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Bertò G, Rooks LT, Broglio SP, McAllister TA, McCrea MA, Pasquina PF, Giza C, Brooks A, Mihalik J, Guskiewicz K, Goldman J, Duma S, Rowson S, Port NL, Pestilli F. Diffusion tensor analysis of white matter tracts is prognostic of persisting post-concussion symptoms in collegiate athletes. Neuroimage Clin 2024; 43:103646. [PMID: 39106542 DOI: 10.1016/j.nicl.2024.103646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/15/2024] [Accepted: 07/19/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND AND OBJECTIVES After a concussion diagnosis, the most important issue for patients and loved ones is how long it will take them to recover. The main objective of this study is to develop a prognostic model of concussion recovery. This model would benefit many patients worldwide, allowing for early treatment intervention. METHODS The Concussion Assessment, Research and Education (CARE) consortium study enrolled collegiate athletes from 30 sites (NCAA athletic departments and US Department of Defense service academies), 4 of which participated in the Advanced Research Core, which included diffusion-weighted MRI (dMRI) data collection. We analyzed the dMRI data of 51 injuries of concussed athletes scanned within 48 h of injury. All athletes were cleared to return-to-play by the local medical staff following a standardized, graduated protocol. The primary outcome measure is days to clearance of unrestricted return-to-play. Injuries were divided into early (return-to-play < 28 days) and late (return-to-play >= 28 days) recovery based on the return-to-play clinical records. The late recovery group meets the standard definition of Persisting Post-Concussion Symptoms (PPCS). Data were processed using automated, state-of-the-art, rigorous methods for reproducible data processing using brainlife.io. All processed data derivatives are made available at https://brainlife.io/project/63b2ecb0daffe2c2407ee3c5/dataset. The microstructural properties of 47 major white matter tracts, 5 callosal, 15 subcortical, and 148 cortical structures were mapped. Fractional Anisotropy (FA) and Mean Diffusivity (MD) were estimated for each tract and structure. Correlation analysis and Receiver Operator Characteristic (ROC) analysis were then performed to assess the association between the microstructural properties and return-to-play. Finally, a Logistic Regression binary classifier (LR-BC) was used to classify the injuries between the two recovery groups. RESULTS The mean FA across all white matter volume was negatively correlated with return-to-play (r = -0.38, p = 0.00001). No significant association between mean MD and return-to-play was found, neither for FA nor MD for any other structure. The mean FA of 47 white matter tracts was negatively correlated with return-to-play (rμ = -0.27; rσ = 0.08; rmin = -0.1; rmax = -0.43). Across all tracts, a large mean ROC Area Under the Curve (AUCFA) of 0.71 ± 0.09 SD was found. The top classification performance of the LR-BC was AUC = 0.90 obtained using the 16 statistically significant white matter tracts. DISCUSSION Utilizing a free, open-source, and automated cloud-based neuroimaging pipeline and app (https://brainlife.io/docs/tutorial/using-clairvoy/), a prognostic model has been developed, which predicts athletes at risk for slow recovery (PPCS) with an AUC=0.90, balanced accuracy = 0.89, sensitivity = 1.0, and specificity = 0.79. The small number of participants in this study (51 injuries) is a significant limitation and supports the need for future large concussion dMRI studies and focused on recovery.
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Affiliation(s)
- Giulia Bertò
- Department of Psychology and Department of Neuroscience, Center for Perceptual Systems, Center for Learning and Memory, The University of Texas at Austin, Austin, TX, USA
| | - Lauren T Rooks
- Indiana University School of Optometry and Program in Neuroscience, Indiana University, Bloomington IN, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation at the Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Christopher Giza
- Pediatric Neurology, University of California, Los Angeles, CA, USA
| | - Alison Brooks
- Department of Orthopaedics and Rehabilitation, University of Wisconsin Madison, Madison WI, USA
| | - Jason Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kevin Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Josh Goldman
- Family Medicine & Sports Medicine, UCLA Medical School, Los Angeles, CA, USA
| | - Stefan Duma
- Departmentl of Biomedical Engineering & Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Steven Rowson
- Departmentl of Biomedical Engineering & Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Nicholas L Port
- Indiana University School of Optometry and Program in Neuroscience, Indiana University, Bloomington IN, USA.
| | - Franco Pestilli
- Department of Psychology and Department of Neuroscience, Center for Perceptual Systems, Center for Learning and Memory, The University of Texas at Austin, Austin, TX, USA.
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Wu YC, Wen Q, Thukral R, Yang HC, Gill JM, Gao S, Lane KA, Meier TB, Riggen LD, Harezlak J, Giza CC, Goldman J, Guskiewicz KM, Mihalik JP, LaConte SM, Duma SM, Broglio SP, Saykin AJ, McAllister TW, McCrea MA. Longitudinal Associations Between Blood Biomarkers and White Matter MRI in Sport-Related Concussion: A Study of the NCAA-DoD CARE Consortium. Neurology 2023; 101:e189-e201. [PMID: 37328299 PMCID: PMC10351550 DOI: 10.1212/wnl.0000000000207389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/22/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To study longitudinal associations between blood-based neural biomarkers (including total tau, neurofilament light [NfL], glial fibrillary acidic protein [GFAP], and ubiquitin C-terminal hydrolase-L1) and white matter neuroimaging biomarkers in collegiate athletes with sport-related concussion (SRC) from 24 hours postinjury to 1 week after return to play. METHODS We analyzed clinical and imaging data of concussed collegiate athletes in the Concussion Assessment, Research, and Education (CARE) Consortium. The CARE participants completed same-day clinical assessments, blood draws, and diffusion tensor imaging (DTI) at 3 time points: 24-48 hours postinjury, point of becoming asymptomatic, and 7 days after return to play. DTI probabilistic tractography was performed for each participant at each time point to render 27 participant-specific major white matter tracts. The microstructural organization of these tracts was characterized by 4 DTI metrics. Mixed-effects models with random intercepts were applied to test whether white matter microstructural abnormalities are associated with the blood-based biomarkers at the same time point. An interaction model was used to test whether the association varies across time points. A lagged model was used to test whether early blood-based biomarkers predict later microstructural changes. RESULTS Data from 77 collegiate athletes were included in the following analyses. Among the 4 blood-based biomarkers, total tau had significant associations with the DTI metrics across the 3 time points. In particular, high tau level was associated with high radial diffusivity (RD) in the right corticospinal tract (β = 0.25, SE = 0.07, p FDR-adjusted = 0.016) and superior thalamic radiation (β = 0.21, SE = 0.07, p FDR-adjusted = 0.042). NfL and GFAP had time-dependent associations with the DTI metrics. NfL showed significant associations only at the asymptomatic time point (|β|s > 0.12, SEs <0.09, psFDR-adjusted < 0.05) and GFAP showed a significant association only at 7 days after return to play (βs > 0.14, SEs <0.06, psFDR-adjusted < 0.05). The p values for the associations of early tau and later RD were not significant after multiple comparison adjustment, but were less than 0.1 in 7 white matter tracts. DISCUSSION This prospective study using data from the CARE Consortium demonstrated that in the early phase of SRC, white matter microstructural integrity detected by DTI neuroimaging was associated with elevated levels of blood-based biomarkers of traumatic brain injury. Total tau in the blood showed the strongest association with white matter microstructural changes.
