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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Cerebral energy status and altered metabolism in early severe TBI – first results of a prospective 31P-MRS feasibility study

Zerebraler Energiehaushalt und -metabolismus beim schweren Schädel-Hirn-Trauma – erste Ergebnisse einer prospektiven 31P-MRS-Studie

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  • presenting/speaker Daniel Pinggera - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Ruth Steiger - Medizinische Universität Innsbruck, Universitätsklinik für Neuroradiologie, Innsbruck, Austria
  • Marlies Bauer - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Johannes Kerschbaumer - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Markus Luger - Medizinische Universität Innsbruck, Universitätsklinik für Anästhesie, Innsbruck, Austria
  • Ronny Beer - Medizinische Universität Innsbruck, Universitätsklinik für Neurologie, Innsbruck, Austria
  • Andreas Rietzler - Medizinische Universität Innsbruck, Universitätsklinik für Neuroradiologie, Innsbruck, Austria
  • Astrid Ellen Grams - Medizinische Universität Innsbruck, Universitätsklinik für Neuroradiologie, Innsbruck, Austria
  • Claudius Thomé - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Ondra Petr - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV248

doi: 10.3205/19dgnc267, urn:nbn:de:0183-19dgnc2679

Published: May 8, 2019

© 2019 Pinggera et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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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 a phosphorous-based advanced neuroimaging technique allowing measurements of pathophysiological processes and tissue metabolism, and may provide objective assessment of primary versus secondary changes. The aim of this pilot study is to evaluate the feasibility and the diagnostic potential of ultra early 31P-MRS in sTBI.

Methods: Adult patients with sTBI, presenting with GCS<8 being eligible for MRI were prospectively included in the study and MRI scans plus 31P-MRS were performed within 72 hours after trauma. 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 healthy controls. Imaging was performed using a 3 Tesla MRI with a Dual Tuned Head Coil. 31P-MRS quantifies phosphorous compound metabolites and changes in ATP metabolism. Ratios of these metabolites are used for assessment of metabolism. One-way analysis of variance (ANOVA) with post hoc procedure of Tukey-HSD was performed to assess pairwise differences.

Results: Ten sTBI patients (3 female and 7 male patients), aged between 20 and 75 years, with a mean initial GCS of 6 were analyzed for this pilot trial. MRI was performed 61h (mean, range 37–71h) 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 was presenting structural normal appearing, but traumatized tissue when compared to the healthy population, thus indicating significant differences in resynthesis and membrane turnover (F (2,33), P=0.005 and, P=0.027, respectively).

Conclusion: 31P-MRS seems to be a promising tool for a comprehensive assessment of patients after sTBI showing pertinent changes in energy metabolism with obvious potential to optimize early guidance of clinical therapy. These changes seem to affect the brain globally