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Zuleger TM, Slutsky-Ganesh AB, Kim H, Anand M, Warren SM, Grooms DR, Yuan W, Riley MA, Gore RK, Myer GD, Diekfuss JA. Differential neural mechanisms for movement adaptations following neuromuscular training in young female athletes with a history of sports-related concussion. Neuroscience 2024; 558:70-80. [PMID: 39154844 PMCID: PMC11457832 DOI: 10.1016/j.neuroscience.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/22/2024] [Accepted: 08/08/2024] [Indexed: 08/20/2024]
Abstract
Sports-related concussion (SRC) in adolescent athletes is associated with an increased risk of subsequent lower extremity injury. Neuromuscular training (NMT) has shown promise for reducing lower extremity injuries following SRC, however, neural adaptations in response to changes in lower extremity biomechanics following NMT in athletes with a history of SRC (HxSRC) remains poorly understood. Therefore, the purpose of this study was to identify changes in neural activity associated with lower extremity movement adaptations following a six-week NMT intervention in athletes with a HxSRC. Thirty-two right-hand/foot-dominant female adolescent athletes (16 with self-reported HxSRC, 16 age- and anthropometrically-matched controls) completed a bilateral leg press task with 3D motion analysis during functional magnetic resonance imaging (fMRI). Movement adaptations were defined as a change in frontal and sagittal plane range of motion (ROM) during the fMRI bilateral leg press task. Significant pre- to post-NMT reductions were observed in the non-dominant (left) mean frontal plane ROM. Whole-brain neural correlate analysis revealed that increased cerebellar activity was significantly associated with reduced mean left-knee frontal ROM for matched controls. Exploratory within group analyses identified neural correlates in the postcentral gyrus for the HxSRC group which was associated with reduced mean left-knee frontal plane ROM. These distinct longitudinal changes provide preliminary evidence of differential neural activity associated with NMT to support knee frontal plane control in athletes with and without a HxSRC.
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Affiliation(s)
- Taylor M Zuleger
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; Neuroscience Graduate Program, University of Cincinnati, Cincinnati, OH, USA.
| | - Alexis B Slutsky-Ganesh
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - HoWon Kim
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA
| | - Manish Anand
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; Department of Mechanical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Shayla M Warren
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA; Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Science and Professions, Ohio University, Grover Center, Athens, OH, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Michael A Riley
- Department of Rehabilitation, Exercise, & Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA; Human Performance & Neuromechanics Lab, University of Cincinnati Digital Futures, Cincinnati, OH, USA
| | - Russell K Gore
- Shepherd Center, Atlanta, GA, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
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Beard K, Gauff AK, Pennington AM, Marion DW, Smith J, Sloley S. Biofluid, Imaging, Physiological, and Functional Biomarkers of Mild Traumatic Brain Injury and Subconcussive Head Impacts. J Neurotrauma 2024. [PMID: 38943278 DOI: 10.1089/neu.2024.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024] Open
Abstract
Post-concussive symptoms are frequently reported by individuals who sustain mild traumatic brain injuries (mTBIs) and subconcussive head impacts, even when evidence of intracranial pathology is lacking. Current strategies used to evaluate head injuries, which primarily rely on self-report, have a limited ability to predict the incidence, severity, and duration of post-concussive symptoms that will develop in an individual patient. In addition, these self-report measures have little association with the underlying mechanisms of pathology that may contribute to persisting symptoms, impeding advancement in precision treatment for TBI. Emerging evidence suggests that biofluid, imaging, physiological, and functional biomarkers associated with mTBI and subconcussive head impacts may address these shortcomings by providing more objective measures of injury severity and underlying pathology. Interest in the use of biomarker data has rapidly accelerated, which is reflected by the recent efforts of organizations such as the National Institute of Neurological Disorders and Stroke and the National Academies of Sciences, Engineering, and Medicine to prioritize the collection of biomarker data during TBI characterization in acute-care settings. Thus, this review aims to describe recent progress in the identification and development of biomarkers of mTBI and subconcussive head impacts and to discuss important considerations for the implementation of these biomarkers in clinical practice.
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Affiliation(s)
- Kryshawna Beard
- General Dynamics Information Technology Fairfax, Falls Church, Virginia, USA
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Amina K Gauff
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Xynergie Federal, LLC, San Juan, United States Minor Outlying Islands
| | - Ashley M Pennington
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Xynergie Federal, LLC, San Juan, United States Minor Outlying Islands
| | - Donald W Marion
- General Dynamics Information Technology Fairfax, Falls Church, Virginia, USA
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Johanna Smith
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Stephanie Sloley
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
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Lavoie G, Bolduc M, Sicard V, Lepore F, Ellemberg D. Maintaining Cognitive Performance at the Expense of Gait Speed for Asymptomatic Concussed Athletes: A Novel Dual-Task and Post-Exercise Assessment. Brain Sci 2024; 14:715. [PMID: 39061455 PMCID: PMC11274567 DOI: 10.3390/brainsci14070715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/09/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Our goal was to evaluate persisting deficits in gait and executive functioning in asymptomatic athletes with a history of concussion using a novel approach combining a dual-task paradigm and post-exercise exertion. Thirty-eight athletes aged 17 to 25 years old participated in the study, including 18 with a history of concussion. The dual-task paradigm required walking continuously at a predetermined self-paced target speed of 6.5 km/h while executing a complex switch task. Athletes completed two conditions, each on separate days: (1) dual task alone and (2) dual task following 20 min of running on a non-motorized treadmill. The statistical analyses revealed a significant reduction in gait speed exclusively for athletes with a history of concussion and only following the post-exercise condition (p = 0.008). These findings suggest that although asymptomatic concussed athletes maintain a cognitive performance comparable to non-concussed athletes, this appears to be achieved at the expense of gait speed. Our results underscore the importance of incorporating gait assessments and post-exercise exertion into concussion evaluation protocols in both research and clinical settings.
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Affiliation(s)
- Gabriel Lavoie
- Psychology, University of Montreal, Montréal, QC H3T 1J4, Canada; (G.L.); (M.B.); (F.L.)
| | - Mathieu Bolduc
- Psychology, University of Montreal, Montréal, QC H3T 1J4, Canada; (G.L.); (M.B.); (F.L.)
| | | | - Franco Lepore
- Psychology, University of Montreal, Montréal, QC H3T 1J4, Canada; (G.L.); (M.B.); (F.L.)
| | - Dave Ellemberg
- Kinesiology, University of Montreal, Montréal, QC H3T 1J4, Canada
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Weaver C, Xiao L, Wen Q, Wu YC, Harezlak J. Biclustering Multivariate Longitudinal Data with Application to Recovery Trajectories of White Matter After Sport-Related Concussion. DATA SCIENCE IN SCIENCE 2024; 3:2376535. [PMID: 39398101 PMCID: PMC11466369 DOI: 10.1080/26941899.2024.2376535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/22/2024] [Accepted: 07/01/2024] [Indexed: 10/15/2024]
Abstract
Biclustering is the task of simultaneously clustering the samples and features of a data set. In doing so, subsets of samples that exhibit similar behaviors across subsets of features can be identified. Motivated by a longitudinal diffusion tensor imaging study of sport-related concussion (SRC), we present the problem of biclustering multivariate longitudinal data in which subjects and features are grouped simultaneously based on longitudinal patterns rather than magnitude. We propose a penalized regression based method for solving this problem by exploiting the heterogeneity in the longitudinal patterns within subjects and features. We evaluate the performance of the proposed methods via a simulation study and apply them to the motivating dataset, revealing distinctive patterns of white-matter abnormalities within subgroups of SRC cases.
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Affiliation(s)
- Caleb Weaver
- Department of Statistics, North Carolina State University
| | - Luo Xiao
- Department of Statistics, North Carolina State University
| | - Qiuting Wen
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine
| | - Yu-Chien Wu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University Bloomington
- Department of Mathematics, University of Wrocław, Poland
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Dybing KM, McAllister TW, Wu YC, McDonald BC, Broglio SP, Mihalik JP, Guskiewicz KM, Goldman JT, Jackson JC, Risacher SL, Saykin AJ, Nudelman KNH. Association of Alzheimer's disease polygenic risk score with concussion severity and recovery metrics. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.10.24309042. [PMID: 39040205 PMCID: PMC11261937 DOI: 10.1101/2024.07.10.24309042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Identification of genetic alleles associated with both Alzheimer's disease (AD) and concussion severity/recovery could help explain the association between concussion and elevated dementia risk. However, there has been little investigation into whether AD risk genes associate with concussion severity/recovery, and the limited findings are mixed. We used AD polygenic risk scores (PRS) and APOE genotypes to investigate any such associations in the NCAA-DoD Grand Alliance CARE Consortium (CARE) dataset. We assessed six outcomes in 931 total participants. The outcomes were two concussion recovery measures (number of days to asymptomatic status, number of days to return to play (RTP)) and four concussion severity measures (scores on SAC and BESS, SCAT symptom severity, and total number of symptoms). We calculated PRS using a published score [1] and performed multiple linear regression (MLR) to assess the relationship of PRS with the outcomes. We also used t-tests and chi-square tests to examine outcomes by APOE genotype, and MLR to analyze outcomes in European and African genetic ancestry subgroups. Higher PRS was associated with longer injury to RTP in the normal RTP (<24 days) subgroup ( p = 0.024), and one standard deviation increase in PRS resulted in a 9.89 hour increase to the RTP interval. There were no other consistently significant effects, suggesting that high AD genetic risk is not strongly associated with more severe concussions or poor recovery in young adults. Future studies should attempt to replicate these findings in larger samples with longer follow-up using PRS calculated from diverse populations.