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Affiliation(s)
- Yu-Chien Wu
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis.
| | - Qiuting Wen
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Rhea Thukral
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Ho-Ching Yang
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Jessica M Gill
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Sujuan Gao
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Kathleen A Lane
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Timothy B Meier
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Larry D Riggen
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Jaroslaw Harezlak
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Christopher C Giza
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Joshua Goldman
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Kevin M Guskiewicz
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Jason P Mihalik
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Stephen M LaConte
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Stefan M Duma
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Steven P Broglio
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Andrew J Saykin
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Thomas Walker McAllister
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
| | - Michael A McCrea
- From the Department of Radiology and Imaging Sciences (Y.-C.W., Q.W., R.T., H.-C.Y., A.J.S.), Indiana University School of Medicine, Indianapolis; School of Nursing (J.M.G.), Johns Hopkins University, Baltimore, MD; Department of Biostatistics and Health Data Science (S.G., K.A.L., L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at University of California Los Angeles; Family Medicine (J.G.), Ronald Reagan UCLA Medical Center, UCLA Health-Santa Monica Medical Center; Matthew Gfeller 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., S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; and Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis
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3
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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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4
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Nigri A, Ferraro S, Gandini Wheeler-Kingshott CAM, Tosetti M, Redolfi A, Forloni G, D'Angelo E, Aquino D, Biagi L, Bosco P, Carne I, De Francesco S, Demichelis G, Gianeri R, Lagana MM, Micotti E, Napolitano A, Palesi F, Pirastru A, Savini G, Alberici E, Amato C, Arrigoni F, Baglio F, Bozzali M, Castellano A, Cavaliere C, Contarino VE, Ferrazzi G, Gaudino S, Marino S, Manzo V, Pavone L, Politi LS, Roccatagliata L, Rognone E, Rossi A, Tonon C, Lodi R, Tagliavini F, Bruzzone MG. Quantitative MRI Harmonization to Maximize Clinical Impact: The RIN-Neuroimaging Network. Front Neurol 2022; 13:855125. [PMID: 35493836 PMCID: PMC9047871 DOI: 10.3389/fneur.2022.855125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Neuroimaging studies often lack reproducibility, one of the cardinal features of the scientific method. Multisite collaboration initiatives increase sample size and limit methodological flexibility, therefore providing the foundation for increased statistical power and generalizable results. However, multisite collaborative initiatives are inherently limited by hardware, software, and pulse and sequence design heterogeneities of both clinical and preclinical MRI scanners and the lack of benchmark for acquisition protocols, data analysis, and data sharing. We present the overarching vision that yielded to the constitution of RIN-Neuroimaging Network, a national consortium dedicated to identifying disease and subject-specific in-vivo neuroimaging biomarkers of diverse neurological and neuropsychiatric conditions. This ambitious goal needs efforts toward increasing the diagnostic and prognostic power of advanced MRI data. To this aim, 23 Italian Scientific Institutes of Hospitalization and Care (IRCCS), with technological and clinical specialization in the neurological and neuroimaging field, have gathered together. Each IRCCS is equipped with high- or ultra-high field MRI scanners (i.e., ≥3T) for clinical or preclinical research or has established expertise in MRI data analysis and infrastructure. The actions of this Network were defined across several work packages (WP). A clinical work package (WP1) defined the guidelines for a minimum standard clinical qualitative MRI assessment for the main neurological diseases. Two neuroimaging technical work packages (WP2 and WP3, for clinical and preclinical scanners) established Standard Operative Procedures for quality controls on phantoms as well as advanced harmonized quantitative MRI protocols for studying the brain of healthy human participants and wild type mice. Under FAIR principles, a web-based e-infrastructure to store and share data across sites was also implemented (WP4). Finally, the RIN translated all these efforts into a large-scale multimodal data collection in patients and animal models with dementia (i.e., case study). The RIN-Neuroimaging Network can maximize the impact of public investments in research and clinical practice acquiring data across institutes and pathologies with high-quality and highly-consistent acquisition protocols, optimizing the analysis pipeline and data sharing procedures.
