Quantitative multivoxel proton spectroscopy of the brain in developmental delay

Purpose To assess whether proton MR spectroscopy of the brain in children with developmental delay reveals a consistent pattern of abnormalities. Materials and Methods Eighty‐eight patients (median age, 4.6 years; interquartile range, 3.1–8.1 years) with unexplained developmental delay, were compared with 48 normally developing age‐matched controls. Patients and controls were assigned to five age‐groups. Multivoxel MR spectroscopy was performed on a volume of interest superior to the lateral ventricles. The relative levels of choline, creatine, N‐acetyl aspartate, and glutamate/glutamine in 24 voxels containing white matter and 12 voxels containing gray matter were quantified in an operator‐independent manner and expressed in proportion to the total metabolite peak area in the volume of interest. Results White matter choline in DD showed less decrease with age. Mean choline levels, compared with mean control levels, increased from 99 to 111% with increasing age. This was statistically significant in the highest age groups (P = 0.015 [7 < yr ≤ 12.8] and P = 0.039 [12.8 < yr]). Other metabolites did not show clear alterations. Conclusion Proton MR spectroscopy in a group of patients with unexplained DD shows small differences in the metabolite pattern, compared with normally developing controls, that is, higher choline in the white matter. The pathophysiological origin and significance may relate to myelination and maturation of the white matter. J. Magn. Reson. Imaging 2009;30:716–721. © 2009 Wiley‐Liss, Inc.