Detection of Cerebral ß-Hydroxy Butyrate, Acetoacetate, and Lactate on Proton MR Spectroscopy in Children with Diabetic Ketoacidosis
Sandra L. Wootton-Gorgesa,
Michael H. Buonocorea,
Nathan Kuppermannb,c,
James Marcinb,
Joseph DiCarlod,
E. Kirk Neelyd,
Patrick D. Barnese and
Nicole Glaserb
a Department Radiology, University of California, Davis School of Medicine
b Department Pediatrics, University of California, Davis School of Medicine
c Department Internal Medicine, Division of Emergency Medicine
, University of California, Davis School of Medicine
d Department of Pediatrics, Stanford University School of Medicine
e Radiology, Stanford University School of Medicine
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FIG 1. Position of voxels for spectroscopy in the periaqueductal region (A) and in the basal ganglia (B).
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FIG 2. Patients with ßOHB, AcAc, both, or neither on initial imaging during DKA therapy.
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FIG 3. Findings in a 3-year-old girl with new-onset DKA.
A, Initial spectra were obtained 2 hours after the start of therapy for DKA (black) in the patient and a phantom containing only ßOHB (gray). ßOHB is seen as a doublet centered at 1.2 ppm.
B, ßOHB is absent in the patient’s spectrum (black) obtained after her recovery from DKA.
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FIG 4. Patients with ßOHB and/or AcAc on initial imaging by the timing of the study after the start of therapy.
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FIG 5. Findings in a 14-year-old male adolescent; arb indicates arbitrary.
A, Initial spectrum (black) during DKA shows AcAc (peak at 2.22 ppm) and ßOHB. Spectrum from the phantom containing ßOHB is gray.
B, On the spectrum obtained after the patient’s recovery from DKA, AcAc and ßOHB are absent.
C, Difference spectrum between A and B.
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FIG 6. Findings in an 11-year-old girl with DKA.
A, Initial spectrum (black) during treatment for DKA and spectrum from phantom containing both lactate and ßOHB (gray). Patient’s spectrum shows lactate and ßOHB as a triplet with peaks from 1.15 to 1.38 ppm. AcAc is noted at 2.22–2.26 ppm.
B, After recovery, no lactate or ßOHB is detected on the patient’s spectrum (black).
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