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Cerebral Energy Status and Altered Metabolism in Early Severe TBI: First Results of a Prospective 31P-MRS Feasibility Study

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Abstract

Objective

Severe traumatic brain injury (sTBI) represents a serious public health issue with high morbidity and mortality. Neuroimaging plays a crucial role in the evaluation of sTBI patients. Phosphorous magnetic resonance spectroscopy (31P-MRS) is an imaging technique for evaluation of energy metabolites. The aim of this study is to evaluate the feasibility and the diagnostic potential of ultra-early 31P-MRS to detect changes in cerebral energy metabolism in sTBI.

Methods

Adult patients with sTBI presenting with GCS ≤ 8 being eligible for MRI were prospectively included in the study and MRI was performed within 72 h after trauma. Imaging was performed using a 3 Tesla MRI. 31P-MRS data from the structurally affected side were compared to data from normal appearing contralateral areas symmetrically to the location of the traumatic lesions, and to data of matched healthy controls.

Results

Ten sTBI patients (3 female, 7 male), aged between 20 and 75 years, with a mean initial GCS of 6 were analyzed. MRI was performed 61 h (mean, range 37–71 h) after trauma. Statistical analysis revealed no significant differences between the lesioned side and contralaterally. An increased PCr/ATP ratio and a decreased PME/PDE ratio were present in structurally normal appearing, but traumatized tissue when compared to the healthy population, thus indicating significant differences in ATP resynthesis and membrane turnover (F (2,33), P = 0.005 and, P = 0.027, respectively).

Conclusion

31P-MRS could provide a better understanding of pertinent global changes in cerebral energy metabolism in sTBI patients under general anesthesia.

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Authors and Affiliations

  1. Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria

    Daniel Pinggera, Marlies Bauer, Johannes Kerschbaumer, Claudius Thomé & Ondra Petr

  2. Department of Neuroradiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Ruth Steiger, Andreas Rietzler, Astrid E. Grams & Elke R. Gizewski

  3. Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria

    Markus Luger

  4. Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

    Ronny Beer

  5. Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria

    Ruth Steiger, Andreas Rietzler, Astrid E. Grams & Elke R. Gizewski

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  1. Daniel Pinggera
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  2. Ruth Steiger
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Correspondence to Astrid E. Grams.

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All authors have declared that they have no conflict of interest.

Ethical Approval

The study was approved by the local ethics committee of the Medical University Innsbruck (Protocol number: AN2014-0201 339/4.6). Written informed consent was obtained according to Austrian law either from the patient when regaining consciousness and legal capacity, or from her/his guardian.

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Pinggera, D., Steiger, R., Bauer, M. et al. Cerebral Energy Status and Altered Metabolism in Early Severe TBI: First Results of a Prospective 31P-MRS Feasibility Study. Neurocrit Care 34, 432–440 (2021). https://doi.org/10.1007/s12028-020-01042-x

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