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Review
. 2018 Feb;28(1):43-53.
doi: 10.1016/j.nic.2017.09.004.

Imaging of Concussion in Young Athletes

Jeffrey P Guenette  1 , Martha E Shenton  2 , Inga K Koerte  3
Affiliations
Review

Imaging of Concussion in Young Athletes

Jeffrey P Guenette et al. Neuroimaging Clin N Am. 2018 Feb.

Abstract

Conventional neuroimaging examinations are typically normal in concussed young athletes. A current focus of research is the characterization of subtle abnormalities after concussion using advanced neuroimaging techniques. These techniques have the potential to identify biomarkers of concussion. In the future, such biomarkers will likely provide important clinical information regarding the appropriate time interval before return to play, as well as the risk for prolonged postconcussive symptoms and long-term cognitive impairment. This article discusses results from advanced imaging techniques and emphasizes imaging modalities that will likely become available in the near future for the clinical evaluation of concussed young athletes.

Keywords: Concussion; Diffusion tensor imaging; Head trauma; MR imaging; Mild traumatic brain injury; Pediatrics; Sports; Susceptibility-weighted imaging.

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Figures

Figure 1
Figure 1
23 year-old male ejected from motor vehicle. (A) Axial CT image bone windows demonstrates a temporal bone fracture (arrow) in the region of the middle meningeal artery. (B) Axial CT image in soft tissue windows at the same level as Figure 1A demonstrates an associated large epidural hemorrhage (white arrows). Small foci of intraparenchymal hemorrhage are also visible (black arrows). (Images courtesy Liangge Hsu M.D., Brigham & Women’s Hospital)
Figure 1
Figure 1
23 year-old male ejected from motor vehicle. (A) Axial CT image bone windows demonstrates a temporal bone fracture (arrow) in the region of the middle meningeal artery. (B) Axial CT image in soft tissue windows at the same level as Figure 1A demonstrates an associated large epidural hemorrhage (white arrows). Small foci of intraparenchymal hemorrhage are also visible (black arrows). (Images courtesy Liangge Hsu M.D., Brigham & Women’s Hospital)
Figure 2
Figure 2
46 year-old man status post 15 foot fall from roof. (A) Axial CT image in soft tissue windows demonstrates a left frontal subarachnoid hemorrhage (white arrow) and left subdural hemorrhage (black arrow). A left frontal subgaleal hematoma is also present. (B) Axial CT image in soft tissue windows, more inferior than Figure 2A, demonstrates bifrontal brain contusions (white arrows) and left subdural hemorrhage (black arrow). (C) Coronal CT image in soft tissue windows demonstrates the same bifrontal contusions (white arrows) clearly located along the floor of the anterior cranial fossa, a common location due to sudden traumatic compression of the brain in this region.
Figure 2
Figure 2
46 year-old man status post 15 foot fall from roof. (A) Axial CT image in soft tissue windows demonstrates a left frontal subarachnoid hemorrhage (white arrow) and left subdural hemorrhage (black arrow). A left frontal subgaleal hematoma is also present. (B) Axial CT image in soft tissue windows, more inferior than Figure 2A, demonstrates bifrontal brain contusions (white arrows) and left subdural hemorrhage (black arrow). (C) Coronal CT image in soft tissue windows demonstrates the same bifrontal contusions (white arrows) clearly located along the floor of the anterior cranial fossa, a common location due to sudden traumatic compression of the brain in this region.
Figure 2
Figure 2
46 year-old man status post 15 foot fall from roof. (A) Axial CT image in soft tissue windows demonstrates a left frontal subarachnoid hemorrhage (white arrow) and left subdural hemorrhage (black arrow). A left frontal subgaleal hematoma is also present. (B) Axial CT image in soft tissue windows, more inferior than Figure 2A, demonstrates bifrontal brain contusions (white arrows) and left subdural hemorrhage (black arrow). (C) Coronal CT image in soft tissue windows demonstrates the same bifrontal contusions (white arrows) clearly located along the floor of the anterior cranial fossa, a common location due to sudden traumatic compression of the brain in this region.
Figure 3
Figure 3
17 year-old male status post motor vehicle collision. (A) Axial CT image in soft tissue windows demonstrates a large right subgaleal hematoma (arrow) without any evident intracranial abnormality. (B) Axial gradient-recall echo (GRE) MR image in a similar plane demonstrates foci of susceptibility artifact (arrows), presumed to represent microhemorrhage, scattered along the gray white junction, in the right thalamus, in the left putamen, and in the fornix body. SWI has replaced GRE at our institution in most routine imaging protocols. (Images courtesy Liangge Hsu M.D., Brigham & Women’s Hospital)
Figure 3
Figure 3