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Hadi Z, Mahmud M, Seemungal BM. Brain Mechanisms Explaining Postural Imbalance in Traumatic Brain Injury: A Systematic Review. Brain Connect 2024; 14:144-177. [PMID: 38343363 DOI: 10.1089/brain.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Introduction: Persisting imbalance and falls in community-dwelling traumatic brain injury (TBI) survivors are linked to reduced long-term survival. However, a detailed understanding of the impact of TBI upon the brain mechanisms mediating imbalance is lacking. To understand the state of the art concerning the brain mechanisms mediating imbalance in TBI, we performed a systematic review of the literature. Methods: PubMed, Web of Science, and Scopus were searched and peer-reviewed research articles in humans, with any severity of TBI (mild, moderate, severe, or concussion), which linked a postural balance assessment (objective or subjective) with brain imaging (through computed tomography, T1-weighted imaging, functional magnetic resonance imaging [fMRI], resting-state fMRI, diffusion tensor imaging, magnetic resonance spectroscopy, single-photon emission computed tomography, electroencephalography, magnetoencephalography, near-infrared spectroscopy, and evoked potentials) were included. Out of 1940 articles, 60 were retrieved and screened, and 25 articles fulfilling inclusion criteria were included. Results: The most consistent finding was the link between imbalance and the cerebellum; however, the regions within the cerebellum were inconsistent. Discussion: The lack of consistent findings could reflect that imbalance in TBI is due to a widespread brain network dysfunction, as opposed to focal cortical damage. The inconsistency in the reported findings may also be attributed to heterogeneity of methodology, including data analytical techniques, small sample sizes, and choice of control groups. Future studies should include a detailed clinical phenotyping of vestibular function in TBI patients to account for the confounding effect of peripheral vestibular disorders on imbalance and brain imaging.
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Affiliation(s)
- Zaeem Hadi
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mohammad Mahmud
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Barry M Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Zuleger TM, Slutsky-Ganesh AB, Anand M, Kim H, Warren SM, Grooms DR, Foss KDB, Riley MA, Yuan W, Gore RK, Myer GD, Diekfuss JA. The effects of sports-related concussion history on female adolescent brain activity and connectivity for bilateral lower extremity knee motor control. Psychophysiology 2023; 60:e14314. [PMID: 37114838 PMCID: PMC10523876 DOI: 10.1111/psyp.14314] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/17/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023]
Abstract
Sports-related concussions (SRCs) are associated with neuromuscular control deficits in athletes following return to play. However, the connection between SRC and potentially disrupted neural regulation of lower extremity motor control has not been investigated. The purpose of this study was to investigate brain activity and connectivity during a functional magnetic resonance imaging (fMRI) lower extremity motor control task (bilateral leg press) in female adolescent athletes with a history of SRC. Nineteen female adolescent athletes with a history of SRC and nineteen uninjured (without a history of SRC) age- and sport-matched control athletes participated in this study. Athletes with a history of SRC exhibited less neural activity in the left inferior parietal lobule/supramarginal gyrus (IPL) during the bilateral leg press compared to matched controls. Based upon signal change detected in the brain activity analysis, a 6 mm region of interest (seed) was defined to perform secondary connectivity analyses using psychophysiological interaction (PPI) analyses. During the motor control task, the left IPL (seed) was significantly connected to the right posterior cingulate gyrus/precuneus cortex and right IPL for athletes with a history of SRC. The left IPL was significantly connected to the left primary motor cortex (M1) and primary somatosensory cortex (S1), right inferior temporal gyrus, and right S1 for matched controls. Altered neural activity in brain regions important for sensorimotor integration and motor attention, combined with unique connectivity to regions responsible for attentional, cognitive, and proprioceptive processing, indicate compensatory neural mechanisms may underlie the lingering neuromuscular control deficits associated with SRC.
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Affiliation(s)
- Taylor M. Zuleger
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- University of Cincinnati, Neuroscience Graduate Program, Cincinnati, OH, USA
| | - Alexis B. Slutsky-Ganesh
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Manish Anand
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Mechanical Engineering, Indian Institute of Technology Madras, Chennai, TN, India
| | - HoWon Kim
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA
| | - Shayla M. Warren
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Science and Professions, Ohio University, Grover Center, Athens, OH, USA
| | - Kim D. Barber Foss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael A. Riley
- Department of Rehabilitation, Exercise, & Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Russell K. Gore
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- Shepherd Center, Atlanta, GA, USA
| | - Gregory D. Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Jed A. Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
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Goubran M, Mills BD, Georgiadis M, Karimpoor M, Mouchawar N, Sami S, Dennis EL, Akers C, Mitchell L, Boldt B, Douglas D, DiGiacomo PS, Rosenberg J, Grant G, Wintermark M, Camarillo DB, Zeineh M. Microstructural Alterations in Tract Development in College Football and Volleyball Players: A Longitudinal Diffusion MRI Study. Neurology 2023; 101:e953-e965. [PMID: 37479529 PMCID: PMC10501097 DOI: 10.1212/wnl.0000000000207543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 05/05/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Repeated impacts in high-contact sports such as American football can affect the brain's microstructure, which can be studied using diffusion MRI. Most imaging studies are cross-sectional, do not include low-contact players as controls, or lack advanced tract-specific microstructural metrics. We aimed to investigate longitudinal changes in high-contact collegiate athletes compared with low-contact controls using advanced diffusion MRI and automated fiber quantification. METHODS We examined brain microstructure in high-contact (football) and low-contact (volleyball) collegiate athletes with up to 4 years of follow-up. Inclusion criteria included university and team enrollment. Exclusion criteria included history of neurosurgery, severe brain injury, and major neurologic or substance abuse disorder. We investigated diffusion metrics along the length of tracts using nested linear mixed-effects models to ascertain the acute and chronic effects of subconcussive and concussive impacts, and associations between diffusion changes with clinical, behavioral, and sports-related measures. RESULTS Forty-nine football and 24 volleyball players (271 total scans) were included. Football players had significantly divergent trajectories in multiple microstructural metrics and tracts. Longitudinal increases in fractional anisotropy and axonal water fraction, and decreases in radial/mean diffusivity and orientation dispersion index, were present in volleyball but absent in football players (all findings |T-statistic|> 3.5, p value <0.0001). This pattern was present in the callosum forceps minor, superior longitudinal fasciculus, thalamic radiation, and cingulum hippocampus. Longitudinal differences were more prominent and observed in more tracts in concussed football players (n = 24, |T|> 3.6, p < 0.0001). An analysis of immediate postconcussion scans (n = 12) demonstrated a transient localized increase in axial diffusivity and mean/radial kurtosis in the uncinate and cingulum hippocampus (|T| > 3.7, p < 0.0001). Finally, within football players, those with high position-based impact risk demonstrated increased intracellular volume fraction longitudinally (T = 3.6, p < 0.0001). DISCUSSION The observed longitudinal changes seen in football, and especially concussed athletes, could reveal diminished myelination, altered axonal calibers, or depressed pruning processes leading to a static, nondecreasing axonal dispersion. This prospective longitudinal study demonstrates divergent tract-specific trajectories of brain microstructure, possibly reflecting a concussive and repeated subconcussive impact-related alteration of white matter development in football athletes.
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Affiliation(s)
- Maged Goubran
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Brian David Mills
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Marios Georgiadis
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Mahta Karimpoor
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Nicole Mouchawar
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Sohrab Sami
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Emily Larson Dennis
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Carolyn Akers
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Lex Mitchell
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Brian Boldt
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - David Douglas
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Phillip Scott DiGiacomo
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Jarrett Rosenberg
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Gerald Grant
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Max Wintermark
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - David Benjamin Camarillo
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA
| | - Michael Zeineh
- From the Departments of Radiology (Maged Goubran, B.D.M., Marios Georgiadis, M.K., N.M., C.A., L.M., D.D., P.S.D., J.R., M.W., M.Z.), Neurosurgery (G.G.), and Bioengineering (D.B.C.), Stanford University, CA; Department of Medical Biophysics (Maged Goubran) and Physical Sciences Platform & Hurvitz Brain Sciences Research Program (Maged Goubran), Sunnybrook Research Institute, University of Toronto, ON, Canada; Stanford Center for Clinical Research (S.S.), CA; Department of Neurology (E.L.D.), University of Utah School of Medicine, Salt Lake City; Department of Radiology (B.B.), Uniformed Services University of the Health Sciences, Bethesda, MD; and Department of Radiology (B.B.), Madigan Army Medical Center, Tacoma, WA.
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9
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Danielli E, Simard N, DeMatteo CA, Kumbhare D, Ulmer S, Noseworthy MD. A review of brain regions and associated post-concussion symptoms. Front Neurol 2023; 14:1136367. [PMID: 37602240 PMCID: PMC10435092 DOI: 10.3389/fneur.2023.1136367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
The human brain is an exceptionally complex organ that is comprised of billions of neurons. Therefore, when a traumatic event such as a concussion occurs, somatic, cognitive, behavioral, and sleep impairments are the common outcome. Each concussion is unique in the sense that the magnitude of biomechanical forces and the direction, rotation, and source of those forces are different for each concussive event. This helps to explain the unpredictable nature of post-concussion symptoms that can arise and resolve. The purpose of this narrative review is to connect the anatomical location, healthy function, and associated post-concussion symptoms of some major cerebral gray and white matter brain regions and the cerebellum. As a non-exhaustive description of post-concussion symptoms nor comprehensive inclusion of all brain regions, we have aimed to amalgamate the research performed for specific brain regions into a single article to clarify and enhance clinical and research concussion assessment. The current status of concussion diagnosis is highly subjective and primarily based on self-report of symptoms, so this review may be able to provide a connection between brain anatomy and the clinical presentation of concussions to enhance medical imaging assessments. By explaining anatomical relevance in terms of clinical concussion symptom presentation, an increased understanding of concussions may also be achieved to improve concussion recognition and diagnosis.
