Citation

Sicard V, Fang Z, Kardish R, Healey K, Smith AM, Reid S, Cron GO, Melkus G, Abdeen N, Yeates KO, Goldfield G, Reed N, Zemek R, Ledoux AA. J. Neurotrauma 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2023.0071

PMID

38204176

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-hours 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 timepoints; 4) Explore perfusion between symptomatic and asymptomatic concussed and OI youths. Youths aged 10-17.99 years presenting to the emergency department with an acute concussion or OI were enrolled. ASL-MRI scans were conducted at 72-hours and 4-weeks post-injury to measure brain perfusion, along with completion of the Health Behaviour Inventory (HBI) to measure symptoms. Abnormal perfusion clusters were identified using voxel-based z-score analysis at each visit. First, mixed 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 timepoint examined the association between HBI and regional perfusion, and between HBI and abnormal perfusion volumes within the concussion group. Fourth, whole-brain 1-way ANCOVAs explored differences in regional and abnormal perfusion based on symptomatic status (symptomatic vs. asymptomatic) and OIs at each timepoint. 70 youths with a concussion [Median age (IQR)=12.70(11.67-14.35), 47.1% female] and 29 with and 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 to the OI group across timepoints, ps≤.004. The concussion group showed lower perfusion within the right superior temporal gyrus at both timepoints and bilateral occipital gyrus at 4-weeks, ps≤.006. The number of hypoperfused clusters was increased at 72-hours compared to 4-weeks in the concussion youths, p<.001, but not in the OIs. Moreover, Group moderated the perfusion-HBI association within the left precuneus and superior frontal gyrus at both timepoints, ps≤.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 to 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.

Language: en

Keywords

BLOOD FLOW; MRI; PEDIATRIC BRAIN INJURY; RECOVERY; TRAUMATIC BRAIN INJURY