H-1 MRS in acute traumatic brain injury

The objective of this study was to demonstrate H-1 MR spectroscopy (MRS) ch anges in cerebral metabolites after acute head trauma, Twenty-five patients (12 children, 13 adults) were examined with quantitative H-1 MRS after clo sed head injury. Clinical grade (Glasgow Coma Scale [GCS]) and outcome (Ran cho Los Amigos Medical Center Outcome Score [ROS]) were correlated with qua ntitative neurochemical findings. N-acetylaspartate (NAA), a neuronal and a xonal marker, was reduced (P <.03-.001). In children, a reduced NAA/creatin e plus phosphocreatine (Cr) level and the presence of detectable lipid/lact ate predicted bad outcome (sensitivity, 89%; specificity, 89%). The first M RS examination of all patients correlated with ROS versus NAA (r =.65, P <. 0001). Although most patients showed MRS abnormalities, striking heterogene ity of H-1 MRS characterized the individual patients. IH MRS identifies mul tiple patterns of diffuse brain injury after blunt head trauma. There was a strong correlation between MRS and outcome. Future prospective studies wil l be needed to determine the clinical usefulness of MRS in predicting outco me from closed head injury.