Proton MR Spectroscopy Correlates Diffuse Axonal Abnormalities with Post-Concussive Symptoms in Mild Traumatic Brain Injury
Proton MR Spectroscopy Correlates Diffuse Axonal Abnormalities with Post-Concussive Symptoms in Mild Traumatic Brain Injury
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DOI：
10.1089/neu.2012.2696
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发表时间：
2013-07-01
影响因子：
4.2
通讯作者：
Gonen, Oded
中科院分区：
文献类型：
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作者：
Kirov, Ivan I.;Tal, Assaf;Gonen, Oded
轻度创伤性脑损伤（mTBI）没有既定的生物标志物，部分原因是脑震荡后症状（PCS）是主观的，常规成像通常不明显。为了测试三维（3D）质子磁共振波谱成像（H-1-MRSI）量化的弥漫性轴索异常是否与患者的PCS相关，我们回顾性研究了26例mTBI患者（平均格拉斯哥昏迷量表[GCS]评分为14.7），18至56岁的患者和13名对照者，伤后3至55天。所有人都在3特斯拉下进行T1和T2加权MRI和3D H-1-MRSI扫描（超过360 cm的480体素，类似于大脑的30%）。在扫描当天，患者完成了症状问卷，那些表明至少有一种最常见的亚急性mTBI症状（头痛，头晕，睡眠障碍，记忆缺陷，视力模糊）的患者被分组为PCS阳性。采用双因素方差分析比较PCS阳性和阴性患者与年龄和性别匹配的对照组的N-乙酰天冬氨酸（NAA）、胆碱（Cho）、肌酸（Cr）和肌醇（mI）的整体灰质和白色物质（GM/WM）绝对浓度。结果表明，PCS阴性组（n = 11）和对照组（n = 8）在任何GM或WM代谢物水平上没有差异。PCS阳性患者（n = 15）的WM NAA低于对照组（n = 12; 7.0 +/- 0.6 vs 7.9 +/- 0.5mM; p = 0.0007）。因此，在大多数神经影像学和GCS评分正常的患者中，整体WM NAA对与常见PCS相关的TBI后遗症表现出敏感性。这表明，在目前缺乏损伤和病理学客观测量的患者人群中，生物标志物具有潜在的作用。
There are no established biomarkers for mild traumatic brain injury (mTBI), in part because post-concussive symptoms (PCS) are subjective and conventional imaging is typically unremarkable. To test whether diffuse axonal abnormalities quantified with three-dimensional (3D) proton magnetic resonance spectroscopic imaging (H-1-MRSI) correlated with patients' PCS, we retrospectively studied 26 mTBI patients (mean Glasgow Coma Scale [GCS] score of 14.7), 18- to 56-year-olds and 13 controls three to 55 days post-injury. All were scanned at 3 Tesla with T1- and T2-weighted MRI and 3D H-1-MRSI (480 voxels over 360 cm(3), similar to 30% of the brain). On scan day, patients completed a symptom questionnaire, and those who indicated at least one of the most common subacute mTBI symptoms (headache, dizziness, sleep disturbance, memory deficits, blurred vision) were grouped as PCS-positive. Global gray matter and white matter (GM/WM) absolute concentrations of N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and myo-inositol (mI) in PCS-positive and PCS-negative patients were compared to age-and gender-matched controls using two-way analysis of variance. The results showed that the PCS-negative group (n = 11) and controls (n = 8) did not differ in any GM or WM metabolite level. The PCS-positive patients (n = 15) had lower WM NAA than the controls (n = 12; 7.0 +/- 0.6 versus 7.9 +/- 0.5mM; p = 0.0007). Global WM NAA, therefore, showed sensitivity to the TBI sequelae associated with common PCS in patients with mostly normal neuroimaging, as well as GCS scores. This suggests a potential biomarker role in a patient population in which objective measures of injury and symptomatology are currently lacking.