title: Neuroimaging findings in pediatric sports-related concussion.
abstract: OBJECTIVE
  The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program.
  
  
  METHODS
  The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age ≤ 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board.
  
  
  RESULTS
  A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient).
  
  
  CONCLUSIONS
  Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.
authors.affiliation: Departments of 1 Surgery.|Pediatrics and Child Health, and.|Section of Neurosurgery, University of Manitoba.|Pan Am Clinic, and.|Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ellis
authors.affiliation: Departments of 1 Surgery.|Pan Am Clinic, and.
authors.forename: Jeff
authors.initials: J
authors.lastname: Leiter
authors.affiliation: Pan Am Clinic, and.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hall
authors.affiliation: Departments of 1 Surgery.|Pediatrics and Child Health, and.|Section of Neurosurgery, University of Manitoba.|Pan Am Clinic, and.|Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McDonald
authors.affiliation: Pediatrics and Child Health, and.|Health Sciences Centre Children's Hospital.
authors.forename: Scott
authors.initials: S
authors.lastname: Sawyer
authors.affiliation: Pediatrics and Child Health, and.|Health Sciences Centre Children's Hospital.
authors.forename: Norm
authors.initials: N
authors.lastname: Silver
authors.affiliation: Diagnostic Imaging and.
authors.forename: Martin
authors.initials: M
authors.lastname: Bunge
authors.affiliation: Diagnostic Imaging and.
authors.forename: Marco
authors.initials: M
authors.lastname: Essig
mesh_terms: D000293:Adolescent; D016080:Arachnoid Cysts / Q000175:diagnosis; D001265:Athletic Injuries / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D001924:Brain Concussion / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D001930:Brain Injuries / Q000175:diagnosis / Q000209:etiology; D002648:Child; D003288:Contusions / Q000175:diagnosis; D004244:Dizziness / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging / Q000379:methods; D004856:Postural Balance; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012887:Skull Fractures / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness / Q000209:etiology
keywords: GRE = gradient recalled echo; ICH = intracranial hemorrhage; IPH = intraparenchymal hemorrhage; LOC = loss of consciousness; SRC = sports-related concussion; SWI = susceptibility-weighted imaging; computed tomography; mTBI = mild traumatic brain injury; magnetic resonance imaging; neuroimaging; pediatric patients; sports-related concussion; trauma