Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Holshouser, B. A. Articles by Ashwal, S. Search for Related Content PubMed PubMed Citation Articles by Holshouser, B. A. Articles by Ashwal, S.

American Journal of Neuroradiology 26:1276-1285, May 2005
© 2005 American Society of Neuroradiology

PEDIATRICS

Proton MR Spectroscopic Imaging Depicts Diffuse Axonal Injury in Children with Traumatic Brain Injury

Barbara A. Holshouser^a, Karen A. Tong^a and Stephen Ashwal^b

^a Department of Radiology, Section of Neuroradiology, Loma Linda University School of Medicine, CA
^b Department of Pediatrics, Division of Child Neurology, Loma Linda University School of Medicine, CA

Address reprint requests to Barbara Holshouser, PhD, MRI-B624, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354

BACKGROUND AND PURPOSE: Diffuse axonal injury (DAI) after traumatic brain injury (TBI) is important in patient assessment and prognosis, yet they are underestimated with conventional imaging techniques. We used MR spectroscopic imaging (MRSI) to detect DAI and determine whether metabolite ratios are accurate in predicting long-term outcomes and to examine regional differences in injury between children with TBI and control subjects.

METHODS: Forty children with TBI underwent transverse proton MRSI through the level of the corpus callosum within 1–16 days after injury. T2-weighted, fluid-attenuated inversion recovery, and susceptibility-weighted MR imaging was used to identify voxels as normal-appearing or as nonhemorrhagic or hemorrhagic injury. Neurologic outcome was evaluated at 6–12 months after injury. Metabolite ratios for total (all voxels), normal-appearing, and hemorrhagic brain were compared and used in a logistic regression model to predict long-term outcome. Total and regional metabolite ratios were compared with control data.

RESULTS: A significant decrease in N-acetylaspartate (NAA)/creatine (Cr) and increase in choline (Cho)/Cr (evidence of DAI) was observed in normal-appearing (P < .05) and visibly injured (hemorrhagic) brain (P < .001) compared with controls. In normal-appearing brain NAA/Cr decreased more in patients with poor outcomes (1.32 ± 0.54) than in those with good outcomes (1.61 ± 0.50, P = .01) or control subjects (1.86 ± 0.1, P = .00). In visibly injured brains, ratios were similarly altered in all patients. In predicting outcomes, ratios from normal-appearing and visibly-injured brain were 85% and 67% accurate, respectively.

CONCLUSION: MRSI can depict injury in brain that appears normal on imaging and is useful for predicting long-term outcomes.

This article has been cited by other articles:

				J. P. Coles Imaging after brain injury Br. J. Anaesth., July 1, 2007; 99(1): 49 - 60. [Abstract] [Full Text] [PDF]

				C. J. Barreiro, J. A. Williams, T. P. Fitton, M. S. Lange, M. E. Blue, L. Kratz, P. B. Barker, M. Degaonkar, V. L. Gott, J. C. Troncoso, et al. Noninvasive Assessment of Brain Injury in a Canine Model of Hypothermic Circulatory Arrest Using Magnetic Resonance Spectroscopy. Ann. Thorac. Surg., May 1, 2006; 81(5): 1593 - 1598. [Abstract] [Full Text] [PDF]