Longitudinal Changes in Magnetic Resonance Spectroscopy in Pediatric Concussion: A Pilot Study

Abstract

<b>Background:</b> Nearly 20% of US adolescents report at least one lifetime concussion. Pathophysiologic models suggest that traumatic biomechanical forces caused by rotational deceleration lead to shear stress, which triggers a neurometabolic cascade beginning with excitotoxicity and leading to significant energy demands and a period of metabolic crisis for the injured brain. Proton magnetic resonance spectroscopy (¹H MRS) offers a means for non-invasive measurement of neurometabolic changes after concussion. <b>Objective:</b> Describe longitudinal changes in metabolites measured <i>in vivo</i> in the brains of adolescent patients with concussion. <b>Methods:</b> We prospectively recruited 9 patients ages 11 to 20 who presented to a pediatric Emergency Department within 24 h of concussion. Patients underwent MRI scanning within 72 h (acute, <i>n</i> = 8), 2 weeks (subacute, <i>n</i> = 7), and at approximately 1 year (chronic, <i>n</i> = 7). Healthy, age and sex-matched controls were recruited and scanned once (<i>n</i> = 9). ¹H MRS was used to measure N-acetyl-aspartate, choline, creatine, glutamate + glutamine, and myo-inositol concentrations in six regions of interest: left and right frontal white matter, posterior white matter and thalamus. <b>Results:</b> There was a significant increase in total thalamus glutamate+glutamine/choline at the subacute (<i>p</i> = 0.010) and chronic (<i>p</i> = 0.010) time points, and a significant decrease in total white matter myo-inositol/choline (<i>p</i> = 0.030) at the chronic time point as compared to controls. <b>Conclusion:</b> There are no differences in ¹H MRS measurements in the acute concussive period; however, changes in glutamate+glutamine and myo-inositol concentrations detectable by ¹H MRS may develop beyond the acute period.