Volumetric MRSI Evaluation of Traumatic Brain Injury

描述（由申请人提供）：本项目的主要目的是利用先进的MR神经成像方法开发评估轻中度创伤性脑损伤（MTBI）的客观措施。MTBI是一个重大的公共卫生问题，目前的评估措施在量化伤害的严重程度或指出可能的后果方面能力有限。该项目的试点阶段已经证明，3特斯拉的体积磁共振光谱成像（MRSI）可以检测到与损伤程度相关的大脑中广泛的代谢变化，即使是轻度损伤和没有明显的结构MRI发现。现在我们建议扩展这项研究，以改善这些变化的特征，并评估使用MRI和弥散加权MRI测量对轻度和中度闭合性头部损伤后功能结局的预后。测量将包括n -乙酰天冬氨酸和胆碱，已知对神经元功能障碍和膜更新敏感的代谢标志物，以及反映神经元组织程度的分数各向异性。结果将与结构MRI、初步临床评估和损伤后多个时间点功能结果的神经心理学评估结果相关联。本研究的第二个目的是检查脑震荡后症状与神经影像学之间的可能联系，这些症状在一小部分患者组中是衰弱和持续的后果。第三个目标是优化定量和多参数神经成像测量，以改善损伤的空间范围和代谢后果程度的表征，以及它们与功能结果测量的关联。据推测，所提出的神经影像学措施的灵敏度和空间覆盖率的提高将改善轻中度损伤的特征。公共卫生相关性：该项目将评估改进的定量MR神经成像方法，以评估与轻度脑损伤相关的代谢和微观结构变化。这些客观措施将指导轻度头部创伤后的治疗和患者管理决策，并为损伤的长期后果提供预期。受这种常见损伤影响的患者群体包括运动相关损伤和爆炸相关脑震荡。

DESCRIPTION (provided by applicant): The primary aim of this project is to develop objective measures for evaluation of mild and moderate Traumatic Brain Injury (MTBI) using advanced MR neuroimaging methods. MTBI represents a major public health problem for which the current assessment measures are limited in their ability to quantify the severity of injury or to indicate possible outcomes. The pilot period of this project has demonstrated that Volumetric Magnetic Resonance Spectroscopic Imaging (MRSI) at 3 Tesla can detect widespread metabolic changes in the brain that correlate with the degree of injury, even for mild injury and in the absence of significant structural MRI findings. It is now proposed to extend this study to improve characterization of these changes and to evaluate the use MRSI and diffusion-weighted MRI measures for prognosis of functional outcomes following mild and moderate closed-head injury. Measurements will include N-Acetylaspartate and choline, metabolic markers known to be sensitive to neuronal dysfunction and membrane turnover, and Fractional Anisotropy, which reflects the degree of neuronal organization. Results will be correlated with findings from structural MRI, initial clinical assessments, and neuropsychological evaluation of functional outcomes at multiple time points after injury. A secondary aim of this study is to examine possible associations between post- concussive symptoms, which are debilitating and persistent consequences in a fraction of this patient group, and neuroimaging measures. A third aim is to optimize the quantitative and multiparametric neuroimaging measures to improve characterization of the spatial extent and the degree of metabolic consequences of the injury, and their associations with functional outcome measures. It is hypothesized that the improved sensitivity and spatial coverage of the proposed neuroimaging measures will improve characterization of mild and moderate injury. PUBLIC HEALTH RELEVANCE: This project will evaluate improved quantitative MR neuroimaging methods for assessment of the metabolic and micro-structural changes associated with mild brain injury. These objective measures will guide treatment and patient management decisions following mild head trauma, as well as providing expectations for long-term consequences of the injury. Patient groups affected by this common injury include sports-related injuries and blast-related concussion.