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Affiliation(s)
- Ethan Danielli
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Nicholas Simard
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - Carol A. DeMatteo
- ARiEAL Research Centre, McMaster University, Hamilton, ON, Canada
- Department of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Dinesh Kumbhare
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephan Ulmer
- Neurorad.ch, Zurich, Switzerland
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Michael D. Noseworthy
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
- ARiEAL Research Centre, McMaster University, Hamilton, ON, Canada
- Department of Radiology, McMaster University, Hamilton, ON, Canada
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10
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Nishat E, Stojanovski S, Scratch SE, Ameis SH, Wheeler AL. Premature white matter microstructure in female children with a history of concussion. Dev Cogn Neurosci 2023; 62:101275. [PMID: 37441978 PMCID: PMC10439504 DOI: 10.1016/j.dcn.2023.101275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/18/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
Childhood concussion may interfere with neurodevelopment and influence cognition. Females are more likely to experience persistent symptoms after concussion, yet the sex-specific impact of concussion on brain microstructure in children is understudied. This study examined white matter and cortical microstructure, based on neurite density (ND) from diffusion-weighted MRI, in 9-to-10-year-old children in the Adolescent Brain Cognitive Development Study with (n = 336) and without (n = 7368) a history of concussion, and its relationship with cognitive performance. Multivariate regression was used to investigate relationships between ND and group, sex, and age in deep and superficial white matter, subcortical structures, and cortex. Partial least square correlation was performed to identify associations between ND and performance on NIH Toolbox tasks in children with concussion. All tissue types demonstrated higher ND with age, reflecting brain maturation. Group comparisons revealed higher ND in deep and superficial white matter in females with concussion. In female but not male children with concussion, there were significant associations between ND and performance on cognitive tests. These results demonstrate a greater long-term impact of childhood concussion on white matter microstructure in females compared to males that is associated with cognitive function. The increase in ND in females may reflect premature white matter maturation.
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Affiliation(s)
- Eman Nishat
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario M5G 0A4, Canada
| | - Sonja Stojanovski
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario M5G 0A4, Canada
| | - Shannon E Scratch
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5G 1V7, Canada; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario M4G 1R8, Canada
| | - Stephanie H Ameis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5T 1R8, Canada; Cundill Centre for Child and Youth Depression, Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario M6J 1H4, Canada
| | - Anne L Wheeler
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario M5G 0A4, Canada.
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11
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Esopenko C, Sollmann N, Bonke EM, Wiegand TLT, Heinen F, de Souza NL, Breedlove KM, Shenton ME, Lin AP, Koerte IK. Current and Emerging Techniques in Neuroimaging of Sport-Related Concussion. J Clin Neurophysiol 2023; 40:398-407. [PMID: 36930218 PMCID: PMC10329721 DOI: 10.1097/wnp.0000000000000864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY Sport-related concussion (SRC) affects an estimated 1.6 to 3.8 million Americans each year. Sport-related concussion results from biomechanical forces to the head or neck that lead to a broad range of neurologic symptoms and impaired cognitive function. Although most individuals recover within weeks, some develop chronic symptoms. The heterogeneity of both the clinical presentation and the underlying brain injury profile make SRC a challenging condition. Adding to this challenge, there is also a lack of objective and reliable biomarkers to support diagnosis, to inform clinical decision making, and to monitor recovery after SRC. In this review, the authors provide an overview of advanced neuroimaging techniques that provide the sensitivity needed to capture subtle changes in brain structure, metabolism, function, and perfusion after SRC. This is followed by a discussion of emerging neuroimaging techniques, as well as current efforts of international research consortia committed to the study of SRC. Finally, the authors emphasize the need for advanced multimodal neuroimaging to develop objective biomarkers that will inform targeted treatment strategies after SRC.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Nico Sollmann
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena M. Bonke
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, Munich, Germany
| | - Tim L. T. Wiegand
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Felicitas Heinen
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nicola L. de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Katherine M. Breedlove
- Center for Clinical Spectroscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Alexander P. Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Center for Clinical Spectroscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Inga K. Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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12
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Diffusion-Weighted Imaging in Mild Traumatic Brain Injury: A Systematic Review of the Literature. Neuropsychol Rev 2023; 33:42-121. [PMID: 33721207 DOI: 10.1007/s11065-021-09485-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
There is evidence that diffusion-weighted imaging (DWI) is able to detect tissue alterations following mild traumatic brain injury (mTBI) that may not be observed on conventional neuroimaging; however, findings are often inconsistent between studies. This systematic review assesses patterns of differences in DWI metrics between those with and without a history of mTBI. A PubMed literature search was performed using relevant indexing terms for articles published prior to May 14, 2020. Findings were limited to human studies using DWI in mTBI. Articles were excluded if they were not full-length, did not contain original data, if they were case studies, pertained to military populations, had inadequate injury severity classification, or did not report post-injury interval. Findings were reported independently for four subgroups: acute/subacute pediatric mTBI, acute/subacute adult mTBI, chronic adult mTBI, and sport-related concussion, and all DWI acquisition and analysis methods used were included. Patterns of findings between studies were reported, along with strengths and weaknesses of the current state of the literature. Although heterogeneity of sample characteristics and study methods limited the consistency of findings, alterations in DWI metrics were most commonly reported in the corpus callosum, corona radiata, internal capsule, and long association pathways. Many acute/subacute pediatric studies reported higher FA and lower ADC or MD in various regions. In contrast, acute/subacute adult studies most commonly indicate lower FA within the context of higher MD and RD. In the chronic phase of recovery, FA may remain low, possibly indicating overall demyelination or Wallerian degeneration over time. Longitudinal studies, though limited, generally indicate at least a partial normalization of DWI metrics over time, which is often associated with functional improvement. We conclude that DWI is able to detect structural mTBI-related abnormalities that may persist over time, although future DWI research will benefit from larger samples, improved data analysis methods, standardized reporting, and increasing transparency.
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13
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Sheldrake E, Lam B, Al-Hakeem H, Wheeler AL, Goldstein BI, Dunkley BT, Ameis S, Reed N, Scratch SE. A Scoping Review of Magnetic Resonance Modalities Used in Detection of Persistent Postconcussion Symptoms in Pediatric Populations. J Child Neurol 2022; 38:85-102. [PMID: 36380680 DOI: 10.1177/08830738221120741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Up to 30% of youth with concussion experience PPCSs (PPCS) lasting 4 weeks or longer, and can significantly impact quality of life. Magnetic resonance imaging (MRI) has the potential to increase understanding of causal mechanisms underlying PPCS. However, there are no clear modalities to assist in detecting PPCS. This scoping review aims to synthesize findings on utilization of MRI among children and youth with PPCS, and summarize progress and limitations. Thirty-six studies were included from 4907 identified papers. Many studies used multiple modalities, including (1) structural (n = 27) such as T1-weighted imaging, diffusion weighted imaging, and susceptibility weighted imaging; and (2) functional (n = 23) such as functional MRI and perfusion-weighted imaging. Findings were heterogeneous among modalities and regions of interest, which warrants future reviews that report on the patterns and potential advancements in the field. Consideration of modalities that target PPCS prediction and sensitive modalities that can supplement a biopsychosocial approach to PPCS would benefit future research.
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Affiliation(s)
- Elena Sheldrake
- Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Lam
- Bloorview Research Institute, Toronto, Ontario, Canada
| | | | - Anne L Wheeler
- Neuroscience and Mental Health Program, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- 7978Centre for Addiction and Mental Health, Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin T Dunkley
- Neuroscience and Mental Health Program, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Ameis
- 7978Centre for Addiction and Mental Health, Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Shannon E Scratch
- Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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14
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Mustafi SM, Yang HC, Harezlak J, Meier TB, Brett BL, Giza CC, Goldman J, Guskiewicz KM, Mihalik JP, LaConte SM, Duma SM, Broglio SP, McCrea MA, McAllister TW, Wu YC. Effects of White-Matter Tract Length in Sport-Related Concussion: A Tractography Study from the NCAA-DoD CARE Consortium. J Neurotrauma 2022; 39:1495-1506. [PMID: 35730116 PMCID: PMC9689766 DOI: 10.1089/neu.2021.0239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Sport-related concussion (SRC) is an important public health issue. White-matter alterations after SRC are widely studied by neuroimaging approaches, such as diffusion magnetic resonance imaging (MRI). Although the exact anatomical location of the alterations may differ, significant white-matter alterations are commonly observed in long fiber tracts, but are never proven. In the present study, we performed streamline tractography to characterize the association between tract length and white-matter microstructural alterations after SRC. Sixty-eight collegiate athletes diagnosed with acute concussion (24-48 h post-injury) and 64 matched contact-sport controls were included in this study. The athletes underwent diffusion tensor imaging (DTI) in 3.0 T MRI scanners across three study sites. DTI metrics were used for tract-based spatial statistics to map white-matter regions-of-interest (ROIs) with significant group differences. Whole-brain white-mater streamline tractography was performed to extract "affected" white-matter streamlines (i.e., streamlines passing through the identified ROIs). In the concussed athletes, streamline counts and DTI metrics of the affected white-matter fiber tracts were summarized and compared with unaffected white-matter tracts across tract length in the same participant. The affected white-matter tracts had a high streamline count at length of 80-100 mm and high length-adjusted affected ratio for streamline length longer than 80 mm. DTI mean diffusivity was higher in the affected streamlines longer than 100 mm with significant associations with the Brief Symptom Inventory score. Our findings suggest that long fibers in the brains of collegiate athletes are more vulnerable to acute SRC with higher mean diffusivity and a higher affected ratio compared with the whole distribution.
