From 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.
Neurology. 2020 Aug 18;95(7):e781-e792. doi: 10.1212/WNL.0000000000009930. Epub 2020 Jul 8.
To study longitudinal recovery trajectories of white matter after sports-related concussion (SRC) by performing diffusion tensor imaging (DTI) on collegiate athletes who sustained SRC.
Collegiate athletes (n = 219, 82 concussed athletes, 68 contact-sport controls, and 69 non-contact-sport controls) were included from the Concussion Assessment, Research and Education Consortium. The participants completed clinical assessments and DTI at 4 time points: 24 to 48 hours after injury, asymptomatic state, 7 days after return-to-play, and 6 months after injury. Tract-based spatial statistics was used to investigate group differences in DTI metrics and to identify white-matter areas with persistent abnormalities. Generalized linear mixed models were used to study longitudinal changes and associations between outcome measures and DTI metrics. Cox proportional hazards model was used to study effects of white-matter abnormalities on recovery time.
In the white matter of concussed athletes, DTI-derived mean diffusivity was significantly higher than in the controls at 24 to 48 hours after injury and beyond the point when the concussed athletes became asymptomatic. While the extent of affected white matter decreased over time, part of the corpus callosum had persistent group differences across all the time points. Furthermore, greater elevation of mean diffusivity at acute concussion was associated with worse clinical outcome measures (i.e., Brief Symptom Inventory scores and symptom severity scores) and prolonged recovery time. No significant differences in DTI metrics were observed between the contact-sport and non-contact-sport controls.
Changes in white matter were evident after SRC at 6 months after injury but were not observed in contact-sport exposure. Furthermore, the persistent white-matter abnormalities were associated with clinical outcomes and delayed recovery time.
通过对患有运动相关性脑震荡（SRC）的大学生运动员进行弥散张量成像（DTI）研究，来研究 SCR 后白质的纵向恢复轨迹。
从 Concussion Assessment，Research and Education Consortium 纳入了 219 名大学生运动员（82 名脑震荡运动员，68 名接触性运动对照者和 69 名非接触性运动对照者）。参与者在 4 个时间点完成临床评估和 DTI：受伤后 24 至 48 小时、无症状状态、重返赛场后 7 天和受伤后 6 个月。基于束的空间统计学用于研究 DTI 指标的组间差异，并确定具有持续异常的白质区域。使用广义线性混合模型研究纵向变化以及结局测量与 DTI 指标之间的关系。使用 Cox 比例风险模型研究白质异常对恢复时间的影响。
在脑震荡运动员的白质中，DTI 衍生的平均扩散率在受伤后 24 至 48 小时及之后脑震荡运动员无症状的时间点显著高于对照组。虽然受影响的白质范围随时间减少，但胼胝体的一部分在所有时间点都存在持续的组间差异。此外，急性脑震荡时平均扩散率升高与更差的临床结局测量（即 Brief Symptom Inventory 评分和症状严重程度评分）和恢复时间延长有关。接触性运动和非接触性运动对照组之间的 DTI 指标没有显著差异。
在受伤后 6 个月时已经可以看到 SCR 后的白质变化，但在接触性运动暴露中没有观察到。此外，持续的白质异常与临床结局和恢复时间延长有关。
