Acute metabolic brain changes following traumatic brain injury and their relevance to clinical severity and outcome.
BACKGROUND
Conventional MRI can provide critical information for care of patients with traumatic brain injury (TBI), but MRI abnormalities rarely correlate to clinical severity and outcome. Previous magnetic resonance spectroscopy studies have reported clinically relevant brain metabolic changes in patients with TBI. However, these changes were often assessed a few to several days after the trauma, with a consequent variation of the metabolic pattern due to temporal changes.


METHODS
Proton magnetic resonance spectroscopic imaging (1H-MRSI) examinations were performed in 10 patients with TBI 48-72 h after the trauma, to obtain early measurements of central brain levels of N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and lactate (La). Metabolite values were expressed as ratios to (1) a metabolic pattern, given by the sum of the resonance intensities of all metabolites detected in the same voxel and (2) intravoxel Cr.


RESULTS
NAA ratios were found to be significantly lower in patients with TBI than in normal controls. In contrast, Cho ratios were significantly higher in patients with TBI than in normal controls. Increased La levels were found in 5 of 10 patients with TBI. Both NAA and La values correlated closely with those of the Glasgow Coma Scale at presentation (r = 0.73 and -0.62, respectively; p<0.01 for both) and the Glasgow Outcome Scale at 3 months (r = -0.79 and 0.79, respectively; p<0.01 for both).


CONCLUSIONS
Spectroscopic measures of neuro-axonal damage occurring soon after a brain trauma are clinically relevant. Significant increases in cerebral La level also may be detected when 1H-MRSI is performed early after the trauma and, at this stage, can represent a reliable index of injury severity and disease outcome in patients with TBI.
Marino
Silvia
S
Department of Neurological and Behavioural Sciences, University of Siena, Viale Bracci 2, 53100 Siena, Italy.
Zei
Ettore
E
Battaglini
Marco
M
Vittori
Cesare
C
Buscalferri
Antonella
A
Bramanti
Placido
P
Federico
Antonio
A
De Stefano
Nicola
N
D000328:Adult; D000368:Aged; D001921:Brain / Q000378:metabolism*; D001930:Brain Injuries / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome