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From the Clinical and Magnetic Resonance Research Center (Drs. Friedman and Brooks, and R.E. Jung and B.T. Montoya) and Departments of Psychology (Drs. Friedman and Yeo, and R.E. Jung), Neurosciences (Dr. Brooks), and Radiology (Dr. Hart), University of New Mexico; and St. Joseph’s Rehabilitation Hospital (Dr. Sloan), Albuquerque, NM.
Address correspondence and reprint requests to Dr. William Brooks, Clinical and Magnetic Resonance Research Center, University of New Mexico Health Sciences Center, 1201 Yale Boulevard NE, Albuquerque, NM 87131.
OBJECTIVE: To determine whether proton MRS (1H-MRS) neurochemical measurements predict neuropsychological outcome of patients with traumatic brain injury (TBI).
BACKGROUND: Although clinical indices and conventional imaging techniques provide critical information for TBI patient triage and acute care, none accurately predicts individual patient outcome.
METHODS: The authors studied 14 patients with TBI soon after injury (45 ± 21 days postinjury) and again at 6 months (172 ± 43 days) and 14 age-, sex-, and education-matched control subjects. N-acetylaspartate (NAA), creatine, and choline were measured in normal-appearing occipitoparietal white and gray matter using quantitative 1H-MRS. Outcome was assessed with the Glasgow Outcome Scale (GOS) and a battery of neuropsychological tests. A composite measure of neuropsychological function was calculated from individual test z-scores probing the major functional domains commonly impaired after head trauma.
RESULTS: Early NAA concentrations in gray matter predicted overall neuropsychological performance (r = 0.74, p = 0.01) and GOS (F = 11.93, p = 0.007). Other metabolite measures were not related to behavioral function at outcome.
CONCLUSION: 1H-MRS provides a rapid, noninvasive tool to assess the extent of diffuse injury after head trauma, a component of injury that may be the most critical factor in evaluating resultant neuropsychological dysfunction. 1H-MRS can be added to conventional MR examinations with minimal additional time, and may prove useful in assessing injury severity, guiding patient care, and predicting patient outcome.
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