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Consistent with our single voxel studies of adults, reduced NAA/Cre and greater Cho/Cre predicted worse cognitive function in children with TBI (see Table 1). Two interesting trends are evident in these data. First, motor skills (manual dexterity and strength of grip) were not related to neurometabolite concentrations, while cognitive skills were. Second, frontal NAA/Cre generally predicted cognitive deficits better than posterior values. These ratio data are inherently more difficult to interpret than "absolute" concentrations due to the potential variability of the denominator, in this case Cre. But, as the NAA/Cre ratio was positively related to function, and the Cho/Cre ratio inversely related, we believe our results reflect the importance of the numerator rather than the denominator. Younger and older children with TBI showed the same pattern of results. Along with our results from adult studies, this suggests that NAA may serve an important clinical role across a very broad age range of individuals with TBI.

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