Sivák Š, Bittšanský M, Grossmann J, Nosál' V, Kantorová E, Siváková J, Demková A, Hnilicová P, Dobrota D, Kurča E
Clinic of Neurology .
Brain Inj. 2014;28(3):341-6. doi: 10.3109/02699052.2013.865270. Epub 2013 Dec 30.
Standard brain magnetic resonance imaging (MRI) is typically normal in most patients after mild traumatic brain injury (MTBI). Proton magnetic resonance spectroscopy (¹H-MRS) is more sensitive to detect subtle post-traumatic changes. The aim of the study was to evaluate the clinical correlations of these changes in the acute phase (within 3 days) after MTBI.
Twenty-one patients with MTBI and 22 controls were studied. Both groups underwent neuropsychological testing and single-voxel ¹H-MRS examination of both frontal lobes and upper brainstem.
Significant decrease in NAA was found in both frontal lobes and in NAA/Cre ratio in the right frontal lobe (p < 0.05). Correlation analysis showed a correlation of NAA in the left frontal lobe with Backward Digit Span (p = 0.022) and Stroop test A (p = 0.0034) and a weak correlation with TMT B time (p = 0.046). The NAA/Cre in the right frontal lobe correlated with Stroop test A (p = 0.007) and with the total score of Digit Span (p = 0.016). Lower NAA was found in the upper brainstem (p = 0.0157) in the sub-group of patients with post-traumatic unconsciousness.
This study found a correlation of ¹H-MRS metabolite changes with cognitive decline and presence or absence of loss of consciousness in the acute phase after MTBI.
在大多数轻度创伤性脑损伤（MTBI）患者中，标准脑磁共振成像（MRI）通常是正常的。质子磁共振波谱（¹H-MRS）对检测创伤后细微变化更为敏感。本研究的目的是评估MTBI后急性期（3天内）这些变化的临床相关性。
对21例MTBI患者和22例对照者进行研究。两组均接受神经心理学测试以及双侧额叶和脑桥上段的单体素¹H-MRS检查。
双侧额叶NAA均显著降低，右侧额叶NAA/Cre比值也显著降低（p < 0.05）。相关性分析显示，左侧额叶NAA与倒背数字广度（p = 0.022）和斯特鲁普测验A（p = 0.0034）相关，与连线测验B时间呈弱相关（p = 0.046）。右侧额叶NAA/Cre与斯特鲁普测验A（p = 0.007）和数字广度总分（p = 0.016）相关。在创伤后昏迷的患者亚组中，脑桥上段NAA较低（p = 0.0157）。
本研究发现，¹H-MRS代谢物变化与MTBI后急性期的认知功能下降以及意识丧失的有无相关。