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Affiliation(s)
- Sourajit M. Mustafi
- Institute of Genetics, San Diego, California, USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ho-Ching Yang
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Timothy B. Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher C. Giza
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
- Division of Pediatric Neurology, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA
| | - Joshua Goldman
- Family Medicine, Ronald Reagan UCLA Medical Center, UCLA Health - Santa Monica Medical Center, Los Angeles, California, USA
| | - Kevin M. Guskiewicz
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason P. Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen M. LaConte
- School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University, Blacksburg, Virginia, USA
- Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Stefan M. Duma
- School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University, Blacksburg, Virginia, USA
| | - Steven P. Broglio
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas W. McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yu-Chien Wu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
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15
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Mito R, Parker DM, Abbott DF, Makdissi M, Pedersen M, Jackson GD. White matter abnormalities characterize the acute stage of sports-related mild traumatic brain injury. Brain Commun 2022; 4:fcac208. [PMID: 36043140 PMCID: PMC9419063 DOI: 10.1093/braincomms/fcac208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/29/2022] [Accepted: 08/14/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Sports-related concussion, a form of mild traumatic brain injury, is characterized by transient disturbances of brain function. There is increasing evidence that functional brain changes may be driven by subtle abnormalities in white matter microstructure, and diffusion MRI has been instrumental in demonstrating these white matter abnormalities in vivo. However, the reported location and direction of the observed white matter changes in mild traumatic brain injury are variable, likely attributable to the inherent limitations of the white matter models used. This cross-sectional study applies an advanced and robust technique known as fixel-based analysis to investigate fibre tract-specific abnormalities in professional Australian Football League players with a recent mild traumatic brain injury. We used the fixel-based analysis framework to identify common abnormalities found in specific fibre tracts in participants with an acute injury (≤12 days after injury; n = 14). We then assessed whether similar changes exist in subacute injury (>12 days and <3 months after injury; n = 15). The control group was 29 neurologically healthy control participants. We assessed microstructural differences in fibre density and fibre bundle morphology and performed whole-brain fixel-based analysis to compare groups. Subsequent tract-of-interest analyses were performed within five selected white matter tracts to investigate the relationship between the observed tract-specific abnormalities and days since injury and the relationship between these tract-specific changes with cognitive abnormalities. Our whole-brain analyses revealed significant increases in fibre density and bundle cross-section in the acute mild traumatic brain injury group when compared with controls. The acute mild traumatic brain injury group showed even more extensive differences when compared with the subacute injury group than with controls. The fibre structures affected in acute concussion included the corpus callosum, left prefrontal and left parahippocampal white matter. The fibre density and cross-sectional increases were independent of time since injury in the acute injury group, and were not associated with cognitive deficits. Overall, this study demonstrates that acute mild traumatic brain injury is characterized by specific white matter abnormalities, which are compatible with tract-specific cytotoxic oedema. These potential oedematous changes were absent in our subacute mild traumatic brain injury participants, suggesting that they may normalize within 12 days after injury, although subtle abnormalities may persist in the subacute stage. Future longitudinal studies are needed to elucidate individualized recovery after brain injury.
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Affiliation(s)
- Remika Mito
- Florey Institute of Neuroscience and Mental Health , Melbourne, VIC 3084 , Australia
| | - Donna M Parker
- Florey Institute of Neuroscience and Mental Health , Melbourne, VIC 3084 , Australia
| | - David F Abbott
- Florey Institute of Neuroscience and Mental Health , Melbourne, VIC 3084 , Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne , Melbourne, VIC 3052 , Australia
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health , Melbourne, VIC 3084 , Australia
- Olympic Park Sports Medicine Centre , Melbourne, VIC 3004 , Australia
| | - Mangor Pedersen
- Florey Department of Neuroscience and Mental Health, University of Melbourne , Melbourne, VIC 3052 , Australia
- Department of Psychology and Neuroscience, Auckland University of Technology (AUT) , Auckland 1010 , New Zealand
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health , Melbourne, VIC 3084 , Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne , Melbourne, VIC 3052 , Australia
- Department of Neurology, Austin Health , Melbourne, VIC 3084 , Australia
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16
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Chung S, Chen J, Li T, Wang Y, Lui YW. Investigating Brain White Matter in Football Players with and without Concussion Using a Biophysical Model from Multishell Diffusion MRI. AJNR Am J Neuroradiol 2022; 43:823-828. [PMID: 35589140 DOI: 10.3174/ajnr.a7522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There have been growing concerns around potential risks related to sports-related concussion and contact sport exposure to repetitive head impacts in young athletes. Here we investigate WM microstructural differences between collegiate football players with and without sports-related concussion. MATERIALS AND METHODS The study included 78 collegiate athletes (24 football players with sports-related concussion, 26 football players with repetitive head impacts, and 28 non-contact-sport control athletes), available through the Federal Interagency Traumatic Brain Injury Research registry. Diffusion metrics of diffusion tensor/kurtosis imaging and WM tract integrity were calculated. Tract-Based Spatial Statistics and post hoc ROI analyses were performed to test group differences. RESULTS Significantly increased axial kurtosis in those with sports-related concussion compared with controls was observed diffusely across the whole-brain WM, and some focal areas demonstrated significantly higher mean kurtosis and extra-axonal axial diffusivity in sports-related concussion. The extent of significantly different WM regions decreased across time points and remained present primarily in the corpus callosum. Similar differences in axial kurtosis were found between the repetitive head impact and control groups. Other significant differences were seen at unrestricted return-to-play with lower radial kurtosis and intra-axonal diffusivity in those with sports-related concussion compared with the controls, mainly restricted to the posterior callosum. CONCLUSIONS This study highlights the fact that there are differences in diffusion microstructure measures that are present not only between football players with sports-related injuries and controls, but that there are also measurable differences between football players with repetitive head impacts and controls. This work reinforces previous work showing that the corpus callosum is specifically implicated in sports-related concussion and also suggests this to be true for repetitive head impacts.
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Affiliation(s)
- S Chung
- From the Department of Radiology (S.C., Y.W.L.), Center for Advanced Imaging Innovation and Research .,Department of Radiology (S.C., Y.W.L.), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University Grossman School of Medicine, New York, New York
| | - J Chen
- Department of Electrical and Computer Engineering (J.C., T.L., Y.W.), New York University Tandon School of Engineering, Brooklyn, New York
| | - T Li
- Department of Electrical and Computer Engineering (J.C., T.L., Y.W.), New York University Tandon School of Engineering, Brooklyn, New York
| | - Y Wang
- Department of Electrical and Computer Engineering (J.C., T.L., Y.W.), New York University Tandon School of Engineering, Brooklyn, New York
| | - Y W Lui
- From the Department of Radiology (S.C., Y.W.L.), Center for Advanced Imaging Innovation and Research.,Department of Radiology (S.C., Y.W.L.), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University Grossman School of Medicine, New York, New York
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17
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Under the Helmet: Perioperative Concussion-Review of Current Literature and Targets for Research. J Neurosurg Anesthesiol 2022; 34:277-281. [PMID: 35522842 DOI: 10.1097/ana.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Abstract
Patients with recent concussion experience disruption in neurocellular and neurometabolic function that may persist beyond symptom resolution. Patients may require anesthesia to facilitate diagnostic or surgical procedures following concussion; these procedures may or may not be related to the injury that caused the patient to sustain a concussion. As our knowledge about concussion continues to advance, it is imperative that anesthesiologists remain up to date with current principles. This Focused Review will update readers on the latest concussion literature, discuss the potential impact of concussion on perianesthetic care, and identify knowledge gaps in our understanding of concussion.
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18
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Wang ML, Wei XE, Yu MM, Li WB. Cognitive impairment in mild traumatic brain injury: a diffusion kurtosis imaging and volumetric study. Acta Radiol 2022; 63:504-512. [PMID: 33641452 DOI: 10.1177/0284185121998317] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND A significant number of patients with mild traumatic brain injury (mTBI) would experience cognitive deficit. PURPOSE To investigate the brain structural changes in sub-acute mTBI by diffusion kurtosis imaging (DKI) and volumetric analysis, and to assess the relationship between brain structural changes and cognitive functions. MATERIAL AND METHODS A total of 23 patients with sub-acute mTBI and 24 control participants were recruited. All the participants underwent examinations of neuropsychological tests, DKI, and magnetic resonance imaging (MRI)-based morphological scans. Images were investigated using whole brain-based analysis and further regions of interest-based analysis for subcortical nuclei. The neuropsychological tests were compared between the mTBI and the control group. Correlation analysis was performed to examine the relationship between gray matter (GM) volume, DKI parameters, and cognitive functions. RESULTS Compared with control participants, mTBI patients performed worse in the domains of verbal memory, attention and executive function (P < 0.05). No regional GM volume differences were observed between the mTBI and control groups (P > 0.05). Using DKI, patients with mTBI showed lower mean kurtosis (MK) in widespread white matter (WM) regions and several subcortical nuclei (P < 0.05), and higher mean diffusivity (MD) in the right pallidum (P < 0.05). Lower MK value of multiple WM regions and several subcortical nuclei correlated with cognitive impairment (P < 0.05). CONCLUSION DKI was sensitive in detecting brain microstructural changes in patients with sub-acute mTBI showing lower MK value in widespread WM regions and several subcortical nuclei, which were statistically associated with cognitive deficits.
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Affiliation(s)
- Ming-Liang Wang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xiao-Er Wei
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Meng-Meng Yu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Wen-Bin Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Imaging center, Kashgar Prefecture Second People’s Hospital, Kashgar, PR China
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19
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Huang S, Huang C, Li M, Zhang H, Liu J. White Matter Abnormalities and Cognitive Deficit After Mild Traumatic Brain Injury: Comparing DTI, DKI, and NODDI. Front Neurol 2022; 13:803066. [PMID: 35359646 PMCID: PMC8960262 DOI: 10.3389/fneur.2022.803066] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/24/2022] [Indexed: 12/29/2022] Open
Abstract
White matter (WM) disruption is an important determinant of cognitive impairment after mild traumatic brain injury (mTBI), but traditional diffusion tensor imaging (DTI) shows some limitations in assessing WM damage. Diffusion kurtosis imaging (DKI) and neurite orientation dispersion and density imaging (NODDI) show advantages over DTI in this respect. Therefore, we used these three diffusion models to investigate complex WM changes in the acute stage after mTBI. From 32 mTBI patients and 31 age-, sex-, and education-matched healthy controls, we calculated eight diffusion metrics based on DTI (fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity), DKI (mean kurtosis), and NODDI (orientation dispersion index, volume fraction of intracellular water (Vic), and volume fraction of the isotropic diffusion compartment). We used tract-based spatial statistics to identify group differences at the voxel level, and we then assessed the correlation between diffusion metrics and cognitive function. We also performed subgroup comparisons based on loss of consciousness. Patients showed WM abnormalities and cognitive deficit. And these two changes showed positive correlation. The correlation between Vic of the splenium of the corpus callosum and Digit Symbol Substitution Test scores showed the smallest p-value (p = 0.000, r = 0.481). We concluded that WM changes, especially in the splenium of the corpus callosum, correlate to cognitive deficit in this study. Furthermore, the high voxel count of NODDI results and the consistency of mean kurtosis and the volume fraction of intracellular water in previous studies and our study showed the functional complementarity of DKI and NODDI to DTI.
