Susceptibility-weighted imaging and proton magnetic resonance spectroscopy in assessment of outcome after pediatric traumatic brain injury.
OBJECTIVE
To assess the role of magnetic resonance imaging, specifically magnetic resonance spectroscopy (MRS) and susceptibility-weighted imaging (SWI), in the evaluation of children with traumatic brain injury (TBI).


METHODS
Literature review and data from our recently published clinical studies.


METHODS
Children with pediatric TBI who underwent SWI. SWI is a 3-dimensional high-resolution magnetic resonance imaging technique that is more sensitive in detecting hemorrhagic lesions seen with diffuse axonal injury (DAI) than conventional imaging. MRS acquires metabolite information that reflects neuronal integrity and function from multiple brain regions and offers early prognostic information regarding outcome.


METHODS
Literature review.


RESULTS
Literature review and review of recently published data from our institution.


CONCLUSIONS
The data suggest that more sensitive imaging techniques that provide early evidence of injury and that are better predictors of outcome are needed to identify children at risk for such deficits. Specifically, the number and volume of hemorrhagic DAI lesions as well as changes in spectral metabolites such as reduced N-acetylaspartate or elevations in choline-related compounds correlate with neurologic disability and impairments of global intelligence, memory, and attention.
Ashwal
Stephen
S
Department of Pediatrics, Division of Child Neurology, Section of Neuroradiology, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA. sashwal@ahs.llumc.edu
Babikian
Talin
T
Gardner-Nichols
Joy
J
Freier
Mary-Catherine
MC
Tong
Karen A
KA
Holshouser
Barbara A
BA
D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001369:Axons / Q000473:pathology; D001930:Brain Injuries / Q000378:metabolism / Q000473:pathology*; D002648:Child; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D006801:Humans; D021621:Imaging, Three-Dimensional; D015601:Injury Severity Score; D020300:Intracranial Hemorrhages / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care
D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline