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<meta name="HW.identifier" content="/ajnr/37/2/360.atom" />
<meta name="HW.pisa" content="ajnr;37/2/360" />
<meta name="DC.Format" content="text/html" />
<meta name="DC.Language" content="en" />
<meta name="DC.Title" content="Elucidating Metabolic Maturation in the Healthy Fetal Brain Using 1H-MR Spectroscopy" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4512" />
<meta name="DC.Date" content="2016-02-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2016 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: 1H-MRS provides a noninvasive way to study fetal brain maturation at the biochemical level. The purpose of this study was to characterize in vivo metabolic maturation in the healthy fetal brain during the second and third trimester using 1H-MRS.

MATERIALS AND METHODS: Healthy pregnant volunteers between 18 and 40 weeks gestational age underwent single voxel 1H-MRS. MR spectra were retrospectively corrected for motion-induced artifacts and quantified using LCModel. Linear regression was used to examine the relationship between absolute metabolite concentrations and ratios of total NAA, Cr, and Cho to total Cho and total Cr and gestational age.

RESULTS: Two hundred four spectra were acquired from 129 pregnant women at mean gestational age of 30.63 ± 6 weeks. Total Cho remained relatively stable across the gestational age ( r 2 = 0.04, P = .01). Both total Cr ( r 2 = 0.60, P &lt; .0001) as well as total NAA and total NAA to total Cho ( r 2 = 0.58, P &lt; .0001) increased significantly between 18 and 40 weeks, whereas total NAA to total Cr exhibited a slower increase ( r 2 = 0.12, P &lt; .0001). Total Cr to total Cho also increased ( r 2 = 0.53, P &lt; .0001), whereas total Cho to total Cr decreased ( r 2 = 0.52, P &lt; .0001) with gestational age. The cohort was also stratified into those that underwent MRS in the second and third trimesters and analyzed separately.

CONCLUSIONS: We characterized metabolic changes in the normal fetal brain during the second and third trimesters of pregnancy and derived normative metabolic indices. These reference values can be used to study metabolic maturation of the fetal brain in vivo.

GA
:   gestational age
tCho
:   total Cho (glycerol 3-phosphocholine + phosphocholine)
tCr
:   total Cr (phosphocreatine + Cr)
tNAA
:   total NAA (NAA + N -acetyl aspartylglutamate)" />
<meta name="DC.Contributor" content="I.E. Evangelou" />
<meta name="DC.Contributor" content="A.J. du Plessis" />
<meta name="DC.Contributor" content="G. Vezina" />
<meta name="DC.Contributor" content="R. Noeske" />
<meta name="DC.Contributor" content="C. Limperopoulos" />
<meta name="article:published_time" content="2016-02-01" />
<meta name="article:section" content="PEDIATRICS" />
<meta name="citation_title" content="Elucidating Metabolic Maturation in the Healthy Fetal Brain Using 1H-MR Spectroscopy" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;&lt;sup&gt;1&lt;/sup&gt;H-MRS provides a noninvasive way to study fetal brain maturation at the biochemical level. The purpose of this study was to characterize in vivo metabolic maturation in the healthy fetal brain during the second and third trimester using &lt;sup&gt;1&lt;/sup&gt;H-MRS.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Healthy pregnant volunteers between 18 and 40 weeks gestational age underwent single voxel &lt;sup&gt;1&lt;/sup&gt;H-MRS. MR spectra were retrospectively corrected for motion-induced artifacts and quantified using LCModel. Linear regression was used to examine the relationship between absolute metabolite concentrations and ratios of total NAA, Cr, and Cho to total Cho and total Cr and gestational age.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Two hundred four spectra were acquired from 129 pregnant women at mean gestational age of 30.63 ± 6 weeks. Total Cho remained relatively stable across the gestational age (&lt;i&gt;r&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.04, &lt;i&gt;P&lt;/i&gt; = .01). Both total Cr (&lt;i&gt;r&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.60, &lt;i&gt;P&lt;/i&gt; &amp;lt; .0001) as well as total NAA and total NAA to total Cho (&lt;i&gt;r&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.58, &lt;i&gt;P&lt;/i&gt; &amp;lt; .0001) increased significantly between 18 and 40 weeks, whereas total NAA to total Cr exhibited a slower increase (&lt;i&gt;r&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.12, &lt;i&gt;P&lt;/i&gt; &amp;lt; .0001). Total Cr to total Cho also increased (&lt;i&gt;r&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.53, &lt;i&gt;P&lt;/i&gt; &amp;lt; .0001), whereas total Cho to total Cr decreased (&lt;i&gt;r&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.52, &lt;i&gt;P&lt;/i&gt; &amp;lt; .0001) with gestational age. The cohort was also stratified into those that underwent MRS in the second and third trimesters and analyzed separately.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;We characterized metabolic changes in the normal fetal brain during the second and third trimesters of pregnancy and derived normative metabolic indices. These reference values can be used to study metabolic maturation of the fetal brain in vivo.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2016/02/01" />
<meta name="citation_mjid" content="ajnr;37/2/360" />
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<meta name="citation_author" content="I.E. Evangelou" />
<meta name="citation_author_institution" content="aFrom the Divisions of Diagnostic Imaging and Radiology (I.E.E., G.V., C.L.)" />
<meta name="citation_author_institution" content="cDepartments of Pediatrics (I.E.E. A.J.D.P., G.V., C.L.)" />
<meta name="citation_author_institution" content="dRadiology (I.E.E., G.V.), The George Washington University School of Medicine and Health Sciences, Washington, DC" />
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<meta name="citation_author" content="A.J. du Plessis" />
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<meta name="twitter:title" content="Elucidating Metabolic Maturation in the Healthy Fetal Brain Using 1H-MR Spectroscopy" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: 1H-MRS provides a noninvasive way to study fetal brain maturation at the biochemical level. The purpose of this study was to characterize in vivo metabolic maturation in the healthy fetal brain during the second and third trimester using 1H-MRS.

MATERIALS AND METHODS: Healthy pregnant volunteers between 18 and 40 weeks gestational age underwent single voxel 1H-MRS. MR spectra were retrospectively corrected for motion-induced artifacts and quantified using LCModel. Linear regression was used to examine the relationship between absolute metabolite concentrations and ratios of total NAA, Cr, and Cho to total Cho and total Cr and gestational age.

RESULTS: Two hundred four spectra were acquired from 129 pregnant women at mean gestational age of 30.63 ± 6 weeks. Total Cho remained relatively stable across the gestational age ( r 2 = 0.04, P = .01). Both total Cr ( r 2 = 0.60, P &lt; .0001) as well as total NAA and total NAA to total Cho ( r 2 = 0.58, P &lt; .0001) increased significantly between 18 and 40 weeks, whereas total NAA to total Cr exhibited a slower increase ( r 2 = 0.12, P &lt; .0001). Total Cr to total Cho also increased ( r 2 = 0.53, P &lt; .0001), whereas total Cho to total Cr decreased ( r 2 = 0.52, P &lt; .0001) with gestational age. The cohort was also stratified into those that underwent MRS in the second and third trimesters and analyzed separately.

CONCLUSIONS: We characterized metabolic changes in the normal fetal brain during the second and third trimesters of pregnancy and derived normative metabolic indices. These reference values can be used to study metabolic maturation of the fetal brain in vivo.

GA
:   gestational age
tCho
:   total Cho (glycerol 3-phosphocholine + phosphocholine)
tCr
:   total Cr (phosphocreatine + Cr)
tNAA
:   total NAA (NAA + N -acetyl aspartylglutamate)" />
<meta name="og-title" property="og:title" content="Elucidating Metabolic Maturation in the Healthy Fetal Brain Using 1H-MR Spectroscopy" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/37/2/360" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: 1H-MRS provides a noninvasive way to study fetal brain maturation at the biochemical level. The purpose of this study was to characterize in vivo metabolic maturation in the healthy fetal brain during the second and third trimester using 1H-MRS.

