Koerte Inga K, Hufschmidt Jakob, Muehlmann Marc, Tripodis Yorghos, Stamm Julie M, Pasternak Ofer, Giwerc Michelle Y, Coleman Michael J, Baugh Christine M, Fritts Nathan G, Heinen Florian, Lin Alexander, Stern Robert A, Shenton Martha E
1 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.
2 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany .
J Neurotrauma. 2016 Feb 15;33(4):346-53. doi: 10.1089/neu.2015.3880. Epub 2015 Dec 15.
Post-mortem studies reveal a high rate of cavum septi pellucidi (CSP) in chronic traumatic encephalopathy (CTE). It remains, however, to be determined whether or not the presence of CSP may be a potential in vivo imaging marker in populations at high risk to develop CTE. The aim of this study was to evaluate CSP in former professional American football players presenting with cognitive and behavioral symptoms compared with noncontact sports athletes. Seventy-two symptomatic former professional football players (mean age 54.53 years, standard deviation [SD] 7.97) as well as 14 former professional noncontact sports athletes (mean age 57.14 years, SD 7.35) underwent high-resolution structural 3T magnetic resonance imaging. Two raters independently evaluated the CSP, and interrater reliability was calculated. Within National Football League players, an association of CSP measures with cognitive and behavioral functioning was evaluated using a multivariate mixed effects model. The measurements of the two raters were highly correlated (CSP length: rho = 0.98; Intraclass Correlation Coefficient [ICC] 0.99; p < 0.0001; septum length: rho = 0.93; ICC 0.96; p < 0.0001). For presence versus absence of CSP, there was high agreement (Cohen kappa = 0.83, p < 0.0001). A higher rate of CSP, a greater length of CSP, as well as a greater ratio of CSP length to septum length was found in symptomatic former professional football players compared with athlete controls. In addition, a greater length of CSP was associated with decreased performance on a list learning task (Neuropsychological Assessment Battery List A Immediate Recall, p = 0.04) and decreased test scores on a measure of estimate verbal intelligence (Wide Range Achievement Test Fourth Edition Reading Test, p = 0.02). Given the high prevalence of CSP in neuropathologically confirmed CTE in addition to the results of this study, CSP may serve as a potential early in vivo imaging marker to identify those at high risk for CTE. Future research is needed to investigate the pathomechanism underlying the development of CSP after repetitive head impacts, and its potential association with neuropathologically confirmed CTE.
尸检研究显示，慢性创伤性脑病（CTE）患者中透明隔腔（CSP）的发生率很高。然而，CSP的存在是否可能成为CTE高危人群的一种潜在体内成像标志物，仍有待确定。本研究的目的是评估出现认知和行为症状的前美国职业橄榄球运动员与非接触性运动运动员的CSP情况。72名有症状的前职业橄榄球运动员（平均年龄54.53岁，标准差[SD]7.97）以及14名前职业非接触性运动运动员（平均年龄57.14岁，SD 7.35）接受了高分辨率结构3T磁共振成像检查。两名评估者独立评估CSP，并计算评估者间的可靠性。在国家橄榄球联盟球员中，使用多变量混合效应模型评估CSP测量值与认知和行为功能之间的关联。两名评估者的测量结果高度相关（CSP长度：rho = 0.98；组内相关系数[ICC]0.99；p < 0.0001；隔长度：rho = 0.93；ICC 0.96；p < 0.0001）。对于CSP的存在与否，一致性很高（科恩kappa系数 = 0.83，p < 0.0001）。与运动员对照组相比，有症状的前职业橄榄球运动员中CSP的发生率更高、CSP长度更长，以及CSP长度与隔长度的比值更大。此外，CSP长度更长与列表学习任务表现下降（神经心理评估量表A表即时回忆测试；p = 0.04）以及估计言语智力测量的测试分数下降（广泛成就测验第四版阅读测试；p = 0.02）相关。鉴于在神经病理学确诊的CTE中CSP的高发生率以及本研究的结果，CSP可能作为一种潜在的早期体内成像标志物，用于识别CTE高危人群。未来需要开展研究，以探究反复头部撞击后CSP形成的病理机制及其与神经病理学确诊的CTE的潜在关联。