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Affiliation(s)
- Sihong Huang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chuxin Huang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mengjun Li
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Huiting Zhang
- MR Scientific Marketing, Siemens Healthcare Ltd., Wuhan, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Radiology Quality Control Center, Changsha, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China
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20
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Robles DJ, Dharani A, Rostowsky KA, Chaudhari NN, Ngo V, Zhang F, O'Donnell LJ, Green L, Sheikh-Bahaei N, Chui HC, Irimia A. Older age, male sex, and cerebral microbleeds predict white matter loss after traumatic brain injury. GeroScience 2022; 44:83-102. [PMID: 34704219 PMCID: PMC8811069 DOI: 10.1007/s11357-021-00459-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022] Open
Abstract
Little is known on how mild traumatic brain injury affects white matter based on age at injury, sex, cerebral microbleeds, and time since injury. Here, we study the fractional anisotropy of white matter to study these effects in 109 participants aged 18-77 (46 females, age μ ± σ = 40 ± 17 years) imaged within [Formula: see text] 1 week and [Formula: see text] 6 months post-injury. Age is found to be linearly associated with white matter degradation, likely due not only to injury but also to cumulative effects of other pathologies and to their interactions with injury. Age is associated with mean anisotropy decreases in the corpus callosum, middle longitudinal fasciculi, inferior longitudinal and occipitofrontal fasciculi, and superficial frontal and temporal fasciculi. Over [Formula: see text] 6 months, the mean anisotropies of the corpus callosum, left superficial frontal fasciculi, and left corticospinal tract decrease significantly. Independently of other predictors, age and cerebral microbleeds contribute to anisotropy decrease in the callosal genu. Chronically, the white matter of commissural tracts, left superficial frontal fasciculi, and left corticospinal tract degrade appreciably, independently of other predictors. Our findings suggest that large commissural and intra-hemispheric structures are at high risk for post-traumatic degradation. This study identifies detailed neuroanatomic substrates consistent with brain injury patients' age-dependent deficits in information processing speed, interhemispheric communication, motor coordination, visual acuity, sensory integration, reading speed/comprehension, executive function, personality, and memory. We also identify neuroanatomic features underlying white matter degradation whose severity is associated with the male sex. Future studies should compare our findings to functional measures and other neurodegenerative processes.
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Affiliation(s)
- David J Robles
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
| | - Ammar Dharani
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
| | - Kenneth A Rostowsky
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
| | - Nikhil N Chaudhari
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
| | - Van Ngo
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
| | - Fan Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Lauren J O'Donnell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Lauren Green
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Nasim Sheikh-Bahaei
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Los Angeles, CA, 90033, USA
| | - Helena C Chui
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA.
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, 90089, USA.
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21
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Tamez-Peña J, Rosella P, Totterman S, Schreyer E, Gonzalez P, Venkataraman A, Meyers SP. Post-concussive mTBI in Student Athletes: MRI Features and Machine Learning. Front Neurol 2022; 12:734329. [PMID: 35082743 PMCID: PMC8784748 DOI: 10.3389/fneur.2021.734329] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/26/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose: To determine and characterize the radiomics features from structural MRI (MPRAGE) and Diffusion Tensor Imaging (DTI) associated with the presence of mild traumatic brain injuries on student athletes with post-concussive syndrome (PCS). Material and Methods: 122 student athletes (65 M, 57 F), median (IQR) age 18.8 (15–20) years, with a mixed level of play and sports activities, with a known history of concussion and clinical PCS, and 27 (15 M, 12 F), median (IQR) age 20 (19, 21) years, concussion free athlete subjects were MRI imaged in a clinical MR machine. MPRAGE and DTI-FA and DTI-ADC images were used to extract radiomic features from white and gray matter regions within the entire brain (2 ROI) and the eight main lobes of the brain (16 ROI) for a total of 18 analyzed regions. Radiomic features were divided into five different data sets used to train and cross-validate five different filter-based Support Vector Machines. The top selected features of the top model were described. Furthermore, the test predictions of the top four models were ensembled into a single average prediction. The average prediction was evaluated for the association to the number of concussions and time from injury. Results: Ninety-one PCS subjects passed inclusion criteria (91 Cases, 27 controls). The average prediction of the top four models had a sensitivity of 0.80, 95% CI: [0.71, 0.88] and specificity of 0.74 95%CI [0.54, 0.89] for distinguishing subjects from controls. The white matter features were strongly associated with mTBI, while the whole-brain analysis of gray matter showed the worst association. The predictive index was significantly associated with the number of concussions (p < 0.0001) and associated with the time from injury (p < 0.01). Conclusion: MRI Radiomic features are associated with a history of mTBI and they were successfully used to build a predictive machine learning model for mTBI for subjects with PCS associated with a history of one or more concussions.
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Affiliation(s)
- José Tamez-Peña
- Tecnologico de Monterrey, Escuela de Medicina, Monterrey, Mexico.,Qmetrics Technologies, Rochester, NY, United States
| | - Peter Rosella
- UR Imaging-UMI, University of Rochester Medical Center, University of Rochester, Rochester, NY, United States
| | | | | | | | - Arun Venkataraman
- UR Imaging-UMI, University of Rochester Medical Center, University of Rochester, Rochester, NY, United States
| | - Steven P Meyers
- UR Imaging-UMI, University of Rochester Medical Center, University of Rochester, Rochester, NY, United States
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22
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Refined Analysis of Chronic White Matter Changes after Traumatic Brain Injury and Repeated Sports-Related Concussions: Of Use in Targeted Rehabilitative Approaches? J Clin Med 2022; 11:jcm11020358. [PMID: 35054052 PMCID: PMC8780504 DOI: 10.3390/jcm11020358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 12/10/2022] Open
Abstract
Traumatic brain injury (TBI) or repeated sport-related concussions (rSRC) may lead to long-term memory impairment. Diffusion tensor imaging (DTI) is helpful to reveal global white matter damage but may underestimate focal abnormalities. We investigated the distribution of post-injury regional white matter changes after TBI and rSRC. Six patients with moderate/severe TBI, and 12 athletes with rSRC were included ≥6 months post-injury, and 10 (age-matched) healthy controls (HC) were analyzed. The Repeatable Battery for the Assessment of Neuropsychological Status was performed at the time of DTI. Major white matter pathways were tracked using q-space diffeomorphic reconstruction and analyzed for global and regional changes with a controlled false discovery rate. TBI patients displayed multiple classic white matter injuries compared with HC (p < 0.01). At the regional white matter analysis, the left frontal aslant tract, anterior thalamic radiation, and the genu of the corpus callosum displayed focal changes in both groups compared with HC but with different trends. Both TBI and rSRC displayed worse memory performance compared with HC (p < 0.05). While global analysis of DTI-based parameters did not reveal common abnormalities in TBI and rSRC, abnormalities to the fronto-thalamic network were observed in both groups using regional analysis of the white matter pathways. These results may be valuable to tailor individualized rehabilitative approaches for post-injury cognitive impairment in both TBI and rSRC patients.
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23
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de Souza NL, Buckman JF, Dennis EL, Parrott JS, Velez C, Wilde EA, Tate DF, Esopenko C. Association between white matter organization and cognitive performance in athletes with a history of sport-related concussion. J Clin Exp Neuropsychol 2021; 43:704-715. [PMID: 34779351 DOI: 10.1080/13803395.2021.1991893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Impairments in cognitive performance after sport-related concussion (SRC) typically resolve within weeks of the injury, whereas alterations to white matter (WM) organization have been found to persist longer into the chronic injury stage. However, longer-term associations between cognition and WM organization following SRC have not been studied. The objective of this study was to compare WM organization and cognitive performance in collegiate athletes an average of almost 4 years post-SRC to athletes with no history of SRC. METHOD National Collegiate Athletic Association Division III athletes (n = 71, age = 19.3 ± 1.2; 14 with self-reported SRC) completed a neurocognitive assessment and diffusion tensor imaging (DTI). WM organization was assessed by extracting measures of fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) from 20 WM regions of interest (ROIs). Multivariate partial least squares analyses were used to compare athletes with and without a history of SRC and assess relationships between DTI-derived metrics of WM organization and cognitive measures. RESULTS Cognitive performance and ROI metrics did not differ between athletes with and without prior SRC. However, among athletes with a history of SRC, better executive function, processing speed, and memory but worse choice reaction time were associated with higher FA and lower MD and RD in several WM tracts. CONCLUSION Athletes with a history of SRC demonstrated greater associations between cognitive performance and WM organization, but also variability in the domains showing associations. Taken together, the findings demonstrate the importance of examining brain-behavior relationships several years after SRC to better gauge how WM organization supports cognition.
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Affiliation(s)
- Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Jennifer F Buckman
- Department of Kinesiology and Health, Rutgers University - New Brunswick, Piscataway, NJ, USA
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.,George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | | | - Carmen Velez
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.,George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - David F Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.,George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA.,Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
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24
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Mortaheb S, Filippini MM, Kaux JF, Annen J, Lejeune N, Martens G, Calderón MAF, Laureys S, Thibaut A. Neurophysiological Biomarkers of Persistent Post-concussive Symptoms: A Scoping Review. Front Neurol 2021; 12:687197. [PMID: 34566837 PMCID: PMC8459021 DOI: 10.3389/fneur.2021.687197] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Persistent post-concussive symptoms (PCS) consist of neurologic and psychological complaints persisting after a mild traumatic brain injury (mTBI). It affects up to 50% of mTBI patients, may cause long-term disability, and reduce patients' quality of life. The aim of this review was to examine the possible use of different neuroimaging modalities in PCS. Methods: Articles from Pubmed database were screened to extract studies that investigated the relationship between any neuroimaging features and symptoms of PCS. Descriptive statistics were applied to report the results. Results: A total of 80 out of 939 papers were included in the final review. Ten examined conventional MRI (30% positive finding), 24 examined diffusion weighted imaging (54.17% positive finding), 23 examined functional MRI (82.61% positive finding), nine examined electro(magneto)encephalography (77.78% positive finding), and 14 examined other techniques (71% positive finding). Conclusion: MRI was the most widely used technique, while functional techniques seem to be the most sensitive tools to evaluate PCS. The common functional patterns associated with symptoms of PCS were a decreased anti-correlation between the default mode network and the task positive network and reduced brain activity in specific areas (most often in the prefrontal cortex). Significance: Our findings highlight the importance to use functional approaches which demonstrated a functional alteration in brain connectivity and activity in most studies assessing PCS.