MATERIALS AND METHODS: Healthy pregnant volunteers between 18 and 40 weeks gestational age underwent single voxel 1H-MRS. MR spectra were retrospectively corrected for motion-induced artifacts and quantified using LCModel. Linear regression was used to examine the relationship between absolute metabolite concentrations and ratios of total NAA, Cr, and Cho to total Cho and total Cr and gestational age.

RESULTS: Two hundred four spectra were acquired from 129 pregnant women at mean gestational age of 30.63 ± 6 weeks. Total Cho remained relatively stable across the gestational age ( r 2 = 0.04, P = .01). Both total Cr ( r 2 = 0.60, P &lt; .0001) as well as total NAA and total NAA to total Cho ( r 2 = 0.58, P &lt; .0001) increased significantly between 18 and 40 weeks, whereas total NAA to total Cr exhibited a slower increase ( r 2 = 0.12, P &lt; .0001). Total Cr to total Cho also increased ( r 2 = 0.53, P &lt; .0001), whereas total Cho to total Cr decreased ( r 2 = 0.52, P &lt; .0001) with gestational age. The cohort was also stratified into those that underwent MRS in the second and third trimesters and analyzed separately.

CONCLUSIONS: We characterized metabolic changes in the normal fetal brain during the second and third trimesters of pregnancy and derived normative metabolic indices. These reference values can be used to study metabolic maturation of the fetal brain in vivo.

