Proton magnetic resonance spectroscopy for detection of axonal injury in the splenium of the corpus callosum of brain-injured patients

Kim M. Cecil, Everett C. Hills, M. Elizabeth Sandel, Douglas H. Smith, Tracy K. McIntosh, Lois J. Mannon, Grant P. Sinson, Linda J. Bagley, Robert I. Grossman, Robert E. Lenkinski

Research output: Contribution to journalArticle

182 Citations (Scopus)

Abstract

Object. This study was conducted to determine whether proton magnetic resonance spectroscopy (MRS) is a sensitive method for detecting diffuse axonal injury, which is a primary sequela of traumatic brain injury (TBI). Diffuse axonal injury is characterized by selective damage to white matter tracts that is caused in part by the severe inertial strain created by rotational acceleration and deceleration, which is often associated with motor vehicle accidents. This axonal injury is typically difficult to detect by using conventional imaging techniques because it is microscopic in nature. The splenium was selected because it is a site vulnerable to shearing forces that produce diffuse axonal injury. Methods. The authors used proton MRS to evaluate the splenium, the posterior commissure of the corpus callosum, in normal control volunteers and in patients with TBI. Proton MRS provided an index of neuronal and axonal viability by measuring levels of N-acetyl aspartate (NAA). Conclusions. A majority of mildly brain injured patients, as well as those more severely injured, showed diminished NAA/creatine (Cr) levels in the splenium compared with normal control volunteers. The patients displaying lowered NAA/Cr in the splenium were also likely to exhibit lowered NAA/Cr in lobar white matter. Also, the levels of NAA/Cr in the splenium of normal volunteers were higher compared with those found in lobar white matter. Decreases in NAA/Cr levels in the splenium may be a marker for diffuse injury. A proton MRS examination may be particularly useful in evaluating mildly injured patients with unexplained neurological and cognitive deficits. It is concluded that MRS is a sensitive tool in detecting axonal injury.

Original languageEnglish (US)
Pages (from-to)795-801
Number of pages7
JournalJournal of Neurosurgery
Volume88
Issue number5
StatePublished - May 1998

Fingerprint

Corpus Callosum
Creatine
Diffuse Axonal Injury
Wounds and Injuries
Brain
Healthy Volunteers
Deceleration
Motor Vehicles
Accidents
N-acetylaspartate
Proton Magnetic Resonance Spectroscopy
Magnetic Resonance Spectroscopy
White Matter

Keywords

  • Diffuse axonal injury
  • Magnetic resonance spectroscopy
  • N-acetyl aspartate
  • Splenium
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Proton magnetic resonance spectroscopy for detection of axonal injury in the splenium of the corpus callosum of brain-injured patients. / Cecil, Kim M.; Hills, Everett C.; Sandel, M. Elizabeth; Smith, Douglas H.; McIntosh, Tracy K.; Mannon, Lois J.; Sinson, Grant P.; Bagley, Linda J.; Grossman, Robert I.; Lenkinski, Robert E.

In: Journal of Neurosurgery, Vol. 88, No. 5, 05.1998, p. 795-801.

Research output: Contribution to journalArticle

Cecil, KM, Hills, EC, Sandel, ME, Smith, DH, McIntosh, TK, Mannon, LJ, Sinson, GP, Bagley, LJ, Grossman, RI & Lenkinski, RE 1998, 'Proton magnetic resonance spectroscopy for detection of axonal injury in the splenium of the corpus callosum of brain-injured patients', Journal of Neurosurgery, vol. 88, no. 5, pp. 795-801.
Cecil, Kim M. ; Hills, Everett C. ; Sandel, M. Elizabeth ; Smith, Douglas H. ; McIntosh, Tracy K. ; Mannon, Lois J. ; Sinson, Grant P. ; Bagley, Linda J. ; Grossman, Robert I. ; Lenkinski, Robert E. / Proton magnetic resonance spectroscopy for detection of axonal injury in the splenium of the corpus callosum of brain-injured patients. In: Journal of Neurosurgery. 1998 ; Vol. 88, No. 5. pp. 795-801.
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abstract = "Object. This study was conducted to determine whether proton magnetic resonance spectroscopy (MRS) is a sensitive method for detecting diffuse axonal injury, which is a primary sequela of traumatic brain injury (TBI). Diffuse axonal injury is characterized by selective damage to white matter tracts that is caused in part by the severe inertial strain created by rotational acceleration and deceleration, which is often associated with motor vehicle accidents. This axonal injury is typically difficult to detect by using conventional imaging techniques because it is microscopic in nature. The splenium was selected because it is a site vulnerable to shearing forces that produce diffuse axonal injury. Methods. The authors used proton MRS to evaluate the splenium, the posterior commissure of the corpus callosum, in normal control volunteers and in patients with TBI. Proton MRS provided an index of neuronal and axonal viability by measuring levels of N-acetyl aspartate (NAA). Conclusions. A majority of mildly brain injured patients, as well as those more severely injured, showed diminished NAA/creatine (Cr) levels in the splenium compared with normal control volunteers. The patients displaying lowered NAA/Cr in the splenium were also likely to exhibit lowered NAA/Cr in lobar white matter. Also, the levels of NAA/Cr in the splenium of normal volunteers were higher compared with those found in lobar white matter. Decreases in NAA/Cr levels in the splenium may be a marker for diffuse injury. A proton MRS examination may be particularly useful in evaluating mildly injured patients with unexplained neurological and cognitive deficits. It is concluded that MRS is a sensitive tool in detecting axonal injury.",
keywords = "Diffuse axonal injury, Magnetic resonance spectroscopy, N-acetyl aspartate, Splenium, Traumatic brain injury",
author = "Cecil, {Kim M.} and Hills, {Everett C.} and Sandel, {M. Elizabeth} and Smith, {Douglas H.} and McIntosh, {Tracy K.} and Mannon, {Lois J.} and Sinson, {Grant P.} and Bagley, {Linda J.} and Grossman, {Robert I.} and Lenkinski, {Robert E.}",
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AU - Cecil, Kim M.

