Award: First Place Trauma and Critical Care Eposter Award

Authors: Ondra Petr, M.D.; Daniel Pinggera, MD; Marlies Bauer, MD; Johannes Kerschbaumer, MD; Christian Freyschlag, MD; Ronny Beer, MD; Astrid Grams, MD; Claudius Thome, MD (Innsbruck, Austria)

Introduction: Phosphorous magnetic resonance spectroscopy (31P-MRS) is a molecular-based advanced neuroimaging technique allowing measurements of pathophysiological processes and tissue metabolism, and may provide objective assessment of brain damage and posttraumatic “tissue at risk”. Pathophysiological changes of cerebral energy metabolism are thought to be detectable based on various phosphorous compound metabolites. The aim of this pilot study is to evaluate the feasibility and the diagnostic potential of 31 P-MRS in sTBI. Methods: All adult patients with sTBI, presenting with GCS<9 being eligible for MRI were prospectively included in the study and MRI scans plus 31 P-MRS were performed within 72 hours after trauma. 31 P-MRS data from the more affected side were compared to data from not affected contralateral areas symmetrically to the location of the traumatic lesions, and to data of healthy controls. Imaging was performed using a 3 Tesla MRI (Verio, Siemens, Germany) with a Dual Tuned Head Coil (RAPID Biomedical GmbH, Rimpar, Germany). 31 P-MRS quantifies phosphorous compound metabolites that are the end products of cellular respiration, like phosphocreatine, inorganic phosphate, phosphomonoester, phosphodiester, ATP, and its breakdown products ADP and AMP. Ratios of these metabolites are used for metabolism assessment. Results: Ten sTBI patients (3 female and 7 male patients), aged between 20 and 75 years, with a mean GCS of 6 were analyzed. MRI was performed 61h (mean) after trauma. Statistical analysis revealed an increased PCr/ATP ratio, indicating ATP resynthesis, and a decreased PME/PDE ratio, indicating membrane turnover, in TBI 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: 31 P-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 provide better guidance of clinical therapy.