Quantitative proton MRS predicts outcome after traumatic brain injury

Friedman, Seth D.; Brooks, William M.; Jung, Rex E.; Chiulli, Stephen J.; Sloan, John H.; Montoya, B.T.; Hart, Blaine L.; Yeo, Ronald A.

doi:10.1212/wnl.52.7.1384

Cited by 179 publications

(118 citation statements)

References 30 publications

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“…This was true for short echotime single-voxel spectra from normal-appearing OGM and POWM, as well as intermediate echo-time regional MRSI data. The findings from the current study are consistent with the literature on single-voxel spectra from normal-appearing brain and suggest that reduced levels of NAA measured relatively soon after a brain injury in both adults and children is associated with long-term neurologic and cognitive outcome (3,34,35). Studies using MRSI in children also showed NAA/Cre reductions early after injury (10) as well as decreased NAA/Cho ratios up to three years post injury (36).…”

Section: Discussionsupporting

confidence: 88%

MR spectroscopy: Predicting long‐term neuropsychological outcome following pediatric TBI

Babikian¹,

Freier²,

Ashwal³

et al. 2006

Magnetic Resonance Imaging

103

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Purpose: To identify useful acute indicators of long-term neurocognitive outcome beyond clinical variables for children and adolescents treated for a traumatic brain injury (TBI). Materials and Methods:The efficacy of magnetic resonance spectroscopy (MRS) acquired 6 Ϯ 4 days after TBI in 20 children/adolescents in predicting intellectual and neuropsychological functioning one to four years post injury was assessed. Short echo-time single voxel MRS (SVS) from normal-appearing brain was compared to intermediate echo-time multivoxel MR spectroscopic imaging (MRSI) from normal-appearing and visibly-injured brain acquired through the level of the corpus callosum (CC).Results: N-acetyl aspartate (NAA) was moderate to strongly correlated with cognitive scores. Mean NAA/creatine (Cre) from MRSI alone explained over 40% of the variance in cognitive scores and 18% of the variance above and beyond demographic and clinical variables alone. Mild to moderate associations were noted between SVS metabolites (glutamate/glutamine [Glx] and myoinositol [mI]) and cognitive scores, with no such associations apparent for choline (Cho) or Cre. Exploratory analyses revealed trends for regional neuroimaging data and specific cognitive abilities. Conclusion:Acute MR spectroscopy of the pediatric brain injury patient improves prognostic ability and may provide valuable information for early treatment and intervention planning.

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Section: Discussionsupporting

confidence: 88%

MR spectroscopy: Predicting long‐term neuropsychological outcome following pediatric TBI

Babikian¹,

Freier²,

Ashwal³

et al. 2006

Magnetic Resonance Imaging

103

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“…In general, however, we found that pooled mean NAA/Cr and NAA/Cho ratios decreased after injury and remained low in patients with poor outcomes. This is in agreement with previous studies (5,11). The changes seen in this study are attributed primarily to NAA decreases that were observed in the spectra and because quantitative Cr levels measured in the same cohort of patients from occipital gray matter and parietal white matter were not significantly different between patients with good and poor outcomes or controls (8).…”

Section: Pooled Measurementssupporting

confidence: 93%

“…The changes seen in this study are attributed primarily to NAA decreases that were observed in the spectra and because quantitative Cr levels measured in the same cohort of patients from occipital gray matter and parietal white matter were not significantly different between patients with good and poor outcomes or controls (8). Decreases in NAA could represent either neuronal loss or neuronal dysfunction, since NAA has been shown to recover after restoration of energy failure (5,18). It has been postulated that a temporary drop in NAA following brain injury may be caused by accelerated lipid synthesis involved in myelin repair or because NAA provides a temporary source of cellular energy locally at the site of axonal injury, thus producing a transient drop that could precede any loss of NAA as a result of axonal death (10).…”

Section: Pooled Measurementsmentioning

confidence: 56%

“…Despite the diversity of MRS techniques and neuroanatomical areas studied following TBI, investigators have shown that correlations exist between metabolite changes and the patient's clinical outcome. Prior studies using single-voxel techniques have shown a significant correlation between unfavorable clinical outcome and reduction in the neuronal and axonal marker Nacetyl-aspartate (NAA) (4 -9) and increases in choline (Cho), a marker for cell membrane disruption (5)(6)(7)(8)10).…”

mentioning

confidence: 99%

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Prospective longitudinal proton magnetic resonance spectroscopic imaging in adult traumatic brain injury

Holshouser

Tong

Ashwal

et al. 2006

Magnetic Resonance Imaging

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Purpose: To investigate whether longitudinal magnetic resonance proton spectroscopic imaging (MRSI) demonstrates regional metabolite abnormalities after traumatic brain injury (TBI) that predict long-term neurologic outcome. Materials and Methods:Two-dimensional-MRSI (point resolved spectroscopy sequence [PRESS]; TR/TE ϭ 3000/ 144 msec; 10 mm) was acquired prospectively in 42 adults with severe TBI through the level of the corpus callosum 7 Ϯ 4 days after injury. Measurements were repeated in 31 patients six to 12 months after injury. Regional and pooled (all regions combined) mean ratios were compared with control values and then used to predict long-term (six-to -12-month) neurologic outcome (good vs. poor) using a logistic regression model. Results:Initial pooled mean N-acetylaspartate (NAA) ratios were lower (P Ͻ 0.01) and choline (Cho)/creatine (Cr) ratios higher (P Ͻ 0.01) in all TBI patients compared to controls. Ratios from the corpus callosum region were affected most and predicted long-term dichotomized outcome with 83% accuracy. When repeated at six to 12 months after injury, pooled mean NAA/Cr remained lower (P ϭ 0.03) and Cho/Cr remained higher (P ϭ 0.01) in patients with poor outcomes. Conclusion:The NAA/Cr ratio from the corpus callosum was most useful for outcome prediction. Chronic alterations of metabolite ratios are likely due to neuronal loss and glial proliferation long after injury.

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“…Most (but not all) of these studies have demonstrated decreased absolute NAA and NAA/Cr ratios and decreased NAA to correlate with poor outcomes. 54,67, [84][85][86] Decreased NAA/Cr ratios have been detected in the splenium of the corpus callosum and, to a lesser, extent in the lobar white matter. 80 In pediatric patients with accidental and nonaccidental TBI, MR spectroscopy has shown potential for providing early prognostic information regarding clinical outcomes.…”

Section: Mr Spectroscopymentioning

confidence: 99%

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Wintermark

Sanelli

Anzai

et al. 2014

AJNR Am J Neuroradiol

109

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SUMMARY:Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge. ABBREVIATIONS:BOLD ϭ blood oxygen level-dependent; FA ϭ fractional anisotropy; MD ϭ mean diffusivity; MEG ϭ magnetoencephalography; TBI ϭ traumatic

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Quantitative proton MRS predicts outcome after traumatic brain injury

Cited by 179 publications

References 30 publications

MR spectroscopy: Predicting long‐term neuropsychological outcome following pediatric TBI

MR spectroscopy: Predicting long‐term neuropsychological outcome following pediatric TBI

Prospective longitudinal proton magnetic resonance spectroscopic imaging in adult traumatic brain injury

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

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