Susceptibility-Weighted Magnetic Resonance Imaging (MRI) of Microbleeds in Pediatric Concussion

Abstract

Objective: The long-term consequences of pediatric concussion on brain structure are poorly understood. This study aimed to evaluate the presence and clinical significance of cerebral microbleeds several years after pediatric concussion. Methods: Children and adolescents 8-19 years of age with either a history of concussion (n = 35), or orthopedic injury (n = 20) participated. Mean time since injury for the sample was 30.4 months (SD = 19.6). Participants underwent susceptibility-weighted imaging, rated their depression and postconcussion symptoms, and completed cognitive testing. Parents of participants also completed symptom ratings for their child. Hypointensities in susceptibility-weighted images indicative of cerebral microbleeds were calculated as a measure of hypointensity burden. Results: Hypointensity burden did not differ significantly between participants with a history of concussion and those with a history of orthopedic injury. Depression ratings (self and parent report), postconcussion symptom ratings (self and parent report), and cognitive performance did not significantly correlate with hypointensity burden in the concussion group. Conclusions: These findings suggest that at approximately 2.5 years postinjury, children and adolescents with prior concussion do not have a greater amount of cerebral microbleeds compared to those with orthopedic injury. Future research should use longitudinal study designs and investigate children with persistent postconcussive symptoms to gain better insight into the long-term effects of concussion on cerebral microbleeds.

Multimodal magnetic resonance imaging of youth sport-related concussion reveals acute changes in the cerebellum, basal ganglia, and corpus callosum that resolve with recovery

“…There also exist other forms of MRI that were not included in the present study, such as susceptibility-weighted imaging (SWI) for the assessment of microbleeds and fluid-attenuated inversion recovery (FLAIR) images to assess white matter hyperintensities. Our recent SWI study found no increase in microbleeds in youth mTBI participants with prolonged symptoms, relative to controls (Virani et al, 2021), and another group demonstrated 10.3389/fnhum.2022.976013 no increase in FLAIR hyperintensities or SWI microbleeds in a SRC cohort, relative to controls (Jarrett et al, 2016). Thus, we chose not to include these forms of MRI in the current study.…”

Appropriate incorporation of susceptibility-weighted magnetic resonance imaging into routine imaging protocols for accurate diagnosis of traumatic brain injuries: a systematic review

“…evaluated the utility of SWI in 106 children with TBIs of various severities. They reported that lesions were detected in 35% of cases, comprising 19% of patients with mild injury, 46% with mild but complex injury, 59% with moderate injury, and 54% with severe injury, suggesting that sensitivity was high across all severities of brain injury but favored detection in patients with more severe injuries [ 37 ]. This view was reflected in the mean number of lesions detected, which ranged between 0.8 and 3.2 for patients with mild brain injury, compared with 8.9 and 14 for patients with moderate and severe injuries, respectively.…”

Precision Concussion Management: Approaches to Quantifying Head Injury Severity and Recovery

“…Susceptibilityweighted imaging (SWI) is a form of MRI that is sensitive to the differences in magnetic properties between tissues and uses that information to generate uniquely contrasted anatomical images [103]. Because of the strong magnetic properties of iron, SWI can be effective in the acute and long-term periods for detecting cerebral micro-hemorrhages caused by this shearing stress [104]. SWI has been observed to detect up to six times as many hemorrhagic lesions and to have increased sensitivity to smaller-sized (<10 mm) lesions in the brains of moderateto-severe TBI patients compared to more traditional T2-weighted MR images [105,106].…”

“…Susceptibility-weighted imaging (SWI) is a form of MRI that is sensitive to the differences in magnetic properties between tissues and uses that information to generate uniquely contrasted anatomical images [ 103 ]. Because of the strong magnetic properties of iron, SWI can be effective in the acute and long-term periods for detecting cerebral micro-hemorrhages caused by this shearing stress [ 104 ].…”