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Affiliation(s)
- Anna Nigri
- U.O. Neuroradiologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Stefania Ferraro
- U.O. Neuroradiologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Claudia A. M. Gandini Wheeler-Kingshott
- Unità di Neuroradiologia, IRCCS Mondino Foundation, Pavia, Italy
- NMR Research Unit, Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Michela Tosetti
- Medical Physics and MR Lab, Fondazione IRCCS Stella Maris, Pisa, Italy
| | - Alberto Redolfi
- Laboratory of Neuroinformatics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Gianluigi Forloni
- Medical Physics and MR Lab, Fondazione IRCCS Stella Maris, Pisa, Italy
| | - Egidio D'Angelo
- Unità di Neuroradiologia, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Domenico Aquino
- U.O. Neuroradiologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Biagi
- Medical Physics and MR Lab, Fondazione IRCCS Stella Maris, Pisa, Italy
| | - Paolo Bosco
- Medical Physics and MR Lab, Fondazione IRCCS Stella Maris, Pisa, Italy
| | - Irene Carne
- Neuroradiology Unit, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Silvia De Francesco
- Laboratory of Neuroinformatics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Greta Demichelis
- U.O. Neuroradiologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ruben Gianeri
- U.O. Neuroradiologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Edoardo Micotti
- Laboratory of Biology of Neurodegenerative Disorders, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Antonio Napolitano
- Medical Physics, IRCCS Istituto Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Fulvia Palesi
- Unità di Neuroradiologia, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Giovanni Savini
- Neuroradiology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elisa Alberici
- Neuroradiology Unit, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Carmelo Amato
- Unit of Neuroradiology, Oasi Research Institute-IRCCS, Troina, Italy
| | - Filippo Arrigoni
- Neuroimaging Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | | | - Marco Bozzali
- Neuroimaging Laboratory, Santa Lucia Foundation, IRCCS, Rome, Italy
| | | | | | - Valeria Elisa Contarino
- Unità di Neuroradiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Simona Gaudino
- Istituto di Radiologia, UOC Radiologia e Neuroradiologia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
| | - Vittorio Manzo
- Department of Radiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | | | - Letterio S. Politi
- Neuroradiology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luca Roccatagliata
- Neuroradiologia IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Dipartimento di Scienze della Salute Università di Genova, Genoa, Italy
| | - Elisa Rognone
- Unità di Neuroradiologia, IRCCS Mondino Foundation, Pavia, Italy
| | - Andrea Rossi
- Dipartimento di Scienze della Salute Università di Genova, Genoa, Italy
- UO Neuroradiologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Caterina Tonon
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Lodi
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabrizio Tagliavini
- Scientific Direction, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- U.O. Neuroradiologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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5
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Kurokawa R, Kamiya K, Koike S, Nakaya M, Uematsu A, Tanaka SC, Kamagata K, Okada N, Morita K, Kasai K, Abe O. Cross-scanner reproducibility and harmonization of a diffusion MRI structural brain network: A traveling subject study of multi-b acquisition. Neuroimage 2021; 245:118675. [PMID: 34710585 DOI: 10.1016/j.neuroimage.2021.118675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/26/2021] [Accepted: 10/21/2021] [Indexed: 01/18/2023] Open
Abstract
Characterization of brain networks by diffusion MRI (dMRI) has rapidly evolved, and there are ongoing movements toward data sharing and multi-center studies. To extract meaningful information from multi-center data, methods to correct for the bias caused by scanner differences, that is, harmonization, are urgently needed. In this work, we report the cross-scanner differences in structural network analyses using data from nine traveling subjects (four males and five females, 21-49 years-old) who underwent scanning using four 3T scanners (public database available from the Brain/MINDS Beyond Human Brain MRI project (http://mriportal.umin.jp/)). The reliability and reproducibility were compared to those of data from another set of four subjects (all males, 29-42 years-old) who underwent scan-rescan (interval, 105-147 days) with the same scanner as well as scan-rescan data from the Human Connectome Project database. The results demonstrated that the reliability of the edge weights and graph theory metrics was lower for data including different scanners, compared to the scan-rescan with the same scanner. Besides, systematic differences between scanners were observed, indicating the risk of bias in comparing networks obtained from different scanners directly. We further demonstrate that it is feasible to reduce inter-scanner variabilities while preserving the inter-subject differences among healthy individuals by modeling the scanner effects at the level of network matrices, when traveling-subject data are available for calibration between scanners. The present data and results are expected to serve as a basis for developing and evaluating novel harmonization methods.
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Affiliation(s)
- Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Kouhei Kamiya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Radiology, Toho University, Tokyo, Japan; Department of Radiology, Juntendo University, Tokyo, Japan.
| | - Shinsuke Koike
- Center for Evolutionary Cognitive Sciences (ECS), Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan; University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan; University of Tokyo Center for Integrative Science of Human Behavior (CiSHuB), Tokyo, Japan; The International Research Center for Neurointelligence (WPI-IRCN), Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan.
| | - Moto Nakaya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Akiko Uematsu
- Center for Evolutionary Cognitive Sciences (ECS), Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan.
| | - Saori C Tanaka
- Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institutes International (ATR), Kyoto, Japan.
| | - Koji Kamagata
- Department of Radiology, Juntendo University, Tokyo, Japan.
| | - Naohiro Okada
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan; The International Research Center for Neurointelligence (WPI-IRCN), Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan; Department of Neuropsychiatry, The University of Tokyo, Tokyo, Japan.
| | - Kentaro Morita
- Department of Neuropsychiatry, The University of Tokyo, Tokyo, Japan.
| | - Kiyoto Kasai
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan; University of Tokyo Center for Integrative Science of Human Behavior (CiSHuB), Tokyo, Japan; The International Research Center for Neurointelligence (WPI-IRCN), Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan; Department of Neuropsychiatry, The University of Tokyo, Tokyo, Japan.
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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6
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Granziera C, Wuerfel J, Barkhof F, Calabrese M, De Stefano N, Enzinger C, Evangelou N, Filippi M, Geurts JJG, Reich DS, Rocca MA, Ropele S, Rovira À, Sati P, Toosy AT, Vrenken H, Gandini Wheeler-Kingshott CAM, Kappos L. Quantitative magnetic resonance imaging towards clinical application in multiple sclerosis. Brain 2021; 144:1296-1311. [PMID: 33970206 PMCID: PMC8219362 DOI: 10.1093/brain/awab029] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/25/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022] Open
Abstract
Quantitative MRI provides biophysical measures of the microstructural integrity of the CNS, which can be compared across CNS regions, patients, and centres. In patients with multiple sclerosis, quantitative MRI techniques such as relaxometry, myelin imaging, magnetization transfer, diffusion MRI, quantitative susceptibility mapping, and perfusion MRI, complement conventional MRI techniques by providing insight into disease mechanisms. These include: (i) presence and extent of diffuse damage in CNS tissue outside lesions (normal-appearing tissue); (ii) heterogeneity of damage and repair in focal lesions; and (iii) specific damage to CNS tissue components. This review summarizes recent technical advances in quantitative MRI, existing pathological validation of quantitative MRI techniques, and emerging applications of quantitative MRI to patients with multiple sclerosis in both research and clinical settings. The current level of clinical maturity of each quantitative MRI technique, especially regarding its integration into clinical routine, is discussed. We aim to provide a better understanding of how quantitative MRI may help clinical practice by improving stratification of patients with multiple sclerosis, and assessment of disease progression, and evaluation of treatment response.
