NMR spectroscopic evaluation of cerebral metabolism in hydrocephalus: A review

Cerebral ischemia contributes to cerebral damage in hydrocephalus. Many stu dies have reported changes in cerebral blood flow and metabolism, supportin g this hypothesis. Magnetic resonance spectroscopy (MRS) enables us to inve stigate cerebral metabolism in a non-invasive and longitudinal manner, ther eby providing a promising way of evaluating pathophysiological changes in e xperimental and clinical hydrocephalus. In this review, the potential of H- 1 (proton) and P-31 (phosphorus) MRS in the assessment of cerebral metaboli sm will be summarized, and a synopsis of in vitro and in vivo MRS studies i n experimental and human hydrocephalus will be presented. Changes in high-e nergy phosphate metabolism, intracellular pH and lactate production in seve ral MRS studies are presumed to reflect cerebral ischemia. In vivo informat ion on neuronal damage, maturational delay and membrane phospholipid metabo lism may also be derived from H-1 and P-31 MRS data. Technical, methodologi cal and pathophysiological considerations, which are important for a correc t interpretation and comparison of different MRS studies, will be discussed . Finally, we will draw some conclusions on the significance of these MRS f indings and the applicability of MRS in the diagnosis and evaluation of cli nical hydrocephalus.