Proton Magnetic Resonance Spectroscopy of Acute TBI

描述（申请人提供）：每年有23万人住院 并在中度和重度创伤性脑损伤（TBI）中存活。 结果一名 大量患有TBI个体忍受终身损伤， 残疾。急性评级量表，例如格拉斯哥昏迷量表（GCS） 显示出有限的预测有效性关于患者的结果和传统的 神经成像技术，如CT和MRI， 脑损伤严重程度和认知功能。 神经影像学的不断进步， 然而，这为研究人员提供了一个重要的机会， TBI后脑功能障碍的病理生理学。 根据NCMRR，“ 应该用现代成像技术研究人类TBI的神经生物学”。 的 本研究的目的是关联质子磁共振波谱（MRS）， 先进的神经成像技术，与TBI严重程度的行为措施， 认知结果 MRS测量大脑代谢物的浓度 如N-乙酰天冬氨酸（NAA）、胆碱（Cho）和谷氨酸（Glu）。虽然MRS 在预测脑损伤的严重程度和病人的预后方面显示出了希望， 在TBI中使用MRS的确切方案尚未确定， 拟议的研究将审查三个关键领域：（1）受伤后 应获取MRS数据的时间段（例如，一周内或 在损伤的一个月内）;（2）应该如何测量代谢物（即， 绝对浓度或浓度随时间的变化）;以及（3） 最适合于MRS数据采集的脑位置（即，收购近 病变部位或在远离可能的脑病变的部位采集）。的 拟议中的研究将通过使用 TBI后的两次急性MRS扫描，以测量NAA、Cho和 谷氨酸及其与损伤严重程度和认知变量的相关性。在 此外，急性MRS数据与行为数据（例如，持续时间 意识丧失，创伤后健忘症的持续时间）将阐明 脑代谢变化与患者变化之间关系 在TBI急性恢复期间的行为。本建议将采用 有前途的，非侵入性的神经成像技术，MRS，以确定最 适当的协议（即，定时，代谢测量，大脑定位， 数据采集）用于MRS对急性TBI的应用。与建立的 使用MRS的协议，该仪器应证明可用于确定 急性干预的有效性（例如，低温、药物 干预）和用于预测患者恢复的急性过程。

DESCRIPTION (provided by applicant): Each year 230,000 people are hospitalized and survive moderate and severe traumatic brain injury (TBI). As a result, a large number of individuals with TBI endure life-long impairment and disability. Acute rating scales such as the Glasgow Coma Scale (GCS) have shown limited predictive validity regarding patient outcome and traditional neuroimaging techniques such as CT and MRI maintain limited correlations with brain injury severity and cognitive functioning. Continued advances in neuroimaging, however, have provided researchers with an important opportunity to study the pathophysiology of brain dysfunction following TBI. According to the NCMRR, "the neurobiology of TBI in humans should be studied with modern imaging techniques". The purpose of this study is to correlate proton magnetic resonance spectroscopy (MRS), an advanced neuroimaging technique, with behavioral measures of TBI severity and cognitive outcome. MRS measures the concentration of cerebral metabolites such as N-acetylaspartate (NAA), choline (Cho), and glutamate (Glu). While MRS has shown promise in predicting brain injury severity and patient outcome, the exact protocols for using MRS with TBI remain undetermined and the purpose of the proposed study is to examine three critical areas: (1) the post-injury time period when the MRS data should be acquired (e.g., within one week or within one month of injury); (2) how metabolites should be measured (i.e., absolute concentrations or changes in concentration over time); and (3) the brain locations best suited for MRS data acquisition (i.e., acquisition near lesion sites or acquisition at sites remote from probable brain lesion). The proposed study will make determinations in these three areas through the use of two acute MRS scans following TBI to measure concentrations of NAA, Cho and Glu and their correlation with injury severity and cognitive variables. In addition, correlation of acute MRS data with behavioral data (e.g., duration of loss of consciousness, duration of post-traumatic amnesia) will elucidate the relationship between changes in brain metabolism and changes in patient behavior during acute recovery from TBI. The present proposal will employ a promising, noninvasive neuroimaging technique, MRS, to determine the most appropriate protocols (i.e., timing, metabolic measurement, brain location for data acquisition) for application of MRS to acute TBI. With an established protocol for using MRS, this instrument should prove useful for determining the effectiveness of acute interventions (e.g. hypothermia, pharmacologic intervention) and for predicting the acute course of patient recovery.