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Affiliation(s)
- Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center, Basel, Switzerland
- Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
- UCL Institutes of Healthcare Engineering and Neurology, London, UK
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola De Stefano
- Neurology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Christian Enzinger
- Department of Neurology and Division of Neuroradiology, Medical University of Graz, Graz, Austria
| | - Nikos Evangelou
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, multiple sclerosis Center Amsterdam, Neuroscience Amsterdam, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefan Ropele
- Neuroimaging Research Unit, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Àlex Rovira
- Section of Neuroradiology (Department of Radiology), Vall d'Hebron University Hospital and Research Institute, Barcelona, Spain
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ahmed T Toosy
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
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7
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Johnson B, Dodd A, Mayer AR, Hallett M, Slobounov S. Are there any differential responses to concussive injury in civilian versus athletic populations: a neuroimaging study. Brain Imaging Behav 2020; 14:110-117. [PMID: 30361946 DOI: 10.1007/s11682-018-9982-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Accurate identification and classification of patients suffering from mild traumatic brain injury (mTBI) is a significant challenge faced by clinicians and researchers. To examine if there are different pathophysiological responses to concussive injury in different populations, evaluated here comparing collegiate athletes versus age-matched non-athletes. Resting-state fMRI data were acquired in the acute phase of concussion from 30 collegiate athletes and from 30 injury and age matched non-athletes. Resting-state functional connectivity measures revealed group differences with reduced connectivity in the anterior cingulate cortex (p < .05) and posterior cingulate cortex (p < 0.05) hubs of the Default Mode Network in the athletes. Given the known positive effects of exercise on brain functional reserves and neural efficiency concept, we expected less pronounced effect of concussion in athletic population. In contrast, there were significant decreases in functional connectivity in athletes that could be a result of previous repetitive subconcussive impacts and history of concussion.
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Affiliation(s)
- Brian Johnson
- Department of Kinesiology, The Pennsylvania State University, 276, Recreation Building, University Park, PA, 16802, USA
| | - Andrew Dodd
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Andrew R Mayer
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA.,Departments of Neurology and Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Mark Hallett
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, 20892, USA
| | - Semyon Slobounov
- Department of Kinesiology, The Pennsylvania State University, 276, Recreation Building, University Park, PA, 16802, USA. .,Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA.
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8
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Bobholz SA, Brett BL, España LY, Huber DL, Mayer AR, Harezlak J, Broglio SP, McAllister T, McCrea MA, Meier TB. Prospective study of the association between sport-related concussion and brain morphometry (3T-MRI) in collegiate athletes: study from the NCAA-DoD CARE Consortium. Br J Sports Med 2020; 55:169-174. [PMID: 32917671 DOI: 10.1136/bjsports-2020-102002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the acute and early long-term associations of sport-related concussion (SRC) and subcortical and cortical structures in collegiate contact sport athletes. METHODS Athletes with a recent SRC (n=99) and matched contact (n=91) and non-contact sport controls (n=95) completed up to four neuroimaging sessions from 24 to 48 hours to 6 months postinjury. Subcortical volumes (amygdala, hippocampus, thalamus and dorsal striatum) and vertex-wise measurements of cortical thickness/volume were computed using FreeSurfer. Linear mixed-effects models examined the acute and longitudinal associations between concussion and structural metrics, controlling for intracranial volume (or mean thickness) and demographic variables (including prior concussions and sport exposure). RESULTS There were significant group-dependent changes in amygdala volumes across visits (p=0.041); this effect was driven by a trend for increased amygdala volume at 6 months relative to subacute visits in contact controls, with no differences in athletes with SRC. No differences were observed in any cortical metric (ie, thickness or volume) for primary or secondary analyses. CONCLUSION A single SRC had minimal associations with grey matter structure across a 6-month time frame.
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Affiliation(s)
- Samuel A Bobholz
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Benjamin L Brett
- Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lezlie Y España
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daniel L Huber
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew R Mayer
- Neurology and Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.,The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA.,Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jaroslaw Harezlak
- Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas McAllister
- Psychiatry, Indiana University School of Medicine, Bloomington, Indiana, USA
| | - Michael A McCrea
- Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy B Meier
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA .,Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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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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10
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Pinto MS, Paolella R, Billiet T, Van Dyck P, Guns PJ, Jeurissen B, Ribbens A, den Dekker AJ, Sijbers J. Harmonization of Brain Diffusion MRI: Concepts and Methods. Front Neurosci 2020; 14:396. [PMID: 32435181 PMCID: PMC7218137 DOI: 10.3389/fnins.2020.00396] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 03/30/2020] [Indexed: 11/13/2022] Open
Abstract
MRI diffusion data suffers from significant inter- and intra-site variability, which hinders multi-site and/or longitudinal diffusion studies. This variability may arise from a range of factors, such as hardware, reconstruction algorithms and acquisition settings. To allow a reliable comparison and joint analysis of diffusion data across sites and over time, there is a clear need for robust data harmonization methods. This review article provides a comprehensive overview of diffusion data harmonization concepts and methods, and their limitations. Overall, the methods for the harmonization of multi-site diffusion images can be categorized in two main groups: diffusion parametric map harmonization (DPMH) and diffusion weighted image harmonization (DWIH). Whereas DPMH harmonizes the diffusion parametric maps (e.g., FA, MD, and MK), DWIH harmonizes the diffusion-weighted images. Defining a gold standard harmonization technique for dMRI data is still an ongoing challenge. Nevertheless, in this paper we provide two classification tools, namely a feature table and a flowchart, which aim to guide the readers in selecting an appropriate harmonization method for their study.
