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Liu Z, Dudley JA, Diekfuss JA, Ahmed N, Edmondson AD, Cecil KM, Yuan W, Zuleger TM, Slutsky-Ganesh AB, Barber Foss KD, Myer GD, Fleischer CC. Associations Between Brain Metabolites Measured With MR Spectroscopy and Head Impacts in High School American Football Athletes. J Magn Reson Imaging 2024. [PMID: 39177233 DOI: 10.1002/jmri.29581] [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: 06/11/2024] [Revised: 08/05/2024] [Accepted: 08/06/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND While changes in brain metabolites after injury have been reported, relationships between metabolite changes and head impacts are less characterized. PURPOSE To investigate alterations in neurochemistry in high school athletes as a function of head impacts, concussion, and the use of a jugular vein compression (JVC) collar. STUDY TYPE Prospective controlled trial. SUBJECTS A total of 284 male American football players, divided into JVC collar and noncollar groups; 215 included in final analysis (age = 15.9 ± 1.0 years; 114 in collar group). FIELD STRENGTH/SEQUENCE 3 Tesla/T1-weighted gradient echo, 1H point resolved spectroscopy, acquired between August and November 2018. ASSESSMENT Head impacts were quantified using accelerometers. Concussion was diagnosed by medical professionals for each team. Pre- to postseason differences in total N-acetylaspartate (tNAA), total choline (tCho), myo-inositol (myoI), and glutamate + glutamine (Glx), in primary motor cortex (M1) and anterior cingulate cortex (ACC), relative to total creatine (tCr), were determined. STATISTICAL TESTS Group-wise comparisons were performed using Wilcoxon signed-rank, Friedman's, and Mann-Whitney U tests. Relationships between ∆metabolite/tCr and mean g-force were analyzed using linear regressions accounting for concussion and JVC collar. Significance was set at P ≤ 0.05. RESULTS In participants without concussion, a significant decrease in tCho/tCr (0.233 ± 1.40 × 10-3 to 0.227 ± 1.47 × 10-7) and increase in Glx/tCr (1.60 ± 8.75 × 10-3 to 1.63 ± 1.08 × 10-2) in ACC were observed pre- to postseason. The relationship between ∆tCho/tCr in M1 and ACC and mean g-force from >80 g to >140 g differed significantly between participants with and without concussion (M1 β ranged from 3.9 × 10-3 to 2.1 × 10-3; ACC β ranged from 2.7 × 10-3 to 2.1 × 10-3). Posthoc analyses revealed increased tCho/tCr in M1 was positively associated with mean g-force >100 g (β = 3.6 × 10-3) and >110 g (β = 2.9 × 10-3) in participants with concussion. Significant associations between∆ myoI / tCr $$ \Delta \mathrm{myoI}/\mathrm{tCr} $$ in ACC and mean g-force >110 g (β = -1.1 × 10-3) and >120 g (β = -1.1 × 10-3) were observed in the collar group only. DATA CONCLUSION Diagnosed concussion and the use of a JVC collar result in distinct neurochemical trends after repeated head impacts. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Zexuan Liu
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Jonathan A Dudley
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nadine Ahmed
- Department of Neuroscience, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Alex D Edmondson
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kim M Cecil
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Weihong Yuan
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Taylor M Zuleger
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alexis B Slutsky-Ganesh
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kim D Barber Foss
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gregory D Myer
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, United Kingdom
| | - Candace C Fleischer
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Fitzgerald B, Bari S, Vike N, Lee TA, Lycke RJ, Auger JD, Leverenz LJ, Nauman E, Goñi J, Talavage TM. Longitudinal changes in resting state fMRI brain self-similarity of asymptomatic high school American football athletes. Sci Rep 2024; 14:1747. [PMID: 38243048 PMCID: PMC10799081 DOI: 10.1038/s41598-024-51688-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
American football has become the focus of numerous studies highlighting a growing concern that cumulative exposure to repetitive, sports-related head acceleration events (HAEs) may have negative consequences for brain health, even in the absence of a diagnosed concussion. In this longitudinal study, brain functional connectivity was analyzed in a cohort of high school American football athletes over a single play season and compared against participants in non-collision high school sports. Football athletes underwent four resting-state functional magnetic resonance imaging sessions: once before (pre-season), twice during (in-season), and once 34-80 days after the contact activities play season ended (post-season). For each imaging session, functional connectomes (FCs) were computed for each athlete and compared across sessions using a metric reflecting the (self) similarity between two FCs. HAEs were monitored during all practices and games throughout the season using head-mounted sensors. Relative to the pre-season scan session, football athletes exhibited decreased FC self-similarity at the later in-season session, with apparent recovery of self-similarity by the time of the post-season session. In addition, both within and post-season self-similarity was correlated with cumulative exposure to head acceleration events. These results suggest that repetitive exposure to HAEs produces alterations in functional brain connectivity and highlight the necessity of collision-free recovery periods for football athletes.
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Affiliation(s)
- Bradley Fitzgerald
- Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA.
| | - Sumra Bari
- Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
- Department of Computer Science, University of Cincinnati, Cincinnati, OH, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Nicole Vike
- Department of Computer Science, University of Cincinnati, Cincinnati, OH, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, USA
| | - Taylor A Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Roy J Lycke
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, USA
| | - Joshua D Auger
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Larry J Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Eric Nauman
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, USA
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Joaquín Goñi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, IN, USA
| | - Thomas M Talavage
- Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
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Delang N, Irwin C, Peek AL, McGregor IS, Desbrow B, McCartney D. The effect of contact/collision sport participation without concussion on neurometabolites: A systematic review and meta-analysis of magnetic resonance spectroscopy studies. J Neurochem 2023; 167:615-632. [PMID: 37908148 DOI: 10.1111/jnc.16000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/22/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
The aim of this study was to systematically review prior research investigating the effects of contact/collision sport participation on neurometabolite levels in the absence of concussion. Four online databases were searched to identify studies that measured neurometabolite levels in contact/collision sport athletes (without concussion) using proton (1 H) or phosphorus (31 P) magnetic resonance spectroscopy (MRS). All study designs were acceptable for inclusion. Meta-analytic procedures were used to quantify the effect of contact/collision sport participation on neurometabolite levels and explore the impact of specific moderating factors (where sufficient data were available). Narrative synthesis was used to describe outcomes that could not be meta-analysed. Nine observational studies involving 300 contact/collision sport athletes were identified. Six studies (providing 112 effect estimates) employed longitudinal (cohort) designs and three (that could not be meta-analysed) employed case-control designs. N-acetylaspartate (NAA; g = -0.331, p = 0.013) and total creatine (tCr; creatine + phosphocreatine; g = -0.524, p = 0.029), but not glutamate-glutamine (Glx), myo-inositol (mI) or total choline (tCho; choline-containing compounds; p's > 0.05), decreased between the pre-season and mid-/post-season period. Several moderators were statistically significant, including: sex (Glx: 6 female/23 male, g = -0.549, p = 0.013), sport played (Glx: 22 American football/4 association football [soccer], g = 0.724, p = 0.031), brain region (mI: 2 corpus callosum/9 motor cortex, g = -0.804, p = 0.015), and the MRS quantification approach (mI: 18 absolute/3 tCr-referenced, g = 0.619, p = 0.003; and tCho: 18 absolute/3 tCr-referenced, g = 0.554, p = 0.005). In case-control studies, contact/collision sport athletes had higher levels of mI, but not NAA or tCr compared to non-contact sport athletes and non-athlete controls. Overall, this review suggests that contact/collision sport participation has the potential to alter neurometabolites measured via 1 H MRS in the absence of concussion. However, further research employing more rigorous and consistent methodologies (e.g. interventional studies with consistent 1 H MRS pulse sequences and quantifications) is required to confirm and better understand the clinical relevance of observed effects.
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Affiliation(s)
- Nathan Delang
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Christopher Irwin
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Aimie L Peek
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Iain S McGregor
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben Desbrow
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Danielle McCartney
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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Jenkins AS, Moore ML, Pollock JR, Brinkman JC, Verhey J, Chhabra A. The 50 Most Cited Papers Pertaining to American Football: Analysis of Studies From the Past 40 Years. Orthop J Sports Med 2022; 10:23259671221141089. [PMID: 36582927 PMCID: PMC9793059 DOI: 10.1177/23259671221141089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Background Bibliometric citation analyses have been widely used in medicine to help researchers gain foundational knowledge about a topic and identify subtopics of popular interest for further investigations. Purpose To identify the 50 most cited research publications related to American football. Study Design Cross-sectional study. Methods The Clarivate Analytics Web of Science database was used to generate a list of publications relating to football. Articles were filtered by the total number of citations, and the top 50 most cited articles studying the sport of football were selected for this analysis. Articles were analyzed by author, publication year, country of origin, institution affiliation, journal, article type, main research topic area, competitive level, and the level of evidence. A total of 247 articles were reviewed to reach the top 50 articles. Results The most studied topic within the top 50 articles was concussion/chronic traumatic encephalopathy (n = 40). Collegiate football was the most studied level of competition (n = 25). The journal publishing the greatest number of top articles was Neurosurgery. Two institutions, the University of North Carolina at Chapel Hill and Boston University School of Medicine, produced over one-third of top 50 articles (n = 18). Conclusion Our analysis indicated that most of the top 50 publications related to the sport of football focused on concussion and CTE, were observational, and were published during or after 2000. The most studied level of competition was collegiate football.
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Affiliation(s)
- Anna S. Jenkins
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale,
Arizona, USA
| | - Michael L. Moore
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale,
Arizona, USA
| | - Jordan R. Pollock
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale,
Arizona, USA
| | | | - Jens Verhey
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona,
USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona,
USA.,Anikar Chhabra, MD, Department of Orthopedic Surgery, Mayo
Clinic Arizona, 5777 E Mayo Boulevard, Phoenix, AZ 85054, USA (
)
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