GA
:   gestational age
tCho
:   total Cho (glycerol 3-phosphocholine + phosphocholine)
tCr
:   total Cr (phosphocreatine + Cr)
tNAA
:   total NAA (NAA + N -acetyl aspartylglutamate)" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node14275--5" data-node-nid="14275" id="top-node-14275--61313101673" data-pisa="ajnr;37/2/360" data-pisa-master="ajnr;ajnr.A4512" data-apath="/ajnr/37/2/360.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">PEDIATRICS</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Elucidating Metabolic Maturation in the Healthy Fetal Brain Using <sup>1</sup>H-MR Spectroscopy</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">I.E. Evangelou</span>, <span class="highwire-citation-author" data-delta="1">A.J. du Plessis</span>, <span class="highwire-citation-author" data-delta="2">G. Vezina</span>, <span class="highwire-citation-author" data-delta="3">R. Noeske</span> and <span class="highwire-citation-author" data-delta="4">C. Limperopoulos</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">February 2016,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">360-366; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4512 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-14275--61313101673" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">I.E. Evangelou </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Divisions of Diagnostic Imaging and Radiology (I.E.E., G.V., C.L.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Pediatrics (I.E.E. A.J.D.P., G.V., C.L.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Radiology (I.E.E., G.V.), The George Washington University School of Medicine and Health Sciences, Washington, DC</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=I.E.%2BEvangelou%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Evangelou%20I&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AI.E.%2BEvangelou%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-9213-0907" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for I.E. Evangelou</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">A.J. du Plessis </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Fetal and Transitional Medicine (A.J.D.P., C.L.), Children's National Medical Center, Washington, DC</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Pediatrics (I.E.E. A.J.D.P., G.V., C.L.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.J.%2Bdu%2BPlessis%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=du%20Plessis%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.J.%2Bdu%2BPlessis%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-3144-8791" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.J. du Plessis</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">G. Vezina </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Divisions of Diagnostic Imaging and Radiology (I.E.E., G.V., C.L.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Pediatrics (I.E.E. A.J.D.P., G.V., C.L.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Radiology (I.E.E., G.V.), The George Washington University School of Medicine and Health Sciences, Washington, DC</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BVezina%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Vezina%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BVezina%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1999-336X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Vezina</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">R. Noeske </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Applied Science Laboratory, GE Healthcare, Berlin, Germany (R.N.).</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BNoeske%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Noeske%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.%2BNoeske%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-6193-366X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. Noeske</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">C. Limperopoulos </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Divisions of Diagnostic Imaging and Radiology (I.E.E., G.V., C.L.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Fetal and Transitional Medicine (A.J.D.P., C.L.), Children's National Medical Center, Washington, DC</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Pediatrics (I.E.E. A.J.D.P., G.V., C.L.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BLimperopoulos%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Limperopoulos%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BLimperopoulos%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-1735-0069" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Limperopoulos</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> <sup>1</sup>H-MRS provides a noninvasive way to study fetal brain maturation at the biochemical level. The purpose of this study was to characterize in vivo metabolic maturation in the healthy fetal brain during the second and third trimester using <sup>1</sup>H-MRS.</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>MATERIALS AND METHODS:</strong> Healthy pregnant volunteers between 18 and 40 weeks gestational age underwent single voxel <sup>1</sup>H-MRS. MR spectra were retrospectively corrected for motion-induced artifacts and quantified using LCModel. Linear regression was used to examine the relationship between absolute metabolite concentrations and ratios of total NAA, Cr, and Cho to total Cho and total Cr and gestational age.</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>RESULTS:</strong> Two hundred four spectra were acquired from 129 pregnant women at mean gestational age of 30.63 ± 6 weeks. Total Cho remained relatively stable across the gestational age (<em>r</em><sup>2</sup> = 0.04, <em>P</em> = .01). Both total Cr (<em>r</em><sup>2</sup> = 0.60, <em>P</em> &lt; .0001) as well as total NAA and total NAA to total Cho (<em>r</em><sup>2</sup> = 0.58, <em>P</em> &lt; .0001) increased significantly between 18 and 40 weeks, whereas total NAA to total Cr exhibited a slower increase (<em>r</em><sup>2</sup> = 0.12, <em>P</em> &lt; .0001). Total Cr to total Cho also increased (<em>r</em><sup>2</sup> = 0.53, <em>P</em> &lt; .0001), whereas total Cho to total Cr decreased (<em>r</em><sup>2</sup> = 0.52, <em>P</em> &lt; .0001) with gestational age. The cohort was also stratified into those that underwent MRS in the second and third trimesters and analyzed separately.</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>CONCLUSIONS:</strong> We characterized metabolic changes in the normal fetal brain during the second and third trimesters of pregnancy and derived normative metabolic indices. These reference values can be used to study metabolic maturation of the fetal brain in vivo.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">GA<span class="def-item-dt-sep"></span></dt><dd>gestational age<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">tCho<span class="def-item-dt-sep"></span></dt><dd>total Cho (glycerol 3-phosphocholine + phosphocholine)<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">tCr<span class="def-item-dt-sep"></span></dt><dd>total Cr (phosphocreatine + Cr)<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">tNAA<span class="def-item-dt-sep"></span></dt><dd>total NAA (NAA + <em>N</em>-acetyl aspartylglutamate)</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2016 by American Journal of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-1">Indicates open access to non-subscribers at <a href="http://www.ajnr.org" rel="license">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/37/2/360.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 37</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 2 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Feb 2016 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">I.E.</span> <span class="nlm-surname">Evangelou</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A.J.</span> <span class="nlm-surname">du Plessis</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Vezina</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Noeske</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Limperopoulos</span></span></span></div>
  
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      <div class="highwire-cite-title">Elucidating Metabolic Maturation in the Healthy Fetal Brain Using <sup>1</sup>H-MR Spectroscopy</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">I.E.</span> <span class="nlm-surname">Evangelou</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A.J.</span> <span class="nlm-surname">du Plessis</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Vezina</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Noeske</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Limperopoulos</span></span></span></div>
  
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