Journal
PEDIATRIC RADIOLOGY
Volume 45, Issue 1, Pages 133-137Publisher
SPRINGER
DOI: 10.1007/s00247-014-3032-y
Keywords
Ketones; Magnetic resonance spectroscopy; Ohtahara syndrome; Ketogenic diet; Infant
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Atypical resonances on proton magnetic resonance spectroscopy (MRS) examinations are occasionally found in children undergoing a metabolic evaluation for neurological conditions. While a radiologist's first instinct is to suspect a pathological metabolite, usually the origin of the resonance arises from an exogenous source. We report the appearance of distinct resonances associated with a ketogenic diet in a male infant presenting with Ohtahara syndrome. These resonances can be confused in interpretation with lactate and glutamate. To confirm assignments, the basis set for quantification was supplemented with simulations of beta-hydroxybutyrate, acetone and acetoacetate in LCModel spectroscopy processing software. We were able to quantitate the levels of end products of a ketogenic diet and illustrate how to distinguish these resonances.
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