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Longitudinal white-matter abnormalities in sports-related concussion: A diffusion MRI study
Yu-Chien Wu1, Jaroslaw Harezlak2, Nahla M H Elsaid2
1From 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. yucwu@iu.edu.
White matter changes after sports-related concussion (SRC) persist for months, impacting recovery. Diffusion tensor imaging (DTI) revealed these abnormalities in collegiate athletes, linking them to prolonged recovery times.
Area of Science:
- Neuroimaging
- Sports Medicine
- Neurology
Background:
- Sports-related concussion (SRC) is a common injury in athletes.
- Understanding the long-term effects of SRC on brain structure is crucial for effective management.
- Diffusion tensor imaging (DTI) offers insights into white matter integrity.
Purpose of the Study:
- To investigate longitudinal white matter recovery trajectories following SRC in collegiate athletes.
- To identify persistent white matter abnormalities using DTI.
- To correlate white matter changes with clinical outcomes and recovery time.
Main Methods:
- 219 collegiate athletes (82 concussed, 68 contact-sport controls, 69 non-contact-sport controls) underwent DTI and clinical assessments.
- Data collected at 4 time points: acute (24-48h post-injury), asymptomatic, 7 days post-return-to-play, and 6 months post-injury.
- Tract-based spatial statistics and generalized linear mixed models analyzed DTI metrics and longitudinal changes.
Main Results:
- Concussed athletes showed elevated mean diffusivity in white matter compared to controls, persisting beyond asymptomatic status.
- Persistent group differences were observed in the corpus callosum.
- Higher acute mean diffusivity correlated with worse clinical outcomes and longer recovery times.
Conclusions:
- White matter alterations are evident up to 6 months post-SRC, unlike in contact-sport exposure.
- Persistent white matter abnormalities are linked to clinical outcomes and delayed recovery.
- DTI can identify individuals at risk for prolonged recovery after concussion.
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