AU - Hills, Everett C.

AU - Sandel, M. Elizabeth

AU - Smith, Douglas H.

AU - McIntosh, Tracy K.

AU - Mannon, Lois J.

AU - Sinson, Grant P.

AU - Bagley, Linda J.

AU - Grossman, Robert I.

AU - Lenkinski, Robert E.

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N2 - Object. This study was conducted to determine whether proton magnetic resonance spectroscopy (MRS) is a sensitive method for detecting diffuse axonal injury, which is a primary sequela of traumatic brain injury (TBI). Diffuse axonal injury is characterized by selective damage to white matter tracts that is caused in part by the severe inertial strain created by rotational acceleration and deceleration, which is often associated with motor vehicle accidents. This axonal injury is typically difficult to detect by using conventional imaging techniques because it is microscopic in nature. The splenium was selected because it is a site vulnerable to shearing forces that produce diffuse axonal injury. Methods. The authors used proton MRS to evaluate the splenium, the posterior commissure of the corpus callosum, in normal control volunteers and in patients with TBI. Proton MRS provided an index of neuronal and axonal viability by measuring levels of N-acetyl aspartate (NAA). Conclusions. A majority of mildly brain injured patients, as well as those more severely injured, showed diminished NAA/creatine (Cr) levels in the splenium compared with normal control volunteers. The patients displaying lowered NAA/Cr in the splenium were also likely to exhibit lowered NAA/Cr in lobar white matter. Also, the levels of NAA/Cr in the splenium of normal volunteers were higher compared with those found in lobar white matter. Decreases in NAA/Cr levels in the splenium may be a marker for diffuse injury. A proton MRS examination may be particularly useful in evaluating mildly injured patients with unexplained neurological and cognitive deficits. It is concluded that MRS is a sensitive tool in detecting axonal injury.

AB - Object. This study was conducted to determine whether proton magnetic resonance spectroscopy (MRS) is a sensitive method for detecting diffuse axonal injury, which is a primary sequela of traumatic brain injury (TBI). Diffuse axonal injury is characterized by selective damage to white matter tracts that is caused in part by the severe inertial strain created by rotational acceleration and deceleration, which is often associated with motor vehicle accidents. This axonal injury is typically difficult to detect by using conventional imaging techniques because it is microscopic in nature. The splenium was selected because it is a site vulnerable to shearing forces that produce diffuse axonal injury. Methods. The authors used proton MRS to evaluate the splenium, the posterior commissure of the corpus callosum, in normal control volunteers and in patients with TBI. Proton MRS provided an index of neuronal and axonal viability by measuring levels of N-acetyl aspartate (NAA). Conclusions. A majority of mildly brain injured patients, as well as those more severely injured, showed diminished NAA/creatine (Cr) levels in the splenium compared with normal control volunteers. The patients displaying lowered NAA/Cr in the splenium were also likely to exhibit lowered NAA/Cr in lobar white matter. Also, the levels of NAA/Cr in the splenium of normal volunteers were higher compared with those found in lobar white matter. Decreases in NAA/Cr levels in the splenium may be a marker for diffuse injury. A proton MRS examination may be particularly useful in evaluating mildly injured patients with unexplained neurological and cognitive deficits. It is concluded that MRS is a sensitive tool in detecting axonal injury.

KW - Diffuse axonal injury

KW - Magnetic resonance spectroscopy

KW - N-acetyl aspartate

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KW - Traumatic brain injury

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