Predicting neuropsychologic outcome after traumatic brain injury in children

Brenner, Tamara Sue; Freier, M. Catherin; Holshouser, Barbara A.; Burley, Todd; Ashwal, Stephen

doi:10.1016/s0887-8994(02)00491-5

Cited by 77 publications

(52 citation statements)

References 29 publications

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“…80 In pediatric patients with accidental and nonaccidental TBI, MR spectroscopy has shown potential for providing early prognostic information regarding clinical outcomes. 62, [87][88][89][90][91][92][93][94] Reduced NAA has been correlated with impaired long-term neuropsychological function in children. 89,90,92,94 Elevated total Cho has also been described and may be related to diffuse axonal injury and/or repair.…”

Section: Mr Spectroscopymentioning

confidence: 99%

“…62, [87][88][89][90][91][92][93][94] Reduced NAA has been correlated with impaired long-term neuropsychological function in children. 89,90,92,94 Elevated total Cho has also been described and may be related to diffuse axonal injury and/or repair. 84,95 Studies have shown that elevated lactate levels are more common following nonaccidental TBI 62,87 and are strongly correlated with poor outcomes.…”

Section: Mr Spectroscopymentioning

confidence: 99%

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Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Wintermark

Sanelli

Anzai

et al. 2014

AJNR Am J Neuroradiol

112

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SUMMARY:Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge. ABBREVIATIONS:BOLD ϭ blood oxygen level-dependent; FA ϭ fractional anisotropy; MD ϭ mean diffusivity; MEG ϭ magnetoencephalography; TBI ϭ traumatic

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Section: Mr Spectroscopymentioning

confidence: 99%

Section: Mr Spectroscopymentioning

confidence: 99%

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Wintermark

Sanelli

Anzai

et al. 2014

AJNR Am J Neuroradiol

112

View full text Add to dashboard Cite

show abstract

“…MRS provides a sensitive assessment of post-injury neurometabolite alterations, particularly in tissue with no visible injury on conventional imaging, and has shown potential for providing early prognostic information regarding clinical outcome in pediatric patients with accidental and nonaccidental TBI (Aaen et al, 2010;Ashwal et al, 2000;Babikian et al, 2006;Brenner et al, 2003;Holshouser et al, 1997Holshouser et al, , 2005 Studies using proton MRS in children have found similar neurometabolite alterations after injury. Typically, N-acetyl aspartate (NAA), an amino acid synthesized in mitochondria, is a neuronal and axonal marker that is reduced as a result of neuronal loss or dysfunction after injury.…”

Section: Perfusion Imagingmentioning

confidence: 99%

“…Typically, N-acetyl aspartate (NAA), an amino acid synthesized in mitochondria, is a neuronal and axonal marker that is reduced as a result of neuronal loss or dysfunction after injury. Several studies have shown a direct correlation of reduced NAA and impaired long-term neuropsychological function in children (Babikian et al, 2005;Brenner et al, 2003;Hunter et al, 2005;Yeo et al, 2006). Total choline (Cho) primarily consisting of phosphoryl and glycerophosphoryl Cho is elevated because of shearing of myelin and cellular membranes (diffuse axonal injury) and/ or repair.…”

Section: Perfusion Imagingmentioning

confidence: 99%

Emerging Imaging Tools for Use with Traumatic Brain Injury Research

Hunter

Wilde

Tong

et al. 2012

Journal of Neurotrauma

116

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This article identifies emerging neuroimaging measures considered by the inter-agency Pediatric Traumatic Brain Injury (TBI) Neuroimaging Workgroup. This article attempts to address some of the potential uses of more advanced forms of imaging in TBI as well as highlight some of the current considerations and unresolved challenges of using them. We summarize emerging elements likely to gain more widespread use in the coming years, because of 1) their utility in diagnosis, prognosis, and understanding the natural course of degeneration or recovery following TBI, and potential for evaluating treatment strategies; 2) the ability of many centers to acquire these data with scanners and equipment that are readily available in existing clinical and research settings; and 3) advances in software that provide more automated, readily available, and cost-effective analysis methods for large scale data image analysis. These include multi-slice CT, volumetric MRI analysis, susceptibility-weighted imaging (SWI), diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), arterial spin tag labeling (ASL), functional MRI (fMRI), including resting state and connectivity MRI, MR spectroscopy (MRS), and hyperpolarization scanning. However, we also include brief introductions to other specialized forms of advanced imaging that currently do require specialized equipment, for example, single photon emission computed tomography (SPECT), positron emission tomography (PET), encephalography (EEG), and magnetoencephalography (MEG)/magnetic source imaging (MSI). Finally, we identify some of the challenges that users of the emerging imaging CDEs may wish to consider, including quality control, performing multi-site and longitudinal imaging studies, and MR scanning in infants and children.

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“…In addition, cognitive performance was positively correlated with NAA/ Cho ratios and negatively correlated with Cho/Cre ratios (5). It remains to be determined whether spectra from regions other than those traditionally sampled for MRS or regions that are associated with specific cognitive abilities are better predictors of outcome following accidental TBI in childhood.…”

mentioning

confidence: 99%

MR spectroscopy: Predicting long‐term neuropsychological outcome following pediatric TBI

Babikian¹,

Freier²,

Ashwal³

et al. 2006

Magnetic Resonance Imaging

Self Cite

104

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Purpose: To identify useful acute indicators of long-term neurocognitive outcome beyond clinical variables for children and adolescents treated for a traumatic brain injury (TBI). Materials and Methods:The efficacy of magnetic resonance spectroscopy (MRS) acquired 6 Ϯ 4 days after TBI in 20 children/adolescents in predicting intellectual and neuropsychological functioning one to four years post injury was assessed. Short echo-time single voxel MRS (SVS) from normal-appearing brain was compared to intermediate echo-time multivoxel MR spectroscopic imaging (MRSI) from normal-appearing and visibly-injured brain acquired through the level of the corpus callosum (CC).Results: N-acetyl aspartate (NAA) was moderate to strongly correlated with cognitive scores. Mean NAA/creatine (Cre) from MRSI alone explained over 40% of the variance in cognitive scores and 18% of the variance above and beyond demographic and clinical variables alone. Mild to moderate associations were noted between SVS metabolites (glutamate/glutamine [Glx] and myoinositol [mI]) and cognitive scores, with no such associations apparent for choline (Cho) or Cre. Exploratory analyses revealed trends for regional neuroimaging data and specific cognitive abilities. Conclusion:Acute MR spectroscopy of the pediatric brain injury patient improves prognostic ability and may provide valuable information for early treatment and intervention planning.

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Predicting neuropsychologic outcome after traumatic brain injury in children

Cited by 77 publications

References 29 publications

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Emerging Imaging Tools for Use with Traumatic Brain Injury Research

MR spectroscopy: Predicting long‐term neuropsychological outcome following pediatric TBI

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