1 Harborview Injury Prevention Research Center, Harborview Medical Center, University of Washington , Seattle, Washington.
2 Department of Neurological Surgery, University of Washington , and Seattle Children's Hospital, Seattle, Washington.
J Neurotrauma. 2017 Oct 1;34(19):2706-2712. doi: 10.1089/neu.2017.4970. Epub 2017 Jul 19.
A subset of patients experience persistent symptoms after pediatric concussion, and magnetic resonance imaging (MRI) is commonly used to evaluate for pathology. The utility of this practice is unclear. We conducted a retrospective cohort study to describe the MRI findings in children with concussion. A registry of all patients seen at our institution from January 2010 through March 2016 with pediatric sports-related concussion was cross-referenced with a database of radiographical studies. Radiology reports were reviewed for abnormal findings. Patients with abnormal computed tomographies or MRI scans ordered for reasons other than concussion were excluded. Among 3338 children identified with concussion, 427 underwent MRI. Only 2 (0.5%) had findings compatible with traumatic injury, consisting in both of microhemorrhage. Sixty-one patients (14.3%) had abnormal findings unrelated to trauma, including 24 nonspecific T changes, 15 pineal cysts, eight Chiari I malformations, and five arachnoid cysts. One child underwent craniotomy for a cerebellar hemangioblastoma after presenting with ataxia; another had cortical dysplasia resected after seizure. The 2 patients with microhemorrhage each had three previous concussions, significantly more than patients whose scans were normal (median, 1) or abnormal without injury (median, 1.5; p = 0.048). MRI rarely revealed intracranial injuries in children post-concussion, and the clinical relevance of these uncommon findings remains unclear. Abnormalities unrelated to trauma are usually benign. However, MRI should be thoughtfully considered in children who present with concerning or atypical symptoms.
一部分患儿在儿童脑震荡后会持续出现症状，磁共振成像（MRI）常用于评估是否存在病变。但目前这种做法的实用性并不明确。我们进行了一项回顾性队列研究，旨在描述脑震荡患儿的 MRI 结果。通过交叉参考本机构 2010 年 1 月至 2016 年 3 月所有接受过儿童运动相关脑震荡的患者登记处和影像学研究数据库，我们确定了所有接受过 MRI 的患儿。对放射学报告进行了异常结果的审查。排除了因其他原因（非脑震荡）而进行异常计算机断层扫描或 MRI 扫描的患者。在确定的 3338 例脑震荡患儿中，427 例行 MRI 检查。仅有 2 例（0.5%）的检查结果符合创伤性损伤，均表现为微出血。61 例（14.3%）患儿的 MRI 检查结果异常与创伤无关，包括 24 例非特异性 T 变化、15 例松果体囊肿、8 例 Chiari I 型畸形和 5 例蛛网膜囊肿。1 例患儿因共济失调就诊后行小脑血管母细胞瘤开颅手术，另 1 例患儿因癫痫发作切除皮质发育不良。2 例微出血患儿均有 3 次既往脑震荡史，明显多于 MRI 检查正常（中位数，1 次）或异常但无损伤（中位数，1.5 次；p = 0.048）的患儿。MRI 很少在儿童脑震荡后发现颅内损伤，这些罕见发现的临床意义尚不清楚。与创伤无关的异常通常是良性的。但是，对于出现令人担忧或非典型症状的患儿，应慎重考虑进行 MRI 检查。
