Imaging in pediatric concussion: A systematic review

CONTEXT: Pediatric mild traumatic brain injury (mTBI) is a common and poorly understood injury. Neuroimaging indexes brain injury and outcome after pediatric mTBI, but remains largely unexplored. OBJECTIVE: To investigate the differences in neuroimaging findings in children/youth with mTBI. Measures of behavior, symptoms, time since injury, and age at injury were also considered. DATA SOURCES: A systematic review was conducted up to July 6, 2016. STUDY SELECTION: Studies were independently screened by 2 authors and included if they met predetermined eligibility criteria: (1) children/youth (5–18 years of age), (2) diagnosis of mTBI, and (3) use of neuroimaging. DATA EXTRACTION: Two authors independently appraised study quality and extracted demographic and outcome data. RESULTS: Twenty-two studies met the eligibility criteria, involving 448 participants with mTBI (mean age = 12.7 years ± 2.8). Time postinjury ranged from 1 day to 5 years. Seven different neuroimaging methods were investigated in included studies. The most frequently used method, diffusion tensor imaging (41%), had heterogeneous findings with respect to the specific regions and tracts that showed group differences. However, group differences were observed in many regions containing the corticospinal tract, portions of the corpus callosum, or frontal white-matter regions; fractional anisotropy was increased in 88% of the studies. LIMITATIONS: This review included a heterogeneous sample with regard to participant ages, time since injury, symptoms, and imaging methods which prevented statistical pooling/modelling. CONCLUSIONS: These data highlight essential priorities for future research (eg, common data elements) that are foundational to progress the understanding of pediatric concussion.