Prognostic performance of magnetic resonance spectrometry in patients with diffuse axonal injury: A prospective cohort study

Abstract

Background: Traumatic brain injury (TBI) is a global concern, and many people suffer from TBI annually. Determining the outcome of patients with brain injury has a valuable clinical impact and results in better management of patients. In this study, we aimed to investigate the predictive value of magnetic resonance spectrometry (MRS) in patients with diffuse axonal injury (DAI). Method: This is a prospective cohort study on patients with DAI in 6 months at a tertiary medical center. According to the eligibility criteria, the patients were enrolled in the study. The MRS scan was conducted on days 3 and 30, and the correlation of metabolites of MRS according to the GCS score of patients on days 3 and 30 was investigated to determine the prognostic impact of MRS in patients with DAI. Results: A total of 50 patients with DAI, including 39 males and 11 females, were recruited. MRS of patients on day 3 and 30 was conducted and showed that the level phosphocreatine (r = -0.56, P < 0.001), NAA/choline ratio (r = 0.86, P < 0.001), and hunter angle (r = 0.59, P < 0.001) on day 3 are significantly correlated with the GCS score of patients on day 30. Phosphocreatine (r = -0.84, P < 0.001), phosphocholine (r = -0.86, P < 0.001), NAA/choline (r = 0.89, P < 0.001), myoinositol (r = -0.75, P < 0.001), and hunter angle (r = 0.89, P < 0.001) on day 30 are substantially associated with day 30 GCS score. Conclusion: Among different investigated metabolites, the level of phosphocreatine, NAA/choline ratio, and hunter angle on day three significantly correlated with patients' GCS on day 30.

Keywords

• Traumatic brain injury
• Diffuse axonal injury
• Prognosis
• Magnetic resonance spectrometry
• Prediction
• GCS score