1H MRS in acute traumatic brain injury.
The objective of this study was to demonstrate 1H MR spectroscopy (MRS) changes in cerebral metabolites after acute head trauma. Twenty-five patients (12 children, 13 adults) were examined with quantitative 1H MRS after closed head injury. Clinical grade (Glasgow Coma Scale [GCS]) and outcome (Rancho Los Amigos Medical Center Outcome Score [ROS]) were correlated with quantitative neurochemical findings. N-acetylaspartate (NAA), a neuronal and axonal marker, was reduced (P < .03-.001). In children, a reduced NAA/creatine plus phosphocreatine (Cr) level and the presence of detectable lipid/lactate predicted bad outcome (sensitivity, 89%; specificity, 89%). The first MRS examination of all patients correlated with ROS versus NAA (r = .65, P < .0001). Although most patients showed MRS abnormalities, striking heterogeneity of 1H MRS characterized the individual patients. 1H MRS identifies multiple patterns of diffuse brain injury after blunt head trauma. There was a strong correlation between MRS and outcome. Future prospective studies will be needed to determine the clinical usefulness of MRS in predicting outcome from closed head injury.
Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
B D
BD
Ross
T
T
Ernst
R
R
Kreis
L J
LJ
Haseler
S
S
Bayer
E
E
Danielsen
S
S
Blüml
T
T
Shonk
J C
JC
Mandigo
W
W
Caton
C
C
Clark
S W
SW
Jensen
N L
NL
Lehman
E
E
Arcinue
R
R
Pudenz
C H
CH
Shelden
D000328:Adult; D001921:Brain / Q000378:metabolism* / Q000473:pathology; D001923:Brain Chemistry; D001930:Brain Injuries / Q000378:metabolism* / Q000473:pathology; D002648:Child; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000378:metabolism / Q000473:pathology; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome