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Brain creatine concentrations are associated with sex and symptom severity after concussion: a cross-sectional MR-spectroscopy investigation of adolescents with concussion.

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Title: Brain creatine concentrations are associated with sex and symptom severity after concussion: a cross-sectional MR-spectroscopy investigation of adolescents with concussion.
Authors: Howell, David R. (AUTHOR), Keeter, Carson L. (AUTHOR), Hatolkar, Ved (AUTHOR), Smulligan, Katherine L. (AUTHOR), Armento, Aubrey M. (AUTHOR), Oldham, Jessie R. (AUTHOR), Wilson, Julie (AUTHOR), Breedlove, Katie (AUTHOR), Lin, Alexander P. (AUTHOR)
Source: Brain Injury. 2026, Vol. 40 Issue 4, p250-259. 10p.
Subjects: Cross-sectional method, Pearson correlation (Statistics), Nuclear magnetic resonance spectroscopy, Research funding, Three-dimensional imaging, T-test (Statistics), Statistical hypothesis testing, Sex distribution, Fatigue (Physiology), Scientific observation, Probability theory, Severity of illness index, Descriptive statistics, Creatine, Limbic system, Pain, Health outcome assessment, Neuroradiology, Data analysis software, Brain concussion, Physical mobility, Regression analysis
Abstract: Background: Post-concussion brain energy is important for recovery, and measuring energy markers with individual characteristics may clarify recovery mechanisms. Purpose: To examine the association between magnetic resonance spectroscopy (MRS)-based brain energy measures (creatine concentration) with sex and patient-reported outcomes after concussion. Methods: We evaluated adolescents with a concussion ≤3 weeks post-injury. Participants underwent 3T short-echo single-voxel MRS using a 32-channel head coil. Point-resolved spectroscopy (TR = 2000 ms, TE = 30 ms, voxel size = 20 × 20 × 20 mm3, 128 averages) quantified posterior cingulate gyrus (PCG) creatine concentration. Participants completed Post-Concussion Symptom Inventory and PROMIS Pediatric Global 25 mobility, fatigue, and pain-interference domains. Results: N = 27 adolescents (N = 15 female, age = 15.8 ± 1.2 years, 11.5 ± 4.4 days after concussion; N = 12 male, age = 15.8 ± 1.5 years, 11.9 ± 4.0 days after concussion) participated. Male participants had greater PCG creatine concentrations than female participants (12.9 ± 0.41 vs. 12.3 ± 0.71 mmol; p = 0.01; d = 1.07). Creatine concentrations were correlated with concussion symptom severity (r = −0.61; p < 0.001), mobility impairments (r = −0.57; p = 0.003), and pain interference (r = −0.40; p = 0.02). Conclusion: Post-concussion sex differences in creatine concentrations were detected, as higher creatine levels moderately correlated with patient-reported outcomes. Creatine may reflect altered energy dynamics in the brain. The absence of a non-injured control group limits determination of whether these differences are concussion-specific or reflective of baseline physiology. [ABSTRACT FROM AUTHOR]
Copyright of Brain Injury is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Brain creatine concentrations are associated with sex and symptom severity after concussion: a cross-sectional MR-spectroscopy investigation of adolescents with concussion.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Brain+Injury%22&quot;&gt;Brain Injury&lt;/searchLink&gt;. 2026, Vol. 40 Issue 4, p250-259. 10p.
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– Name: Abstract
  Label: Abstract
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  Data: Background: Post-concussion brain energy is important for recovery, and measuring energy markers with individual characteristics may clarify recovery mechanisms. Purpose: To examine the association between magnetic resonance spectroscopy (MRS)-based brain energy measures (creatine concentration) with sex and patient-reported outcomes after concussion. Methods: We evaluated adolescents with a concussion ≤3 weeks post-injury. Participants underwent 3T short-echo single-voxel MRS using a 32-channel head coil. Point-resolved spectroscopy (TR = 2000 ms, TE = 30 ms, voxel size = 20 &#215; 20 &#215; 20 mm3, 128 averages) quantified posterior cingulate gyrus (PCG) creatine concentration. Participants completed Post-Concussion Symptom Inventory and PROMIS Pediatric Global 25 mobility, fatigue, and pain-interference domains. Results: N = 27 adolescents (N = 15 female, age = 15.8 &#177; 1.2 years, 11.5 &#177; 4.4 days after concussion; N = 12 male, age = 15.8 &#177; 1.5 years, 11.9 &#177; 4.0 days after concussion) participated. Male participants had greater PCG creatine concentrations than female participants (12.9 &#177; 0.41 vs. 12.3 &#177; 0.71 mmol; p = 0.01; d = 1.07). Creatine concentrations were correlated with concussion symptom severity (r = −0.61; p &lt; 0.001), mobility impairments (r = −0.57; p = 0.003), and pain interference (r = −0.40; p = 0.02). Conclusion: Post-concussion sex differences in creatine concentrations were detected, as higher creatine levels moderately correlated with patient-reported outcomes. Creatine may reflect altered energy dynamics in the brain. The absence of a non-injured control group limits determination of whether these differences are concussion-specific or reflective of baseline physiology. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: &lt;i&gt;Copyright of Brain Injury is the property of Taylor &amp; Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1080/02699052.2025.2612037
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        Text: English
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      – SubjectFull: Nuclear magnetic resonance spectroscopy
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      – SubjectFull: Severity of illness index
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      – SubjectFull: Creatine
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