Research Reports - Proton MR spectroscopy correlates diffuse axonal abnormalities with post-concussive symptoms in mild traumatic brain injury

J Neurotrauma. 2013 Jan 22

Kirov II, Tal A, Babb JS, Reaume J, Bushnik T, Ashman T, Flanagan SR, Grossman RI, Gonen O

There are no established biomarkers for mild traumatic brain injury (mTBI), in
part because post-concussive symptoms (PCS) are subjective and conventional
imaging is typically unremarkable. To test whether diffuse axonal abnormalities
quantified with three-dimensional (3D) proton magnetic resonance spectroscopic
imaging (1H-MRSI) correlated with patients' PCS, we retrospectively studied 26
mTBI patients (mean Glasgow Coma Scale score of 14.7), 18-56 years old, 3 - 55
days post injury and 13 controls. All were scanned at 3 Tesla with T1-and
T2-weighted MRI and 3D 1H-MRSI (480 voxels over 360 cm3, ~30% of the brain). On
scan day patients completed a symptom questionnaire and those indicating at least
one of the most common acute/subacute mTBI symptoms (headache, dizziness, sleep
disturbance, memory deficits, blurred vision) were grouped as PCS-positive.
Global gray- and white matter (GM/WM) absolute concentrations of
N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and myo-inositol (mI) in
the PCS-positive and PCS-negative patients were compared to age- and
gender-matched controls using two-way analysis of variance. The results showed
that the PCS-negative group (n=11) and controls (n=8) did not differ in any GM or
WM metabolite level. The PCS-positive patients (n=15), however, had lower WM NAA
than the controls (n=12): 7.0±0.6 mM (mean± standard deviation) versus 7.9±0.5mM
(p=0.0007). Global WM NAA, therefore, showed sensitivity to the TBI sequelae
associated with common PCS in individuals with mostly normal neuroimaging as well
as GCS scores. This suggests a potential biomarker role in a patient population
in which objective measures of injury and symptomatology are currently lacking.

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