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A combined microdialysis and FDG-PET study of glucose metabolism in head injury

  • Clinical Article
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Abstract

Background

Microdialysis continuously monitors the chemistry of a small focal volume of the cerebral extracellular space. Positron emission tomography (PET) establishes metabolism of the whole brain but only for the scan’s duration. This study’s objective was to apply these techniques together, in patients with traumatic brain injury, to assess the relationship between microdialysis (extracellular glucose, lactate, pyruvate, and the lactate/pyruvate (L/P) ratio as a marker of anaerobic metabolism) and PET parameters of glucose metabolism using the glucose analogue [18F]-fluorodeoxyglucose (FDG). In particular, we aimed to determine the fate of glucose in terms of differential metabolism to pyruvate and lactate.

Materials and methods

Microdialysis catheters (CMA70 or CMA71) were inserted into the cerebral cortex of 17 patients with major head injury. Microdialysis was performed during FDG-PET scans with regions of interest for PET analysis defined by the location of the gold-tipped microdialysis catheter. Microdialysate analysis was performed on a CMA600 analyser.

Findings

There was significant linear relationship between the PET-derived parameter of glucose metabolism (regional cerebral metabolic rate of glucose; CMRglc) and levels of lactate (r = 0.778, p < 0.0001) and pyruvate (r = 0.799, p < 0.0001), but not with the L/P ratio.

Conclusion

The results suggest that in this population of patients, glucose was metabolised to both lactate and pyruvate, but was not associated with an increase in the L/P ratio. This suggests an increase in glucose metabolism to both lactate and pyruvate, as opposed to a shift towards anaerobic metabolism.

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Acknowledgements

We gratefully acknowledge the following. Study support: the Medical Research Council (Grant No G9439390 ID 65883) and the Academy of Medical Sciences / Health Foundation. Authors’ support: KLHC, the MRC (Acute Brain Injury Programme Grant) and the National Institute for Health Research Biomedical Research Centre, Cambridge. IT, Codman and the Evelyn Trust; PGA, the Stroke Association, UK; PJH, Academy of Medical Sciences / Health Foundation Senior Surgical Scientist Fellowship. Technical assistance: L Maskell. Statistical advice: H Richards.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UK

    Peter J. Hutchinson, Mark T. O’Connell, Alex Seal, Ivan Timofeev, Pippa G. Al-Rawi, John D. Pickard & Keri L. H. Carpenter

  2. Division of Anaesthesia, Department of Medicine, University of Cambridge, Box 93, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UK

    Jurgens Nortje, Jonathan P. Coles & David K. Menon

  3. Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Box 65, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UK

    Peter J. Hutchinson, Mark T. O’Connell, Jurgens Nortje, Jonathan P. Coles, Timothy D. Fryer, David K. Menon, John D. Pickard & Keri L. H. Carpenter

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  1. Peter J. Hutchinson
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  2. Mark T. O’Connell
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  6. Pippa G. Al-Rawi
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  9. David K. Menon
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  11. Keri L. H. Carpenter
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Corresponding author

Correspondence to Keri L. H. Carpenter.

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Comment

This manuscript reports extracellular neurochemical data collected during metabolic imaging studies using cerebral microdialysis and positron emission tomography (PET) respectively in severely head-injured patients. From the comparisons of these two types of measurements, the authors concluded that the rates of cerebral glucose metabolism had a significant linear relationship with extracellular concentrations of lactate and pyruvate. However, the degree of cerebral glycolysis was not related to the extracellular lactate/pyruvate ratio suggesting that anaerobic metabolism was not a major feature in these subjects.

David Hovda

UCLA, USA

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Hutchinson, P.J., O’Connell, M.T., Seal, A. et al. A combined microdialysis and FDG-PET study of glucose metabolism in head injury. Acta Neurochir (Wien) 151, 51–61 (2009). https://doi.org/10.1007/s00701-008-0169-1

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  • DOI: https://doi.org/10.1007/s00701-008-0169-1

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