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Cerebral energy status and altered metabolism in early brain injury after aneurysmal SAH: first results of a prospective 31P-MRS study
EANS Academy. Görke A. Sep 27, 2019; 276095; EP01085
Alice Görke
Alice Görke

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Abstract
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Background and purpose: Acute changes of cerebral energy metabolism in early brain injury (EBI) after aneurysmal SAH play a crucial role for overall neurologic outcome. However, direct detection of these alterations is limited. 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 primary versus secondary alterations. Pathophysiological changes of cerebral energy metabolism are detectable based on various phosphorous compound metabolites.
The aim of this pilot study is to evaluate the feasibility and the diagnostic potential of ultra early 31P-MRS in aSAH.
Methods: Adult patients with aSAH, treated for ruptured aneurymss between June 2016 and July 2017 and being eligible for MRI, were prospectively included in the study. MRI scans plus 31P-MRS were performed within 72 hours after aSAH. 31P-MRS data from the structurally affected side / vascular territory (ACA, MCA, PCA, BA, VA, basal ganglia analyzed separately) were compared to data from normal appearing contralateral areas, and to data of healthy controls. Imaging was performed using a 3-Tesla MRI with a Dual Tuned Head Coil. 31P-MRS quantifies phosphorous compound metabolites and changes in ATP metabolism. Ratios of these metabolites are used for metabolism assessment. One-way analysis of variance (ANOVA) with post hoc procedure of Tukey-HSD was performed to assess pairwise differences.
Results: Fourteen aSAH patients (11 female and 3 male patients) met inclusion criteria and were analyzed. Statistical analysis revealed substantial acute numerous alterations of cerebral energy metabolism in early brain injury after aSAH (P< 0.05).
Conclusion: 31P-MRS seems to be a promising tool for a comprehensive assessment of patients after aneurysmal SAH showing pertinent changes in energy metabolism with an obvious potential to optimize early guidance of clinical therapy.
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