Department of Neurology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
Neurotherapeutics. 2020 Apr;17(2):522-538. doi: 10.1007/s13311-020-00843-4.
Modern neurocritical care relies on ancillary diagnostic testing in the form of multimodal monitoring to address acute changes in the neurological homeostasis. Much of our armamentarium rests upon physiological and biochemical surrogates of organ or regional level metabolic activity, of which a great deal is invested at the metabolic-hemodynamic-hydrodynamic interface to rectify the traditional intermediaries of glucose consumption. Despite best efforts to detect cellular neuroenergetics, current modalities cannot appreciate the intricate coupling between astrocytes and neurons. Invasive monitoring is not without surgical complication, and noninvasive strategies do not provide an adequate spatial or temporal resolution. Without knowledge of the brain's versatile behavior in specific metabolic states (glycolytic vs oxidative), clinical practice would lag behind laboratory empiricism. Noninvasive metabolic imaging represents a new hope in delineating cellular, nigh molecular level energy exchange to guide targeted management in a diverse array of neuropathology.
现代神经危重症医学依赖于辅助诊断测试，如多模态监测，以应对神经内稳态的急性变化。我们的大部分手段都依赖于器官或区域水平代谢活动的生理和生化替代物，其中很大一部分投入到代谢-血液动力学-动力学界面，以纠正葡萄糖消耗的传统中间产物。尽管我们努力检测细胞神经能量代谢，但目前的方法无法理解星形胶质细胞和神经元之间复杂的偶联。有创监测并非没有手术并发症，而无创策略也不能提供足够的空间或时间分辨率。如果不知道大脑在特定代谢状态下（糖酵解与氧化）的多样化行为，临床实践将落后于实验室经验主义。无创代谢成像代表了一种新的希望，可以描绘细胞、近分子水平的能量交换，以指导多种神经病理学的靶向管理。
