Purpose To separately measure N‐acetyl aspartul glutamate (NAAG), N‐acetyl aspartate (NAA), aspartate (Asp), and glutamate (Glu) concentrations in white matter (WM) using J‐editing techniques in patients with mild traumatic brain injury (mTBI) in the acute phase. Methods Twenty‐four patients with closed concussive head injury and 29 healthy volunteers were enrolled in the current study. For extended 1H MRS examination, patients and controls were equally divided into two subgroups. In subgroup 1 (12 patients/15 controls), NAAG and NAA concentrations were measured in WM separately with MEGA‐PRESS (echo time/repetition time [TE/TR] = 140/2000 ms; δONNAA/ δOFFNAA = 4.84/4.38 ppm, δONNAAG/ δOFFNAAG = 4.61/4.15 ppm). In subgroup 2 (12 patients/14 controls), Asp and Glu concentrations were acquired with MEGA‐PRESS (TE/TR = 90/2000 ms; δONAsp/ δOFFAsp = 3.89/5.21 ppm) and TE‐averaged PRESS (TE from 35 ms to 185 ms with 2.5‐ms increments; TR = 2000 ms) pulse sequences, respectively. Results tNAA and NAAG concentrations were found to be reduced, while NAA concentrations were unchanged, after mild mTBI. Reduced Asp and elevated myo‐inositol (mI) concentrations were also found. Conclusion The main finding of the study is that the tNAA signal reduction in WM after mTBI is associated with a decrease in the NAAG concentration rather than a decrease in the NAA concentration, as was thought previously. This finding highlights the importance of separating these signals, at least for WM studies, to avoid misinterpretation of the results. NAAG plays an important role in selectively activating mGluR3 receptors, thus providing neuroprotective and neuroreparative functions immediately after mTBI. NAAG shows potential for the development of new therapeutic strategies for patients with injuries of varying severity.

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BackgroundIn most cases, lateral patellar dislocation (LPD) is accompanied by chondral injury and may initiate gradual degeneration of patellar cartilage, which might be detected with a T2 mapping, a well‐established method for cartilage lesions assessment.PurposeTo examine short‐term consequences of single first‐time LPD in teenagers by T2 mapping of the patellar‐cartilage state.Study TypeProspective.Population95 patients (mean age: 15.1 ± 2.3; male/female: 46/49) with first‐time, complete, traumatic LPD and 51 healthy controls (mean age: 14.7 ± 2.2, male/female: 29/22).Field Strength/Sequence3.0 T; axial T2 mapping acquired using a 2D turbo spin‐echo sequence.AssessmentMRI examination was conducted 2–4 months after first LPD. T2 values were calculated in manually segmented cartilage area via averaging over three middle level slices in six cartilage regions: deep, intermediate, superficial layers, and medial lateral parts.Statistical TestsANOVA analysis with Tukey's multiple comparison test, one‐vs.‐rest logistic regression analysis. The threshold of significance was set at P < 0.05.ResultsIn lateral patellar cartilage, a significant increase in T2 values was found in deep and intermediate layers in both patient groups with mild (deep: 34.7 vs. 31.3 msec, intermediate: 38.7 vs. 34.6 msec, effect size = 0.55) and severe (34.8 vs. 31.3 msec, 39.1 vs. 34.6 msec, 0.55) LPD consequences as compared to controls. In the medial facet, only severe cartilage damage showed significant prolongation of T2 times in the deep layer (34.3 vs. 30.7 msec, 0.55). No significant changes in T2 values were found in the lateral superficial layer (P = 0.99), whereas mild chondromalacia resulted in a significant decrease of T2 in the medial superficial layer (41.0 vs. 43.8 msec, 0.55).Data ConclusionThe study revealed substantial difference in T2 changes after LPD between medial and lateral areas of patellar cartilage.Evidence Level2Technical Efficacy Stage2

Treatment of patients with severe traumatic brain injury is very expensive. The main problem of medical care with its adaptation to neurological outcomes is the choice of diagnostic techniques as predictive tools that reliably predict long-term neurological and psychological outcomes. The extended range of magnetic resonance techniques, including SWI, diffusion-weighted and diffusion-tensor images (DWI / DTI), magnetic resonance spectroscopy (MRS) and functional magnetic resonance imaging allows to identify not only anatomical, but also functional brain damage. In the review, the authors discuss the latest information on visual and quantitative assessment of abnormalities in patient with TBI; new understanding and clinical significance of various MRI methods are shown as well. The authors define new biomarkers and their potential for predicting TBI outcomes. Several combined modalities not only provide better understanding of major physiological changes in patients with TBI, but they also improve diagnostic accuracy in outcome predicting. The present review is a summary of some important researches published recently.

Introduction. Spinal injury in pediatric practice is met relatively rare; spinal fractures in children do not exceed 5%, and the incidence rate does not exceed 5:100000. However, spinal injuries have a high rate of fetal outcomes (up to 5-10%), and have significant long-lasting negative effects. Therefore, to timely detect such injuries is extremely important for determining treatment tactics, preventing secondary damage to nerve structures and preventing the formation of spinal deformity. Purpose. To assess and compare CT and MRI potentials for developing a diagnostic algorithm in children with thoracolumbar spine injury. Material and methods. 4355 patients, aged 6 months - 17 years, with thoracolumbal spine injury were included into the study . All patients had radiography of the thoracic or lumbar spine and MRI of three spinal sections. Multispiral computed tomography ( MSCT) was performed with Brilliance 16 and 64 scanners. Information on the thoracolumbal spine picture obtained by scanning the chest and abdomen was assessed using findings of frontal and sagittal and 3D reformatted images. MRI was performed on Achieva 3 T scanner; multi-planar T1-, T2-weighted images of (WI) TSE and STIR images in axial, frontal and sagittal projections with a slice thickness of 2-4 mm were obtained. A special spinal 32 channel coil was used. Results. To compare the effectiveness of CT and MRI techniques in the diagnostics of thoracolumbar spinal injury, a sampling of 95 patients was selected. The number of injuries (total and their distribution by the type of injury) was defined using the sample findings. The total number of detected injuries was: only by MRI = 325; only by CT = 228; MRI + CT = 199. By the results of McNemar test, it has been found out that MRI detects statistically significantly better explosive fractures of the vertebrae, ruptures of the posterior longitudinal ligament (PLL) and yellow ligament (YL), ruptures of third column ligaments, herniated discs, epidural and sublingual hematomas, hematomyelia, complete and partial ruptures of the spinal cord and its edema; CT has superiority in detecting fractures of posterior vertebral elements. Conclusion. Currently, MSCT remains a key imaging technique in the diagnostics of acute spinal injuries in most cases in children and adults. Our findings confirm that MRI - in the absence of standard absolute contraindications - can serve as a worthy alternative for assessing damages of the vertebral bodies, ligaments, intervertebral discs, spinal cord and its roots in the acute stage of injury, yielding only in detecting injuries in vertebra posterior elements. The absence of ionizing radiation is also one of MSCT advantages which makes its use preferable for spinal injury diagnostics in children, both for primary and for control examinations.