Longitudinal and Prognostic Evaluation of Mild Traumatic Brain Injury: A 1H-Magnetic Resonance Spectroscopy Study
Longitudinal and Prognostic Evaluation of Mild Traumatic Brain Injury: A 1H-Magnetic Resonance Spectroscopy Study
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DOI：
10.1089/neu.2013.3224
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发表时间：
2014-06-01
影响因子：
4.2
通讯作者：
Gullapalli, Rao P.
中科院分区：
文献类型：
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作者：
George, Elijah O.;Roys, Steve;Gullapalli, Rao P.
在大多数轻度创伤性脑损伤（mTBI）患者中，计算机断层扫描和/或结构磁共振成像无法检测到脑组织损伤。即使在确诊的脑损伤病例中，传统的神经影像学方法在预测患者的神经心理学结果方面也缺乏灵敏度。本研究的目的是（1）使用严格控制的检查窗，在mTBI的不同阶段，横断面确定mTBI患者与健康对照的神经代谢特征的偏差，以及（2）确定mTBI的急性神经代谢标志物与慢性神经认知表现之间的相关性。在mTBI的早期亚急性期（n = 43;损伤后5.44 +/- 3.15天（DPI））、晚期亚急性期（n = 33; 37.00 +/- 12.26 DPI）和慢性期（n = 27; 195.30 +/- 19.60 DPI）对患者进行检查。21名神经系统完整的受试者作为对照。质子磁共振波谱成像（H-1-MRSI）用于获得不同脑区的代谢测量。自动神经心理学评估量表（ANAM）用于mTBI慢性期患者的认知评估。丘脑和半卵圆中心（CSV）的测量结果最能反映损伤，并用于预测神经认知结果。本研究的主要发现是：（1）Cho/Cre降低在丘脑中测量的（胆碱与肌酸比率）（p = 0.042）和CSV（p = 0.017）在mTBI的晚期亚急性期;（2）CSV中早期亚急性Cre测量与慢性ANAM评分测量延迟（r = 0.497，p = 0.019）和立即（r = 0.391，p = 0.072）代码替换。这些发现表明，丘脑和CSV中的代谢测量可以潜在地作为mTBI的诊断和预后标志物。
In the majority of patients with mild traumatic brain injury (mTBI), brain tissue impairment is undetectable by computed tomography and/or structural magnetic resonance imaging. Even in confirmed cases of head injury, conventional neuroimaging methods lack sensitivity in predicting neuropsychological outcomes of patients. The objectives of this study were to (1) cross-sectionally determine deviations in the neurometabolic profile of patients with mTBI from healthy controls at different stages of mTBI using tightly controlled examination windows, and (2) determine associations between acute neurometabolic markers of mTBI and chronic neurocognitive performance. Patients were examined at the early subacute (n = 43; 5.44 +/- 3.15 days post-injury (DPI)), late subacute (n = 33; 37.00 +/- 12.26 DPI) and chronic (n = 27; 195.30 +/- 19.60 DPI) stages of mTBI. Twenty-one neurologically intact subjects were used as controls. Proton magnetic resonance spectroscopy imaging (H-1-MRSI) was used to obtain metabolic measurements from different brain regions. The Automated Neuropsychological Assessment Metrics (ANAM) was used for cognitive evaluation of patients at the chronic stage of mTBI. Measurements in the thalamus and centrum semiovale (CSV) emerged as the most indicative of injury and were used to predict neurocognitive outcome. The major findings of this study are (1) decreases in Cho/Cre (choline-to-creatine ratio) measured in the thalamus (p = 0.042) and CSV (p = 0.017) at the late subacute stage of mTBI; (2) positive associations of early subacute Cre measurements in the CSV with chronic ANAM scores measuring performance in delayed (r = 0.497, p = 0.019) and immediate (r = 0.391, p = 0.072) code substitution. These findings show that metabolic measurements in the thalamus and CSV can potentially serve as diagnostic and prognostic markers of mTBI.