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Affiliation(s)
- Sepehr Mortaheb
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Physiology of Cognition Lab., GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Maria Maddalena Filippini
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Neuromotor and Rehabilitation Department, Azienda Unita Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Jean-François Kaux
- Physical Medicine and Sport Traumatology Department, Sports, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athletes Health, FIMS Collaborative Centre of Sport Medicine, University and University Hospital of Liège, Liège, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Institute of NeuroScience, University of Louvain, Brussels, Belgium
| | - Géraldine Martens
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Physical Medicine and Sport Traumatology Department, Sports, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athletes Health, FIMS Collaborative Centre of Sport Medicine, University and University Hospital of Liège, Liège, Belgium
| | | | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
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25
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Major B, Symons GF, Sinclair B, O'Brien WT, Costello D, Wright DK, Clough M, Mutimer S, Sun M, Yamakawa GR, Brady RD, O'Sullivan MJ, Mychasiuk R, McDonald SJ, O'Brien TJ, Law M, Kolbe S, Shultz SR. White and Gray Matter Abnormalities in Australian Footballers With a History of Sports-Related Concussion: An MRI Study. Cereb Cortex 2021; 31:5331-5338. [PMID: 34148076 DOI: 10.1093/cercor/bhab161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Sports-related concussion (SRC) is a form of mild traumatic brain injury that has been linked to long-term neurological abnormalities. Australian rules football is a collision sport with wide national participation and is growing in popularity worldwide. However, the chronic neurological consequences of SRC in Australian footballers remain poorly understood. This study investigated the presence of brain abnormalities in Australian footballers with a history of sports-related concussion (HoC) using multimodal MRI. Male Australian footballers with HoC (n = 26), as well as noncollision sport athletes with no HoC (n = 27), were recruited to the study. None of the footballers had sustained a concussion in the preceding 6 months, and all players were asymptomatic. Data were acquired using a 3T MRI scanner. White matter integrity was assessed using diffusion tensor imaging. Cortical thickness, subcortical volumes, and cavum septum pellucidum (CSP) were analyzed using structural MRI. Australian footballers had evidence of widespread microstructural white matter damage and cortical thinning. No significant differences were found regarding subcortical volumes or CSP. These novel findings provide evidence of persisting white and gray matter abnormalities in Australian footballers with HoC, and raise concerns related to the long-term neurological health of these athletes.
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Affiliation(s)
- Brendan Major
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Georgia F Symons
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Ben Sinclair
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia
| | - William T O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Daniel Costello
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - David K Wright
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Meaghan Clough
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Steven Mutimer
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Glenn R Yamakawa
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Rhys D Brady
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Michael J O'Sullivan
- Department of Faculty of Medicine, UQ Centre for Clinical Research and Institute of Molecular Bioscience, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, VIC 3086, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Meng Law
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Radiology, Alfred Health, Melbourne, VIC 3004, Australia.,Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, VIC 3800, Australia
| | - Scott Kolbe
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
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26
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Tayebi M, Holdsworth SJ, Champagne AA, Cook DJ, Nielsen P, Lee TR, Wang A, Fernandez J, Shim V. The role of diffusion tensor imaging in characterizing injury patterns on athletes with concussion and subconcussive injury: a systematic review. Brain Inj 2021; 35:621-644. [PMID: 33843389 DOI: 10.1080/02699052.2021.1895313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Traumatic brain injury (TBI) is a major public health problem. The majority of TBIs are in the form of mild TBI (also known as concussion) with sports-related concussion (SRC) receiving public attention in recent years.Here we have performed a systematic review of the literature on the use of Diffusion Tensor Imaging (DTI) on sports-related concussion and subconcussive injuries. Our review found different patterns of change in DTI parameters between concussed and subconcussed groups. The Fractional Anisotropy (FA) was either unchanged or increased for the concussion group, while the subconcussed group generally experienced a decrease in FA. A reverse pattern was observed for Mean Diffusivity (MD) - where the concussed group experienced a decrease in MD while the subconcussed group showed an increase in MD. However, in general, discrepancies were observed in the results reported in the literature - likely due to the huge variations in DTI acquisition parameters, and image processing and analysis methods used in these studies. This calls for more comprehensive and well-controlled studies in this field, including those that combine the advanced brain imaging with biomechancial modeling and kinematic sensors - to shed light on the underlying mechanisms behind the structural changes observed from the imaging studies.
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Affiliation(s)
- Maryam Tayebi
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Samantha J Holdsworth
- Department of Anatomy and Medical Imaging & Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Insitute, Gisborne, New Zealand
| | - Allen A Champagne
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Poul Nielsen
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Tae-Rin Lee
- Advanced Institute of Convergence Technology, Seoul National University, Seoul, Republic of Korea
| | - Alan Wang
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Anatomy and Medical Imaging & Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Vickie Shim
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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27
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Brett BL, Koch KM, Muftuler LT, Budde M, McCrea MA, Meier TB. Association of Head Impact Exposure with White Matter Macrostructure and Microstructure Metrics. J Neurotrauma 2021; 38:474-484. [PMID: 33003979 PMCID: PMC7875606 DOI: 10.1089/neu.2020.7376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Prior studies have reported white matter abnormalities associated with a history of cumulative concussion and/or repetitive head impacts (RHI) in contact sport athletes. Growing evidence suggests these abnormalities may begin as more subtle changes earlier in life in active younger athletes. We investigated the relationship between prior concussion and contact sport exposure with multi-modal white matter microstructure and macrostructure using magnetic resonance imaging. High school and collegiate athletes (n = 121) completed up to four evaluations involving neuroimaging. Linear mixed-effects models examined associations of years of contact sport exposure (i.e., RHI proxy) and prior concussion across multiple metrics of white matter, including total white matter volume, diffusion tensor imaging (DTI) metrics, diffusion kurtosis imaging (DKI) metrics, and quantitative susceptibility mapping (QSM). A significant inverse association between cumulative years of contact sport exposure and QSM was observed, F(1, 237.77) = 4.67, p = 0.032. Cumulative contact sport exposure was also associated with decreased radial diffusivity, F(1, 114.56) = 5.81, p = 0.018, as well as elevated fractional anisotropy, F(1, 115.32) = 5.40, p = 0.022, and radial kurtosis, F(1, 113.45) = 4.03, p = 0.047. In contrast, macroscopic white matter volume was not significantly associated with cumulative contact sport exposure (p > 0.05). Concussion history was not significantly associated with QSM, DTI, DKI, or white matter volume (all, p > 0.05). Cumulative contact sport exposure is associated with subtle differences in white matter microstructure, but not gross white matter macrostructure, in young active athletes. Longitudinal follow-up is required to assess the progression of these findings to determine their contribution to potential adverse effects later in life.
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Affiliation(s)
- Benjamin L. Brett
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kevin M. Koch
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Depertment of Radiology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Imaging Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - L. Tugan Muftuler
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Depertment of Radiology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew Budde
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A. McCrea
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy B. Meier
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Biomedical Engineering, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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28
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Wilde EA, Goodrich-Hunsaker NJ, Ware AL, Taylor BA, Biekman BD, Hunter JV, Newman-Norlund R, Scarneo S, Casa DJ, Levin HS. Diffusion Tensor Imaging Indicators of White Matter Injury Are Correlated with a Multimodal Electroencephalography-Based Biomarker in Slow Recovering, Concussed Collegiate Athletes. J Neurotrauma 2020; 37:2093-2101. [DOI: 10.1089/neu.2018.6365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Elisabeth A. Wilde
- George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Naomi J. Goodrich-Hunsaker
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Ashley L. Ware
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics, University of Houston, Houston, Texas, USA
| | - Brian A. Taylor
- Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Brian D. Biekman
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics, University of Houston, Houston, Texas, USA
| | - Jill V. Hunter
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
- E.B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas, USA
| | - Roger Newman-Norlund
- Department of Psychology, University of South Carolina School of Arts and Sciences, Columbia, South Carolina, USA
| | - Samantha Scarneo
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Douglas J. Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Harvey S. Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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29
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Rausa VC, Shapiro J, Seal ML, Davis GA, Anderson V, Babl FE, Veal R, Parkin G, Ryan NP, Takagi M. Neuroimaging in paediatric mild traumatic brain injury: a systematic review. Neurosci Biobehav Rev 2020; 118:643-653. [PMID: 32905817 DOI: 10.1016/j.neubiorev.2020.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 08/02/2020] [Accepted: 08/29/2020] [Indexed: 01/05/2023]
Abstract
Neuroimaging is being increasingly applied to the study of paediatric mild traumatic brain injury (mTBI) to uncover the neurobiological correlates of delayed recovery post-injury. The aims of this systematic review were to: (i) evaluate the neuroimaging research investigating neuropathology post-mTBI in children and adolescents from 0-18 years, (ii) assess the relationship between advanced neuroimaging abnormalities and PCS in children, (iii) assess the quality of the evidence by evaluating study methodology and reporting against best practice guidelines, and (iv) provide directions for future research. A literature search of MEDLINE, PsycINFO, EMBASE, and PubMed was conducted. Abstracts and titles were screened, followed by full review of remaining articles where specific eligibility criteria were applied. This systematic review identified 58 imaging studies which met criteria. Based on several factors including methodological heterogeneity and relatively small sample sizes, the literature currently provides insufficient evidence to draw meaningful conclusions about the relationship between MRI findings and clinical outcomes. Future research is needed which incorporates prospective, longitudinal designs, minimises potential confounds and utilises multimodal imaging techniques.
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Affiliation(s)
- Vanessa C Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Jesse Shapiro
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
| | - Marc L Seal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Psychology Service, The Royal Children's Hospital, Melbourne, Australia.
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
| | - Ryan Veal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Georgia Parkin
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Nicholas P Ryan
- Department of Paediatrics, University of Melbourne, Victoria, Australia; Cognitive Neuroscience Unit, Deakin University, Geelong, Australia.
