Abstract
Medical advances in intensive care currently allow patients suffering from severe brain lesions to survive. In most cases, this evolution is based on behavioral testing which implies some subjectivity and does not always lead to an accurate diagnosis. Magnetic resonance imaging (MRI) may help to improve the diagnosis of patients with disorders of consciousness and provide prognosis regarding the recovery of patients’ brain functioning. Indeed, spectroscopy and diffusion tensor imaging detect invisible tissue lesions using FLAIR and T2* sequences. These techniques allow a better diagnosis and prognosis of patients with disorders of consciousness (particularly when they are combined) and permit a better detection of the deterioration or recovery of post-traumatic brain functioning by considering the fluctuation of the NAA/Cr and FA values in time. To our mind, in the future these non-invasive techniques will play a determinative role in the monitoring of post-comatose patients.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Laureys S, Boly M. The changing spectrum of coma. Nat Clin Pract Neurol. 2008;4:544–6.
Childs NL, Mercer WN, Childs HW. Accuracy of diagnosis of persistent vegetative state. Neurology. 1993;43:1465–7.
Andrews K, Murphy L, Munday R, et al. Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ. 1996;313:13–6.
Schnakers C, Vanhaudenhuyse A, Giacino J, et al. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 2009;9:35.
Kampfl A, Schmutzhard E, Franz G, et al. Prediction of recovery from post-traumatic vegetative state with cerebral magnetic-resonance imaging. Lancet. 1998;351:1763–7.
Shibata Y, Matsumura A, Meguro K, et al. Differentiation of mechanism and prognosis of traumatic brain stem lesions detected by magnetic resonance imaging in the acute stage. Clin Neurol Neurosurg. 2000;102:124–8.
Firsching R, Woischneck D, Klein S, et al. Brain stem lesions after head injury. Neurol Res. 2002;24:145–6.
Uzan M, Albayram S, Dashti SG, et al. Thalamic proton magnetic resonance spectroscopy in vegetative state induced by traumatic brain injury. J Neurol Neurosurg Psychiatry. 2003;74:33–8.
Salazar AM, Grafman JH, Vance SC, et al. Consciousness and amnesia after penetrating head injury: neurology and anatomy. Neurology. 1986;36:178–87.
Huisman TA, Schwamm LH, Schaefer PW, et al. Diffusion tensor imaging as potential biomarker of white matter injury in diffuse axonal injury. AJNR Am J Neuroradiol. 2004;25:370–6.
Ross BD, Ernst T, Kreis R, et al. 1H MRS in acute traumatic brain injury. J Magn Reson Imaging. 1998;8:829–40.
Marino S, Zei E, Battaglini M, et al. Acute metabolic brain changes following traumatic brain injury and their relevance to clinical severity and outcome. J Neurol Neurosurg Psychiatry. 2007;78:501–7.
Trivedi MA, Ward MA, Hess TM, et al. Longitudinal changes in global brain volume between 79 and 409 days after traumatic brain injury: relationship with duration of coma. J Neurotrauma. 2007;24:766–71.
Weiss N, Galanaud D, Carpentier A, et al. Clinical review: prognostic value of magnetic resonance imaging in acute brain injury and coma. Crit Care. 2007;11:230.
Carpentier A, Galanaud D, Puybasset L, et al. Early morphologic and spectroscopic magnetic resonance in severe traumatic brain injuries can detect “invisible brain stem damage” and predict “vegetative states”. J Neurotrauma. 2006;23:674–85.
Yanagawa Y, Tsushima Y, Tokumaru A, et al. A quantitative analysis of head injury using T2*-weighted gradient-echo imaging. J Trauma. 2000;49:272–7.
Wedekind C, Fischbach R, Pakos P, et al. Comparative use of magnetic resonance imaging and electrophysiologic investigation for the prognosis of head injury. J Trauma. 1999;47:44–9.
Firsching R, Woischneck D, Diedrich M, et al. Early magnetic resonance imaging of brainstem lesions after severe head injury. J Neurosurg. 1998;89:707–12.
Danielsen ER, Ross B. Magnetic resonance spectroscopy diagnosis of neurological diseases. 1st ed. New York: Marcel Dekker, Inc; 1999.
Baslow MH, Suckow RF, Gaynor K, et al. Brain damage results in down-regulation of N-acetylaspartate as a neuronal osmolyte. Neuromolecular Med. 2003;3:95–104.
Moffett JR, Ross B, Arun P, et al. N-acetylaspartate in the CNS: from neurodiagnostics to neurobiology. Prog Neurobiol. 2007;81:89–131.
Sullivan EV, Adalsteinsson E, Spielman DM, et al. N-acetylaspartate–a marker of neuronal integrity. Ann Neurol. 2001;50:823. author reply 4–5.
Tshibanda L, Vanhaudenhuyse A, Galanaud D, et al. Magnetic resonance spectroscopy and diffusion tensor imaging in coma survivors: promises and pitfalls. Prog Brain Res. 2009;177:215–29.
Choe BY, Suh TS, Choi KH, et al. Neuronal dysfunction in patients with closed head injury evaluated by in vivo 1 H magnetic resonance spectroscopy. Invest Radiol. 1995;30:502–6.
Cecil KM, Hills EC, Sandel ME, et al. Proton magnetic resonance spectroscopy for detection of axonal injury in the splenium of the corpus callosum of brain-injured patients. J Neurosurg. 1998;88:795–801.
Garnett MR, Blamire AM, Corkill RG, et al. Early proton magnetic resonance spectroscopy in normal-appearing brain correlates with outcome in patients following traumatic brain injury. Brain. 2000;123(Pt 10):2046–54.
Holshouser BA, Tong KA, Ashwal S, et al. Prospective longitudinal proton magnetic resonance spectroscopic imaging in adult traumatic brain injury. J Magn Reson Imaging. 2006;24:33–40.
Brooks WM, Stidley CA, Petropoulos H, et al. Metabolic and cognitive response to human traumatic brain injury: a quantitative proton magnetic resonance study. J Neurotrauma. 2000;17:629–40.
Castillo M, Kwock L, Mukherji SK. Clinical applications of proton MR spectroscopy. AJNR Am J Neuroradiol. 1996;17:1–15.
Wood SJ, Berger G, Velakoulis D, et al. Proton magnetic resonance spectroscopy in first episode psychosis and ultra high-risk individuals. Schizophr Bull. 2003;29:831–43.
Huisman T, Sorensen A, Hergan K, et al. Diffusion-weighted imaging for the evaluation of diffuse axonal injury in closed head injury. J Comput Assist Tomogr. 2003;27:5–11.
Perlbarg V, Puybasset L, Tollard E, et al. Relation between brain lesion location and clinical outcome in patients with severe traumatic brain injury: a diffusion tensor imaging study using voxel-based approaches. Hum Brain Mapp. 2009;30:3924–33.
Tollard E, Galanaud D, Perlbarg V, et al. Experience of diffusion tensor imaging and 1H spectroscopy for outcome prediction in severe traumatic brain injury: preliminary results. Crit Care Med. 2009;37:1448–55.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag London
About this chapter
Cite this chapter
Tshibanda, JF.L., Demertzi, A., Soddu, A. (2012). Spectroscopy and Diffusion Tensor Imaging in Disorders of Consciousness. In: Schnakers, C., Laureys, S. (eds) Coma and Disorders of Consciousness. Springer, London. https://doi.org/10.1007/978-1-4471-2440-5_5
Download citation
DOI: https://doi.org/10.1007/978-1-4471-2440-5_5
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-2439-9
Online ISBN: 978-1-4471-2440-5
eBook Packages: MedicineMedicine (R0)