急性轻度创伤性脑损伤患者后扣带回皮层的大分子抑制性γ-氨基丁酸编辑磁共振波谱分析

Macromolecular-Suppressed GABA-Edited MR Spectroscopy in the Posterior Cingulate Cortex of Patients With Acute Mild Traumatic Brain Injury.

作者信息

Manzhurtsev Andrei V, Yakovlev Alexey N, Bulanov Petr A, Menshchikov Petr E, Ublinskiy Maxim V, Melnikov Ilya A, Akhadov Tolib A, Semenova Natalia A

机构信息

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russian Federation.

Emanuel Institute of Biochemical Physics of the Russian Academy of Sciences, Moscow, Russian Federation.

出版信息

J Magn Reson Imaging. 2023 May;57(5):1433-1442. doi: 10.1002/jmri.28410. Epub 2022 Aug 29.

DOI:10.1002/jmri.28410

PMID:36053885

Abstract

BACKGROUND

Mild traumatic brain injury (mTBI) causes a number of molecular and cellular alterations. There is evidence of an imbalance between the main excitatory (glutamate, Glu) and the main inhibitory (gamma-aminobutyric acid [GABA]) neurotransmitters following mTBI. In vivo human GABA-Glu balance studies following mTBI are sparse.

PURPOSE

To investigate the effect of acute mTBI on the GABA concentration measured in the posterior cingulate cortex (PCC) of pediatric patients by using the macromolecular (MM)-suppressed GABA J-editing technique.

STUDY TYPE

Prospective patient and phantom.

PARTICIPANTS

A total of 14 pediatric patients (mean age 16.0 ± 1.7) with acute mTBI (<3 days after trauma; Glasgow Coma Scale 15) and 16 healthy volunteers (mean age 16.9 ± 2.8). Phantom: 524 cm sphere containing 10 mM glycine, 10 mM GABA.

FIELD STRENGTH/SEQUENCE: A 3 T, MEGA-PRESS pulse sequence.

ASSESSMENT

GABA spectra were processed in Gannet software. MM-suppressed GABA editing efficiency was derived from the phantom study. Absolute GABA and glutamate + glutamine (Glx) concentrations were quantified using different types of correction and compared between groups. N-acetyl aspartate (NAA) and choline (Cho) levels relative to tCr were also compared.

STATISTICAL TESTS

Shapiro-Wilk test, Mann-Whitney U test, Student t-test, Pearson or Spearman correlations. P < 0.01 was considered statistically significant.

RESULTS

The MM-suppressed GABA editing efficiency was 0.63. GABA signal fit error was <16% for all participants. The GABA concentration in the PCC of the mTBI group was significantly different from that in healthy controls: GABA/tCr was higher by 27%, absolute GABA concentration with different types of correction was higher by ≈17%. No significant differences were observed in Glx concentrations (P ≥ 0.32) or in Glx/tCr (P ≥ 0.1), NAA/tCr (P = 0.55), and Cho/tCr levels (P = 0.85).

DATA CONCLUSION

We report an increase in the GABA concentration in the PCC region in acute mTBI pediatric patients. This may suggest activation of GABA synthesis and impairment of the GABAergic system after acute mTBI.

EVIDENCE LEVEL

3 TECHNICAL EFFICACY: Stage 1.

摘要

背景

轻度创伤性脑损伤（mTBI）会导致多种分子和细胞改变。有证据表明，mTBI后主要兴奋性神经递质（谷氨酸，Glu）和主要抑制性神经递质（γ-氨基丁酸 [GABA]）之间存在失衡。mTBI后人体GABA-Glu平衡的体内研究较少。

目的

采用大分子（MM）抑制的GABA J编辑技术，研究急性mTBI对小儿患者后扣带回皮质（PCC）中GABA浓度的影响。

研究类型

前瞻性患者和体模研究。

参与者

14例急性mTBI（创伤后<3天；格拉斯哥昏迷量表评分为15分）的小儿患者（平均年龄16.0±1.7岁）和16名健康志愿者（平均年龄16.9±2.8岁）。体模：直径524 cm的球体，含有10 mM甘氨酸、10 mM GABA。

场强/序列：3T，MEGA-PRESS脉冲序列。

评估

在Gannet软件中处理GABA谱。MM抑制的GABA编辑效率来自体模研究。使用不同类型的校正方法对绝对GABA和谷氨酸+谷氨酰胺（Glx）浓度进行定量，并在组间进行比较。还比较了相对于肌酸（tCr）的N-乙酰天门冬氨酸（NAA）和胆碱（Cho）水平。

统计检验

Shapiro-Wilk检验、Mann-Whitney U检验、Student t检验、Pearson或Spearman相关性分析。P<0.01被认为具有统计学意义。

结果

MM抑制的GABA编辑效率为0.63。所有参与者的GABA信号拟合误差<16%。mTBI组PCC中的GABA浓度与健康对照组有显著差异：GABA/tCr高出27%，采用不同类型校正方法的绝对GABA浓度高出约17%。Glx浓度（P≥0.32）、Glx/tCr（P≥0.1）、NAA/tCr（P = 0.55）和Cho/tCr水平（P = 0.85）均未观察到显著差异。