Predictive value of proton magnetic resonance spectroscopy in pediatric closed head injury

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 br ain injury using clinical rating scales, a 15-point MRI scoring system, and occipital gray matter short-echo proton MRS. We compared the differences b etween the acutely determined variables (metabolite ratios and the presence of lactate) and 6- to 12-month outcomes. The metabolite ratios were abnorm al (lower NAA/Cre or NAA/Cho; higher Cho/Cre) in patients with a poor outco me. Lactate was evident in 91% of infants and 80% of children with poor out comes; none of the patients with a good outcome had lactate. At best, the c linical 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 whe n the lactate variable was combined with MRI ratios or clinical variables. The findings of spectral sampling in areas of brain not directly injured re flected the effects of global metabolic changes. Proton MRS provides object ive data early after traumatic brain injury that can improve the ability to predict long-term neurologic outcome. (C) 2000 by Elsevier Science Inc, Al l rights reserved.