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Affiliation(s)
- Maíra Siqueira Pinto
- Department of Radiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.,imec-Vision Lab, University of Antwerp, Antwerp, Belgium
| | - Roberto Paolella
- imec-Vision Lab, University of Antwerp, Antwerp, Belgium.,Icometrix, Leuven, Belgium
| | | | - Pieter Van Dyck
- Department of Radiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | | | - Ben Jeurissen
- imec-Vision Lab, University of Antwerp, Antwerp, Belgium
| | | | | | - Jan Sijbers
- imec-Vision Lab, University of Antwerp, Antwerp, Belgium
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11
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Rizk T, Turtzo LC, Cota M, Van Der Merwe AJ, Latour L, Whiting MD, Chan L. Traumatic microbleeds persist for up to five years following traumatic brain injury despite resolution of other acute findings on MRI. Brain Inj 2020; 34:773-781. [PMID: 32228304 DOI: 10.1080/02699052.2020.1725835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The primary objective of this study was to track the incidence and progression of traumatic microbleeds (TMBs) for up to five years following traumatic brain injury (TBI). METHODS Thirty patients with mild, moderate, or severe TBI received initial MRI within 48 h of injury and continued in a longitudinal study for up to five years. The incidence and progression of MRI findings was assessed across the five year period. In addition to TMBs, we noted the presence of other imaging findings including diffusion weighted imaging (DWI) lesions, extra-axial and intraventricular hemorrhage, hematoma, traumatic meningeal enhancement (TME), fluid-attenuated inversion recovery (FLAIR) hyperintensities, and encephalomalacia. RESULTS TMBs were observed in 60% of patients at initial presentation. At one-year follow-up, TMBs were more persistent than other neuroimaging findings, with 83% remaining visible on MRI. In patients receiving serial MRI 2-5 years post-injury, acute TMBs were visible on all follow-up scans. In contrast, most other imaging markers of TBI had either resolved or evolved into ambiguous abnormalities on imaging by one year post-injury. CONCLUSIONS These findings suggest that TMBs may serve as a uniquely persistent indicator of TBI and reinforce the importance of acute post-injury imaging for accurate characterization of persistent imaging findings.
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Affiliation(s)
- Theresa Rizk
- Department of Rehabilitation Medicine, National Institutes of Health Clinical Center , Bethesda, MD, USA
| | - L Christine Turtzo
- National Institutes of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, MD, USA
| | - Martin Cota
- Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
| | | | - Lawrence Latour
- National Institutes of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
| | - Mark D Whiting
- Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
| | - Leighton Chan
- Department of Rehabilitation Medicine, National Institutes of Health Clinical Center , Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
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12
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Wang Y, Nencka AS, Meier TB, Guskiewicz K, Mihalik JP, Alison Brooks M, Saykin AJ, Koch KM, Wu YC, Nelson LD, McAllister TW, Broglio SP, McCrea MA. Cerebral blood flow in acute concussion: preliminary ASL findings from the NCAA-DoD CARE consortium. Brain Imaging Behav 2020; 13:1375-1385. [PMID: 30159767 DOI: 10.1007/s11682-018-9946-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sport-related concussion (SRC) has become a major health problem, affecting millions of athletes each year. Despite the increasing occurrence and prevalence of SRC, its underlying mechanism and recovery course have yet to be fully elucidated. The National Collegiate Athletic Association-Department of Defense Grand Alliance: Concussion Assessment, Research and Education (CARE) Consortium is a large-scale, multisite study of the natural history of concussion across multiple sports. The Advanced Research Core (ARC) of CARE is focused on the advanced biomarker assessment of a reduced subject cohort. This paper reports findings from two ARC sites to evaluate cerebral blood flow (CBF) changes in acute SRC, as measured using advanced arterial spin labeling (ASL) magnetic resonance imaging (MRI). We compared relative CBF maps assessed in 24 concussed contact sport athletes obtained at 24-48 h after injury to those of a control group of 24 matched contact sport players. Significantly less CBF was detected in several brain regions in concussed athletes, while clinical assessments also indicated clinical symptom and performance impairments in SRC patients. Correlations were found between decreased CBF in acute SRC and clinical assessments, including Balance Error Scoring System total score and Immediate Post-Concussion Assessment and Cognitive Test memory composite and impulse control composite scores, as well as days from injury to asymptomatic. Although using different ASL MRI sequences, our preliminary results from two sites are consistent with previous reports and suggest that advanced ASL MRI methods might be useful for detecting acute neurobiological changes in acute SRC.
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Affiliation(s)
- Yang Wang
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Andrew S Nencka
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Kevin Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, 250 East Franklin Street, Chapel Hill, NC, USA
| | - Jason P Mihalik
- Department of Exercise and Sport Science, University of North Carolina, 250 East Franklin Street, Chapel Hill, NC, USA
| | - M Alison Brooks
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 340 West 10th Street, Indianapolis, IN, USA
| | - Kevin M Koch
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Yu-Chien Wu
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 340 West 10th Street, Indianapolis, IN, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, 340 West 10th Street, Indianapolis, IN, USA
| | - Steven P Broglio
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
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13
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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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14
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Bigler ED, Abildskov TJ, Eggleston B, Taylor BA, Tate DF, Petrie JA, Newsome MR, Scheibel RS, Levin H, Walker WC, Goodrich‐Hunsaker N, Tustison NJ, Stone JR, Mayer AR, Duncan TD, York GE, Wilde EA. Structural neuroimaging in mild traumatic brain injury: A chronic effects of neurotrauma consortium study. Int J Methods Psychiatr Res 2019; 28:e1781. [PMID: 31608535 PMCID: PMC6877164 DOI: 10.1002/mpr.1781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The chronic effects of neurotrauma consortium (CENC) observational study is a multisite investigation designed to examine the long-term longitudinal effects of mild traumatic brain injury (mTBI). All participants in this initial CENC cohort had a history of deployment in Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom (Iraq), and/or their follow-on conflicts (Operation Freedom's Sentinel). All participants undergo extensive medical, neuropsychological, and neuroimaging assessments and either meet criteria for any lifetime mTBI or not. These assessments are integrated into six CENC core studies-Biorepository, Biostatistics, Data and Study Management, Neuroimaging, and Neuropathology. METHODS The current study outlines the quantitative neuroimaging methods managed by the Neuroimaging Core using FreeSurfer automated software for image quantification. RESULTS At this writing, 319 participants from the CENC observational study have completed all baseline assessments including the imaging protocol and tertiary data quality assurance procedures. CONCLUSIONS/DISCUSSION The preliminary findings of this initial cohort are reported to describe how the Neuroimaging Core manages neuroimaging quantification for CENC studies.
