Cerebral Energy Status and Altered Metabolism in Early Brain Injury After Aneurysmal Subarachnoid Hemorrhage: A Prospective 31P-MRS Pilot Study

Stephanie Alice Treichl; Wing Mann Ho; Ruth Steiger; Astrid Ellen Grams; Andreas Rietzler; Markus Luger; Elke Ruth Gizewski; Claudius Thomé; Ondra Petr

doi:10.3389/fneur.2022.831537

Cerebral Energy Status and Altered Metabolism in Early Brain Injury After Aneurysmal Subarachnoid Hemorrhage: A Prospective 31P-MRS Pilot Study

Front Neurol. 2022 Feb 28:13:831537. doi: 10.3389/fneur.2022.831537. eCollection 2022.

Authors

Stephanie Alice Treichl¹, Wing Mann Ho¹, Ruth Steiger^{2

3}, Astrid Ellen Grams², Andreas Rietzler^{2

3}, Markus Luger⁴, Elke Ruth Gizewski^{2

3}, Claudius Thomé¹, Ondra Petr¹

Affiliations

¹ Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
² Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.
³ Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
⁴ Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria.

Abstract

Background: Acute changes of cerebral energy metabolism in early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) may play a crucial role for overall neurological 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 based on various phosphorous compound metabolites. This method may provide objective assessment of both primary and secondary changes.

Objective: The aim of this pilot study was to evaluate the feasibility and the diagnostic potential of early 31P-MRS in aSAH.

Methods: Patients with aSAH treated for ruptured aneurysms between July 2016 and October 2017 were prospectively included in the study. 3-Tesla-MRI including 31P-MRS was performed within the first 72 h after hemorrhage. Data of the vascular territories of the anterior, middle, and posterior cerebral arteries (ACA, MCA, PCA) and the basal ganglia were separately analyzed and compared with data of a healthy age- and sex-matched control group. Phosphorous compound metabolites were quantified, and ratios of these metabolites were further evaluated. Influence of treatment modality, clinical conditions, and analgosedation were analyzed.

Results: Data of 13 patients were analyzed. 31P-MRS showed significant changes in cerebral energy metabolism after aSAH in all cerebrovascular territories. Both PCr/ATP and PCr/Pi ratio were notably increased (P < 0.001). Also, Pi/ATP was significantly decreased in all cerebrovascular territories (P = 0.014). PME/PDE ratio was overall significant decreased (P < 0.001).

Conclusion: 31P-MRS is a promising non-invasive imaging tool for the assessment of changes in energy metabolism after aSAH. It allows a detailed insight into EBI and seems to harbor a high potential for clinical practice.

Keywords: 31-P-MR-spectroscopy; brain metabolism; early brain injury; energy status; subarachnoid hemorrhage.