Neuroimaging in Pediatric Patients with Mild Traumatic Brain Injury: Relating the Current 2018 Centers for Disease Control Guideline and the Potential of Advanced Neuroimaging Modalities for Research and Clinical Biomarker Development

Fong, Alina K.; Allen, Mark D.; Waltzman, Dana; Sarmiento, Kelly; Yeates, Keith Owen; Suskauer, Stacy J.; Wintermark, Max; Lindberg, Daniel M.; Tate, David F.; Wilde, Elizabeth A; Loewen, Jaycie L.

doi:10.1089/neu.2020.7100

Cited by 8 publications

(6 citation statements)

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“…However, patients with concussion typically undergo neither computed tomography nor ‘conventional’ magnetic resonance imaging as the diagnostic capacity of these procedures for mild forms of brain injury is limited [ 84 ]. In fact, computed tomography is not suitable for the detection of developmental changes occurring in the adolescent brain or pathophysiological processes characteristic of acute, subacute, or chronic stages of concussion [ 31 , 85 ]. These limitations significantly restrict the clinical utility of this technique in concussion.…”

Section: Role Of Neuroimaging In Concussionmentioning

confidence: 99%

“…An emerging line of research further indicates that detecting abnormalities in emotional regulation regions may help explain anxiety symptoms in adolescents following concussion [ 29 ]. However, using these techniques is currently clinically indicated as neither a diagnostic nor a prognostic tool for concussion [ 30 , 31 ]. There are practical challenges to including advanced neuroimaging techniques in clinical practice [ 31 ], including (1) high costs for implementation and maintenance, (2) prolonged time to collect neuroimaging data that does not match current workflows, and (3) specialized training needed to properly interpret findings.…”

Section: Introductionmentioning

confidence: 99%

“…However, using these techniques is currently clinically indicated as neither a diagnostic nor a prognostic tool for concussion [ 30 , 31 ]. There are practical challenges to including advanced neuroimaging techniques in clinical practice [ 31 ], including (1) high costs for implementation and maintenance, (2) prolonged time to collect neuroimaging data that does not match current workflows, and (3) specialized training needed to properly interpret findings. Their use is also often inaccessible in clinical practice, contributing to their limited use in clinical settings.…”

Section: Introductionmentioning

confidence: 99%

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Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging

Santos

Jia-Richards

Kontos

et al. 2023

IJERPH

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Emotional dysregulation symptoms following a concussion are associated with an increased risk for emotional dysregulation disorders (e.g., depression and anxiety), especially in adolescents. However, predicting the emergence or worsening of emotional dysregulation symptoms after concussion and the extent to which this predates the onset of subsequent psychiatric morbidity after injury remains challenging. Although advanced neuroimaging techniques, such as functional magnetic resonance imaging and diffusion magnetic resonance imaging, have been used to detect and monitor concussion-related brain abnormalities in research settings, their clinical utility remains limited. In this narrative review, we have performed a comprehensive search of the available literature regarding emotional regulation, adolescent concussion, and advanced neuroimaging techniques in electronic databases (PubMed, Scopus, and Google Scholar). We highlight clinical evidence showing the heightened susceptibility of adolescents to experiencing emotional dysregulation symptoms following a concussion. Furthermore, we describe and provide empirical support for widely used magnetic resonance imaging modalities (i.e., functional and diffusion imaging), which are utilized to detect abnormalities in circuits responsible for emotional regulation. Additionally, we assess how these abnormalities relate to the emotional dysregulation symptoms often reported by adolescents post-injury. Yet, it remains to be determined if a progression of concussion-related abnormalities exists, especially in brain regions that undergo significant developmental changes during adolescence. We conclude that neuroimaging techniques hold potential as clinically useful tools for predicting and, ultimately, monitoring the treatment response to emotional dysregulation in adolescents following a concussion.

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Section: Role Of Neuroimaging In Concussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging

Santos

Jia-Richards

Kontos

et al. 2023

IJERPH

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“…Neuroimaging can detect neural anatomical abnormalities following concussion. In recent years, studies have shown structural and functional abnormalities in the brain following concussion ( 19 ). Diffusion Magnetic Resonance Imaging (dMRI), in particular, has been used to show micro- and macro-structural abnormalities in white matter tracts ( 20 , 21 ).…”

