The Clinical Utility of Magnetic Resonance Spectroscopy in Traumatic Brain Injury: Recommendations from the ENIGMA MRS Working Group

Abstract

Proton magnetic resonance spectroscopy provides a non-invasive and quantitative measure of brain metabolites. Traumatic brain injury impacts cerebral metabolism and a number of research groups have successfully used this technique as a biomarker of injury and/or outcome in both pediatric and adult TBI populations. However, this technique is underutilized, with studies being performed primarily at centers with access to MR research support. In this paper we present a technical introduction to the acquisition and analysis of in vivo magnetic resonance spectroscopy and review magnetic resonance spectroscopy findings in different injury populations. In addition, we propose a basic data acquisition scheme that can be added to any imaging protocol, regardless of clinical magnetic resonance platform. We outline a number of considerations for study design as a way of encouraging the use of magnetic resonance spectroscopy in the study of traumatic brain injury, as well as recommendations to improve data harmonization across groups already using this technique.

ENIGMA and global neuroscience: A decade of large-scale studies of the brain in health and disease across more than 40 countries

“…Another limitation of this type of data is that the depth of phenotyping varies across centers, which can lead to a limited set of clinical and other scales shared by all centers. As we discuss below, ENIGMA is now beginning to address these limitations with a series of newly funded and planned studies 111,112,114,[118][119][120][121] . The paucity of longitudinal data in the literature is also reflected within ENIGMA, which includes a limited number of longitudinal studies.…”

The ENIGMA Brain Injury working group: approach, challenges, and potential benefits

“…Soon after, groups for Adult msTBI (Olsen et al 2020) and Acute Emergency Department (Civilian) Mild TBI were formed, followed by a group focusing on Intimate Partner Violence (Esopenko et al 2020). The newest groups to be formed are focused on emerging imaging methods that may have particular relevance in TBI, namely Magnetic Resonance Spectroscopy (MRS) (Bartnik-Olson et al 2020), Arterial Spin Labeling (ASL), and resting state fMRI (rsfMRI), as well as a group on Cognitive Endpoints (see Fig. 1).…”

Toward a global and reproducible science for brain imaging in neurotrauma: the ENIGMA adult moderate/severe traumatic brain injury working group

“…Magnetic resonance spectroscopy (MRS) is (unlike PET) a noninvasive tool to measure brain metabolites that are indicative of injury. MRS has shown alterations in metabolites reflecting neuronal health and cellular turnover in TBI ( Bartnik-Olson et al 2019;Brown et al 2018). Whole brain N-acetylaspartate (NAA), which is a proxy for neuronal integrity, and choline (Cho), a cell membrane marker, correlate with injury severity and neuropsychological functioning (Govind et al 2010;Govindaraju et al 2004;Maudsley et al 2015), as well as with coarse global outcomes (GOS) at 3 months post injury (Marino et al 2007).…”