0:00

Okay.

0:00

And then, uh, spectroscopy.

0:02

So, uh, there's a saying

0:03

that spectroscopy is all something for the future, right?

0:06

It has a lot of potential, but it never seems

0:07

to quite hit it in clinical practice.

0:09

I mean, the babies, if they're moving, right?

0:12

Uh, you have this big voxel and a small head,

0:14

and then there's a lot of variation

0:15

between scanners and things.

0:17

Uh, the tips I wanna give you, so a short echo is good

0:20

for metabolic disorders, right?

0:21

Because it's shorter. So you have a noisy baseline,

0:23

but you can, you can catch small metabolites, right?

0:26

So like, uh, things that you might not be able

0:28

to detect once you have a longer echo

0:30

and you clean up the baseline.

0:32

Um, so if you're looking for metabolic disorders,

0:33

do a short echo, long echo, uh, takes a little bit longer,

0:37

cleans up the baseline, so you just

0:38

get the major metabolites.

0:39

If you're just trying to grade HIE,

0:41

then do just the long echo.

0:43

'cause you really are just concerned about the ratios.

0:45

And then the 1 44, the intermediate echo, like

0:48

that's really just academic, right?

0:49

The idea is that because of the j coupling

0:51

of the methyl group on the lactate doublet, right?

0:54

That you could invert

0:55

below the baseline if you had a lactate peak.

0:58

But honestly, this is really obvious.

1:00

If it's a big lactate doublet, you're,

1:02

it's not gonna be diagnostic dilemma.

1:03

So why would you waste time doing another one?

1:06

Uh, unless you want it for a talk or something.

1:08

And then, um, if it's a small one, right?

1:11

Uh, if it's a small one that like you're questioning like a

1:13

mild lactate peak at short echo, uh, by the time you get

1:16

to longer echo, it'll have decay, right?

1:18

So just because you have a small doublet

1:19

and you don't see it invert, uh,

1:21

because it's all noisy in here at intermediate echo,

1:24

it doesn't mean it wasn't lactate.

1:25

Basically, if it's a narrow thing at one point,

1:27

44 parts per million, like I would call it lactate, right?

1:30

Um, it doesn't matter. Like I don't see the point

1:32

of doing this in general and then evolution wise, right?

1:37

Again, depending on the nature of the injury, right?

1:39

You can see like for example, this patient had progressive,

1:43

uh, HIE cons, you know, secondary energy failure.

1:45

So day four, day seven, day 10,

1:47

you see the lactate and lipids coming up.

1:49

You see the NAA coming down, right?

1:52

And so basically this, this, uh, this neonate was having

1:56

progressive, uh, injury metabolically, right?

1:59

But again, we never interpret these in isolation.

2:01

It's always in conjunction with all

2:03

of the basic anatomic imaging.