Diffuse axonal injury in mild traumatic brain injury: a 3D multivoxel proton MR spectroscopy study.
Diffuse axonal injury in mild traumatic brain injury: a 3D multivoxel proton MR spectroscopy study.
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DOI：
10.1007/s00415-012-6626-z
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发表时间：
2013-01
影响因子：
6
通讯作者：
Gonen O
中科院分区：
文献类型：
--
作者：
Kirov II;Tal A;Babb JS;Lui YW;Grossman RI;Gonen O
由于轻度创伤性脑损伤（mTBI）经常导致神经系统症状，即使没有临床MRI发现，我们的目标是测试弥漫性轴索损伤是否可以用多体素质子磁共振光谱成像（1H-MRSI）量化。从26名18-56岁、损伤后3 - 55天的mTBI患者（格拉斯哥昏迷评分平均14.7分）和13名健康匹配的同时代患者（3特斯拉）中获得T1和t2加权MRI和三维1H-MRSI（超过360 cm3的480体素，约30%的大脑）。测定每个体素的n -乙酰天冬氨酸（NAA）、胆碱（Cho）、肌酸（Cr）和肌醇（mI）浓度以及灰质、白质（GM/WM）和脑脊液组分。使用线性回归估计全球GM和WM绝对代谢浓度，并使用双向方差分析将患者与对照组进行比较。GM组患者NAA、Cr、Cho、mI平均浓度（8.4±0.7、6.9±0.6、1.3±0.2、5.5±0.6 mM）， WM组患者Cr、Cho、mI平均浓度（4.8±0.5、1.4±0.2、4.6±0.7 mM）与对照组无显著差异。然而，患者的NAA明显低于对照组的WM（7.2±0.8 mM vs 7.7±0.6 mM, p=0.0125）。患者WM中Cho和Cr水平与mTBI时间呈正相关。这种1H-MRSI方法使我们能够确定早期mTBI后遗症是(i)弥漫性的（而不仅仅是局部的），（ii）神经元性的（而不是胶质性的）和（iii）全白质（而不是灰质）。这些发现支持了一种假设，即与更严重的头部创伤类似，mTBI也会导致弥漫性轴索损伤，但损伤后不久主要是功能障碍而不是细胞死亡。
Since mild traumatic brain injury (mTBI) often leads to neurological symptoms even without clinical MRI findings, our goal was to test whether diffuse axonal injury is quantifiable with multivoxel proton MR spectroscopic imaging (1H-MRSI). T1- and T2-weighted MRI and three dimensional 1H-MRSI (480 voxels over 360 cm3, ∼30% of the brain) were acquired at 3 Tesla from 26 mTBI patients (mean Glasgow Coma Scale score 14.7), 18–56 years old, 3–55 days post injury and 13 healthy matched contemporaries. The N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and myo-inositol (mI) concentrations and gray-, white-matter (GM/WM) and cerebrospinal fluid fractions were obtained in each voxel. Global GM and WM absolute metabolic concentrations were estimated using linear regression, and patients were compared with controls using two-way analysis of variance. Patients' mean NAA, Cr, Cho and mI concentrations in GM (8.4±0.7, 6.9±0.6, 1.3±0.2, 5.5±0.6 mM) and Cr, Cho and mI in WM (4.8±0.5, 1.4±0.2, 4.6±0.7 mM) were not different from controls'. NAA, however, was significantly lower in patients' than controls' WM (7.2±0.8 versus 7.7±0.6 mM, p=0.0125). The Cho and Cr levels in patients' WM positively correlated with time from mTBI. This 1H-MRSI approach allowed us to ascertain that early mTBI sequelae are (i) diffuse (not merely local), (ii) neuronal (not glial) and (iii) in the global white (not gray) matter. These findings support the hypothesis that, similarly to more severe head trauma, mTBI also results in diffuse axonal injury, but that dysfunction, rather than cell death, dominates shortly after injury.
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