Predictive value of proton magnetic resonance spectroscopy in pediatric closed head injury
S Ashwal1, B A Holshouser, S K Shu
1Division of Child Neurology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California 92350, USA.
Insights
Proton magnetic resonance spectroscopy (MRS) can predict traumatic brain injury outcomes. The presence of lactate in brain tissue is a strong indicator of poor neurological outcomes in infants and children.
Area of Science:
- Neuroscience
- Biochemistry
- Pediatric Neurology
Background:
- Traumatic brain injury (TBI) in infants and children can lead to long-term neurological deficits.
- Accurate early prediction of TBI outcomes is crucial for appropriate clinical management and intervention.
- Current outcome prediction methods may lack objectivity or sufficient predictive power.
Purpose of the Study:
- To evaluate the utility of proton magnetic resonance spectroscopy (MRS) in predicting neurological outcomes following acute TBI in pediatric patients.
- To compare the predictive value of MRS-derived metabolic variables (metabolite ratios, lactate) with clinical assessments and MRI findings.
- To determine if combining different assessment methods improves outcome prediction accuracy.
Main Methods:
- Study included 26 infants and 27 children with acute TBI.
- Assessments included clinical rating scales, a 15-point MRI scoring system, and occipital gray matter proton MRS.
- Proton MRS analyzed metabolite ratios (NAA/Cre, NAA/Cho, Cho/Cre) and the presence of lactate, correlating these with 6- to 12-month outcomes.
Main Results:
- Abnormal metabolite ratios (lower NAA/Cre or NAA/Cho; higher Cho/Cre) were associated with poor outcomes.
- Lactate was detected in 91% of infants and 80% of children with poor outcomes, and in none with good outcomes.
- Lactate alone demonstrated high predictive accuracy (96% for both infants and children), outperforming clinical variables and not improving with combined methods.
Conclusions:
- Proton MRS provides objective, early data for predicting long-term neurological outcomes after pediatric TBI.
- The presence of lactate via proton MRS is a highly sensitive and specific biomarker for poor TBI outcomes in children.
- MRS findings reflect global metabolic changes, offering valuable insights beyond directly injured brain areas.
Abstract:
We studied 26 infants (1-18 months old) and 27 children (18 months or older) with acute nonaccidental (n = 21) or other forms (n = 32) of traumatic brain injury using clinical rating scales, a 15-point MRI scoring system, and occipital gray matter short-echo proton MRS. We compared the differences between the acutely determined variables (metabolite ratios and the presence of lactate) and 6- to 12-month outcomes. The metabolite ratios were abnormal (lower NAA/Cre or NAA/Cho; higher Cho/Cre) in patients with a poor outcome. Lactate was evident in 91% of infants and 80% of children with poor outcomes; none of the patients with a good outcome had lactate. At best, the clinical variables alone predicted the outcome in 77% of infants and 86% of children, and lactate alone predicted the outcome in 96% of infants and 96% of children. No further improvement in outcome prediction was observed when the lactate variable was combined with MRI ratios or clinical variables. The findings of spectral sampling in areas of brain not directly injured reflected the effects of global metabolic changes. Proton MRS provides objective data early after traumatic brain injury that can improve the ability to predict long-term neurologic outcome.
