Neurometabolism and Outcome in Traumatic Brain Injury

创伤性脑损伤（TBI）是年轻人死亡和发病的主要原因，否则健康的人群，并导致巨大的社会和经济成本。 虽然常用的临床标志物在大型研究中与总体功能有统计学联系，但它们在预测个体患者的认知功能方面用处不大。同样，尽管传统的神经影像学研究可以指导急性临床治疗，但结果预测是不可靠的，特别是在损伤解决的早期阶段。我们实验室的初步数据显示，通过非侵入性磁共振波谱测量的脑细胞损伤的神经代谢物标记物与认知功能和结果密切相关。 此外，我们的数据表明，某些解剖位置比其他位置受到更严重的伤害（即，前脑多于后脑），并且灰质神经代谢物比白色物质更可靠地预测认知结果，表明对TBI的反应的组织异质性。我们还表明，这些神经代谢物的恢复暂时与认知改善有关。我们提出了一种新的方法来评估和研究TBI使用定量磁共振光谱成像（SI）和MRI量化细胞脑损伤。 这些测量N-乙酰天冬氨酸，含胆碱化合物，和水弛豫时间是一个强大的新工具，用于预测脑功能和结果。 使用这些神经代谢物标志物的损伤在正常出现（MRI）的大脑，我们的目标是确定是否特定的模式解剖和/或组织类型的损伤与特定形式的认知功能障碍。磁共振波谱成像提供了一个强大的新工具，调查脑外伤后神经元的代谢完整性，并可能提供新的见解临床管理，病人的异质性，预测的结果，并确定有效的治疗方案。

Traumatic brain injury (TBI) is the leading cause of death and morbidity in young, otherwise healthy populations and results in an enormous social and economic cost. Although commonly used clinical markers are statistically linked with gross functioning in large studies, they are less useful in predicting cognitive functioning in individual patients. Similarly, although conventional neuroimaging studies can guide acute clinical management, outcome prediction is unreliable, particularly at early stages of injury resolution. Preliminary data from our laboratory show that neurometabolite markers of brain cellular injury measured by non-invasive magnetic resonance spectroscopy are strongly correlated with cognitive function and outcome. Further, our data show that certain anatomic locations are more intensely injured than others (i.e., anterior brain more than posterior), and that gray matter neurometabolites predict cognitive outcome more reliably than white matter, suggesting tissue heterogeneity of response to TBI. We also show that recovery of these neurometabolites is temporarily associated with cognitive improvement. We propose a novel approach for assessment and study of TBI using quantitative magnetic resonance spectroscopic imaging (SI) and MRI to quantify cellular brain injury. These measurements of N- acetylaspartate, choline-containing compounds, and water relaxation times are a powerful new tool for prediction of brain function and outcome. Using these neurometabolite markers of injury in normal-appearing (by MRI) brain, we aim to determine whether specific patterns-anatomic and/or tissue-type of injury are associated with specific forms of cognitive dysfunction. Magnetic resonance spectroscopic imaging offers a robust new tool to investigate the metabolic integrity of the neuron following TBI, and may provide new insight into clinical management, patient heterogeneity, prediction of outcome, and the determination of effectiveness of therapeutic options.