Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Hum Brain Mapp. 2018 Nov;39(11):4276-4289. doi: 10.1002/hbm.24245. Epub 2018 Jul 2.
Recent studies demonstrated evidence of physiological changes in the brain following sport-related concussion (SRC) that persisted beyond the point at which athletes achieved full symptom recovery. Diffusion MRI techniques have been used to study brain white matter (WM) changes following SRC; however, longitudinal studies that follow injured athletes from the acute to chronic stages of injury are sparse. The current study explores potential persisting effects of the injury, which serves as a follow-up to our previous work that reported WM changes in the acute and subacute phase of SRC recovery. Concussed high school and collegiate football players (n = 17) and well-matched teammate controls (n = 20) were followed up at 6 months postinjury with diffusion tensor (DTI) and diffusion kurtosis imaging (DKI) as well as measures of self-reported symptoms, cognitive functioning, and balance. Results of tract-based spatial statistics (TBSS) analyses revealed continued widespread decreased mean and axial diffusivity compared to control subjects in 6-month follow-up scans. On the other hand, kurtosis metrics, which were significantly higher in concussed athletes in the acute phase, had normalized. WM tract regions-of-interest (ROIs) were created from significant clusters in the TBSS analysis, and linear mixed effects (LME) analyses were used to look at longitudinal changes in these ROIs over time. LME analyses revealed few time × group interactions indicating findings were relatively stable over time. In addition, acute concussion symptoms predicted diffusivity measures at 6 months postinjury. Findings indicate that DTI and DKI may be useful tools in assessing concussion severity, recovery, and possible long-term effects of concussion.
最近的研究表明，运动相关性脑震荡（SRC）后大脑的生理变化在运动员完全恢复症状后仍持续存在。扩散磁共振成像（MRI）技术已被用于研究 SRC 后大脑白质（WM）的变化；然而，从损伤的急性期到慢性期对受伤运动员进行纵向研究的情况很少。本研究探讨了损伤的潜在持续影响，这是对我们之前研究的后续，该研究报告了 SRC 恢复的急性期和亚急性期 WM 变化。对 17 名患有 SRC 的高中和大学橄榄球运动员和 20 名配对良好的队友对照者进行了随访，在损伤后 6 个月时进行了弥散张量成像（DTI）和弥散峰度成像（DKI）以及自我报告症状、认知功能和平衡的测量。基于束的空间统计学（TBSS）分析的结果显示，与对照组相比，在 6 个月的随访扫描中，弥散张量成像的平均和轴向弥散度继续广泛降低。另一方面，在急性期脑震荡运动员中显著升高的峰度指标已恢复正常。从 TBSS 分析中的显著聚类中创建了 WM 束区兴趣（ROI），并使用线性混合效应（LME）分析来观察这些 ROI 在随时间的纵向变化。LME 分析显示，时间与组之间的交互作用很少，表明发现结果在一段时间内相对稳定。此外，急性脑震荡症状预测了 6 个月后的弥散度测量。研究结果表明，DTI 和 DKI 可能是评估脑震荡严重程度、恢复和脑震荡可能的长期影响的有用工具。