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
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30
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Wu YC, Harezlak J, Elsaid NMH, Lin Z, Wen Q, Mustafi SM, Riggen LD, Koch KM, Nencka AS, Meier TB, Mayer AR, Wang Y, Giza CC, DiFiori JP, Guskiewicz KM, Mihalik JP, LaConte SM, Duma SM, Broglio SP, Saykin AJ, McCrea MA, McAllister TW. Longitudinal white-matter abnormalities in sports-related concussion: A diffusion MRI study. Neurology 2020; 95:e781-e792. [PMID: 32641518 PMCID: PMC7605507 DOI: 10.1212/wnl.0000000000009930] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 02/07/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To study longitudinal recovery trajectories of white matter after sports-related concussion (SRC) by performing diffusion tensor imaging (DTI) on collegiate athletes who sustained SRC. METHODS Collegiate athletes (n = 219, 82 concussed athletes, 68 contact-sport controls, and 69 non-contact-sport controls) were included from the Concussion Assessment, Research and Education Consortium. The participants completed clinical assessments and DTI at 4 time points: 24 to 48 hours after injury, asymptomatic state, 7 days after return-to-play, and 6 months after injury. Tract-based spatial statistics was used to investigate group differences in DTI metrics and to identify white-matter areas with persistent abnormalities. Generalized linear mixed models were used to study longitudinal changes and associations between outcome measures and DTI metrics. Cox proportional hazards model was used to study effects of white-matter abnormalities on recovery time. RESULTS In the white matter of concussed athletes, DTI-derived mean diffusivity was significantly higher than in the controls at 24 to 48 hours after injury and beyond the point when the concussed athletes became asymptomatic. While the extent of affected white matter decreased over time, part of the corpus callosum had persistent group differences across all the time points. Furthermore, greater elevation of mean diffusivity at acute concussion was associated with worse clinical outcome measures (i.e., Brief Symptom Inventory scores and symptom severity scores) and prolonged recovery time. No significant differences in DTI metrics were observed between the contact-sport and non-contact-sport controls. CONCLUSIONS Changes in white matter were evident after SRC at 6 months after injury but were not observed in contact-sport exposure. Furthermore, the persistent white-matter abnormalities were associated with clinical outcomes and delayed recovery time.
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Affiliation(s)
- Yu-Chien Wu
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.
| | - Jaroslaw Harezlak
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Nahla M H Elsaid
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Zikai Lin
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Qiuting Wen
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Sourajit M Mustafi
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Larry D Riggen
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Kevin M Koch
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Andrew S Nencka
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Timothy B Meier
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Andrew R Mayer
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Yang Wang
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Christopher C Giza
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - John P DiFiori
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Kevin M Guskiewicz
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Jason P Mihalik
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Stephen M LaConte
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Stefan M Duma
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Steven P Broglio
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Andrew J Saykin
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Michael A McCrea
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Thomas W McAllister
- From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor
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Anesthesia and the brain after concussion. Curr Opin Anaesthesiol 2020; 33:639-645. [PMID: 32796169 DOI: 10.1097/aco.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of acute and chronic repeated concussion. We address epidemiology, pathophysiology, anesthetic utilization, and provide some broad-based care recommendations. RECENT FINDINGS Acute concussion is associated with altered cerebral hemodynamics. These aberrations can persist despite resolution of signs and symptoms. Multiple repeated concussions can cause chronic traumatic encephalopathy, a disorder associated with pathologic findings similar to some organic dementias. Anesthetic utilization is common following concussion, especially soon after injury, a time when the brain may be most vulnerable to secondary injury. SUMMARY Brain physiology may be abnormal following concussion and these abnormalities may persist despite resolutions of clinical manifestations. Those with recent concussion or chronic repeated concussion may be susceptible to secondary injury in the perioperative period. Clinicians should suspect concussion in any patient with recent trauma and strive to maintain cerebral homeostasis in the perianesthetic period.
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Muftuler LT, Meier TB, Keith M, Budde MD, Huber DL, McCrea MA. Serial Diffusion Kurtosis Magnetic Resonance Imaging Study during Acute, Subacute, and Recovery Periods after Sport-Related Concussion. J Neurotrauma 2020; 37:2081-2092. [PMID: 32253977 DOI: 10.1089/neu.2020.6993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Sport-related concussion (SRC) is common in contact sports, but there remains a lack of reliable, unbiased biomarkers of brain injury and recovery. Although the symptoms of SRC generally resolve over a period of days to weeks, the lack of a biomarker impairs detection and return-to-play decisions. To this date, the pathophysiological recovery profile and relationships between brain changes and symptoms remained unclear. In the current study, diffusion kurtosis imaging (DKI) was used to monitor the effects of SRC on the brain and the trajectory of recovery in concussed American football players (n = 96) at <48 h, and 8, 15, and 45 days post-injury, who were compared with a matched group of uninjured players (n = 82). The concussed group reported significantly higher symptoms within 48 h after injury than controls, which resolved by the 8-day follow-up. The concussed group also demonstrated poorer performance on balance testing at <48 h and 8 days than controls. There were no significant differences between the groups in the Standardized Assessment of Concussion (SAC), a cognitive screening measure. DKI data were acquired with 3 mm isotropic resolution, and analyzed using tract-based spatial statistics (TBSS). Additionally, voxel- and region of interest-based analyses were also conducted. At <48 h, the concussed group showed significantly higher axial kurtosis than the control group. These differences increased in extent and magnitude at 8 days, then receded at 15 days, and returned to the normal levels by 45 days. Kurtosis fractional anisotropy (FA) exhibited a delayed response, with a consistent increase by days 15 and 45. The results indicate that changes detected in the acute period appear to be prolonged compared with clinical recovery, but additional brain changes not observable acutely appear to progress. Although further studies are needed to understand the pathological features of DKI changes after SRC, these findings highlight a potential disparity between clinical symptoms and pathophysiological recovery after SRC.
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Affiliation(s)
- L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Monica Keith
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daniel L Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Cheng H, Deaton LM, Qiu M, Ha S, Pacoma R, Lao J, Tolley V, Moran R, Keeton A, Lamb JR, Fathman J, Walker JR, Schumacher AM. Tau overexpression exacerbates neuropathology after repeated mild head impacts in male mice. Neurobiol Dis 2019; 134:104683. [PMID: 31765727 DOI: 10.1016/j.nbd.2019.104683] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/22/2019] [Accepted: 11/20/2019] [Indexed: 02/07/2023] Open
Abstract
Repeated mild traumatic brain injury (rmTBI) can lead to development of chronic traumatic encephalopathy (CTE), which is characterized by progressive neurodegeneration with presence of white matter damage, gliosis and hyper-phosphorylated tau. While animal models of rmTBI have been documented, few characterize the molecular pathogenesis and expression profiles of relevant injured brain regions. Additionally, while the usage of transgenic tau mice in rmTBI is prevalent, the effects of tau on pathological outcomes has not been well studied. Here we characterized a 42-impact closed-head rmTBI paradigm on 3-4 month old male C57BL/6 (WT) and Tau-overexpressing mice (Tau58.4). This injury paradigm resulted in chronic gliosis, T-cell infiltration, and demyelination of the optic nerve and associated white matter tracts at 1-month post-injury. At 3-months post-injury, Tau58.4 mice showed progressive neuroinflammation and neurodegeneration in multiple brain regions compared to WT mice. Corresponding to histopathology, RNAseq of the optic nerve tract at 1-month post-injury showed significant upregulation of inflammatory pathways and downregulation of myelin synthetic pathways in both genotypes. However, Tau58.4 mice showed additional changes in neurite development, protein processing, and cell stress. Comparisons with published transcriptomes of human Alzheimer's Disease and CTE revealed common signatures including neuroinflammation and downregulation of protein phosphatases. We next investigated the demyelination and T-cell infiltration phenotypes to determine whether these offer potential avenues for therapeutic intervention. Tau58.4 mice were treated with the histamine H3 receptor antagonist GSK239512 for 1-month post-injury to promote remyelination of white matter lesions. This restored myelin gene expression to sham levels but failed to repair the histopathologic lesions. Likewise, injured T-cell-deficient Rag2/Il2rg (R2G2) mice also showed evidence for inflammation and loss of myelin. However, unlike immune-competent mice, R2G2 mice had altered myeloid cell gene expression and fewer demyelinated lesions. Together this data shows that rmTBI leads to chronic white matter inflammatory demyelination and axonal loss exacerbated by human tau overexpression but suggests that immune-suppression and remyelination alone are insufficient to reverse damage.
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Affiliation(s)
- Hank Cheng
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Lisa M Deaton
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Minhua Qiu
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Sukwon Ha
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Reynand Pacoma
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Jianmin Lao
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Valerie Tolley
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Rita Moran
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Amber Keeton
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - John R Lamb
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA
| | - John Fathman
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - John R Walker
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Andrew M Schumacher
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
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34
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Meier TB, Giraldo-Chica M, España LY, Mayer AR, Harezlak J, Nencka AS, Wang Y, Koch KM, Wu YC, Saykin AJ, Giza CC, Goldman J, DiFiori JP, Guskiewicz KM, Mihalik JP, Brooks A, Broglio SP, McAllister T, McCrea MA. Resting-State fMRI Metrics in Acute Sport-Related Concussion and Their Association with Clinical Recovery: A Study from the NCAA-DOD CARE Consortium. J Neurotrauma 2019; 37:152-162. [PMID: 31407610 DOI: 10.1089/neu.2019.6471] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
There has been a recent call for longitudinal cohort studies to track the physiological recovery of sport-related concussion (SRC) and its relationship with clinical recovery. Resting-state functional magnetic resonance imaging (rs-fMRI) has shown potential for detecting subtle changes in brain function after SRC. We investigated the effects of SRC on rs-fMRI metrics assessing local connectivity (regional homogeneity; REHO), global connectivity (average nodal strength), and the relative amplitude of slow oscillations of rs-fMRI (fractional amplitude of low-frequency fluctuations; fALFF). Athletes diagnosed with SRC (n = 92) completed visits with neuroimaging at 24-48 h post-injury (24 h), after clearance to begin the return-to-play (RTP) progression (asymptomatic), and 7 days following unrestricted RTP (post-RTP). Non-injured athletes (n = 82) completed visits yoked to the schedule of matched injured athletes and served as controls. Concussed athletes had elevated symptoms, worse neurocognitive performance, greater balance deficits, and elevated psychological symptoms at the 24-h visit relative to controls. These deficits were largely recovered by the asymptomatic visit. Concussed athletes still reported elevated psychological symptoms at the asymptomatic visit relative to controls. Concussed athletes also had elevated REHO in the right middle and superior frontal gyri at the 24-h visit that returned to normal levels by the asymptomatic visit. Additionally, REHO in these regions at 24 h predicted psychological symptoms at the asymptomatic visit in concussed athletes. Current results suggest that SRC is associated with an acute alteration in local connectivity that follows a similar time course as clinical recovery. Our results do not indicate strong evidence that concussion-related alterations in rs-fMRI persist beyond clinical recovery.
