In the United States, approximately 2.53 million people sustain a concussion each year. Relative to adults, youth show greater cognitive deficits following concussion and a longer recovery. An accurate and reliable imaging method is needed to determine injury severity and symptom resolution. The primary objective of this study was to characterize concussions with diffusion tensor imaging (DTI). This was performed through a normative Z-scoring analysis of DTI metrics, fractional anisotropy, axial diffusivity and radial diffusivity, to quantify patient specific injuries and identify commonly damaged brain regions in paediatric concussion patients relative to healthy controls. It was hypothesized that personalizing the detection analysis through normative Z-scoring would provide understanding of trauma-induced microstructural damage. Concussion patients were volunteers recruited from the Emergency Department of the McMaster Children’s Hospital with a recent concussion (n=26), nine males and 17 females, mean age 14.22 +/- 2.64, while healthy paediatric brain DTI datasets (25 males and 24 females, mean age = 13.52+/-1.03) were obtained from an MRI data repository. Significant abnormalities were commonly found in the longitudinal fasciculus, fronto-occipital fasciculus, and corticospinal tract, while unique abnormalities were localized in a number of other areas reflecting the individuality of each child’s injury. Total brain injury burden, as determined by the number of regions with outlier fractional anisotropy Z-scores, significantly correlated with post-concussion symptoms score (PCSS; p<0.038) and age of injury (p<0.001). These results show that DTI was able to detect microstructural changes caused by concussion, on a per-person basis, and has potential to be a useful tool for improving diagnostic accuracy and prognosis of a concussion.

中文翻译：

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小儿脑震荡的脑微结构异常的定位和鉴定

在美国，每年约有253万人患有脑震荡。相对于成年人，青年在脑震荡后表现出更大的认知缺陷，并且恢复时间更长。需要一种准确可靠的成像方法来确定损伤的严重程度和症状的缓解。这项研究的主要目的是利用弥散张量成像（DTI）表征脑震荡。这是通过对DTI指标，分数各向异性，轴向扩散率和径向扩散率进行规范性Z评分分析来量化的，具体量化了患者的特定伤害，并确定了相对于健康对照的小儿脑震荡患者中通常受损的大脑区域。假设通过规范的Z值评分对检测分析进行个性化设置，将有助于理解创伤引起的微结构损伤。脑震荡患者是从麦克马斯特儿童医院急诊室招募的志愿者，最近有脑震荡（n = 26），男9例，女17例，平均年龄14.22 +/- 2.64，而儿科大脑DTI健康数据集（男25例，女24例） ，平均年龄= 13.52 +/- 1.03）是从MRI数据存储库中获得的。通常在纵筋膜，额枕筋膜和皮质脊髓束中发现明显的异常，而独特的异常则分布在许多其他区域，反映了每个孩子的受伤情况。由具有异常分数各向异性Z分数的区域数量确定的总脑损伤负担与脑震荡后症状评分（PCSS; p <0.038）和损伤年龄（p <0.001）显着相关。