Department of Psychology, Brigham Young University, Provo, UT, USA; Neuroscience Center, Brigham Young University, Provo, UT, USA.
Int J Psychophysiol. 2018 Oct;132(Pt A):105-123. doi: 10.1016/j.ijpsycho.2017.09.006. Epub 2017 Sep 13.
Structural neuroimaging of athletes who have sustained a sports-related concussion (SRC) can be viewed as either standard clinical imaging or with advanced neuroimaging methods that quantitatively assess brain structure. Negative findings from conventional computed tomography (CT) or magnetic resonance imaging (MRI) are the norm in SRC. Nonetheless, these conventional measures remain the first line of neuroimaging of the athlete as they do detect clinically significant pathologies, when present, such as hemorrhagic abnormalities in the form of hematomas, contusions and mircobleeds along with regions of focal encephalomalacia or other signal abnormalities, with CT best capable of detecting skull fractures. However, advanced neuroimaging techniques hold particular promise in detecting subtle neuropathology in the athlete which standard clinical neuroimaging cannot. To best understand what conventional as well as quantitative neuroimaging methods are detecting in SRC, this review begins by covering basic neuroanatomical principles associated with mild traumatic brain injury (mTBI) and the brain regions most vulnerable to injury from SRC, as these regions define where advanced neuroimaging methods most likely detect abnormalities. Advanced MRI techniques incorporate quantitative metrics that include volume, shape, thickness along with diffusion parameters that provide a more fine-grained analysis of brain structure. With advancements in image analysis, multiple quantitative neuroimaging metrics now can be utilized in assessing SRC. Such multimodality approaches are particularly relevant and important for assessing white matter and network integrity of the brain following injury, including SRC. This review focuses just on the structural side of neuroimaging in SRC, but these techniques also are being integrated with functional neuroimaging, where the combination of the two approaches may provide superior methods in assessing the pathological effects of SRC.
运动员在遭受运动相关脑震荡(SRC)后的结构神经影像学可以被视为标准的临床影像,也可以使用定量评估大脑结构的先进神经影像学方法。常规计算机断层扫描(CT)或磁共振成像(MRI)的阴性结果在 SRC 中很常见。尽管如此,这些常规方法仍然是运动员神经影像学的第一线,因为它们确实可以检测到存在的临床显著病变,例如血肿、挫伤和微出血等出血异常,以及局灶性脑软化或其他信号异常区域,CT 最能检测到颅骨骨折。然而,先进的神经影像学技术在检测运动员的细微神经病理学方面具有特殊的潜力,而标准的临床神经影像学无法做到这一点。为了更好地理解常规和定量神经影像学方法在 SRC 中检测到的内容,本综述首先介绍了与轻度创伤性脑损伤(mTBI)相关的基本神经解剖学原理以及最容易受到 SRC 损伤的大脑区域,因为这些区域定义了先进神经影像学方法最有可能检测到异常的位置。先进的 MRI 技术结合了定量指标,包括体积、形状、厚度以及扩散参数,为大脑结构提供了更精细的分析。随着图像分析的进步,现在可以利用多种定量神经影像学指标来评估 SRC。这种多模态方法对于评估脑白质和网络完整性,特别是在 SRC 后的评估中特别相关和重要。本综述仅关注 SRC 中神经影像学的结构方面,但这些技术也正在与功能神经影像学相结合,两种方法的结合可能为评估 SRC 的病理影响提供更好的方法。