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Affiliation(s)
- Erin D. Bigler
- Psychology Department and Neuroscience CenterBrigham Young UniversityProvoUtah
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
| | - Tracy J. Abildskov
- Psychology Department and Neuroscience CenterBrigham Young UniversityProvoUtah
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
| | - Barry Eggleston
- Biostatistics and EpidemiologyRTI InternationalDurhamNorth Carolina
| | - Brian A. Taylor
- Biomedical EngineeringVirginia Commonwealth UniversityRichmondVirginia
| | - David F. Tate
- Missouri Institute of Mental HealthUniversity of Missouri‐St. LouisSt. LouisMissouri
| | - Jo Ann Petrie
- Psychology Department and Neuroscience CenterBrigham Young UniversityProvoUtah
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
| | - Mary R. Newsome
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
| | - Randall S. Scheibel
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
| | - Harvey Levin
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
| | - William C. Walker
- Biomedical EngineeringVirginia Commonwealth UniversityRichmondVirginia
| | - Naomi Goodrich‐Hunsaker
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVirginia
| | - Nicholas J. Tustison
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVirginia
| | - James R. Stone
- Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVirginia
| | - Andrew R. Mayer
- Neurology and Brain and Behavioral Health InstituteUniversity of New MexicoAlbuquerqueNew Mexico
| | - Timothy D. Duncan
- Medical Imaging and RadiologyVA Portland Health Care SystemPortlandOregon
| | - Gerry E. York
- Alaska Radiology AssociatesTBI Imaging and ResearchAnchorageAlaska
| | - Elisabeth A. Wilde
- Michael DeBakey VA Medical Center and Baylor College of MedicineHoustonTexas
- Department of NeurologyUniversity of UtahSalt Lake CityUtah
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15
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Song J, Chow HM, Nikam R, Kandula V, Choudhary AK, Li H. Reproducibility of axonal water fraction derived from the spherical mean diffusion weighted signal. Magn Reson Imaging 2019; 63:49-54. [PMID: 31425799 DOI: 10.1016/j.mri.2019.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/23/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
Recent years have seen growing interest in measuring axonal water fraction (AWF) using the spherical mean diffusion weighted signal, but information about the reproducibility of this method is needed before applying it in large-scale studies. The current study aims to evaluate the reproducibility of AWF derived from the spherical mean signal method. This retrospective study analyzed the Human Connectome Project (HCP) test-retest diffusion data of ten healthy adults. The diffusion scan was performed two times for each subject. Diffusion tensor imaging-based fractional anisotropy (FA) was calculated with b = 1000 s/mm2. AWF was calculated with b = 3000 s/mm2 using the spherical mean signal method. Gradient nonlinearities were corrected in both methods. Reproducibility was assessed using the reproducibility error, which is the percent absolute change relative to the mean. The mean reproducibility error of fractional anisotropy (FA) is 9.7 ± 1.0% in white matter and 18.0 ± 2.0% in gray matter. The mean reproducibility error of AWF is 4.6 ± 0.6% in white matter and 7.0 ± 1.5% in gray matter. Spherical mean signal-based AWF is more reproducible than FA for the HCP high resolution, low signal-to-noise ratio diffusion data.
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Affiliation(s)
- Jucai Song
- Henan Orthopedic Institute, Henan Luoyang Orthopedic Hospital, Zhengzhou, Henan 450000, China
| | - Ho Ming Chow
- Katzin Diagnostic & Research PET/MR Center, Nemours - Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA
| | - Rahul Nikam
- Department of Radiology, Nemours - Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA
| | - Vinay Kandula
- Department of Radiology, Nemours - Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA
| | - Arabinda K Choudhary
- Department of Radiology, Nemours - Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA
| | - Hua Li
- Katzin Diagnostic & Research PET/MR Center, Nemours - Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA.
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16
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Prohl AK, Scherrer B, Tomas-Fernandez X, Filip-Dhima R, Kapur K, Velasco-Annis C, Clancy S, Carmody E, Dean M, Valle M, Prabhu SP, Peters JM, Bebin EM, Krueger DA, Northrup H, Wu JY, Sahin M, Warfield SK. Reproducibility of Structural and Diffusion Tensor Imaging in the TACERN Multi-Center Study. Front Integr Neurosci 2019; 13:24. [PMID: 31417372 PMCID: PMC6650594 DOI: 10.3389/fnint.2019.00024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multi-site MRI studies are often necessary for recruiting sufficiently sized samples when studying rare conditions. However, they require pooling data from multiple scanners into a single data set, and therefore it is critical to evaluate the variability of quantitative MRI measures within and across scanners used in multi-site studies. The aim of this study was to evaluate the reproducibility of structural and diffusion weighted (DW) MRI measurements acquired on seven scanners at five medical centers as part of the Tuberous Sclerosis Complex Autism Center of Excellence Research Network (TACERN) multisite study. METHODS The American College of Radiology (ACR) phantom was imaged monthly to measure reproducibility of signal intensity and uniformity within and across seven 3T scanners from General Electric, Philips, and Siemens vendors. One healthy adult male volunteer was imaged repeatedly on all seven scanners under the TACERN structural and DW protocol (5 b = 0 s/mm2 and 30 b = 1000 s/mm2) over a period of 5 years (age 22-27 years). Reproducibility of inter- and intra-scanner brain segmentation volumes and diffusion tensor imaging metrics fractional anisotropy (FA) and mean diffusivity (MD) within white matter regions was quantified with coefficient of variation. RESULTS The American College of Radiology Phantom signal intensity and uniformity were similar across scanners and changed little over time, with a mean intra-scanner coefficient of variation of 3.6 and 1.8%, respectively. The mean inter- and intra-scanner coefficients of variation of brain structure volumes derived from T1-weighted (T1w) images of the human phantom were 3.3 and 1.1%, respectively. The mean inter- and intra-scanner coefficients of variation of FA in white matter regions were 4.5 and 2.5%, while the mean inter- and intra-scanner coefficients of variation of MD in white matter regions were 5.4 and 1.5%. CONCLUSION Our results suggest that volumetric and diffusion tensor imaging (DTI) measurements are highly reproducible between and within scanners and provide typical variation amplitudes that can be used as references to interpret future findings in the TACERN network.
