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Acute metabolic brain changes following traumatic brain injury and their relevance to clinical severity and outcome
  1. Silvia Marino1,
  2. Ettore Zei3,
  3. Marco Battaglini1,
  4. Cesare Vittori3,
  5. Antonella Buscalferri3,
  6. Placido Bramanti2,
  7. Antonio Federico1,
  8. Nicola De Stefano1
  1. 1Department of Neurological and Behavioural Sciences, University of Siena, Siena, Italy
  2. 2IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
  3. 3Department of Anesthesia and Intensive Care, University of Siena, Siena, Italy
  1. Correspondence to:
 Dr N De Stefano
 Department of Neurological and Behavioural Sciences, Neurology & Neurometabolic Unit, University of Siena, Viale Bracci 2, 53100 Siena, Italy; destefano{at}


Background: Conventional MRI can provide critical information for care of patients with traumatic brain injury (TBI), but MRI abnormalities rarely correlate to clinical severity and outcome. Previous magnetic resonance spectroscopy studies have reported clinically relevant brain metabolic changes in patients with TBI. However, these changes were often assessed a few to several days after the trauma, with a consequent variation of the metabolic pattern due to temporal changes.

Methods: Proton magnetic resonance spectroscopic imaging (1H-MRSI) examinations were performed in 10 patients with TBI 48–72 h after the trauma, to obtain early measurements of central brain levels of N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and lactate (La). Metabolite values were expressed as ratios to (1) a metabolic pattern, given by the sum of the resonance intensities of all metabolites detected in the same voxel and (2) intravoxel Cr.

Results: NAA ratios were found to be significantly lower in patients with TBI than in normal controls. In contrast, Cho ratios were significantly higher in patients with TBI than in normal controls. Increased La levels were found in 5 of 10 patients with TBI. Both NAA and La values correlated closely with those of the Glasgow Coma Scale at presentation (r = 0.73 and −0.62, respectively; p<0.01 for both) and the Glasgow Outcome Scale at 3 months (r = −0.79 and 0.79, respectively; p<0.01 for both).

Conclusion: Spectroscopic measures of neuro-axonal damage occurring soon after a brain trauma are clinically relevant. Significant increases in cerebral La level also may be detected when 1H-MRSI is performed early after the trauma and, at this stage, can represent a reliable index of injury severity and disease outcome in patients with TBI.

  • Cho, choline
  • Cr, creatine
  • GCS, Glasgow Coma Scale
  • GOS, Glasgow Outcome Scale
  • 1H-MRS, voxel proton magnetic resonance spectroscopy
  • 1H-MRSI, proton magnetic resonance spectroscopic imaging
  • La, lactate
  • MR, magnetic resonance
  • NAA, N-acetylaspartate
  • NC, normal control
  • TBI, traumatic brain injury
  • TE, echo time
  • TR, repetition time
  • VOI, volume of interest

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  • Published Online First 6 November 2006

  • Competing interests: None declared.