Proton magnetic resonance spectroscopy: Application in non-accidental trauma

Overall, the data from several studies suggest that MRS performed early after injury can be used to evaluate injury severity and more accurately predict long-term prognosis in children with NAT. MRS provides complementary information and frequently detects injury in brain regions that appear normal with conventional MRI and may help better understand the biomechanical forces and tissue changes that cause specific clinical symptoms. A better understanding of these relations is essential if we are to design therapies that might salvage injured brain tissue in these infants and children. All require further study to examine the effects of age, severity and location of injury, gender, and occurrence of ischemia or seizures on long-term neurological, neuropsychological, and behavioral function. MRSI, because it samples a larger area of the brain compared to single voxel MRS, is useful for demonstrating that injury after NAT is much more diffuse than what conventional imaging may show and helps to explain why global neuropsychological deficits are often seen in patients with normal or mild imaging findings. Future studies with higher field strength scanners optimized to acquire 3D MRSI in less time may be extremely useful for evaluating the full extent of brain injury after NAT. It is also likely that the combined use of MRS with newer techniques like diffusion tensor imaging may provide additional information than either method alone and may also provide new insights regarding the evolution of injury over time.