Section: Introductionmentioning

confidence: 99%

White Matter Abnormalities Associated With Prolonged Recovery in Adolescents Following Concussion

et al. 2021

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Background: Concussion symptoms in adolescents typically resolve within 4 weeks. However, 20 – 30% of adolescents experience a prolonged recovery. Abnormalities in tracts implicated in visuospatial attention and emotional regulation (i.e., inferior longitudinal fasciculus, ILF; inferior fronto-occipital fasciculus, IFOF; uncinate fasciculus; UF) have been consistently reported in concussion; yet, to date, there are no objective markers of prolonged recovery in adolescents. Here, we evaluated the utility of diffusion MRI in outcome prediction. Forty-two adolescents (12.1 – 17.9 years; female: 44.0%) underwent a diffusion Magnetic Resonance Imaging (dMRI) protocol within the first 10 days of concussion. Based on days of injury until medical clearance, adolescents were then categorized into SHORT (<28 days; N = 21) or LONG (>28 days; N = 21) recovery time. Fractional anisotropy (FA) in the ILF, IFOF, UF, and/or concussion symptoms were used as predictors of recovery time (SHORT, LONG). Forty-two age- and sex-matched healthy controls served as reference. Higher FA in the ILF (left: adjusted odds ratio; AOR = 0.36, 95% CI = 0.15 – 0.91, P = 0.030; right: AOR = 0.28, 95% CI = 0.10 – 0.83, P = 0.021), IFOF (left: AOR = 0.21, 95% CI = 0.07 – 0.66, P = 0.008; right: AOR = 0.30, 95% CI = 0.11 – 0.83, P = 0.020), and UF (left: AOR = 0.26, 95% CI = 0.09 – 0.74, P = 0.011; right: AOR = 0.28, 95% CI = 0.10 – 0.73, P = 0.010) was associated with SHORT recovery. In additional analyses, while adolescents with SHORT recovery did not differ from HC, those with LONG recovery showed lower FA in the ILF and IFOF (P < 0.014). Notably, inclusion of dMRI findings increased the sensitivity and specificity (AUC = 0.93) of a prediction model including clinical variables only (AUC = 0.75). Our findings indicate that higher FA in long associative tracts (especially ILF) might inform a more objective and accurate prognosis for recovery time in adolescents following concussion.

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“…1-3 While neuroimaging is not recommended for routine concussions, 4-6 the use of conventional head computed tomography (HCT) remains an important part of SRC management in those with concerning clinical presentations, such as prolonged loss of consciousness, focal neurological deficits, and worsening symptoms. 7-9 Performed typically during the acute phase of injury, HCT is used to rule out intracranial pathologies that may warrant surgical intervention or closer observation. 10-14…”

mentioning

confidence: 99%

Positive Head Computed Tomography Findings in the Setting of Sport Head Injuries: Can These Athletes Return-to-Play?

Williams

Jonzzon

et al. 2023

Neurosurgery

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BACKGROUND: The literature on athletes with positive head computed tomography (HCT) findings in the setting of sport head injuries remains sparse. OBJECTIVE: To report the proportions of athletes with a positive HCT and compare acute injury characteristics and recovery between those with and without a positive HCT. METHODS: A retrospective, single-institution, cohort study was performed with all athletes aged 12 to 23 years seen at a regional concussion center from 11/2017 to 04/2022. The cohort was dichotomized into positive vs negative HCT (controls). Acute injury characteristics (ie, loss of consciousness and amnesia) and recovery, as measured by days to return-to-learn (RTL), symptom resolution, and return-to-play (RTP) were compared. χ2 and Mann-Whitney U tests were performed. RESULTS: Of 2061 athletes, 226 (11.0%) received an HCT and 9 (4.0%) had positive findings. HCT findings included 4 (44.4%) subdural hematomas, 1 (11.1%) epidural hematoma, 2 (22.2%) facial fractures, 1 (11.1%) soft tissue contusion, and 1 (11.1%) cavernous malformation. All 9 (100.0%) athletes were treated nonoperatively and successfully returned-to-play at a median (IQR) of 73.0 (55.0-82.0) days. No differences in loss of consciousness or amnesia were seen between positive HCT group and controls. The Mann-Whitney U test showed differences in RTL (17.0 vs 4.0 days; U = 45.0, P = .016) and RTP (73.0 vs 27.0 days; U = 47.5, P = .007) but not in symptom resolution. Our subanalysis showed no differences across all recovery metrics between acute hemorrhages and controls. CONCLUSION: Among athletes seen at a regional concussion center who underwent an acute HCT, positive findings were seen in 4%. Although athletes with a positive HCT had longer RTL and RTP, symptom resolution was similar between those with a positive and negative HCT. All athletes with a positive HCT successfully returned to play. Despite a more conservative approach to athletes with a positive HCT, clinical outcomes are similar between those with and without a positive HCT.

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Neuroimaging in Pediatric Patients with Mild Traumatic Brain Injury: Relating the Current 2018 Centers for Disease Control Guideline and the Potential of Advanced Neuroimaging Modalities for Research and Clinical Biomarker Development

Cited by 8 publications

References 85 publications

Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging

Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging

White Matter Abnormalities Associated With Prolonged Recovery in Adolescents Following Concussion

Positive Head Computed Tomography Findings in the Setting of Sport Head Injuries: Can These Athletes Return-to-Play?

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