Longitudinal Changes in Magnetic Resonance Spectroscopy in Pediatric Concussion: A Pilot Study

Area of Science:

• Neuroscience
• Biomedical Engineering
• Radiology

Background:

• Concussion affects nearly 20% of US adolescents, involving complex neurometabolic cascades initiated by traumatic forces.
• Pathophysiology suggests rotational deceleration causes shear stress, leading to excitotoxicity and a metabolic crisis in the injured brain.
• Proton magnetic resonance spectroscopy (¹H MRS) provides a non-invasive method to assess in vivo neurometabolic alterations post-concussion.

Purpose of the Study:

• To characterize longitudinal neurometabolic changes in adolescent concussion patients using proton magnetic resonance spectroscopy (¹H MRS).
• To investigate alterations in specific brain metabolites within the acute, subacute, and chronic phases following concussion in adolescents.

Main Methods:

• Prospective recruitment of 9 adolescent concussion patients (ages 11-20) presenting within 24 hours of injury.
• Serial MRI scans including ¹H MRS were performed at acute (<72h), subacute (2 weeks), and chronic (~1 year) time points.
• Measurements of N-acetyl-aspartate, choline, creatine, glutamate+glutamine, and myo-inositol were taken in six brain regions, compared against 9 age/sex-matched controls.

Main Results:

• No significant differences in ¹H MRS metabolite concentrations were observed during the acute concussive period compared to controls.
• A significant increase in thalamus glutamate+glutamine/choline was detected in the subacute and chronic phases (p=0.010).
• A significant decrease in white matter myo-inositol/choline was observed at the chronic time point (p=0.030).

Conclusions:

• ¹H MRS reveals no acute neurometabolic changes in adolescent concussion.
• Metabolite alterations, specifically in glutamate+glutamine and myo-inositol, become detectable beyond the acute phase of concussion.
• These findings highlight the potential of ¹H MRS for monitoring long-term neurometabolic recovery in adolescent concussion.