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Affiliation(s)
- Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Lezlie Y España
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Neurology and Psychiatry Departments, University of New Mexico School of Medicine, Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana
| | - Andrew S Nencka
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yang Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kevin M Koch
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yu-Chien Wu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christopher C Giza
- Departments of Pediatrics and Neurosurgery, University of California Los Angeles, Los Angeles, California
| | - Joshua Goldman
- Departments of Family Medicine and Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California.,Center for Sports Medicine, Orthopaedic Institute for Children, Los Angeles, California
| | - John P DiFiori
- Hospital for Special Surgery, Primary Sports Medicine Service, New York, New York
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina
| | - Jason P Mihalik
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina
| | - Alison Brooks
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Steven P Broglio
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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35
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Wilde EA, Newsome MR, Ott SD, Hunter JV, Dash P, Redell J, Spruiell M, Diaz M, Chu ZD, Goodrich-Hunsaker N, Petrie J, Li R, Levin H. Persistent Disruption of Brain Connectivity after Sports-Related Concussion in a Female Athlete. J Neurotrauma 2019; 36:3164-3171. [PMID: 31119974 DOI: 10.1089/neu.2019.6377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Structural and functional connectivity (FC) after sports-related concussion (SRC) may remain altered in adolescent athletes despite symptom resolution. Little is known, however, about how alterations in structural connectivity and FC co-present in female athletes whose symptom recovery tends to be prolonged. Despite resolution of symptoms, one month after her second SRC, an 18-year-old female athlete had decreased structural connectivity in the corpus callosum and cingulum, with altered FC near those regions, compared with other SRC and orthopedically injured athletes. Findings show persistent effects of SRC on advanced brain imaging and the possibility of greater vulnerability of white matter tracts in females.
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Affiliation(s)
- Elisabeth A Wilde
- Michael E. De Bakey Veterans Affairs Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas.,University of Utah, Salt Lake City, Utah.,George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Mary R Newsome
- Michael E. De Bakey Veterans Affairs Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Summer D Ott
- University of Texas, Health Science Center at Houston - UTHealth, Houston, Texas
| | - Jill V Hunter
- Baylor College of Medicine, Houston, Texas.,Texas Children's Hospital, Houston, Texas
| | - Pramod Dash
- University of Texas, Health Science Center at Houston - UTHealth, Houston, Texas
| | - John Redell
- University of Texas, Health Science Center at Houston - UTHealth, Houston, Texas
| | | | - Marlene Diaz
- Michael E. De Bakey Veterans Affairs Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Zili D Chu
- Baylor College of Medicine, Houston, Texas
| | | | | | - Ruosha Li
- University of Texas, Health Science Center at Houston - UTHealth, Houston, Texas
| | - Harvey Levin
- Michael E. De Bakey Veterans Affairs Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
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36
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Cubon VA, Murugavel M, Holmes KW, Dettwiler A. Preliminary evidence from a prospective DTI study suggests a posterior-to-anterior pattern of recovery in college athletes with sports-related concussion. Brain Behav 2018; 8:e01165. [PMID: 30566282 PMCID: PMC6305925 DOI: 10.1002/brb3.1165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 09/04/2018] [Accepted: 10/24/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We compared the integrity of white matter (WM) microstructure to the course of recovery in athletes who sustained one sports-related concussion (SRC), assessing individual longitudinal changes in WM fiber tracts following SRC using pre- and post-injury measurements. MATERIALS AND METHODS Baseline diffusion tensor imaging (DTI) scans and neuropsychological tests were collected on 53 varsity contact-sport college athletes. Participants (n = 13) who subsequently sustained an SRC underwent DTI scans and neuropsychological testing at 2 days, 2 weeks, and 2 months following injury. RESULTS Relying on tract-based spatial statistics (TBSS) analyses, we found that radial diffusivity (RD) and mean diffusivity (MD) were significantly increased at 2 days post-injury compared to the same-subject baseline (corrected p < 0.02). These alterations were visible in anterior/posterior WM regions spanning both hemispheres, demonstrating a diffuse pattern of injury after concussion. Implicated WM fiber tracts at 2 days include the following: right superior/inferior longitudinal fasciculus; right/left inferior fronto-occipital fasciculus; right corticospinal tract; right acoustic radiation; right/left anterior thalamic radiations; right/left uncinate fasciculus; and forceps major/minor. At 2 weeks post-injury, persistently elevated RD and MD were observed solely in prefrontal portions of WM fiber tracts (using same-subject contrasts). No significant differences were found for FA in any of the post-injury comparisons to baseline. Plots of individual subject RD and MD in prefrontal WM demonstrated homogenous increases from baseline to just after SRC; thereafter, trajectories became more variable. Most subjects' diffusivity values remained elevated at 2 months post-injury relative to their own baseline. Over the 2-month period after SRC, recovery of WM fiber tracts appeared to follow a posterior-to-anterior trend, paralleling the posterior-anterior pattern of WM maturation previously identified in the normal population. CONCLUSION These results suggest greater vulnerability of prefrontal regions to SRC, underline the importance of an individualized approach to concussion management, and show promise for using RD and MD for imaging-based diagnosis of SRC.
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Affiliation(s)
- Valerie A Cubon
- Department of Chemistry and Biochemistry, Kent State University at Trumbull, Warren, Ohio
| | - Murali Murugavel
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Katharine W Holmes
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Annegret Dettwiler
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
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37
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Monk SH, Legarreta AD, Kirby P, Brett BL, Yengo-Kahn AM, Bhatia A, Solomon GS, Zuckerman SL. Imaging findings after acute sport-related concussion in American football players: A systematic review. J Clin Neurosci 2018; 61:28-35. [PMID: 30487055 DOI: 10.1016/j.jocn.2018.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/05/2018] [Indexed: 12/21/2022]
Abstract
Sport-related concussion (SRC) has emerged as a major public health problem. The results of brain imaging studies following SRC have raised questions about long-term neurologic health, but the clinical implications of these findings remain unknown. A systematic review of brain imaging findings after SRC was performed utilizing the following inclusion criteria: football players, brain imaging within 6 months of SRC, and sample size >5. Studies were assessed for: 1) methodology, 2) imaging outcomes, and 3) number of positive statistical comparisons. Imaging was classified as immediate (≤1 week post-injury) or subacute (>1 week to 6 months post-injury). Eleven studies met inclusion criteria. Eight of the 11 studies conducted a total of 809 comparisons of brain function, of which 149 (18%) were statistically significant. Nine of the 11 studies (82%) reported positive immediate findings, but were more likely to be subject to recall bias (86% vs. 0%) and to lack baseline advanced brain imaging (78% vs. 50%) than negative studies. Only 3 of 9 studies that reported subacute findings (33%) reported positive results, and these positive studies were also more likely to be subject to recall bias (100% vs. 40%) and to lack baseline advanced brain imaging (100% vs. 67%) than negative studies. The results of the study demonstrate the transitory nature of positive imaging findings and methodological limitations that complicate study interpretation. Further research is required to correlate imaging findings with clinical outcomes.
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Affiliation(s)
- Steve H Monk
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Andrew D Legarreta
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Paul Kirby
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Benjamin L Brett
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aashim Bhatia
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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38
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Lancaster MA, Meier TB, Olson DV, McCrea MA, Nelson LD, Muftuler LT. Chronic differences in white matter integrity following sport-related concussion as measured by diffusion MRI: 6-Month follow-up. Hum Brain Mapp 2018; 39:4276-4289. [PMID: 29964356 DOI: 10.1002/hbm.24245] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/19/2018] [Accepted: 05/29/2018] [Indexed: 12/24/2022] Open
Abstract
Recent studies demonstrated evidence of physiological changes in the brain following sport-related concussion (SRC) that persisted beyond the point at which athletes achieved full symptom recovery. Diffusion MRI techniques have been used to study brain white matter (WM) changes following SRC; however, longitudinal studies that follow injured athletes from the acute to chronic stages of injury are sparse. The current study explores potential persisting effects of the injury, which serves as a follow-up to our previous work that reported WM changes in the acute and subacute phase of SRC recovery. Concussed high school and collegiate football players (n = 17) and well-matched teammate controls (n = 20) were followed up at 6 months postinjury with diffusion tensor (DTI) and diffusion kurtosis imaging (DKI) as well as measures of self-reported symptoms, cognitive functioning, and balance. Results of tract-based spatial statistics (TBSS) analyses revealed continued widespread decreased mean and axial diffusivity compared to control subjects in 6-month follow-up scans. On the other hand, kurtosis metrics, which were significantly higher in concussed athletes in the acute phase, had normalized. WM tract regions-of-interest (ROIs) were created from significant clusters in the TBSS analysis, and linear mixed effects (LME) analyses were used to look at longitudinal changes in these ROIs over time. LME analyses revealed few time × group interactions indicating findings were relatively stable over time. In addition, acute concussion symptoms predicted diffusivity measures at 6 months postinjury. Findings indicate that DTI and DKI may be useful tools in assessing concussion severity, recovery, and possible long-term effects of concussion.
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Affiliation(s)
- Melissa A Lancaster
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel V Olson
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael A McCrea
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lindsay D Nelson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Center for Imaging Research Medical College of Wisconsin, Milwaukee, Wisconsin
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