Role of Magnetic Resonance Spectroscopy for Prognosis of Patients with Traumatic Brain Injury

Abstract

Background Traumatic brain injury (TBI) is one of the leading causes of death worldwide. Long-term clinical outcome following TBI can be difficult to predict. Evaluation of the degree of severity of injury and prediction of outcome are important for the management of these patients.

Objective To evaluate whether degree of severity of injury and outcome in moderate to severe TBI is possible by proton magnetic resonance spectroscopy (1H-MRS).

Materials and Methods Patients with moderate (Glasgow coma scale [GCS] 9–13) and severe head injury (GCS: 5–8), within 1 week of trauma with their normal computed tomographic (CT) scan findings, their magnetic resonance imaging (MRI) finding, and neurologic status were investigated with single-voxel proton MRS (¹H-MRS). The study included 51 patients and 24 controls.

Result The MRS study revealed lower ratio of N-acetylaspartate (NAA)/choline (Cho) and NAA/creatine (Cr) and higher ratio of Cho/Cr and lactate level compared with the control group. The ratio of NAA/Cr, NAA/Cho, and Cho/Cr were statistically significant with initial GCS (p = < 0.00001, r = 0.7595; p = < 0.00001, r = 0.7506; and p < 0.00001, r = −0.5923, respectively), and these ratios were also statistically significant with Glasgow outcome scale (GOS) (p < 0.00001, r = 0.8498, p < 0.00001, r =0.9323, p < 0.00001, r = −0.9082, respectively). The ratio of NAA/Cr, NAA/Cho, and Cho/Cr were also statistically significant with severity of injury (p < 0.0001).

Conclusion MRS can quantify damage after TBI and may be a method of assessing severity and outcome in TBI.

Keywords

proton magnetic resonance spectroscopy - traumatic brain injury - N-acetylaspartate - choline - creatinine

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