Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland.
Department of Neurology, Health Care Centre, Hospital 5, St. James's Hospital, Dublin, Ireland.
J Neurotrauma. 2020 Jan 15;37(2):347-356. doi: 10.1089/neu.2019.6483. Epub 2019 Nov 8.
Whereas the diagnosis of moderate and severe traumatic brain injury (TBI) is readily visible on current medical imaging paradigms (magnetic resonance imaging [MRI] and computed tomography [CT] scanning), a far greater challenge is associated with the diagnosis and subsequent management of mild TBI (mTBI), especially concussion which, by definition, is characterized by a normal CT. To investigate whether the integrity of the blood-brain barrier (BBB) is altered in a high-risk population for concussions, we studied professional mixed martial arts (MMA) fighters and adolescent rugby players. Additionally, we performed the linear regression between the BBB disruption defined by increased gadolinium contrast extravasation on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) on MRI and multiple biomechanical parameters indicating the severity of impacts recorded using instrumented mouthguards in professional MMA fighters. MMA fighters were examined pre-fight for a baseline and again within 120 h post-competitive fight, whereas rugby players were examined pre-season and again post-season or post-match in a subset of cases. DCE-MRI, serological analysis of BBB biomarkers, and an analysis of instrumented mouthguard data, was performed. Here, we provide pilot data that demonstrate disruption of the BBB in both professional MMA fighters and rugby players, dependent on the level of exposure. Our data suggest that biomechanical forces in professional MMA and adolescent rugby can lead to BBB disruption. These changes on imaging may serve as a biomarker of exposure of the brain to repetitive subconcussive forces and mTBI.
虽然中度和重度创伤性脑损伤 (TBI) 的诊断在当前的医学成像模式（磁共振成像 [MRI] 和计算机断层扫描 [CT] 扫描）中显而易见，但轻度 TBI（mTBI）的诊断和后续管理却面临着更大的挑战，尤其是脑震荡，根据定义，脑震荡的 CT 扫描结果正常。为了研究在脑震荡高危人群中血脑屏障 (BBB) 的完整性是否发生改变，我们研究了职业混合武术 (MMA) 战士和青少年橄榄球运动员。此外，我们还对 MRI 上动态对比增强磁共振成像 (DCE-MRI) 显示的 BBB 破坏（通过钆对比剂外渗增加定义）与使用仪器化牙套记录的专业 MMA 战士的撞击严重程度的多个生物力学参数之间进行了线性回归。MMA 战士在赛前进行基线检查，在比赛后 120 小时内再次进行检查，而橄榄球运动员在赛前进行检查，在某些情况下，在赛后或赛后再次进行检查。进行了 DCE-MRI、BBB 生物标志物的血清学分析以及仪器化牙套数据的分析。在这里，我们提供了初步数据，证明了职业 MMA 战士和橄榄球运动员的 BBB 破坏与暴露程度有关。我们的数据表明，职业 MMA 和青少年橄榄球中的生物力学力可能导致 BBB 破坏。这些影像学上的变化可能是大脑反复受到亚震荡力和 mTBI 暴露的生物标志物。
