Jon Robert Hunsaker MD, Presenter: Nothing to Disclose

A model using Magnetic Resonance Spectroscopic Imaging (MRSI) metabolite and clinical data reported 100% accuracy in predicting long-term neurological outcome in cases of pediatric non-accidental trauma (NAT). This study provides additional cases of pediatric NAT focusing on the utility of MRSI in predicting outcomes and testing the previously described outcome prediction model. Exploration of alternative models employing MRSI and clinical data were also developed and evaluated.

68 children with confirmed NAT underwent MRSI evaluation (mean of 5 days post-injury, range of 0-20 days). Clinical, and imaging findings were recorded. Using MRSI various regional and mean total metabolite ratios were measured including N-acetylaspartate/Creatine (NAA/Cr), NAA/Choline (NAA/Cho), Choline/Creatine (Cho/Cr), Lactate/Creatine (Lac/Cr). Long term outcomes were defined at > 6 months using the Pediatric Cerebral Performance Category Score (PCPCS) as good (1= normal, 2 = mild disability, or 3 = moderate disability; n = 53) or poor (4 = severe disability, 5 = vegetative state, or 6 = death; n = 15). Clinical and MRSI results were evaluated for significance between dichotomized outcome groups. Logistic regression was employed for the testing of the previously reported outcome prediction model and for the development of an alternative outcome prediction model.

Age, initial GCS and initial glucose were significant clinical indicators of outcome as were the following MRSI metabolite ratios: Mean NAA/Cr, NAA/Cho and Lac/Cr. Data entered into the original integrated model yielded 88.2% overall correct outcome prediction. A new simplified outcome prediction model was developed using initial GCS and total NAA/Cr and yielded 89.9% overall correct outcome prediction.

MRSI is an effective means of detecting reduced NAA levels (evidence of neuronal loss or dysfunction), elevated choline levels (evidence of axonal injury) and the presence of lactate (evidence of hypoxic-ischemic injury) and there is a significant correlation between these metabolites and neurological outcomes in pediatric NAT. Our new simplified outcome prediction model demonstrates improvement over the previously described model.

MRSI data, specifically NAA/Cr, in concert with initial GCS provides a simple and more accurate outcome prediction model in cases of pediatric NAT than previously available.

Hunsaker, J, Magnetic Resonance Spectroscopic Imaging Provides Prognostic Information Regarding Outcomes in Children with Nonaccidental Trauma.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11002990.html