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Affiliation(s)
- Anna K. Prohl
- Computational Radiology Laboratory, Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Benoit Scherrer
- Computational Radiology Laboratory, Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Xavier Tomas-Fernandez
- Computational Radiology Laboratory, Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Rajna Filip-Dhima
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Kush Kapur
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Clemente Velasco-Annis
- Computational Radiology Laboratory, Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Sean Clancy
- Computational Radiology Laboratory, Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Erin Carmody
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Meghan Dean
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Molly Valle
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Sanjay P. Prabhu
- Division of Neuroradiology, Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Jurriaan M. Peters
- Computational Radiology Laboratory, Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - E. Martina Bebin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Darcy A. Krueger
- Department of Neurology and Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Hope Northrup
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Joyce Y. Wu
- Division of Pediatric Neurology, UCLA Mattel Children’s Hospital, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Mustafa Sahin
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Simon K. Warfield
- Computational Radiology Laboratory, Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
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17
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Klein AP, Tetzlaff JE, Bonis JM, Nelson LD, Mayer AR, Huber DL, Harezlak J, Mathews VP, Ulmer JL, Sinson GP, Nencka AS, Koch KM, Wu YC, Saykin AJ, DiFiori JP, Giza CC, Goldman J, Guskiewicz KM, Mihalik JP, Duma SM, Rowson S, Brooks A, Broglio SP, McAllister T, McCrea MA, Meier TB. Prevalence of Potentially Clinically Significant Magnetic Resonance Imaging Findings in Athletes with and without Sport-Related Concussion. J Neurotrauma 2019; 36:1776-1785. [PMID: 30618331 DOI: 10.1089/neu.2018.6055] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Previous studies have shown that mild traumatic brain injury (mTBI) can cause abnormalities in clinically relevant magnetic resonance imaging (MRI) sequences. No large-scale study, however, has prospectively assessed this in athletes with sport-related concussion (SRC). The aim of the current study was to characterize and compare the prevalence of acute, trauma-related MRI findings and clinically significant, non-specific MRI findings in athletes with and without SRC. College and high-school athletes were prospectively enrolled and participated in scanning sessions between January 2015 through August 2017. Concussed contact sport athletes (n = 138; 14 female [F]; 19.5 ± 1.6 years) completed up to four scanning sessions after SRC. Non-concussed contact (n = 135; 15 F; 19.7 ± 1.6) and non-contact athletes (n = 96; 15 F; 20.0 ± 1.7) completed similar scanning sessions and served as controls. Board-certified neuroradiologists, blinded to SRC status, reviewed T1-weighted and T2-weighted fluid-attenuated inversion recovery and T2*-weighted and T2-weighted images for acute (i.e., injury-related) or non-acute findings that prompted recommendation for clinical follow-up. Concussed athletes were more likely to have MRI findings relative to contact (30.4% vs. 15.6%; odds ratio [OR] = 2.32; p = 0.01) and non-contact control athletes (19.8%; OR = 2.11; p = 0.04). Female athletes were more likely to have MRI findings than males (43.2% vs. 19.4%; OR = 2.62; p = 0.01). One athlete with SRC had an acute, injury-related finding; group differences were largely driven by increased rate of non-specific white matter hyperintensities in concussed athletes. This prospective, large-scale study demonstrates that <1% of SRCs are associated with acute injury findings on qualitative structural MRI, providing empirical support for clinical guidelines that do not recommend use of MRI after SRC.
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Affiliation(s)
- Andrew P Klein
- 1 Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Julie E Tetzlaff
- 2 Department of Pathology, Pediatric Division, and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Joshua M Bonis
- 1 Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lindsay D Nelson
- 3 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew R Mayer
- 4 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
| | - Daniel L Huber
- 3 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jaroslaw Harezlak
- 5 Department of Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana
| | - Vincent P Mathews
- 1 Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John L Ulmer
- 1 Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Grant P Sinson
- 3 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew S Nencka
- 1 Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kevin M Koch
- 1 Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yu-Chien Wu
- 6 Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew J Saykin
- 6 Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - John P DiFiori
- 7 Department of Family Medicine and Orthopedics, University of California Los Angeles, Los Angeles, California
| | - Christopher C Giza
- 8 Department of Pediatrics and Neurosurgery, and University of California Los Angeles, Los Angeles, California
| | - Joshua Goldman
- 9 Department of Family Medicine, University of California Los Angeles, Los Angeles, California
| | - Kevin M Guskiewicz
- 10 Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina
| | - Jason P Mihalik
- 10 Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina
| | - Stefan M Duma
- 11 Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia
| | - Steven Rowson
- 11 Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia
| | - Alison Brooks
- 12 Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Steven P Broglio
- 13 School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Thomas McAllister
- 14 Department of Psychiatry, Indiana University School of Medicine, Bloomington, Indiana
| | - Michael A McCrea
- 3 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy B Meier
- 3 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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18
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Long-Term Neuroimaging Findings in American Football Players: Systematic Review. World Neurosurg 2018; 120:e365-e379. [DOI: 10.1016/j.wneu.2018.08.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/11/2018] [Indexed: 01/08/2023]
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19
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Wilde EA, Provenzale JM, Taylor BA, Boss M, Zuccolotto A, Hachey R, Pathak S, Tate DF, Abildskov TJ, Schneider W. Assessment of quantitative magnetic resonance imaging metrics in the brain through the use of a novel phantom. Brain Inj 2018; 32:1266-1276. [PMID: 30169993 DOI: 10.1080/02699052.2018.1494855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Multisite and longitudinal neuroimaging studies are important in uncovering trajectories of recovery and neurodegeneration following traumatic brain injury (TBI) and concussion through the use of diffusion tensor imaging (DTI) and other imaging modalities. This study assessed differences in anisotropic diffusion measurement across four scanners using a human and a novel phantom developed in conjunction with the Chronic Effects of Neurotrauma Consortium. METHOD Human scans provided measurement within biological tissue, and the novel physical phantom provided measures of anisotropic intra-tubular diffusion to serve as a model for intra-axonal water diffusion. Intra- and inter-scanner measurement variances were compared, and the impact on effect size was calculated. RESULTS Intra-scanner test-retest reliability estimates for fractional anisotropy (FA) demonstrated relative stability over testing intervals. The human tissue and phantom showed similar FA ranges, high linearity and large within-device effect sizes. However, inter-scanner measures of FA indicated substantial differences, some of which exceeded typical DTI effect sizes in mild TBI. CONCLUSION The diffusion phantom may be used to better elucidate inter-scanner variability in DTI-based measurement and provides an opportunity to better calibrate results obtained from scanners used in multisite and longitudinal studies. Novel solutions are being evaluated to understand and potentially overcome these differences.
