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Original research
Can quantitative susceptibility mapping help diagnose and predict recovery of concussion in children? An A-CAP study
  1. Nicholas Sader1,
  2. David Gobbi1,2,3,4,
  3. Brad Goodyear1,2,3,4,
  4. Richard Frayne1,2,3,4,5,
  5. Ashley L Ware3,6,7,8,
  6. Miriam H Beauchamp9,
  7. William R Craig10,
  8. Quynh Doan11,
  9. Roger Zemek12,13,
  10. Jay Riva-Cambrin1,7,
  11. Keith Owen Yeates3,7,8
  12. On behalf of the Pediatric Emergency Research Canada A-CAP study team
  1. 1 Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  2. 2 Department of Radiology, University of Calgary, Calgary, Alberta, Canada
  3. 3 Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  4. 4 Seaman Family MR Research Centre and Calgary Image Processing and Analysis Centre (CIPAC), Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
  5. 5 Department of Neuroscience, University of Calgary, Calgary, Alberta, Canada
  6. 6 Department of Psychology, Georgia State University, Atlanta, Georgia, USA
  7. 7 Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
  8. 8 Department of Psychology, University of Calgary, Calgary, Alberta, Canada
  9. 9 Department of Psychology, University of Montreal & CHU Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
  10. 10 Department of Pediatrics, University of Alberta, Stollery Children’s Hospital, Edmonton, Alberta, Canada
  11. 11 Department of Pediatrics, University of British Columbia, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
  12. 12 Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
  13. 13 Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Keith Owen Yeates, Department of Psychology, University of Calgary, Calgary, Canada; kyeates{at}


Background Quantitative susceptibility mapping (QSM) is an MRI technique that is a potential biomarker for concussion. We performed QSM in children following concussion or orthopaedic injury (OI), to assess QSM performance as a diagnostic and prognostic biomarker.

Methods Children aged 8–17 years with either concussion (N=255) or OI (N=116) were recruited from four Canadian paediatric emergency departments and underwent QSM postacutely (2–33 days postinjury) using 3 Tesla MRI. QSM Z-scores within nine regions of interest (ROI) were compared between groups. QSM Z-scores were also compared with the 5P score, the current clinical benchmark for predicting persistent postconcussion symptoms (PPCS), at 4 weeks postinjury, with PPCS defined using reliable change methods based on both participant and parent reports.

Results Concussion and OI groups did not differ significantly in QSM Z-scores for any ROI. Higher QSM Z-scores within frontal white matter (WM) independently predicted PPCS based on parent ratings of cognitive symptoms (p=0.001). The combination of frontal WM QSM Z-score and 5P score was better at predicting PPCS than 5P score alone (p=0.004). The area under the curve was 0.72 (95% CI 0.63 to 0.81) for frontal WM susceptibility, 0.69 (95% CI 0.59 to 0.79) for the 5P score and 0.74 (95% CI 0.65 to 0.83) for both.

Conclusion The findings suggest that QSM is a potential MRI biomarker that can help predict PPCS in children with concussion, over and above the current clinical benchmark, and thereby aid in clinical management. They also suggest a frontal lobe substrate for PPCS, highlighting the potential for QSM to clarify the neurophysiology of paediatric concussion.

  • concussion
  • paediatric
  • MRI

Data availability statement

Data are available on reasonable request.

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Data availability statement

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  • Contributors NS: designed analyses, processed images, designed statistical analyses and analyzedanalysed data, drafted manuscript. DG: processed imaging data, edited manuscript. BG: edited manuscript. RF: edited manuscript. ALW: edited manuscript. MHB: edited manuscript. WRC: edited manuscript. QD: edited manuscript. RZ: edited manuscript. JR-C: designed statistical analyses, edited manuscript. KOY: designed parent study, provided data, designed statistical analyses, edited manuscript, guarantor. Data were verified by NS and KOY.

  • Funding This work is supported by a Canadian Institute of Health Research (CIHR) Foundation Grant (FDN143304) to KOY. NS received funding from the CIHR Frederick Banting and Charles Best Canada Graduate Scholarship Masters Award, Faculty of Graduate Studies Master’s Research Scholarship (University of Calgary), 2021 Canadian Society for Clinical Investigation (CSCI)/CIHR Resident Research Award, and the 2021 K.G. McKenzie Memorial Prize for Clinical Neuroscience Research from the Canadian Neurosurgical Society.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.