Multiparametric MRI changes persist beyond recovery in concussed adolescent hockey players
Kathryn Y Manning1, Amy Schranz1, Robert Bartha1
1From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada.
Objective:
To determine whether multiparametric MRI data can provide insight into the acute and long-lasting neuronal sequelae after a concussion in adolescent athletes.
Methods:
Players were recruited from Bantam hockey leagues in which body checking is first introduced (male, age 11-14 years). Clinical measures, diffusion metrics, resting-state network and region-to-region functional connectivity patterns, and magnetic resonance spectroscopy absolute metabolite concentrations were analyzed from an independent, age-matched control group of hockey players (n = 26) and longitudinally in concussed athletes within 24 to 72 hours (n = 17) and 3 months (n = 14) after a diagnosed concussion.
Results:
There were diffusion abnormalities within multiple white matter tracts, functional hyperconnectivity, and decreases in choline 3 months after concussion. Tract-specific spatial statistics revealed a large region along the superior longitudinal fasciculus with the largest decreases in diffusivity measures, which significantly correlated with clinical deficits. This region also spatially intersected with probabilistic tracts connecting cortical regions where we found acute functional connectivity changes. Hyperconnectivity patterns at 3 months after concussion were present only in players with relatively less severe clinical outcomes, higher choline concentrations, and diffusivity indicative of relatively less axonal disruption.
Conclusions:
Changes persisted well after players' clinical scores had returned to normal and they had been cleared to return to play. Ongoing white matter maturation may make adolescent athletes particularly vulnerable to brain injury, and they may require extended recovery periods. The consequences of early brain injury for ongoing brain development and risk of more serious conditions such as second impact syndrome or neural degenerative processes need to be elucidated.