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Affiliation(s)
- Elisabeth A Wilde
- a Department of Veterans Affairs Medical Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,b Department of Neurology, University of Utah , Salt Lake City , UT , USA.,c Departments of Physical Medicine and Rehabilitation, Neurology, and Radiology, Baylor College of Medicine , Houston , TX , USA
| | - James M Provenzale
- d Department of Radiology, Duke University Medical Center , Durham , NC , USA
| | - Brian A Taylor
- e Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University , Richmond , VA , USA
| | - Michael Boss
- f Department of Physics, University of Colorado Boulder , Boulder , CO , USA.,g National Institute of Standard and Technology , Boulder , CO , USA
| | - Anthony Zuccolotto
- h Phantom Metrics Division of Psychology Software Tools Inc , Pittsburgh, Pennsylvania, USA
| | - Rebecca Hachey
- i Learning Research and Development Center, University of Pittsburgh , Pittsburgh , PA , USA
| | - Sudhir Pathak
- i Learning Research and Development Center, University of Pittsburgh , Pittsburgh , PA , USA
| | - David F Tate
- j Missouri Institute of Mental Health, University of Missouri-St. Louis , St. Louis , MO , USA
| | - Tracy J Abildskov
- b Department of Neurology, University of Utah , Salt Lake City , UT , USA.,k Department of Psychology, Brigham Young University , Provo , UT , USA
| | - Walter Schneider
- h Phantom Metrics Division of Psychology Software Tools Inc , Pittsburgh, Pennsylvania, USA.,i Learning Research and Development Center, University of Pittsburgh , Pittsburgh , PA , USA.,l Departments of Psychology and Engineering, University of Pittsburgh Medical Center , Pittsburgh , PA , USA.,m Departments of Neurosurgery and Radiology, University of Pittsburgh Medical Center , Pittsburgh , PA , USA
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20
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Mustafi SM, Harezlak J, Koch KM, Nencka AS, Meier TB, West JD, Giza CC, DiFiori JP, Guskiewicz KM, Mihalik JP, LaConte SM, Duma SM, Broglio SP, Saykin AJ, McCrea M, McAllister TW, Wu YC. Acute White-Matter Abnormalities in Sports-Related Concussion: A Diffusion Tensor Imaging Study from the NCAA-DoD CARE Consortium. J Neurotrauma 2018; 35:2653-2664. [PMID: 29065805 DOI: 10.1089/neu.2017.5158] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Sports-related concussion (SRC) is an important public health issue. Although standardized assessment tools are useful in the clinical management of acute concussion, the underlying pathophysiology of SRC and the time course of physiological recovery after injury remain unclear. In this study, we used diffusion tensor imaging (DTI) to detect white matter alterations in football players within 48 h after SRC. As part of the NCAA-DoD CARE Consortium study of SRC, 30 American football players diagnosed with acute concussion and 28 matched controls received clinical assessments and underwent advanced magnetic resonance imaging scans. To avoid selection bias and partial volume effects, whole-brain skeletonized white matter was examined by tract-based spatial statistics to investigate between-group differences in DTI metrics and their associations with clinical outcome measures. Mean diffusivity was significantly higher in brain white matter of concussed athletes, particularly in frontal and subfrontal long white matter tracts. In the concussed group, axial diffusivity was significantly correlated with the Brief Symptom Inventory and there was a similar trend with the symptom severity score of the Sport Concussion Assessment Tool. In addition, concussed athletes with higher fractional anisotropy performed better on the cognitive component of the Standardized Assessment of Concussion. Overall, the results of this study are consistent with the hypothesis that SRC is associated with changes in white matter tracts shortly after injury, and these differences are correlated clinically with acute symptoms and functional impairments.
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Affiliation(s)
- Sourajit Mitra Mustafi
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Jaroslaw Harezlak
- 2 Department of Epidemiology and Biostatistics, School of Public Health, Indiana University , Bloomington, Indiana
| | - Kevin M Koch
- 3 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Andrew S Nencka
- 3 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Timothy B Meier
- 4 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - John D West
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Christopher C Giza
- 5 Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Division of Pediatric Neurology, Mattel Children's Hospital-UCLA Los Angeles , California
| | - John P DiFiori
- 6 Division of Sports Medicine, Departments of Family Medicine and Orthopedics, University of California Los Angeles , Los Angeles, California
| | - Kevin M Guskiewicz
- 7 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
| | - Jason P Mihalik
- 7 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
| | - Stephen M LaConte
- 8 School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University , Virginia Tech Carilion Research Institute, Roanoke, Virginia
| | - Stefan M Duma
- 9 School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University , Blacksburg, Virginia
| | - Steven P Broglio
- 10 NeuroTrauma Research Laboratory, School of Kinesiology, University of Michigan , Ann Arbor, Michigan
| | - Andrew J Saykin
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Michael McCrea
- 4 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Thomas W McAllister
- 11 Department of Psychology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Yu-Chien Wu
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
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