1H-MR Spectroscopy in Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) is a common cause of neurological damage and disability. Conventional imaging (CT scan or MRI) is highly sensitive in detecting lesions and provides important clinical information regarding the need for acute intervention. However, abnormalities detected by CT scan or conventional MRI have limited importance in the classification of the degree of clinical severity and in predicting patients' outcome. This can be explained by the widespread microscopic tissue damage occurring after trauma, which is not observable with the conventional structural imaging methods. Advances in neuroimaging over the past two decades have greatly helped in the clinical care and management of patients with TBI. The advent of newer and more sensitive imaging techniques is now being used to better characterize the nature and evolution of injury and the underlying mechanisms that lead to progressive neurodegeneration, recovery or subsequent plasticity. This review will describe the role of proton magnetic resonance spectroscopic (MRS), an advanced MRI technique as related to its use in TBI. Proton MRS is a noninvasive approach that acquires metabolite information reflecting neuronal integrity and function from multiple brain regions and allows to assess clinical severity and to predict disease outcome.

Neuroprotective efficacy of decompressive craniectomy after controlled cortical impact injury in rats: An MRI study

“…Several studies on TBI revealed decreased NAA, suggesting neuronal mitochondrial dysfunction and/or neurodegeneration ; decreased Cho, implicating membrane breakdown and/or inflammation (Brooks et al, 2001); and elevated Lac, suggesting hypoxia (Lin et al, 2012;Marino et al, 2011). In this study, we assumed that creatine, a molecule involved in energy processing, is a stable criterion (Schuhmann et al, 2003).…”

Multimodal assessment of primary motor cortex integrity following sport concussion in asymptomatic athletes

“…The assessment of metabolic disruption using 1 H-MRS has been mostly studied in patients who sustained different severities of traumatic brain injuries (TBI). In these populations, studies have shown consistent decreases in NAA within a month following injury, which is usually considered the acute phase (Brooks et al, 2001; Macmillan et al, 2002; Govindaraju et al, 2004; Marino et al, 2011). Although less consistent (Xu et al, 2011), results for other brain metabolites showed altered Glx (Shutter et al, 2004; Babikian et al, 2006) and elevated lactate (lac), total choline (tCho), and mIns (Brooks et al, 2001; Marino et al, 2011) in the acute phase.…”

“…In these populations, studies have shown consistent decreases in NAA within a month following injury, which is usually considered the acute phase (Brooks et al, 2001; Macmillan et al, 2002; Govindaraju et al, 2004; Marino et al, 2011). Although less consistent (Xu et al, 2011), results for other brain metabolites showed altered Glx (Shutter et al, 2004; Babikian et al, 2006) and elevated lactate (lac), total choline (tCho), and mIns (Brooks et al, 2001; Marino et al, 2011) in the acute phase. Studies conducted with a population of concussed athletes showed a similar pattern of reduction in NAA (Cimatti, 2006; Vagnozzi et al, 2008; Vagnozzi et al, 2010; Henry et al, 2010; Johnson et al, 2012) and an increase in Glu (Henry et al, 2010) within a month post-concussion.…”

Brain Temperature Is Increased During the First Days of Life in Asphyxiated Newborns: Developing Brain Injury Despite Hypothermia Treatment

“…15 However, until now, brain thermometry has been used only a few times with neonates, 16,17 and even more rarely with neonates with hypoxic-ischemic encephalopathy. 18,19 Bainbridge et al 18 have demonstrated the feasibility of this technique with neonates using single-voxel MR spectroscopy placed in the thalamus and/or white matter to show the correlation between brain and rectal temperatures in healthy neonates; in addition, in their study, only 9 neonates had brain temperature measurements during hypothermia treatment.…”