 with HIV-positive and 5 with HIV-negative mothers, were studied within the first 10 days of life in a 1.5-T scanner. After T1- and T2- weighted images were obtained, proton spectra were performed using vox els of interest (3.4 cm(3)) in the deep parietooccipital white matter. Peaks were identified as N-acetyl-aspartate (2.0 ppm), creatine and p hosphocreatine (3.0 ppm), choline (3.2 ppm), and inositol (3.5 ppm). P eak areas were used to calculate metabolic ratios: N-acetyl-aspartate to creatine, inositol to creatine, and creatine to choline. RESULTS: A ll newborns of HIV-positive mothers had abnormal proton spectra compar ed with control infants; a nonspecific amino acid peak in the 2.1- to 2.6-ppm area was elevated, broad, and overlapping the N-acetyl-asparta te peak in all the HIV-exposed newborns and in only 1 of the 5 control newborns. The choline-to-creatine ratio was higher in HIV-exposed new borns at 2.3 +/- 0.4 (normal term, 0.9 +/- 0.3), as was the N-acetyl-a spartate-to-creatine ratio at 2.6 +/- 0.9 (for control subjects, 1.2 /- 0.4). MR images from these brain regions were all considered normal . Because acquired immunodeficiency syndrome develops in only a small fraction of neonates born to HIV-seropositive mothers, the above spect ral abnormalities found in all our subjects may result from indirect e ffects of HIV such as intrauterine growth retardation. CONCLUSIONS: Th ese findings indicate that proton MR spectroscopy might play an import ant role in detecting early central nervous system complications in ne wborns of HIV-seropositive mothers.