Longitudinal Brain Perfusion and Symptom Presentation Following Pediatric Concussion: A Pediatric Concussion
Veronik Sicard1, Zhuo Fang2, Rachel Kardish1,3
1Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Insights
Arterial spin labelling (ASL) reveals regional brain perfusion differences in youth with concussion compared to orthopedic injury (OI). While concussion patients showed altered perfusion in specific brain areas, symptom severity did not correlate with abnormal perfusion volumes.
Area of Science:
- Neuroimaging
- Pediatric Neurology
- Radiology
Background:
- Advanced neuroimaging, specifically arterial spin labelling (ASL), shows promise for prognostic assessment in pediatric concussion.
- Understanding brain perfusion changes and their recovery post-injury is crucial for effective management of youth concussion.
Purpose of the Study:
- To compare global and regional brain perfusion between youth with concussion and orthopedic injury (OI) at 72 hours and 4 weeks post-injury.
- To analyze patterns of abnormal brain perfusion and recovery in both groups.
- To investigate the relationship between perfusion and symptom burden, and differences between symptomatic and asymptomatic individuals.
Main Methods:
- Youth aged 10-17 with acute concussion or OI underwent ASL-magnetic resonance imaging at 72 hours and 4 weeks post-injury.
- Brain perfusion was measured, and symptom burden was assessed using the Health Behavior Inventory (HBI).
- Voxel-based z-score analysis identified abnormal perfusion clusters; statistical analyses examined group differences, recovery, and symptom associations.
Main Results:
- The concussion group exhibited greater perfusion in the anterior cingulate cortex/middle frontal gyrus compared to the OI group.
- Concussion patients showed reduced perfusion in the right superior temporal gyrus and bilateral occipital gyrus.
- The number of hypoperfused clusters decreased from 72 hours to 4 weeks in concussed youth, indicating recovery.
Conclusions:
- Regional brain perfusion alterations are detectable in youth with concussion using ASL, differentiating them from OI.
- While symptoms may correlate with regional perfusion changes, they were not associated with the volume of abnormal perfusion.
- ASL imaging may offer valuable insights into the neurophysiological impact of concussion in pediatric populations.
Abstract:
Emerging evidence suggests that advanced neuroimaging modalities such as arterial spin labelling (ASL) might have prognostic utility for pediatric concussion. This study aimed to: 1) examine group differences in global and regional brain perfusion in youth with concussion or orthopedic injury (OI) at 72 h and 4 weeks post-injury; 2) examine patterns of abnormal brain perfusion within both groups and their recovery; 3) investigate the association between perfusion and symptom burden within concussed and OI youths at both time-points; and 4) explore perfusion between symptomatic and asymptomatic concussed and OI youths. Youths ages 10.00-17.99 years presenting to the emergency department with an acute concussion or OI were enrolled. ASL-magnetic resonance imaging scans were conducted at 72 h and 4 weeks post-injury to measure brain perfusion, along with completion of the Health Behavior Inventory (HBI) to measure symptoms. Abnormal perfusion clusters were identified using voxel-based z-score analysis at each visit. First, mixed analyses of covariance (ANCOVAs) investigated the Group*Time interaction on global and regional perfusion. Post hoc region of interest (ROI) analyses were performed on significant regions. Second, within-group generalized estimating equations investigated the recovery of abnormal perfusion at an individual level. Third, multiple regressions at each time-point examined the association between HBI and regional perfusion, and between HBI and abnormal perfusion volumes within the concussion group. Fourth, whole-brain one-way ANCOVAs explored differences in regional and abnormal perfusion based on symptomatic status (symptomatic vs. asymptomatic) and OIs at each time-point. A total of 70 youths with a concussion [median age (interquartile range; IQR) = 12.70 (11.67-14.35), 47.1% female] and 29 with an OI [median age (IQR) = 12.05 (11.18-13.89), 41.4% female] were included. Although no Group effect was found in global perfusion, the concussion group showed greater adjusted perfusion within the anterior cingulate cortex/middle frontal gyrus (MFG) and right MFG compared with the OI group across time-points (ps ≤ 0.004). The concussion group showed lower perfusion within the right superior temporal gyrus at both time-points and bilateral occipital gyrus at 4 weeks, (ps ≤ 0.006). The number of hypoperfused clusters was increased at 72 h compared with 4 weeks in the concussion youths (p < 0.001), but not in the OIs. Moreover, Group moderated the HBI-perfusion association within the left precuneus and superior frontal gyrus at both time-points, (ps ≤ 0.001). No association was found between HBI and abnormal perfusion volume within the concussion group at any visits. At 4 weeks, the symptomatic sub-group (n = 10) showed lower adjusted perfusion within the right cerebellum and lingual gyrus, while the asymptomatic sub-group (n = 59) showed lower adjusted perfusion within the left calcarine, but greater perfusion within the left medial orbitofrontal cortex, right middle frontal gyrus, and bilateral caudate compared with OIs. Yet, no group differences were observed in the number of abnormal perfusion clusters or volumes at any visit. The present study suggests that symptoms may be associated with changes in regional perfusion, but not abnormal perfusion levels.
