Magnetic resonance spectroscopy predicts outcomes for children with nonaccidental trauma
Gregory S Aaen1, Barbara A Holshouser, Clare Sheridan
1Loma Linda University School of Medicine, Department of Pediatrics, 11175 Campus St, Room A1120, Loma Linda, CA 92354, USA.
Insights
Proton magnetic resonance spectroscopic imaging (MRSI) can predict outcomes in children with nonaccidental trauma (NAT). Reduced N-acetylaspartate and elevated lactate levels on MRSI scans correlate with poor neurologic outcomes in infants with NAT.
Area of Science:
- Pediatric neurology
- Neuroimaging
- Trauma research
Background:
- Traumatic brain injury (TBI) in children can result from nonaccidental trauma (NAT).
- Early prediction of neurologic outcomes in pediatric TBI is crucial for management.
- Proton magnetic resonance spectroscopic imaging (MRSI) measures brain metabolites.
Purpose of the Study:
- To evaluate proton MRSI findings in children with NAT-induced TBI.
- To determine if early brain metabolite changes predict long-term neurologic outcomes.
Main Methods:
- Proton MRSI (1.5 T) was performed on 90 children with confirmed NAT within 30 days of injury.
- Regional metabolite ratios (N-acetylaspartate/creatine, N-acetylaspartate/choline) and lactate presence were measured.
- Long-term outcomes were assessed at >=6 months and grouped into good or poor categories.
Main Results:
- Significantly decreased N-acetylaspartate/creatine and N-acetylaspartate/choline ratios were observed in patients with poor outcomes (P < .001).
- A logistic regression model incorporating clinical factors and MRSI data accurately predicted outcomes in 100% of cases.
- Elevated lactate levels on MRSI scans were also associated with poor outcomes.
Conclusions:
- Reduced N-acetylaspartate levels indicate neuronal loss/dysfunction, while elevated lactate suggests altered energy metabolism in NAT patients.
- Elevated lactate may signify hypoxic-ischemic injury, a potential consequence of NAT.
- Early MRSI can serve as a valuable tool for predicting long-term neurologic prognosis in pediatric NAT.
Objective:
We evaluated proton magnetic resonance spectroscopic imaging (MRSI) findings for children with traumatic brain injury attributable to nonaccidental trauma (NAT) early after injury, to determine whether brain metabolite changes predicted outcomes.
Methods:
Proton MRSI (1.5 T) was performed (mean: 5 days after injury [range: 1-30 days]) through the level of the corpus callosum for 90 children with confirmed NAT. Regional N-acetylaspartate/total creatine, N-acetylaspartate/total choline, and choline/creatine ratios and the presence of lactate were measured. Data on long-term outcomes defined at > or =6 months were collected for 44 of 90 infants. We grouped patients into good (normal, mild disability, or moderate disability; n = 32) and poor (severe disability, vegetative state, or dead; n = 12) outcome groups.
Results:
We found that N-acetylaspartate/creatine and N-acetylaspartate/choline ratios (mean total, corpus callosum, and frontal white matter) were significantly decreased in patients with poor outcomes (P < .001). A logistic regression model using age, initial Glasgow Coma Scale score, presence of retinal hemorrhage, lactate on MRSI scans, and mean total N-acetylaspartate/creatine ratio predicted outcomes accurately in 100% of cases.
Conclusions:
Reduced N-acetylaspartate levels (ie, neuronal loss/dysfunction) and elevated lactate levels (altered energy metabolism) correlated with poor neurologic outcomes for infants with NAT. Elevated lactate levels may reflect primary or secondary hypoxic-ischemic injury, which may occur with NAT. Our data suggest that MRSI performed early after injury can be used for long-term prognosis.
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