17 year-old male status post motor vehicle collision. (A) Axial CT image in soft tissue windows demonstrates a large right subgaleal hematoma (arrow) without any evident intracranial abnormality. (B) Axial gradient-recall echo (GRE) MR image in a similar plane demonstrates foci of susceptibility artifact (arrows), presumed to represent microhemorrhage, scattered along the gray white junction, in the right thalamus, in the left putamen, and in the fornix body. SWI has replaced GRE at our institution in most routine imaging protocols. (Images courtesy Liangge Hsu M.D., Brigham & Women’s Hospital)
Figure 4
Figure 4
(A) Axial, (B) sagittal, and (C) coronal images of the brain with automatic segmentation label maps generated by FreeSurfer superimposed on T1-weighted high resolution MR images.
Figure 4
Figure 4
(A) Axial, (B) sagittal, and (C) coronal images of the brain with automatic segmentation label maps generated by FreeSurfer superimposed on T1-weighted high resolution MR images.
Figure 4
Figure 4
(A) Axial, (B) sagittal, and (C) coronal images of the brain with automatic segmentation label maps generated by FreeSurfer superimposed on T1-weighted high resolution MR images.
Figure 5
Figure 5
22 year-old male soccer player with history of concussion. (A) Frontal, (B) lateral, and (C) superior views of corpus callosum white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. The interhemispheric traversing fibers are particularly well demonstrated on the frontal and superior views. (D) Frontal, (E) lateral, and (F) superior views of corpus callosum (warm colors) and cingulate gyri (cyan spectrum) white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. Quantitative measures of the tracts are used to identify subtle white matter abnormalities not visible on conventional imaging.
Figure 5
Figure 5
22 year-old male soccer player with history of concussion. (A) Frontal, (B) lateral, and (C) superior views of corpus callosum white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. The interhemispheric traversing fibers are particularly well demonstrated on the frontal and superior views. (D) Frontal, (E) lateral, and (F) superior views of corpus callosum (warm colors) and cingulate gyri (cyan spectrum) white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. Quantitative measures of the tracts are used to identify subtle white matter abnormalities not visible on conventional imaging.
Figure 5
Figure 5
22 year-old male soccer player with history of concussion. (A) Frontal, (B) lateral, and (C) superior views of corpus callosum white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. The interhemispheric traversing fibers are particularly well demonstrated on the frontal and superior views. (D) Frontal, (E) lateral, and (F) superior views of corpus callosum (warm colors) and cingulate gyri (cyan spectrum) white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. Quantitative measures of the tracts are used to identify subtle white matter abnormalities not visible on conventional imaging.
Figure 5
Figure 5
22 year-old male soccer player with history of concussion. (A) Frontal, (B) lateral, and (C) superior views of corpus callosum white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. The interhemispheric traversing fibers are particularly well demonstrated on the frontal and superior views. (D) Frontal, (E) lateral, and (F) superior views of corpus callosum (warm colors) and cingulate gyri (cyan spectrum) white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. Quantitative measures of the tracts are used to identify subtle white matter abnormalities not visible on conventional imaging.
Figure 5
Figure 5
22 year-old male soccer player with history of concussion. (A) Frontal, (B) lateral, and (C) superior views of corpus callosum white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. The interhemispheric traversing fibers are particularly well demonstrated on the frontal and superior views. (D) Frontal, (E) lateral, and (F) superior views of corpus callosum (warm colors) and cingulate gyri (cyan spectrum) white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. Quantitative measures of the tracts are used to identify subtle white matter abnormalities not visible on conventional imaging.
Figure 5
Figure 5
22 year-old male soccer player with history of concussion. (A) Frontal, (B) lateral, and (C) superior views of corpus callosum white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. The interhemispheric traversing fibers are particularly well demonstrated on the frontal and superior views. (D) Frontal, (E) lateral, and (F) superior views of corpus callosum (warm colors) and cingulate gyri (cyan spectrum) white matter fiber tracts generated with two-tensor tractography from diffusion-weighted images. Quantitative measures of the tracts are used to identify subtle white matter abnormalities not visible on conventional imaging.
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References

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